The Aging of America
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Forward 179 THE AGING OF AMERICA DAVID SATCHER, MD, PhD Centers for Disease Control and Prevention Dramatic shifts are occurring in the structure of the American population. As a nation, we are literally growing older. Persons aged 65 years and older constitute the fastest growing segment of our population. Between 1950 and 1980, the size of this age group doubled from 12.3 million to 25.5 million, and the "very old" age group, those 85 years and older, experienced a 281 percent increase to become 2.2 million. In 1995, it was estimated that 33.6 million Americans were aged 65 years and older, 3.6 million of whom were at least 85 years old, and 54,000 were centenarians. Older Americans represent about 13 percent of the population. Future population projections suggest that this trend will become even more pronounced. The U.S. Census Bureau estimates that by the year 2030,69.8 million people will be 65 years and older; 8.4 million of them will be 85 years and older. By 2050, overall there will be an estimated 78.8 million Americans in the 65 years and over age category, representing 21 percent of the population.1 Most older Americans are women. Currently, there are 13.4 million men and 20.2 million women aged over 65; a ratio of 65 men for every 100 women. This imbalance is even more pronounced in the 85 and older group, where the ratio is 44:100. In the United States, more older Americans live in either the South or the West. They are usually widowed and living alone. Today, only one in six persons aged 65 and over participate in the workforce; that will change to one in four as the number of persons aged 65 years and older increases. Racial and ethnic minorities currently comprise 14 percent of Americans aged 65 and over—a number that is expected to increase to 25 percent by the year 2030. By that year, the number of African Americans will have increased by 300 percent, Hispanic Americans by 395 percent, and Asian/Pacific Islanders and Native Americans by 250 percent.1 All of these demographic changes have major consequences for public health, health and social services, and medical care for the elderly. For along with these shifts in the demographic characteristics of our population are occurring changes in the disease burden. During the 20th century we have Journal of Health Care for the Poor and Underserved · Vol. 7, No. 3 · 1996 180 The Aging of America witnessed a dramatic change in life expectancy. In 1900, average life expectancy was 47 years. Today, it is 78 years. An American infant born today is likely to live over 25 years longer than did his or her great-grandparents. In addition, that American infant is likely to die from a chronic disease rather than an infectious disease and will live at least a decade of his or her life with some disability. Heart disease and cancer account for 60 percent of the deaths in persons aged 65 years and older. Almost 80 percent of older adults live with one or more diseases or chronic conditions. The top 10 chronic conditions in this population are arthritis (48 percent), hypertension (38 percent), hearing impairments (29 percent), heart disease (28 percent), cataracts (16 percent), orthopedic impairments (16 percent), chronic sinusitis (15 percent), diabetes (9 percent), visual impairments (80 percent), and varicose veins (7 percent). Older Americans of a minority race or ethnic group have higher rates of disease. For example, in African Americans the prevalence of arthritis is 108 percent, hypertension 141 percent, and diabetes 207 percent as a proportion of the incidences of each in whites. These conditions produce substantial disability in the African American elderly population. Although not as prevalent as the 10 leading chronic conditions, three additional chronic conditions that afflict the elderly cause significant disability, diminished quality of life, and high health care costs. These are osteoporosis, urinary incontinence, and Alzheimer's disease. An estimated 20-25 million Americans are at increased risk for fracture due to low bone density. More than 1 million fractures in the United States each year are attributable...