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Getting older, getting better (cont.) ‘Old age isn’t painful’
"The expectation is higher of how healthy they will be at any given age, and that itself is leading to healthier people from lifestyle changes," said Dr. Cynthia Rosenberg, chief of geriatrics at The Western Pennsylvania Hospital. "I can’t imagine 20 years ago giving directions in my office on how to exercise, and having it taken seriously," she said, but that’s exactly what happens now with many patients because of their increased awareness of the benefits of physical activity, regardless of age. She said many elderly people do get "the dwindles" — an array of ailments that include cognitive problems, unsteady gait, falls, depression, loss of energy, incontinence and more. But she and other specialists emphasize that not all older people suffer these setbacks. "Old age itself isn’t painful and doesn’t hurt," said Dr. Fred Rubin, a geriatrician at UPMC Shadyside. "My patients every day say to me, ‘I hurt, but what can I expect? I’m old.’ I say, ‘You can expect to feel normal.’ Everyone’s aging is unique. The aging are the most heterogenous part of the population – there’s more of a spread in health status among 100 65-year-olds than among 100 20-year-olds.’" Researchers say reaching age 65 has little impact on most people’s health. Age 85 is a more useful marker of potential problems. About one-fourth of the people above 85 are in nursing homes. More than a third of those who are living in the community after that age have trouble walking. Frances Kramer, 87, a resident of the Little Sisters of the Poor multi-level care center in Brighton Heights, recently shifted from an apartment to a personal care setting because of declining vision and hearing, but that was after more than eight decades of relative health. Her two older sisters had warned her that they became much frailer also when hitting age 85. "I’ve had more problems in the past two years than in my whole life before," said Kramer, a former nurse. "Now, I’ll be happy if I get to the millennium." Life span improvements It’s no shock that people reaching their mid-80s have health problems. They’ve already surpassed normal life expectancy, which has been rising throughout the 20th century. The average life span for someone born in 1900 was 47 years, while for someone born in 1996 it is projected to be 76 years, with women typically living longer than men in both eras. The life expectancy improvements can be deceiving, though, because they are average figures that include childhood deaths. The increase in life expectancy once someone reaches 65 actually has been only about five years this century. The average person who turned 65 in 1900 could expect to live almost to age 77, while those turning 65 in 1996 are expected to live to be 82.
"It was easy to make dramatic gains in life expectancy early in the century because we were able to save babies" from infectious disease, said S. Jay Olshansky, a University of Chicago demographer. "When we introduce medical technology to save older people, you don’t buy very much survival time," he noted, because preventing an individual’s death from heart disease or stroke may just give him a few more years before dying instead from cancer or other illness. Most demographers see people continuing to live longer in the next century because of medical advances and lifestyle modifications. The most optimistic forecasters believe people could eventually have a normal life span of 100 or more, while others see it tapering off in the 80s. "There’s just constant, incremental progress," said Ronald Lee, chairman of the Center for Economics and Demography of Aging at the University of California at Berkeley. "I don’t expect it to slow down or reach any limit. If we continue at the same pace, we will reach 85 years or so life expectancy in another 70 years or so." The critical issue isn’t just how long people live, though, but the quality of those additional years. One reason Alzheimer’s disease seems like such a recent phenomenon is that in the past, few people lived long enough to get it. One study showed Alzheimer’s affects just 4 percent of the non-institutionalized population ages 65-74, but 48 percent of those 85 and older. The country had an estimated 3.8 million Alzheimer’s cases in 1990. Some experts project that will rise to more than 10 million by 2050, once all of the baby boomers are at least 85. Depression can be another factor of old age, as individuals strong enough to outlive their contemporaries deal with the loss of their loved ones, friends, and acquaintances. One national survey of the 70-plus population found just 3 percent overall had major clinical depression, which is less than the rate in middle-aged adults, but among those who had lost a spouse, the diagnosis exceeded 15 percent. White men 85 and older, in particular, are six times more likely to commit suicide than the general population. "We are creating an extraordinary population of very healthy old people, but also creating a population of unhealthy older people," Olshansky said. "We’re creating a big experiment … a set of conditions that never existed before in our species." A health care magnet Pittsburgh would seem to be a good place for an experiment in the health of aging. The concentration of elderly in the region, nearly 18 percent of its population, foreshadows the growth of the older population nationally. Medicare already pumps about $2.5 billion a year into the metropolitan area’s economy to cover health expenses of those 65 and over. Elderly patients make up 58 percent of the daily census in Allegheny County hospitals. University of Pittsburgh researchers receive an estimated $30 million a year in grants to study illnesses and issues associated with aging. With the burgeoning senior population as its underpinnings, the area’s health care industry exploded in the past two decades. Health services provide 112,000 jobs in the Pittsburgh metropolitan area now, compared with 67,800 in 1979. Nearly 11 percent of the local economy is based in health care; only Philadelphia has a larger percentage among major cities. "The growth of the non-hospital type of services has been phenomenal, all of the home health care, the various assisted living and independent living facilities opening up across our region," said Shikha Iyengar, University of Pittsburgh Medical Center vice president for geriatric services. "That has really added to the employment base, which used to just be hospitals and a few nursing homes." For elderly people experiencing memory problems, falls, weakness and other symptoms that increase with age, the best places to be assessed are comprehensive programs like UPMC’s Benedum Geriatrics Center and those at other hospitals. There are scores of other health programs springing up around the region that target older people, providing opportunities for better diets, more exercise, social interaction, transportation assistance and home modifications. Medical clinics operating in the Vintage senior center in East Liberty and the Center in the Woods in California, Pa., enable older adults to receive treatment in the same central location they visit for meals, classes and other activities. Senior centers in Turtle Creek and McCandless are trying out new programs that bring a doctor and nurse into the center each month to treat groups of patients and provide health education. Exercise programs and health seminars have become a staple of other senior centers and congregate living sites. Another program provides frail elderly people with a team care approach in their homes, in a central adult day care site, and at a medical clinic attached to that site. The pilot is being conducted in Green Tree by Lutheran Affiliated Services and Mercy Health System, modeled on successful programs elsewhere in the nation. The common goal of most of the new health efforts for the elderly is to identify problems early and keep them where they want to be — at home. That also reduces their use of costly hospital and nursing home services that are straining Medicare and Medicaid budgets. Federal officials know how important it is to limit these expensive forms of care. One sign of that: Medicare spending on at-home services more than quadrupled from 1990 to 1996. Aging specialists foresee more improvements in seniors’ health and how they’re cared for in the future, but they also are concerned about the sheer numbers of older people who will flood into the health care system. The fastest-growing population in both the Pittsburgh area and the nation is the group with the greatest health needs, those 85 and over. So far no one is describing their condition as a crisis, but that term might be used more commonly in the 21st century. Besides tending to the frail elderly’s health needs, the country will have to figure out a financing cure for Medicare, which is projected to run out of funds in 2008. That’s only three years before the baby boomers begin hitting age 65, which will eventually create a huge demand for hearing aids, wheelchairs and round-the-clock nursing care. Duke University professor Eric Stallard, senior investigator on the National Long Term Care Survey, said it’s reasonable to estimate that by 2040, the number of elderly with some disability will nearly double to 13.5 million. More than half of those would be in the severely disabled category, needing either nursing home care or comprehensive home assistance with dressing, toileting and other basic functions. Government forecasters say the number of older adults in nursing homes – about 1.4 million at present – could be twice that by the year 2030, depending on how many older adults seek alternative forms of care. "Health is relatively predictable, and we can estimate the amount of need. How to deal with that, I don’t know," Stallard said. "It’s a great opportunity for providers of care, because with the built-in increase of the population they’re serving, they can come in with creative ideas for the appropriate care of people. "The bottom line is we live longer and we live healthier than any other generation in history, but we don’t avoid dying and we don’t avoid disability late in life."
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