Health of Older Americans: NewPublicHealth Q&A With Marie Bernard

Nov 28, 2011, 7:24 PM, Posted by NewPublicHealth

MarieBernard Marie Bernard, National Institute on Aging

In 1980, there were 720,000 people aged 90 and older in the United States. In 2010, that number climbed to 1.9 million people. But by 2050, the ranks of people 90 and older may reach 9 million, according to a new report, “90+ in the United States: 2006–2008.The report, from the U.S. Census Bureau, was commissioned by the National Institute on Aging (NIA), and details the demographic, health and economic status of America's oldest adults.

"With the aging boom it is critical to develop demographic data providing as detailed a picture as possible of our oldest population," says NIA Director Richard J. Hodes, MD. "The information on a variety of factors—income, health status, disabilities and living arrangements—will be particularly useful to researchers, planners and policymakers."

Key findings from the report include:

  • A majority of the 90-plus population are widowed white women who live alone or in a nursing home.
  • Social Security provides almost half of this group's personal income.
  • Almost all have health insurance coverage through Medicare and/or Medicaid.
  • Most say they have one or more types of disability.
  • Women aged 90 years and older outnumber men nearly three to one; 74.1 percent of the total population aged 90 and older in 2006 to 2008 were women.
  • Whites represent 88.1 percent of the total 90-and-older population. Blacks make up 7.6 percent, Hispanics 4 percent and Asians 2.2 percent.

NewPublicHealth spoke with Marie Bernard, MD, a noted geriatrician and deputy director of the NIA about how the report can inform current efforts aimed at healthier aging.

NewPublicHealth: What do we know about the health of current seniors?

Dr. Bernard: Their health is better than prior cohorts, but it is a segment of the population who over the course of time can develop health problems. Alzheimer’s disease, for example, increases in prevalence as do other diseases. But those who make it to 100 really seem to be survivors, and you don’t see much in the way of new health issues then.

NPH: What should people do now to increase the chances of a healthy oldest age?

Dr. Bernard: People over 85 should continue to do the sorts of things young people do. Eat well, exercise. Even if you’re 90, 95, you can exercise. Go4life is a new resources from the NIA that has plenty of suggestions on exercising when you’re older. People should also make sure they work with a primary care physician to get the correct preventive health interventions and treatments for any health issued they have, in order to keep themselves as healthy as possible.

NPH: What specific prevention activities do you think is moving the number of oldest old so high?

Dr. Bernard: Vaccinations, antibiotics, treatments for high blood pressure, diabetes, cholesterol lowering. And for the current cohort of 90-somethings, it’s probably those things and preserving function and mobility, which are important as one ages and potentially becomes frail.

You’re never too old to change your eating and exercise habits. We have a study of nursing home residents who never exercised and were given very light weights and were able to improve their ability. Diet is harder to change. A 90-year-old woman recently said to me, “Young woman, I’ve been eating this way for 90 years, and I’m not going to change,” though at that age we’re looking for small changes. If I saw a 90-year-old woman who suddenly lost 20 pounds, I’d be concerned.

NPH: Why do we need demographic data on this group?

Dr. Bernard: It’s a new frontier. At the beginning of the 20th century, people lived to 40 or 50, at the end of the century they lived to be 70 to 80. We haven’t had enough large numbers of people living past 90 to know how to get them to live that long and how to take care of them once they get there.

Manifestations of illness will be interesting to track in these individuals. We know that when you look at someone 65 versus 85 there are differences as one gets older. There are tendencies for bodies to change, such as less of a reserve if stressed and the need for different medication doses. There may be a survivor effect, once you get to be that age, keep doing the same things, but we just don’t know.

NPH: What are the conditions that are keeping minorities from living to a healthier older age at the same rate as Whites?

Dr. Bernard: Factors that occur at a younger age, such as obesity, high blood pressure, diabetes [have an impact on disparities in longevity]. As members of minorities have access to better health resources and education, I hope we’ll see larger numbers of minority individuals living to exceptional life spans, but it’s going to take continued work.

>>Bonus: Read the NIA's Health Disparities Strategic Plan to help eliminate the racial gap in life expectancy.

>>Read more news on the health of older adults.

This commentary originally appeared on the RWJF New Public Health blog.