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SOURCE: National Center for Health Statistics, Health Interview Survey. 1984

B. CHRONIC CONDITIONS AND HEALTH PROBLEMS CHRONIC CONDITIONS, ALTHOUGH NOT NECESSARILY LIMITING, ARE THE BURDEN OF OLDER AGE

The pattern of illness and disease has changed in the past 80 years. Acute conditions were predominant at the turn of the century, chronic conditions are now the more prevalent health problem for elderly persons.3 There has also been a change in the pattern of wellness within an individual's lifetime. As individuals grow older, acute conditions become less frequent and chronic conditions become more prevalent. Cross-sectional data has shown that the likelihood of suffering from a chronic illness or disabling condition increases rapidly with age. More than four out of five persons 65 and over have at least one chronic condition and multiple conditions are commonplace among older persons.

The leading chronic conditions for the elderly in 1985 were arthritis and hypertensive disease, heart conditions, and hearing impairments (chart 4-2). In most cases, the rates for these diseases are much higher for the elderly population than for persons 45 to 64. For instance, the likelihood of suffering from arthritis is 76 percent higher for those 65 and over than for those age 45 to 64; the

3 National Center for Health Statistics. 1981 Ambulatory Medical Care Survey. Reported in U.S. Senate Special Committee on Aging. Aging America. 1984.

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likelihood of hypertension is 60 percent higher for the older age group.

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Most visits to the hospital among older persons are for chronic conditions. Digestive conditions, genitourinary conditions and injuries are the leading causes of hospitalization among the elderly. Likewise, most physician visits by older persons are for such chronic conditions as circulatory problems, diabetes, arthritis, and eye problems.

The types of conditions experienced by older people vary by sex and race. Older men are more likely than women to experience acute illnesses that are life threatening, while elderly women are more likely to have chronic illnesses that cause physical limitations. Osteoporosis, for example, is much more common among older women than men, while coronary heart disease is much more common among older men. The health situation of elderly blacks is generally poorer than that of elderly whites. For example, hypertension was more prevalent among blacks 65 to 74 years old (45 percent) than whites (33 percent) according to health data from 1971-75.4

Severe chronic illness can prevent individuals from functioning independently, increasing the need for long-term care services. In 1985, an estimated 5.2 million persons 65 years or older are expect

4U.S. Bureau of the Census. Prepared by Jacob S. Seigel. Demographic and Socioeconomic Aspects of Aging in the United States. Series P-23, No. 138.

ed to be mildly to severely disabled and in need of assistance and special aids to maintain independence. This figure is expected to reach 7.2 million by the turn of the century, 10.1 million by the year 2020, and 14.4 million by 2050.5

The severity of certain chronic diseases may be reduced in the near future by new technologies. Such clinical innovations as renal dialysis, insulin pumps, and medications to reduce vascular spasming after a stroke are examples of recent advances that could benefit older persons.

HEART DISEASE IS THE LEADING HEALTH PROBLEM FOR THE ELDERLY

Heart disease leads all other conditions in each of four major indicators of mortality or health care utilization. It accounts for 10 percent of all doctor visits, 18 percent of all short-stay hospital and bed disability days, and 45 percent of all deaths (chart 4-3). Sex differences in heart disease mortality are dramatic. In 1983, the age adjusted death rate was more than twice as high for white men than for white women. Although heart disease remains the major contributor to poor health and death in old age, the past three decades have shown a marked decline in death rates for heart disease. One probable contributing factor to the overall decline in heart disease mortality of the past three decades has been an increase in the control of hypertension, a major risk factor in heart disease. 6

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SOURCE: Reported in Health: United States: 1982, National Center
for Health Statistics

Heart disease, cancer, and stroke together account for over threequarters of all deaths among the elderly. They also are responsible

"Manton and Liu, 1984.

• National Center for Health Statistics: Health, United States, 1985.

for about 2 percent of doctor visits, 40 percent of hospital days, and 50 percent of all days spent in bed. Arthritis and rheumatism, the leading chronic conditions, on the other hand, account for relatively few deaths and only 2 percent of hospital days. They do, however, account for 16 percent of days spent in bed, nearly as much as for heart disease.

MENTAL HEALTH PROBLEMS OF THE ELDERLY ARE SIGNIFICANT IN THEIR IMPACT ON MENTAL STATUS AND EMOTIONAL STATE IN LATER LIFE

The mental health problems of the elderly are significant in frequency, in their impact on mental status in later life, and in their potential influence on the course of physical illness in older adults. Studies over the last several decades have documented that between 15 and 25 percent of older persons have serious symptoms due to mental disorders. More recent reports have continued to document comparably high levels of major disorders, symptoms, and suicide. The number of persons with mental disorders living in nursing homes continues to rise. At the same time, 27 percent of State mental hospital patients are 65 years of age or older.

Alzheimer's disease is the leading cause of cognitive impairment in old age.R Alzheimer's disease and other organic mental disorders affect more than 6 percent of older adults. Cognitive impairment, whether from Alzheimer's or other causes, is one of the principal reasons for institutionalization of the elderly.

Suicide remains more frequent in the elderly than in any other age group, and is highest in white men; suicide is nearly 25 percent more common among white males 65-74 in comparison to their counterparts 18-24, and it is over 70 percent more common among white men 75-84 as compared to those 18-24.9

The relationship between mental and physical health is particularly significant among older persons. There is a growing body of knowledge pointing out the adverse effects of mental health problems on the course of illness in later life.10 Psychiatric consultation has had a positive effect on the length of stay and outcome for cardiac surgery patients.11

Depression plays an important role in the overall health status of older persons. Symptoms of depression have been described in as many as 15 percent of older persons living in the community. While differing rates of depression have been reported to describe the profile of mental health in old age, these rates may be misleading because they often reflect only "primary" depressions-depressions that occur for other than physical causes or drug side effects. When the numbers of those who suffer from secondary depression are factored in, a more accurate picture of depression in late life

7 Roth, M. The Psychiatric Disorders of Later Life. Psychiatric Annals, 6:57-101, 1976.

8 Mortimer, J.A. Alzheimer's Disease and Senile Dementia: Prevalence and Incidence, in Alzheimer's Disease, edited by Reisberg. New York, The Free Press, 1983.

Blazer, Bachar, and Manton: Suicide in Later Life: Review and Commentary, JAGS, 34:519525, 1986.

10 Cohen, G. Toward an Interface of Mental and Physical Health Phenomena in Geriatrics: Clinical Findings and Questions, in Aging 2000: Our Health Care Destiny, Volume I, edited. New York, Springer-Verlag, 1985.

11 Levitan and Kornfeld: Clinical and cost benefits of liaison psychiatry. American Journal of Psychiatry 138: 790-793, 1981.

emerges. Older people are more at risk for secondary depressions, due to illness or drug side effects, than any other age group because they suffer from more physical illness and take more medication than other age groups.

Many factors have contributed to what has become a sicker nursing home population now as compared to the past. This applies to both the mental and physical health of nursing home residents. Mental health problems, however, have always been high in nursing home patients. Several studies have found as many as 70 to 80 percent of residents experiencing psychiatric problems. One recent study identified 94 percent of the residents of a nursing home with mental disorders. 12

C. ACTIVITY LIMITATION

ONE OF FIVE ELDERLY PERSONS HAS SOME DEGREE OF LIMITATION WHILE A SMALL PROPORTION ARE SEVERELY DISABLED

The severity of any disease can differ tremendously from person to person, causing varying degrees of limitation in activity. For example, one person with arthritis may become housebound, while another only suffers from occasional flare-ups. In 1984, a special supplement to the National Health Interview survey was added to collect information about the physical limitations of older people living in the community.

A widely used measure of disability among older persons is the number of people with activity of daily living limitation (ADL). On the ADL scale, disabled individuals are classified as mildly disabled (an ADL of one to two), disabled (an ADL of three to four) or severely disabled (an ADL of five to six). Data from the supplement on aging show that over 22 percent of older persons living in the community have some degree of disability (table 4-1). Women have more difficulty with ADL's than men. For those who have ADL limitation, less than half received help from some source.

TABLE 4-1. PEOPLE AGE 65 AND OVER LIVING IN COMMUNITIES, UNITED STATES, 1984

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Source: National Center for Health Statistics, National Health Interview Survey, Supplement on Aging, 1984.

12 Rovner, et al: Prevalence of mental illness in a community nursing home. American Jour

nal of Psychiatry 143: 1446-1449, 1986.

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