Write a 1,050- to 1,400-word paper describing the demographics of the aging population and how they have changed.

 

Include the following in your paper:

 

• The trends in growth of the older adult population
  • Gender
  • Age
  • Health
• Implications of these trends on the future needs of the older population
• How ageism affects the older population
• The influence of changing demographics on stereotypes

 

Provide a minimum of three references.

Format your paper consistent with APA guidelines.

Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population

Somatic Disease and Multiple Chronic Conditions

Cardiovascular Disease

Cardiovascular disease remains the most common cause of death of older adults, although death rates have dropped in the last 20 years. This category includes chronic ischemic heart disease, congestive heart failure, and arrhythmia. Ischemic heart disease may be underdiagnosed in the oldest-old (20). Normal aging includes vascular remodeling and vascular stiffness (21). Atherosclerosis causes inflammation and further vascular changes (22) increasing risk for cardiac events, cerebrovascular events, peripheral vascular disease, cognitive impairment, and other organ damage.
Hypertension

Hypertension, a major contributor to atherosclerosis, is the most common chronic disease of older adults (23). Isolated systolic hypertension is particularly common among older adults and is associated with mortality even at advanced ages. The value of intensive pharmacotherapy for hypertension in people over age 75 remains controversial. Evidence seems to suggest that aggressive treatment should be offered (24) and continued as long as it is well-tolerated and consistent with the patient’s goals.
Cancer

Cancer is the second leading cause of death in older adults. However, by age 85, the death rate from cancer begins to fall (25). Slow-growing tumors seem to be common in this population.

Response to cancer treatment depends on functional status rather than age. Individuals in their ninth or tenth decade should not be denied aggressive cancer treatment simply due to age.

DEMOGRAPHIC TRENDS OF AGING PAPER

Screening is not recommended for breast cancer after age 75, due to insufficient evidence for benefit, although there may be benefit for women with a long life expectancy (26, 27). Similarly, for people over age 75 in the US, colon cancer screening is only recommended in cases where there is a long predicted life expectancy and a perceived strong capacity to tolerate cancer treatment, if needed (27, 28). At any age, life expectancy is quite variable in older adults, based on comorbidities and other factors (29).

Screening for prostate cancer is not recommended due to frequent false positives, which are burdensome, and to identification of slow-growing tumors (30).
Osteoarthritis

Osteoarthritis is the second most common chronic condition (23) among American older adults and a common cause of chronic pain and disability. Fifty-two percent of 85-year olds had a diagnosis of osteoarthritis in one study (20). The prevalence of osteoarthritis seems to be higher among women than men. Obesity is a risk factor for osteoarthritis and as the population ages (and particularly as the overweight population ages), the rate of severe hip, and knee arthritis will increase. Pain management will continue to be a vexing clinical and health policy problem as virtually all analgesics have remarkable risks in older adults. Osteoarthritis treatments also include costly joint replacement surgery, which is often accompanied by intensive rehabilitative therapies. Low back pain is itself a common symptom particularly in older women and the cause is often multifactorial. Non-pharmacologic treatments can help.
Diabetes Mellitus

Diabetes rates have been increasing as populations age and become more overweight. The prevalence of diabetes among American older adults may increase more than 400% by 2050 (31). Diabetes remains a strong risk factor for cardiovascular disease at age 85 (32). Diabetes is also associated with peripheral arterial disease and peripheral neuropathy, contributing to diabetic foot ulcers and amputations. Diabetic foot ulcers occur in 6% of diabetic patients annually and amputations in about 0.5%. Management approaches in diabetes should be individualized. Sulfonylureas and insulin carry a substantial risk of hypoglycemia and use should be weighed carefully in vulnerable older adults. Transitions from hospital to home or post-acute care are risky times for patients treated with hypoglycemic agents as dosing needs may fluctuate (31). Regular foot examinations are critical for people with diabetes to prevent amputations. Regular walking can improve circulation in the legs.
Osteoporosis

Osteopenia is normal loss of bone density with aging. Many 85-year-old adults have osteoporosis, a more severe weakening of bone density. Osteoporosis is associated with an increased rate of bone fractures, while osteopenia is not. Bone density screening is recommended for women over age 65 (33). Although the prevalence of fractures in men increases by age 85, the value of osteoporosis screening for men has not been clearly demonstrated. The effectiveness and safety of calcium and vitamin D supplementation in order to prevent fractures remains controversial.
Multiple Chronic Conditions

Sixty two percent of Americans over 65 have more than one chronic condition (34) and the prevalence of multiple chronic conditions is increasing (35), due to aging of populations and to increasing diabetes rates. Older adults with multiple chronic conditions account for a large percentage of health spending (36). Targeting this population for research and for quality improvement should improve care and reduce costs.

DEMOGRAPHIC TRENDS OF AGING PAPER
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Physical Function

Normal age-related changes and accumulated pathology contribute to functional changes seen with aging.
Walking Speed

Walking speed declines with normal aging but will decline additionally due to disease. Walking speed measurements can be used to predict future community ambulation, falls, disability (37), and risk of mortality (38). Measurement of walking speed is quick, safe, requires no special equipment, and adds no significant cost to clinical care. In one study, the average walking speed for the age group of 85–89 is 1.1 m/s for men and 0.8 m/s for women. After age 90 years, mean waking speed decreased to 0.9 m/s for men and 0.8 m/s for women (39). Physical activity interventions can improve walking speed.
Mobility Disability

Seventy-three percent of Americans over age 85 have some difficulty with walking according to a US Census study. Mobility disability is associated with social isolation, falls, and depression. One-third of people over age 85 with a disability live alone (40).
Disability in Activities of Daily Living

Disability rates are relatively high among adults over age 85. Rates of disability in activities like dressing and bathing, and disability in instrumental activities of daily living such as cooking, all rise with age over 80. Difficulty with bathing typically precedes difficulty with dressing or difficulty with using the toilet. In one study, 75% of people aged 85 had difficulty or disability with bathing and 25% had difficulty or disability with using the toilet (41). People with disabilities often also struggle with chronic pain, depression, and complex medication regimens (42). The percentage of older adults with disabilities has modestly decreased in recent decades.
Falls

Falls are a major cause of morbidity and disability among older adults. 30–40% of adults over age 70 fall each year and rates are particularly high for older adults in long-term care facilities. Falls account for more than half of injuries among older adults. Fall-related death rates are higher for adults over age 85 than for other age groups (43). Physical activity, vitamin D supplementation, balance exercise, and home safety assessment as a part of a multifactorial fall prevention program have been shown to reduce the incidence of falls (44). Individuals with balance problems or falls should have a multifactorial falls risk assessment (45).
Frailty

Frailty is defined as special vulnerability to stressors and is suggested by weakness, slowness, exhaustion, and weight loss (46). In one study, 38% of people aged 85–89 were frail (47). Frailty status can be assessed easily and the frail state predicts future disability, falls, hospitalizations, and poor surgical outcomes. Targeted interventions for frail populations would likely include physical activity and nutritional components (48) as well as medication reviews.
Continence

Thirty percent of women over age 65 and 50% of older adults in nursing facilities have urinary incontinence (49). Common causes for incontinence among women include overactive bladder, stress incontinence, and functional incontinence. Urinary incontinence reduces well-being and quality of life (50). However, common incontinence medications cause burdensome side effects.

 

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