Health
Status
Indicator 12 Life Expectancy
Indicator 13 Mortality
Indicator 14 Chronic Health Conditions
Indicator 15 Memory Impairment
Indicator 16 Depressive Symptoms
Indicator 17 Self-Rated Health Status
Indicator 18 Disability
Life
expectancy is a summary measure of the overall health of a population. It
represents the average number of years of life remaining to a person at a given
age if death rates were to remain constant. In the United States, improvements
in health have resulted in increased life expectancy and contributed to the
growth of the older population over the past century.
- Americans
are living longer than ever before. In 1900, life expectancy at birth was
about 49 years. By 1960, life expectancy had increased to 70 years, and in
1997, life expectancy at birth was 79 years for women and 74 years for men.
- Life
expectancies at ages 65 and 85 have also increased. Under current mortality
conditions, people who survive to age 65 can expect to live an average of
nearly 18 more years, more than five years longer than persons age 65 in
1900. The life expectancy of persons who survive to age 85 today is about 7
years for women and 6 years for men.
- Educational
attainment is associated with higher life expectancy. The life expectancy of
high school graduates at age 65 is approximately one year longer than the
life expectancy at that age for persons who did not graduate from high
school.[20]
- Life
expectancy varies by race, but the difference decreases with age. In 1997,
life expectancy at birth was 6 years higher for white persons than for black
persons. At age 65, white persons can expect to live an average of 2 years
longer than black persons. Among those who survive to age 85, however, the
life expectancy among black persons is slightly higher than among white
persons. The declining race differences in life expectancy at older ages are
a subject of debate. Some research shows that age misreporting may have
artificially increased life expectancy for black persons, particularly when
birth certificates were not available.[21] Other research, however,
suggests that black persons who survive to the oldest ages may be healthier
than white persons and have lower mortality rates.[22]
Data for this indicator can be found in Tables 12a
and 12b.
Overall,
death rates in the U.S. population have declined during the past century. But
for some diseases, death rates among older Americans have increased in recent
years.
- Between
1980 and 1997, age-adjusted death rates for heart disease and stroke
declined by approximately one-third. Death rates for cancer and pneumonia
and influenza increased slightly over the same period. Age-adjusted death
rates for diabetes increased by 32 percent since 1980, and death rates for
chronic obstructive pulmonary diseases increased by 57 percent.
- In
1997, the leading cause of death among persons age 65 or older was heart
disease (1,832 deaths per 100,000 persons), followed by cancer (1,133 per
100,000), stroke (426 per 100,000), chronic obstructive pulmonary diseases
(281 per 100,000), pneumonia and influenza (237 per 100,000), and diabetes
(141 per 100,000). Among persons age 85 or older, heart disease was
responsible for 40 percent of all deaths.23
- In
1997, death rates were higher for older men than for older women at every
age except the very oldest, persons age 95 or older, for whom men’s and
women’s rates were nearly equal.[24]
- The
relative importance of certain causes of death varied according to sex and
race and Hispanic origin. For example, in 1997, diabetes was the third
leading cause of death among American Indian and Alaska Native men and women
age 65 or older, the fourth leading cause of death among older Hispanic men
and women, and ranked sixth among older white men and women and older Asian
and Pacific Islander men.
- Alzheimer’s
disease was the sixth leading cause of death among white women age 85 or
older; however, it was less common among black women in the same age group
or men of either race.
Data
for this indicator can be found in Tables 13a, 13b, and 13c.
Indicator
14 - Chronic
Health Conditions
Chronic diseases are long-term illnesses that are rarely
cured. These diseases can become a significant health and financial burden to
not only those persons who have them, but also their families and the nation’s
health care system. Chronic conditions such as arthritis, diabetes, and heart
disease negatively affect quality of life, contributing to declines in
functioning and the inability to remain in the community.[25] Five of
the six leading causes of death among older Americans are chronic diseases. (See
“Indicator 13: Mortality.”)
- Between
1984 and 1995, the prevalence of stroke increased by 1 percentage point,
diabetes by 2 percentage points, arthritis by 3 percentage points, heart
disease by 5 percentage points, and cancer by 7 percentage points. The
prevalence of hypertension remained fairly constant over this period. These
trends are generally evident among older persons regardless of age, sex, or
race and Hispanic origin.
- In
1995, about 58 percent of persons age 70 or older reported having arthritis,
45 percent reported having hypertension, and 21 percent reported having
heart disease. Other chronic diseases included cancer (19 percent), diabetes
(12 percent), and stroke (9 percent). About 64 percent of older women
reported having arthritis, 48 percent reported having hypertension, and 19
percent reported having heart disease. Older men were less likely to report
having arthritis (50 percent) and hypertension (41 percent), but were more
likely to report having heart disease (25 percent). Men were also more
likely to have had cancer (23 percent), compared with women (17 percent).
- The
prevalence of chronic conditions also varies by race and ethnicity in the
older population. In 1995, arthritis was reported by 67 percent of
non-Hispanic black persons, 58 percent of non-Hispanic white persons, and 50
percent of Hispanic persons. Non-Hispanic black persons were also more
likely to report having diabetes, stroke, and hypertension than either
non-Hispanic white persons or Hispanic persons. Cancer was reported by 21 percent of non-Hispanic white persons,
compared with 9 percent of non-Hispanic black persons, and 11 percent of
Hispanic persons.
Data
for this indicator can be found in Table 14.
Memory
skills are important to general cognitive functioning, and declining scores on
tests of memory are indicators of general cognitive loss for older adults. Low
cognitive functioning (i.e., memory impairment) is a major risk factor for
entering a nursing home.[26]
- The
prevalence of moderate or severe memory impairment is slightly lower among
older women than among older men. In 1998, memory impairment occurred among
35 percent of women age 85 or older, compared with 37 percent of men in the
same age group.
- In
1998, the percentage of older adults with moderate or severe memory
impairment ranged from about 4 percent among persons ages 65 to 69 to about
36 percent among persons age 85 or older.
Data
for this indicator can be found in Table 15.
Depressive
symptoms are an important indicator of general well-being and mental health
among older Americans. Higher levels of depressive symptoms are associated with
higher rates of physical illness, greater functional disability, and higher
health care resource utilization.[27]
- Women
between the ages of 65 and 84 are more likely than men to have severe
depressive symptoms. Among persons age 85 or older, men and women have a
similar prevalence of severe depressive symptoms.
- In
1998, about 15 percent of persons ages 65 to 69, 70 to 74, and 75 to 79 had
severe symptoms of depression, compared with 21 percent of persons ages 80
to 84, and 23 percent of persons age 85 or older.
Data
for this indicator can be found in Table 16.
Indicator
17 - Self-Rated
Health Status
Asking people to rate their own health as excellent, very
good, good, fair, or poor provides a common indicator of health easily measured
in surveys. It represents physical, emotional, and social aspects of health and
well-being. Good to excellent self-reported health correlates with lower risk of
mortality.[28]
- During
the period 1994 to 1996, 72 percent of older Americans reported their health
as good, very good, or excellent. Women and men reported comparable levels
of health status.
- Positive
health evaluations decline with age. Among non-Hispanic white men ages 65 to
74, 76 percent reported good to excellent health, compared with 67 percent
among non-Hispanic white men age 85 or older. A similar decline with age was
reported by non-Hispanic black and Hispanic older men, and by women, with
the exception of non-Hispanic black women.
- Among
older men and women in every age group, non-Hispanic black and Hispanic
persons were less likely to report good health than non-Hispanic white
persons.
Data
for this indicator can be found in Table 17.
Functioning
in later years may be diminished if illness, chronic disease, or injury limits
physical and/or mental abilities. Changes in disability rates have important
implications for work and retirement policies, health and long-term care needs,
and the social well-being of the older population. By monitoring and
understanding these trends, policymakers are better able to make informed
decisions.
- The
proportion of Americans age 65 or older with a chronic disability declined
from 24 percent in 1982 to 21 percent in 1994.
- Despite
the decline in rates, the number of older Americans with chronic
disabilities increased by about 600,000 from 6.4 million in 1982 to 7
million in 1994. This is because the overall population of older persons was
growing fast enough to outweigh the decline in disability rates. However, if
disability rates had not declined from 1982 to 1994, then the disabled
population would have increased by almost 1.5 million bringing the total
number of older Americans with chronic disabilities close to 7.9 million.
- There
was a decline in disability rates for both sexes since 1982, when 27 percent
of older women and 20 percent of older men had a chronic disability. By
1994, about 25 percent of older women and 16 percent of older men had a
chronic disability.
Different
indicators can be used to monitor disability including limitations in Activities
of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), and
measures of physical, cognitive, and social functioning.
Aspects of physical functioning such as the ability to climb
stairs,
walk a quarter mile, or reach up over one's head are more closely linked to
physiological capabilities than are ADLs and IADLs which may be influenced by
social and cultural role expectations and by changes in technology.
- Between
1984 and 1995, older Americans reported improvements in physical functioning
in the ability to walk a quarter mile, climb stairs, reach up over one’s
head, and stoop, crouch or kneel. Both men and women reported improvements
in each of these categories.
- The
percentage unable to perform at least one of nine physical activities
without assistance or special equipment was higher among women than men but
declined for both groups: from 23 percent to 20 percent among men and from
34 percent to 29 percent among women.
- In
1995, older black persons were more likely than older white persons to be
unable to perform at least one of nine physical activities (33 percent and
25 percent, respectively).
Data
for this indicator can be found in Tables 18a, 18b, and 18c.
Contacts:
Top
of Page