9.3: Age Categories in Late Adulthood

There have been many ways to categorize the ages of individuals in late adulthood. In this chapter, we will be dividing the stage into four categories: young-old (65–74), old-old (75–84), the oldest-old (85–99), and centenarians (100+) for comparison. These categories are based on the conceptions of aging, including biological, psychological, social, and chronological differences. They also reflect the increase in longevity of those living to this latter stage.

Young-old:

Generally, this age span includes many positive aspects and is considered the "golden years" of adulthood. When compared to those who are older, the young-old experience relatively good health and social engagement (Smith, 2000), knowledge and expertise (Singer et al., 2003), and adaptive flexibility in daily living (Riediger et al., 2005). The young-old also show strong performance in attention, memory, and crystallized intelligence. In fact, those identified as young-old are more similar to those in midlife. This group is less likely to require long-term care or to be dependent or poor, and more likely to be married, working for pleasure rather than income, and living independently. Overall, those in this age period feel a sense of happiness and emotional well-being that is better than at any other period of adulthood (Carstensen et al., 2003; George, 2009; Robins & Trzesniewski, 2005). It is also an unusual age in that these people are considered both in old age and not in old age (Rubinstein, 2002).

Figure \(\PageIndex{1}\). Young-old generally experience positive well-being. Image source.

Old-old:

Adults in this age period are likely to be living independently, but often experience physical impairments as chronic diseases increase in frequency after age 75. For example, congestive heart failure is 10 times more common in people 75 and older, than in younger adults (National Library of Medicine, 2019). In fact, half of all cases of heart failure occur in people after age 75 (Strait & Lakatta, 2012). In addition, hypertension and cancer rates are also more common after 75, but because they are linked to lifestyle choices, they typically can be can prevented, lessoned, or managed (Barnes, 2011b).

Oldest-old:

This age group often includes people who have more serious chronic ailments among the older adult population. In the U.S., the oldest-old represented 14% of the older adult population in 2015 (He et al., 2016). This age group is one of the fastest growing worldwide and is projected to increase more than 300% over its current levels (NIA, 2015b). The oldest-old are projected to be nearly 18 million by 2050, or about 4.5% of the U.S. population, compared with less than 2% of the population today. Females comprise more than 60% of those 85 and older, but they also suffer from more chronic illnesses and disabilities than older males (Gatz et al., 2016).

Figure \(\PageIndex{2}\). Percentage of emergency department admissions and deaths, ages 65 and over. Adapted from source.

While this age group accounts for only 2% of the U. S. population, it accounts for 9% of all hospitalizations (Levant et al., 2015). In a study of over 64,000 patients age 65 and older who visited an emergency department, the admission rates increased with age. 35% of admissions after an emergency room visit were the young-old, almost 43% were the old-old, and nearly half were the oldest-old (Lee et al., 2018). The mortality rate was also higher with age. The most common reasons for hospitalization for the oldest-old were congestive heart failure, pneumonia, urinary tract infections, septicemia, stroke, and hip fractures. In recent years, hospitalizations for many of these medical problems have been reduced. However, hospitalization for urinary tract infections and septicemia has increased for those 85 and older (Levant et al., 2015).

Those 85 and older are more likely to require long-term care and to be in nursing homes than the youngest-old. Almost 50% of the oldest-old require some assistance with daily living activities (APA, 2016). However, most still live in the community rather than a nursing home, as shown in Figure \(\PageIndex{3}\) (Stepler, 2016b). The oldest-old are less likely to be married and living with a spouse compared with the majority of the young-old (APA, 2016; Stepler, 2016c). As can be seen in Figure \(\PageIndex{3}\), gender is also an important factor in the likelihood of being married or living with one's spouse.

Figure \(\PageIndex{3}\). Living arrangements of older adults in 2014. Adapted from Pew Research Center.

Centenarians:

A segment of the oldest-old are centenarians, that is, 100 and older, and some are also referred to as supercentarians, those 110 and older (Wilcox et al., 2008). In 2015 there were nearly half a million centenarians worldwide, and it is estimated that this age group will grow to almost 3.7 million by 2050. The U.S. has the most centenarians, but Japan and Italy have the most per capita (Stepler, 2016e). Most centenarians tended to be healthier than many of their peers as they were growing older, and often there was a delay in the onset of any serious disease or disability until their 90s. Additionally, 25% reached 100 with no serious chronic illnesses, such as depression, osteoporosis, heart disease, respiratory illness, or dementia (Ash et al. 2015). Centenarians are more likely to experience a rapid terminal decline in later life, meaning that for most of their adulthood, and even older adult years, they are relatively healthy in comparison to many other older adults (Ash et al., 2015; Wilcox et al., 2008). According to Guinness World Records (2016), Jeanne Louise Calment has been documented to be the longest-living person at 122 years and 164 days old (see Figure \(\PageIndex{4}\)).

Figure \(\PageIndex{4}\). Jeanne Louise Calment from France. Image source.