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Tuesday, 18 February 2014

Defining Age as Sickness

From the beginnings of my research into aging nearly 20 years ago, I was shocked and then disheartened to see that pretty much all writing – academic, popular, personal and professional – started from and ended with the belief that getting old is entirely about disease, debility and decline.

That is the reason I started this blog – because I refused to believe then, at about age 55, that my future was so grim and I wanted to report on what aging is really like.

That is not to say I am a fantasist or an idiot. Certainly, as we age, the physical and, sometimes, mental challenges can pile up.

It is, for example, well known that what are called the diseases of age – cancer, diabetes, Parkinson's, rheumatoid arthritis, dementia, heart disease and more – begin to kick in big time in people's mid-70s.

Even when we escape those most frightening of conditions, the lesser ones take up much more of our time than when we were young and middle-aged. Colds and influenza, for example, hit harder and last longer.

And aren't skin tags, liver spots or those seborrheic keratoses fun enhancements to old age.

Nevertheless, for all these years it has appeared to me that there is a whole lot more to old age than all that decline business that is positive and good and life-enhancing.

So I was surprised to read the result of a recent study:

”Only about a third of Americans ages 65 and older are fully able to take care of themselves and go about their daily lives completely independently...”

That's from a December report at Medical News Today (MNT). The report itself was published in the February 2014 issue of American Journal of Public Health (abstract only here) and actually, the number is 31 percent – a bit short of one-third.

Since there are about 41 million U.S. citizens age 65 and older, that's more than 27 million of us who, to greater or lesser degrees, need help with some of the basic tasks of daily life.

There were 8,077 participants in the study, a representative sampling all age 65 and older, and the researchers asked them in face-to-face interviews about seven activities of daily living:

Going outside
Getting around inside
Getting out of bed
Eating
Getting cleaned up
Using the bathroom
Dressing

Here is how the two-thirds who need some amount of help in daily activities shake out:

”About a quarter succeed in accomplishing what they need to do on their own using walkers or other assistive devices

“Another 18 percent say they have trouble even when using these devices

“Six percent cope by reducing their activities - bathing or going outside less often, for example

“21 percent manage by receiving help from others.

Vicki Freedman, a research professor at the University of Michigan Institute for Social Research and the study's lead author told MNT:

"'Nearly 80 percent of all older adults find ways to manage on their own without assistance from others,' [she] said.

"'The group using devices on their own without difficulty is especially interesting. They seem to be able to participate in activities they enjoy and report well-being as high as those who are fully able to care for themselves.'”

I would like to know more about that 80 percent of ALL older adults who “manage on their own” but since the full report is behind a paid firewall, it helps to some degree that the MNT story tells us, as would be expected, that

”...the proportion of older adults able to function independently varies greatly by activity and by age. For example, 90 percent of older adults are fully able to eat by themselves, while only 54 percent are fully able to bathe by themselves.

“About 45 percent of those ages 65 to 69 are fully able to carry out all activities independently, compared with only 4 percent of those ages 90 and older.”

It seems apparent that those who need the most help with daily activities are the oldest old and it would have been helpful to have a further age breakdown – perhaps into three groups: 65-75; 76-85; 86 and older to truly understand who it is in greater need of aid.

But without that, I suppose I must stand corrected in my belief that most of us are not as impaired as the aging literature reports. To repeat,

"Only about a third of Americans ages 65 and older are fully able to take care of themselves and go about their daily lives completely independently...”

It's a question to explore another day, but for now that does make one wonder how our right wing politicians think raising the eligibility age for Social Security and Medicare is humanely possible.


At The Elder Storytelling Place today, Marcy Belson: Mexicali


Posted by Ronni Bennett at 05:30 AM | Permalink | Email this post

Comments

This is what I meant, Ronni, when I made the comment on an earlier article that I thought your infrequent experiences with medical issues were not really representative of most old people. Most of us have stuff wrong with us. (Doesn't mean we are ready for the shredder, though!)

I moved into a senior area by accident in my 30s and have spent the last 20 years just observing. I do think there's a huge pile of horse pucky sold to the public about aging. It's described very well in Susan Jacoby's book "Never Say Die, the Myth and Marketing of the New Old Age".

I know plenty of seniors that are feeble in their 60s with diabetes, in scooters, or with major heart issues so they can't walk more than 20 feet. They also do die of this stuff by 75 after being pretty feeble for well over 10 to 15 years - medicine can keep you going longer than in the past. They don't all walk hand in hand on the beach until 95.

All we see in the media are the pack of lies from people like Jane Fonda - sex at 70+ is better than 21 and all that good stuff. Um - no it's not, stop lying.

Statistics don't lie, I was floored by the number for "the median age of widowhood" for white women is 61 and black women 54". We aren't all married to men 20 years older than ourselves. By 61 half of women have outlived their husband - 61 not 70, not 80 - so zero years of joint retirement for half of all couples.

Bah humbug, I say to statistics. Statistics can be skewed to prove any point you want to make and studies are often done to "get money for somebody's agenda"!
That is why elder's blogging is so very important. It tells a clearer non-agendized picture. Thanks for your blog, Ronni.
As far as not being entirely independent as seniors, are there ANY humans out there of any age who are totally independent of other people??!! We are designed to be interdependent on each other and we have the brains to use tools that help us accomplish tasks we cannot accomplish with only our fingernails and saliva!
The tools we use, even as seniors, are often temporary and are laid aside from time to time as we "improve". Improvement is not limited to young people. Two of my neighbors in their 80's almost got killed in a collision with a semi-truck on a freeway, and both EVENTUALLY recovered. It was amazing. Two of the occupants in their car were dead at the scene but these two "frail elderly" were patched back together and healed and went on to live and accomplish.
Bah humbug, I say to statistics.

Too often we think if it doesn't happen to us (or conversely, if it did), it did/didn't happen to any one else. I learned that while serving in a couple combat zones in the Army and talking to others about their experiences in the same places. All we know is what happened to us in our immediate area. That goes for a lot of things in our lives.

I live in a 55+ apartment complex and it's like living in an assisted living apartment. The figures you quoted would work here. I was beginning to wonder if some of these folks were faking it. I guess I will have to re-think that.

Yes, at 72,I have stuff wrong with me. It really bothers me that there is such emphasis on all that is or could be wrong with older people. Our local history museum is crammed with volunteers in their 70's and 80's.

The kind of help I need these days is heavy lifting not personal care. I'm down sizing once more to eliminate more of that, stuff stored in boxes. Seems like a large number of people to need such basic care after 65. I too would like to see a more definitive age breakdown.

Sadly I do see my friends and relatives husbands dying more often the last couple of years. Life expectancy for men in the USA is about 78 two years less than Canada and Great Britain. I wonder how much the lack of emphasis on preventive care contributes to that. Worries me that I might outlive my sons.

Here in the wonderful world of Full Time RV'ing, many do
continue to live and die in the RV.
It is the "hitch-up and go"
and the "stop and stay-awhile"
chores that become beyond difficult to "don't want to," and then, "cannot do it."

Many of us choose a "home base" for summer and or winter places to stay put seasonally. Some go back to a "stix & brix" abode near the kids.
Like everyone else who ages we do not want to leave our
"homes."
Last fall I bought a large 36' trailer; a fifth-wheel with 3 "slides" to live in at
my home base. There are a couple of elder's here who are in their 90's, many in our 80's, and a few in their
70's. Most of those who are
younger are still traveling parts of the year many to former home areas where they have family and doctors they
continue to see for basic needs....

A cruise ship seems like a great choice to me. Just go on a "final cruise"...When I die, just throw me overboard!

Some time ago I read about a lady who did just that as she found nursing homes were far more expensive!

Fortunately, my health is fine except for a "bad back" and my genes are good...Mom celebrated 103 years on the planet, New Years Eve, 2013!

I will just be singing, and playing, "I'll Be Sailing Along, On Moonlight Bay"....

Has anyone read the Roger Angell piece in the current New Yorker?? His view from 93 is pretty interesting and well documented. That Susan Jacoby book is pretty negative, especially about women over 60 being without partners. Vera, for Jane Fonda and some others of us sex at 70 plus IS better than it was at 21!! I am about to pick up Malcolm Cowley on the view from 80 and check into his thoughts. More to come.

Like Tuli Reno, I live in an assisted living facility. Discussing one's illnesses is what goes for sport here. "My pressure is 160, what's yours?", as if they were keeping score. Ambulances come and go with such frequency that it's if they were on a schedule like a bus.
People base their daily routines around doctors visits and even what they eat is dictated by their "conditions". Quite frankly, it's depressing as hell. "So why don't you leave" you say. I live here because of my financial condition rather than my physical one. Therefore, maybe what should be discussed is not how poorly we feel, but how poor we, as seniors, really are.

Yesterday my partner (61) and I (66) went for what we considerate a pleasant, moderate 7 miles hike over a lovely green ridge. It required some exertion, but nothing excessive.

We have belonged to a group of 12 or so women who have met with each other every six weeks for over 30 years, all roughly our age (60-70) comfortably middle class, white, urban. We reflected during our hike that only one other individual in that group would have found what we were doing a pleasure and for most it simply would have been out of the question. Some have suffered acute disabilities and others are just aging.

So there's a small sample.

I was struck by something I read recently in which women coming to a cardiovascular clinic were asked what women die of. Most said breast cancer -- WRONG! The answer the docs wanted was heart disease. I would have said "aging." Eventually our parts give out and we stop, don't we?

I wonder how much the high proportion of oldsters needing help is linked to emotional well being. Without friends or family who can provide love and reason to remain active, it's easy to focus attention on the negatives. The Angell article mentioned above shows that as well as how much one's personality (and mental health) can overcome a growing list of ailments.

And another vote for great sex at 70. What's great is not the physical part--it's not worrying about performance. Instead adjusting expectations, accepting limitations, and focusing on the caring. And having a sense of humor. For those lucky enough to have a caring partner.

Hmmm, maybe applicable to more than sex.

"It's a question to explore another day, but for now that does make one wonder how our right wing politicians think raising the eligibility age for Social Security and Medicare is humanely possible."

Bazinga!

Of course the intent of raising the SS age is to ensure that enough die off before they can claim their entitlements they paid into all of their working lives. That way the debt that the GOP are always screeching about will be diminished by default

It's fascinating to me that there's a side to this story which doesn't get as much attention as it should: namely the demographics of Type 2 diabetes. It used to be called adult-onset diabetes to distinguish it from Type 1 (or juvenile onset) diabetes.

For some years though, obesity and the incidence of Type 2 diabetes have been increasing dramatically throughout the world. Type 2 now affects pre-teens and teenagers.

This trend along with the challenge of properly managing Type 2 suggests that people will become disabled at young ages when they should be experiencing the most productive years of their lives.

Old age is great ---until it is not---

I feel so lucky to be healthy so far at 68 and am enjoying life.

I have to go with Vera though---I think Sex is OK when one is older --but I really loved that rollick in the hay time of life--

As many of you know I am on my way to being 89 years old and I am dependent on others for transportation. Other than that, I am doing it "my way".

I am slower, use a walker if I am feeling weak or need to step down from a curb, use a cane when needed (not in my house) and do not keep the outside as well groomed as I used to. Does that make me typical?

I have two neighbors that I will use for comparison. One walks her dog twice daily, keeps her outside and inside immaculate without help and has no debilitating diseases. She is one year younger than I. Another is pretty much housebound, has a severe back disability, relies on her daughter for transportation and has a housekeeper come in weekly to clean. Yet she still cooks for herself and is able to take care of herself in all other ways. She is 97 years old.

I have another friend who is fighting cancer and is in her forties. Without her mother to help her, she would probably be in a nursing home.

So which of we 4 women fit into the neat box of a statistic? My point being it that we can find all sorts of differences in all ages.

So Jane Fonda can still enjoy sex at 70? Well, good for her but what exactly does this prove? Some of us did not have the opportunity to find out what that would be like.

I read comments and shaking my head. Independent 79, recovering from bad fall and lucky nothing broken. Still do everything but a little slower, nothing quite the same with some immune disorders but life is still wonderful. Most I know at this time are like me.
Darlene is doing great and since my fall I take a cane when shopping - makes me feel more secure at this time.
May just keep it close
always :) Then I think back to my mother who passed away at 82, father 59 but grandmothers in late 80's and 92 and independent..

Thank you, Darlene, for putting this all in the kind of perspective it needs.

What happens to people as they age really is all over the map, as even the relatively few comments above suggest. So far, my husband (84) and I (77) have been fortunate enough to avoid the "big, bad" scourges of aging like heart disease and cancer. We're still able to perform all "ADLs" ("Activities of Daily Living" in medical-speak).

We do our own shopping and most housecleaning and yard chores for ourselves, although we no longer undertake some of the heaviest interior and yard maintenance tasks that we might have 20 years ago. I'm planning my painting schedule for spring/summer, even though I need to be a little more careful on a ladder now.

We try to do what we can to maintain our health but recognize that the inevitable is--well, inevitable. Our hope is to depart this world (without suffering a lengthy period of illness and decline) at approximately the same time BEFORE we run out of money!!!

"It's a question to explore another day, but for now that does make one wonder how our right wing politicians think raising the eligibility age for Social Security and Medicare is humanely possible."

That supposes that the right wingers are rational or humane which is highly doubtful.

Remember that no two people are exactly alike. Isn't that wonderful! Each of us know ourselves better than anyone else.

Again, I want to thank you, Ronni, for the incredible service you provide, urging everyone to think about aging and how different it is for different people.

I live in an "active" older (55+) adults complex. It is quite large, - 30 multistory buildings with patio homes and town houses scattered among them. There are around 3000 people more or less who live here. Sounds terrible, but we're in a park-like setting with a golf course, club house, swimming pools tennis courts, etc. not to mention a wild life refuge across the street from my building. The "active" means that if you can't drive or get around any more, it's up to you to make arrangements for care. In other words it's not assisted living.

I am 75 and probably in the middle age range for my building. I walk my dog 4 times a day and I bought a folding exercise bike. I put about 5 miles on the bike before I found it hurt my back so I sold it to my neighbor down the hall who was 95 when she bought it. She's 97 now and has put several hundred miles on the bike.

People here manage one way or another. Even if you need a walker, you don't have to stay home. There's a women in my building who needs a walker to get around, but she goes to every single Broncos home game. If you can't cook, there are people who will do it for you. There are people who clean for you at quite reasonable rates ($15/hr.) There are people who will come in to do your hair and nails.

What I'm trying to say is that you adjust. You still have a life. You still have interests. You may hurt more than you did 20-30 years ago, but you can still enjoy life even if you can't run laps anymore or drive.

I imagine that those in a 2-person household fare better in the "ADL" ratings as they age. I'm single, 65, still working fulltime and recovering from a foot injury (ice involved!). I imagine my day-to-day life right now would be significantly easier and less stressful with a spouse assisting with the everyday household tasks I am falling behind on.

It would be interesting if we knew the stats above for those living alone vs. as part of a couple. Probably more than 31%...

Mostly I'm very happy with my singlehood. I see however that from a practical standpoint it would be useful to have a helper around as we grow older. Fortunately I have a wonderful son and daughter-in-law nearby!


"Only about a third of Americans ages 65 and older are fully able to take care of themselves ..." Yikes! I'm still healthy and independent at 70. Am I missing something? Has the doctor overlooked something? I really must be more appreciative of my good health.

Am wondering where Carol from Colorado lives. I'm in Denver and her place sounds ideal. I'm adrift in suburbia with neighbors all working and half my age.

I'm a bit of a cynic when it comes to stats. I find (in my studies on elders) that the level of income as an elder has a whole pile to do with outlook and overall health. For instance and elder friend, an artist, 97, uses an expensive treadmill to track his daily health and can afford not to venture out in snow and ice and gets deliveries of essentials, etc.
Also, the Canadian Statistics on KNOWN elder suicides are downright frightening. Much of it tied to financial well being which would reflect on physical, mental and emotional.
XO
WWW

This is an example of how useful your blog is, Ronni. I started reading it years ago, in my 50s; I'm 62 now. As I'm trying to figure out when/how/if to retire, this post and the comments are really helpful.

I wonder what counts as assistance. Does someone in their 90's using a bath chair count? Or would that be considered independent? It sounds as though helpful devices counted as "needing some help"?

I'm with Darlene(again). I bet if this had been a study of a representative sampling of ALL adult ages, the result would have been only slightly different. There are people who don't do many things associated with independent living because of lack of interest, yet they might use the verb 'can't' instead of 'don't want to'. Even the higher 45% of those between 65 and 69 seems like a low amount for total self-care.

I agree with PiedType; I am also healthy and still working full-time and turn 70 next week. I have a boyfriend in his 70s and sex is a joy at this age. I certainly have it more often and with more gusto than I did when I was in my 30s. I thank God that I feel good (I did have breast cancer at 64) but I learned to go with the flow and enjoy every minute of my day. I will keep working till I drop because I love what I do.

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