Senior Health - Health-related Quality Of Life As Life Winds Down

Advancing age is accompanied by periods of diminished health and functioning. Quality of life consequently suffers. How many elderly are affected? The chart shows the results of Centers for Disease Control (CDC) researchers' examination of data collected in 1994 (CDC has been asking quality-of-life questions only since 1993). Sensory impairment is common among the elderly — 18.1% of those aged 70+ had impaired vision, 33.2% had impaired hearing (more men are affected than women and only 11.6% of adults used a hearing aid), and 8.6% reported both hearing and vision impairments. African Americans had a slightly higher rate of vision impairment but a lower rate of hearing impairment.

Vision and hearing impairments are just the tip of the iceberg. With these and other common chronic conditions of old age (e.g., arthritis, hypertension, heart disease, diabetes) comes difficulty in performing the normal activities of daily life.

Percentage of Older Adults With Activity Limitations: 1994

Sex/Race	75-84	>=85	75-84	>=85	75-84 >=85
	Functional Activities		ADL		IADL
Male	37.0	50.0	10.6	21.0	21.9	42.1
Female	46.2	65.6	13.5	29.2	32.3	57.9
Black	42.1	59.5	11.9	25.8	27.8	52.1
White	52.5	76.3	19.0	35.0	24.3	67.4

The table shows data on older adults who reported limitations in basic functional activities, activities of daily living (ADL), and instrumental activities of daily living (IADL). Functional activities include lifting, climbing stairs, walking, sustained standing, bending, reaching, and grasping. Activities of daily living (ADL) include bathing, dressing, getting around inside the home, toileting, eating, and getting in and out of beds and chairs. Instrumental activities of daily living (IADL) include shopping, managing money, using the telephone, performing household chores, and preparing meals. Whites and women are affected more than blacks and men — three quarters of Caucasians and two-thirds of women aged 85+ reported difficulty getting around (total population 85+ is about 3 million; two-thirds are women).

Coping with chronic illness on top of activity limitations and life events like loss of teeth,¹⁸ financial problems, or the death of a spouse can lead to dementia, depression, and suicide. Between 25-50% of persons aged 85+ are affected by dementia, most commonly Alzheimer's disease. Depression, which is treatable, is often not recognized in the elderly (in 2000, 19% of persons aged 85+ had depressive symptoms, according to the Health and Retirement Study). Research has shown that over a period of four years, depressive symptoms in persons aged 70+ resulted in a 55% greater decline in physical abilities than might otherwise be expected. Elderly suicides (aged 65+) account for 20% of the total, though the elderly make up only 12% of the population. Men aged 85+ are particularly vulnerable.

The Administration on Aging reports that while the picture presented above may be "disheartening," the future promises something better: "Future cohorts of older Americans are expected to have fewer disabilities than past generations. Findings from the National Long-Term Care Surveys regarding the health and disability status of Americans, conducted by Duke University under the auspices of the National Institute on Aging, show that disability rates among older persons are falling, and this trend is expected to continue." This finding is bolstered by CDC: In 1997, half of all persons aged 75+ reported some kind of activity limitation, a figure that had fallen to 45.6% in 1999.¹⁹

Sources: Chart/Table: Vincent A. Campbell, Ph.D., et al., "Surveillance for Sensory Impairment, Activity Limitation, and Health- Related Quality of Life Among Older Adults — United States, 1993-1997," Tables 3 and 4 CDC, http://www.cdc.gov/mmwr/preview/mmwrhtml/ss4808a6.htm#top, and Health, United States, 2001, table 57, updated, http://www.cdc.gov/nchs/products/pubs/pubd/hus/tables/2001/01hus057.pdf. Marjorie Valbrun, "As America Ages, Abuse Grows Old," Philadelphia Inquirer, Feb. 6, 1994. CDC, "New Findings on Health, Quality of Life of U.S. Seniors Released," December 17, 1999, http://www.cdc.gov/od/oc/media/pressrel/r991217a.htm. JAMA Patient Page, "Depression — Symptoms of Depression in the Elderly Contribute to Physical Decline," http://www.medem.com. Online data retrieved September 2002.