Abstract
By 2050, the American 85 years old and over population will triple. Clinicians and the public health community need to develop a culture of sensitivity to the needs of this population and its subgroups. Sensory changes, cognitive changes, and weakness may be subtle or may be severe in the heterogeneous population of people over age 85. Falls, cardiovascular disease, and difficulty with activities of daily living are common but not universal. This paper reviews relevant changes of normal aging, diseases, and syndromes common in people over age 85, cognitive and psychological changes, social and environmental changes, and then reviews common discussions which clinicians routinely have with these patients and their families. Some hearing and vision loss are a part of normal aging as is decline in immune function. Cardiovascular disease and osteoporosis and dementia are common chronic conditions at age 85. Osteoarthritis, diabetes, and related mobility disability will increase in prevalence as the population ages and becomes more overweight. These population changes have considerable public health importance. Caregiver support, services in the home, assistive technologies, and promotion of home exercise programs as well as consideration of transportation and housing policies are recommended. For clinicians, judicious prescribing and ordering of tests includes a consideration of life expectancy, lag time to benefit, and patient goals. Furthermore, healthy behaviors starting in early childhood can optimize quality of life among the oldest-old.
Highlights
The percentage of national populations over age 65 has been increasing in the last 10 years and will continue to rise for another 20 years due to improved life expectancies and a post-World War 2 baby boom
Now is the time for the public health community to plan for the “older-older age wave.”
This paper presents a model for the clinical and public health needs of adults over age 85
Summary
The percentage of national populations over age 65 has been increasing in the last 10 years and will continue to rise for another 20 years due to improved life expectancies and a post-World War 2 baby boom. Now is the time for the public health community to plan for the “older-older age wave.”. As the baby boom-generation ages from 65 to 85, there will be a more intense need for services in the home and in community and institutional settings. The common framework for describing different older adult populations is “young-old” [2], “old” [3], and “old-old.”. When caring for older adults as a clinician or as a caregiver, predicting the future and planning for the most likely aging trajectories are key steps. This paper presents a model for the clinical and public health needs of adults over age 85. The changes associated with a chronologic age of 85 can be divided into a few domains: normal aging, common diseases, and functional, cognitive/psychiatric, and social changes
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