15.2: Health Risks in Late Adulthood
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Learning Objectives
By the end of this section, you will be able to:
- Identify the major physical health concerns of late adulthood
- Identify the major mental health concerns of late adulthood
- Describe research and issues related to health-care expenses
Growing up, Jarvis listened to his older relatives complain about their aches and pains and thought, “I’ll never do that.” Now, as he enters his seventies, he realizes how wrong he was. Although his overall health is pretty good, years of serving in the military and working in construction have resulted in some hearing loss, as well as arthritis in his hands, wrists, and knees. These problems don’t significantly impair his functioning, but Jarvis takes more aspirin than he used to and has started to wear a hearing aid. Following a cancer scare, he gave up smoking and discovered that he was breathing better and had more stamina than he expected to have at his age. Jarvis worries less than he did when he was younger, although the cost of health care gives him some anxiety. He resolves to do his best to stay healthy so he can keep enjoying life.
This section describes different types of physical and mental health risks and how they relate to older adults. Policy issues related to health-care affordability and accessibility can also play a role in health risks in late adulthood.
Physical Health Concerns in Late Adulthood
In health research, good health is typically defined by omission. In other words, researchers typically view good health as the lack of any short- or long-term diseases or conditions that can have a negative effect on quality of life, functioning, or future.
Acute and Chronic Health Problems
An acute condition tends to occur quickly and last only a brief period. Examples include many short-term, common, and contagious conditions such as the common cold and flu. Acute conditions are not associated with age. On the other hand, a chronic condition often develops slowly over time and is positively correlated with age. The defining characteristic of a chronic condition is that it has a long duration, several months or longer, or even occurs on a constant basis and needs management to prevent worsening over time (National Council on Aging, 2020). Examples include osteoarthritis, heart disease, asthma, and diabetes. Poor lifestyle choices such as unhealthy diet, a sedentary lifestyle, and smoking increase the risk of developing some of these health conditions.
As we get older, the odds of facing chronic health conditions increase. Around 70 percent of U.S. adults aged fifty-five to sixty-four years manage at least one chronic health condition, and 14 percent have three or more. By age sixty-five years, those numbers have risen to 86 and 23 percent, respectively (Centers for Disease Control and Prevention, 2015). Due to the increasing population of older adults, however, the number of individuals with at least one chronic health problem is expected to double between 2020 and 2050 (Ansah & Chiu, 2023). This is particularly worrisome because of the high cost of medical care for chronic conditions; in the United States, 85 percent of health-care costs are spent on chronic conditions (Holman et al., 2020). In 2011, this cost was predicted to reach $47 trillion by 2030 (Hacker, 2024). Since the COVID-19 pandemic, the number of people needing care for chronic conditions has increased, and this figure is now predicted to be even higher (Cutler, 2022; Tene et al., 2023; Tufts et al., 2023).
Acute conditions, however, become less common with age. Preschool children on average experience six to eight colds per year, sometimes one per month, because of their limited immunity to different viruses. As we get older, the lifelong process of contracting these acute conditions builds immunity to specific infections, decreasing the odds of future acute illness (Pappas, 2022). This is not to say that acute conditions are not a problem for older adults. As mentioned earlier, many acute conditions such as the flu, pneumonia, RSV (respiratory syncytial virus), and COVID-19 can be more serious and potentially fatal for older adults because the immune system’s ability to respond to infections weakens with age. This is a main reason older adults have been more likely to experience serious illness from COVID-19 and why they are highly encouraged to get regularly vaccinated.
Sexual Functioning in Older Age
Sexual activity remains a common element of relationships in later life. While sexual activity may be less frequent, a large percentage of older adults still enjoy sex (Jackson et al., 2020; Lee et al., 2016; Ricoy-Cano et al., 2020). Several studies have indicated that 50 to 80 percent of adults aged sixty to seventy-four years and 15 to 30 percent of adults over age eighty years report being sexually active, with men reporting more sexual activity than women (Jackson et al., 2020; Lee et al., 2016).
Physical health may affect sexual functioning more in older adults than in other age groups. For example, estrogen and testosterone levels decline after middle age (Brotto et al., 2016; Hochberg & Konner, 2020; Hull et al., 2011; Ricoy-Cano et al., 2020), which can affect both sex drive and performance (including vaginal lubrication and the ability to achieve an erection). Joint pain and loss of flexibility, both of which increase in later life, may make certain sexual positions uncomfortable. Health problems such as high blood pressure and diabetes, also more likely in later life, are reliably associated with lower rates of sexual activity and desire (Brotto et al., 2016; Jackson et al., 2020; Lee et al., 2016). Some research proposes that loss of sex drive or performance may be an early indicator of health problems (Jackson et al., 2020), suggesting that health-care providers should ask older patients about their sexual health as a routine part of medical checkups.
Another issue is prevention of sexually transmitted infections (STIs). Over the past decade or so, rates of STIs have increased in many countries, and older adults aren’t exempt (Bourchier et al., 2020; Morgan et al., 2023; Smith et al., 2020). However, older adults are generally unlikely to use prevention methods such as condoms or PrEP (Morgan et al., 2023), and they demonstrate low knowledge of STI transmission, symptoms, and prevention (Smith et al., 2020). Therefore, health-care providers should screen for STIs and discuss safe sex methods with their older patients.
Specific Threats to Health in Older Age
Researchers examining data from the Centers for Disease Control and Prevention (Xu et al., 2022) found that seven of the ten leading causes of death for older adults were chronic health conditions that typically become more common in later years (Figure 15.10). The leading cause of death in the United States for 2020 and 2021 was heart disease , an example of a chronic condition associated with many lifestyle factors such as diet, exercise, and stress. The second leading cause of death was cancer, followed by COVID-19, injuries, stroke, respiratory disease, Alzheimer’s disease, diabetes, liver disease/cirrhosis, and kidney disease. The more common age-related causes of death, such as heart disease, some types of cancer, respiratory disease, and diabetes, are all at least partly caused by environmental and lifestyle characteristics (National Center for Health Statistics, 2021).
Many common causes of death are consistent across racial and ethnic groups, with subtle variations in their frequency. This is true for all the age-related causes of death as well, with heart disease and cancer leading across all racial and ethnic groups in the United States (Centers for Disease Control and Prevention, 2022). These variations are generally believed to be caused by environmental factors, particularly the chronic stress associated with poverty and institutionalized racism (Cunningham et al., 2017; Leitner et al., 2016). This chronic stress may accelerate the development of health problems (Forde, 2019; Simons, Lei, Klopack, Beach, et al., 2021; Simons, Lei, Kopack, Zhang, et al., 2021), and racism both within and outside of the health-care system can prevent people from receiving appropriate medical care (Leitner et al., 2016; Sim et al., 2021; Simons, Lei, Klopack, Beach, et al., 2021; Simons, Lei, Kopack, Zhang, et al., 2021). The end result is that medical problems may go untreated, thus leading to decreased life expectancy .
One study compared eleven of the highest-income countries—United States, United Kingdom, Germany, Sweden, France, the Netherlands, Switzerland, Denmark, Canada, Japan, and Australia—to better understand similarities and differences in health and health outcomes around the world. The United States appeared healthier than most countries on some high-risk factors such as smoking, and it ranked near the middle on alcohol consumption. On weight, however, the United States ranked worst, with 70.1 percent of the population overweight or obese; Australia was next at 63.4 percent; and Japan had the fewest problems related to weight, with 23.8 percent of the population considered overweight or obese. Overall, the United States had the shortest average life expectancy at 78.8 years, and Japan the highest at 83.9 years (Papanicolas et al., 2018) (Figure 15.11).
Health problems and outcomes in developing and low-income countries are vastly different, because they are often those associated with living in poverty. For example, data from the World Health Organization suggest that neonatal conditions, diarrhea, malaria, tuberculosis, and HIV are all top-ten causes of death in countries within the bottom 25 percent when ranked on income (World Health Organization, 2020).
An interesting variation on international differences in health and life expectancy comes from the study of “ Blue Zones ,” the areas of the world with an unusually high number of people older than their predicted life expectancy, in many cases 100 years of age or more (Buettner, 2008; Buettner & Skemp, 2016; Herbert et al., 2022; Kreouzi et al., 2022; Poulain & Herm, 2022). These places are Nicoya Peninsula, Costa Rica; Ikaria, Greece; Sardinia, Italy; Okinawa, Japan; and Loma Linda, California, in the United States. Their residents have longevity and good health in common, but they differ ethnically, economically, and geographically. What commonalities, then, are producing these good health outcomes?
Research has found several shared characteristics that appear to positively affect their health:
- Moving naturally —Blue Zone residents don’t get formal exercise but are physically active in their daily lives (gardening, doing housework, walking to get places).
- Having a sense of purpose —They are motivated and goal oriented.
- Managing stress —They have regular rituals, such as prayer and ancestor worship, that help them cope with stress.
- Monitoring their food portions and mealtimes —They eat until they’re only 80 percent full and also eat their largest meal at midday instead of in the evening.
- Following a plant-based diet —Most of their protein comes from beans and lentils; they may eat meat but not frequently.
- Drinking in moderation —Having one to two glasses of wine per day is associated with longer life in these groups; however, there’s controversy about the role of alcohol consumption in health.
- Participating in a faith-based community —Most residents attend some kind of religious services several times a month.
- Putting family first —Residents prioritize living with or near extended family and spending time with children and life partners.
- Surrounding themselves with support —They create networks of close friends who support their healthy behaviors and provide companionship (Buettner & Skemp, 2016; Herbert et al., 2022; Kreouzi et al., 2022; Poulain & Herm, 2022).
While it’s hard to say conclusively that these behaviors are causing the increased life expectancy, they’re consistent with other research associating them with positive health outcomes (Kreouzi et al., 2022). Many such behaviors, such as creating networks of close friends, consuming mainly plant-based protein, and being naturally active, can be achieved without spending a lot of money. This suggests that people in low-income situations may be able to incorporate some of these behaviors into their lives and increase their chances of living longer and healthier lives. However, other facets of SES may also limit awareness of best health practices. For example, some studies find that lower educational level and lower income are associated with less knowledge about how to promote good health (Svendsen et al., 2020). Research studies recommend public health strategies work to improve health equity by promoting better knowledge of health risk and health promotion behaviors across populations (Sorensen et al., 2015).
Mental Health Concerns in Late Adulthood
While some mental health problems are specific to later life, such as different types of dementia, other challenges such as anxiety and depression are less common for older adults than for younger age groups. A subfield of psychology called geropsychology focuses on enhancing the mental health of older adults (American Psychological Association, 2024). Geropsychologists are specially trained to address the way mental health problems may manifest themselves in late life.
Depression
Unfortunately, due to systemic ageism, people often negatively stereotype older adults as living lonely lives and struggling with depression as they face. However, according to research, these stereotypes are far from accurate. In fact, depression rates tend to decrease with age, and young adults are more than four times more likely to have depression than adults aged fifty years and older (Figure 15.12). Research in countries throughout Europe also suggests that older adults tend to defy stereotypes that they are a depressed group (Beller et al., 2021; Copeland et al., 1999). As it turns out, not only does the risk of depression decrease, but the experience of positive emotions increases (Cartensen & DeLiema, 2018).
These findings don’t suggest that depression is irrelevant to older populations. Nearly one in twenty older adults deal with major depression within a given year, and many more face less severe depressive symptoms. Research suggests that economic hardship, loneliness, serious chronic health problems, caregiving for a loved one, the loss of a loved one, and cognitive impairment all place older adults experiencing those events at a higher risk for depression than their peers (Alexopoulos, 2005; Işik et al., 2020). Adequate social support, exercise, and confidence in physical ability tend to reduce the risk of depression (Miller et al., 2019), as does setting and achieving realistic and personally meaningful goals (Samantaray & Kar, 2021). Being able to adapt to new circumstances is also beneficial; for example, looking at a move to a retirement community as a relief from the responsibilities of home ownership instead of a loss of independence may prevent someone from being distressed about this change (Regier & Parmalee, 2021).
Research shows that older adults are at a higher risk for suicide. Overall, men are much more likely to die by suicide, a finding consistent across race, ethnicity, and age. White people tend to have higher suicide rates than other racial and ethnic groups. Those in the earlier part of older adulthood (ages sixty-five to seventy-four years) have the lowest rate of suicide across adulthood, with around fifteen suicides per 100,000 individuals. The rate increases to nineteen suicides per 100,000 people for those aged seventy-five to eighty-four years, and more than twenty-two per 100,000 people for adults aged eighty-five years and older (American Foundation for Suicide Prevention, 2024). Having depression, being unmarried, and living alone make suicide more common in older age (Wiktorsson et al., 2010). Loss of a spouse has also been linked to suicide ideation in this population (Heuser & Howe, 2019).
Anxiety
Like depression, anxiety is more common in women than men; 23 percent of women reported experiencing an anxiety disorder in the past year compared to 14 percent of men (National Institute of Mental Health, n.d.). Lifetime prevalence of anxiety disorders is around 34 percent, but research generally suggests they typically first appear from childhood to early adulthood. They tend to peak in the early part of middle adulthood before decreasing during the later part of middle adulthood and throughout older age (Bandelow & Michaelis, 2022; Javaid et al., 2023) (Figure 15.13).
While anxiety is less common in later life, nearly one in ten older adults reported experiencing an anxiety disorder within the past year. Older adults with anxiety disorders frequently have comorbid disorders such as depression, serious medical issues, and cognitive decline. Late-onset anxiety is not common; most older adults dealing with anxiety also experienced it at younger ages. Anxiety in older adults can be successfully treated with either medication or cognitive behavioral therapy (Ando et al., 2023; Wolitzky-Taylor et al., 2010).
Health-Care Costs in Older Age
Paying for health care to treat the potential problems of later life can be both complicated and expensive in the United States. Despite having the lowest average life expectancy among high-income nations, the United States spent the highest percentage of gross domestic product (17.8 percent) and the highest amount per individual, including for individual health care, in addition to tax contributions toward public health-care programs (Figure 15.14) (Papanicolas et al., 2018). These statistics are concerning. They suggest that people in the United States are paying much more than those in comparable countries for health care, yet they are last in life expectancy among the nations studied.
One reason for the higher cost of health care in the United States may be the nation’s complex health-care system. Most other affluent countries have universal health care , a system that makes health-care services accessible to all citizens with little or no out-of-pocket costs for individuals because the government subsidizes the cost through taxes. In the United States, in contrast, health care can be paid for entirely out of pocket or through privately purchased health insurance, employer-provided health insurance, or a variety of federal and state programs. This complex system can be difficult to navigate, especially for older adults who may have limited income and greater health-care needs. Few of these options cover all costs or all types of health care, and individuals typically pay at least some expenses themselves, either directly or through the purchase of supplemental insurance. Thus, socioeconomic status is a factor in access to high-quality health care.
Medicare is a U.S. federal program that pays some health-care costs for many older adults, particularly related to hospital care and doctor visits. Because many expenses such as vision care and dental care are not covered, however, most older adults also purchase supplemental health insurance or a Medicare Advantage plan (Medicare, n.d.) if they don’t already have other insurance. Medicare does not automatically offer prescription drug coverage, a significant expense for older adults; this has to be added separately or covered through another form of insurance. Individuals who are unable to pay for health coverage may qualify for Medicaid , a program like Medicare but for those with limited income (Medicaid, n.d.).
Link to Learning
Read an article about older U.S. adults who either ration or skip taking their prescription drugs because they can’t afford the cost.
While older adults face several health risks such as those related to normative age-related changes and increased health care costs, there are many protective factors that can promote mental and physical health and well-being in older adulthood. For example, older adults often experience healthy sexual functioning and lower risks of depression and anxiety than in earlier adulthood. Finally, several health promoting behaviors, or protective factors, can be introduced to improve health and life expectancy in older adults, such as engaging in physical activity, eating well, having a good social support system, and managing stress.
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