Chapter 1 Learning Objectives

At the conclusion of this chapter, students will be able to:

Introduction

Older adults comprise a larger portion of the population than in the past. According to the 2016 Canadian census, 16.9% of the population was 65 and older (Statistics Canada, 2017). Figure 1.2.1 shows the population distribution by age in Canada for the year 2022, which gives a visual representation. Older adults (50-65 years) now comprise a greater percentage of the population than children (0-19 years). For the first time in Canadian history, the percentage of Canadians 65 years and older in 2016 exceeded the number of children aged 14 and younger, and this trend is expected to continue (Statistics Canada, 2019).

After World War II, from 1946-1964, there was a temporary marked increase in the birth rate. The term “baby boomer” refers to a person born in this timeframe, and this generation makes up a large proportion of the population in North America. As people born in this period grow older and retire, the need for services and products to support this age group increases. The proportion of older people is expected to reach its peak in 2029, when the last cohort of the baby boomer generation reaches the age of 65 and older (Statistics Canada, 2019).

A better way to appreciate the diversity of experiences is to go beyond chronological age and examine how well the person is aging. Many older people enjoy good health, social satisfaction, and overall well-being,  representing optimal aging, while others of similar age experience poor health and increased dependency on others. When looking at large populations, the WHO (2016) measures how many equivalent years of full health a newborn is expected to have on average. This age considers current age-specific mortality, morbidity, and disability risks and is called Healthy Life Expectancy. In 2015, the global Healthy Life Expectancy was 63.1 years, up from 58.5 years in 2000. The WHO African Region had the lowest Healthy Life Expectancy at 52.3 years, while the WHO Western Pacific Region had the highest at 68.7 years. In Canada in 2019, the Healthy Life Expectancy for males was 70.5 and 72 years for females.

Clicking on the following link will bring you to an interactive map depicting life expectancy around the world. Click on countries of interest to see changes in life expectancy over time: https://ourworldindata.org/grapher/life-expectancy?tab=map

There are two concerns about an aging population. First, the larger proportion of older people to young people will create a burden on the economy, and second, longevity for more elderly people may increase activity limitations and disability. The goal is to improve life quality and longevity so older adults can be independent longer, limiting illness and disability. This goal is called compressed morbidity or healthy life expectancy. There is mixed evidence of modest increased healthy life expectancy and longer life in Canada and the U.S. (Bushnik, Tjepkema, & Martel, 2018), especially for males. Across the world, such changes so far have not resulted in equally compressed morbidity.

In the Blue Zones shown on the map above of longevity around the world, people not only live longer, but they live longer with good quality of life (Buettner & Skemp, 2017).

Source: 99-OlderAsianMen(httpswww.piqsels.comenpublic-domain-photo-otiox) is licensed under a CC0 (Creative Commons Zero) license

1.5 Gender Differences in Life Expectancy

Worldwide, there are recorded gender gaps in life expectancy as women on average are more likely to live a longer life than men. These small differences in life expectancies can be attributed to biological characteristics of the male and female sexes as well as varied lifestyles and environments that influence behaviour patterns throughout one’s day-to-day life.

Biological Explanations

Biological differences in sex chromosomes and a different pattern of gene expression is theorized as one reason why females have a longer life expectancy than males (Chmielewski, Boryslawski, & Strzelec, 2016). Males are heterogametic (XY), whereas females are homogametic (XX) with respect to the sex chromosomes. Males can only express their X chromosome genes that come from the mother, while females have an advantage by selecting the “better” X chromosome from their mother or father, while inactivating the “worse” X chromosome.  This process of selection for “better” genes is impossible in males and results in the greater genetic and developmental stability of females.

Due to the inability to select the ‘better’ of the two X chromosomes, men are more likely to contract viral and bacterial infections, and their immunity at the cellular level decreases significantly faster with age. Although women are slightly more prone to autoimmune and inflammatory diseases, such as rheumatoid arthritis, the gradual deterioration of the immune system is slower in women (Caruso, Accardi, Virruso, & Candore, 2013; Hirokawa et al., 2013).

Looking at the influence of hormones, estrogen levels in women appear to have a protective effect on their heart and circulatory systems (Viña, Borrás, Gambini, Sastre, & Pallardó, 2005). Estrogen also has antioxidant properties that protect against harmful effects of free radicals, which damage cell components, cause mutations, and are in part responsible for the aging process. Testosterone levels are higher in men than in women and are related to more frequent cardiovascular and immune disorders.  The level of testosterone is also responsible, in part, for male behavioural patterns, including increased level of aggression and violence (Martin, Poon, & Hagberg, 2011; Borysławski & Chmielewski, 2012).

Lifestyle Factors

Not all the reasons women live longer than men are biological. As previously mentioned, male behavioural patterns and lifestyle play a significant role in the shorter lifespans for males. One significant factor is that males work in more dangerous jobs, including police, firefighters, and construction, and are more exposed to violence. According to the Federal Bureau of Investigation (2014) there were 11,961 homicides in the U.S. in 2014, and of those, 77% were males. Males are more than three times more likely to commit suicide (CDC, 2016a). Further, males serve in the military in much larger numbers than females. According to the Department of Defense (2015), in 2014, 83% of all Services (Navy, Army, Marine Corps and Air Force) officers were male, while 85% of all enlisted service members were male.

Other lifestyle factors can make older adults more at risk for health and nutrition issues, shortening their life expectancy. Older adults often experience a lack of motivation to cook for themselves. This could be because they may be cooking for one, have limited appetite, or lack mobility. People in this population group can experience a lack of access to adequate nutrition and resources that aid in their overall health. Some lack knowledge of their nutrient needs or how these change due to aging and changing body composition. Older adults often take multiple medications, which can cause interactions with each other or with certain nutrients compromising nutrient absorption- a potential cause of malnutrition in older adults. Some older adults are unable to consume certain food textures, making it difficult to get all necessary nutrients for the day. Overall, most older people experience feeling less hungry; however, not being hungry is not the same as being nourished, and these adults may experience malnutrition as a result.  

LGBTQ+ Communities

The LGBTQ+ communities in Canada experience numerous health inequities that affect their life expectancy. Health inequities are experienced differently by each of the LGBTQIA2 communities, but in general, people in these communities are more likely than heterosexual Canadians to develop mental health disorders, have suicidal thoughts and attempt suicide. Social factors such as the long-time stigmatization of gender and sexual diversity can render these individuals vulnerable and invisible. The stress associated with discrimination is directly linked to psychological distress and higher suicide risk among members of the LGBTQ+ community (Casey, 2019). Older adults who identify with the LGBTQ+ community are more likely to live alone than heterosexual people of the same age, potentially contributing to a lack of social support and isolation. There are also concerns about lower quality health care due to sexual orientation or gender identity (Casey, 2019). Sexual and gender minorities often need to educate health professionals about their risk factors and health needs, adding an extra burden. Ways to promote health equity for LGBTQ+ communities include providing opportunities for social connections in LGBTQ+ safe public spaces and improving health provider sexual diversity training at all levels – including administrative staff, care attendants, nurses, physicians, psychologists, dietitians, and social workers (Casey, 2019). 

To obtain more information about the current health inequities affecting these communities as well as ways in which the inequities can be reduced see The Standing Committee of Health developed a report at: https://www.ourcommons.ca/Content/Committee/421/HESA/Reports/RP10574595/hesarp28/hesarp28-e.pdf

1.6 Age Categories for Older People

There have been many ways to categorize older people. For example, age may be divided into categories: young–old (65-84), oldest-old (85-99), and centenarians (100+). These categories are based on aging conceptions, including biological, psychological, social, and chronological differences. 

Young-old

The age range of 65-84 may be classified as the young-old category (Ortman et al., 2014). According to Barnes (2011a), this age category spans the post-employment years for many people until approximately 80-85 years, when age-related limitations typically begin to occur for current and recent cohorts in physical, emotional, and cognitive development. Generally, this age span includes many positive aspects and is considered the “golden years“ of adulthood. Why so positive? Individuals at this age often have fewer responsibilities than in previous stages, and when combined with adequate finances and good health, they can pursue leisure and self-fulfillment opportunities. It is also an unusual age in that people are considered both old and not old in age (Rubinstein, 2002). 

When compared to those above 85, the young-old experience relatively good health and social engagement (Smith, 2000), knowledge and expertise (Singer, Verhaeghen, Ghisletta, Lindenberger, & Baltes, 2003), and adaptive flexibility in daily living (Riediger, Freund, & Baltes, 2005). The young-old also show strong performance in attention, memory, and crystallized intelligence. In fact, those identified as young-old are more like those in midlife than those who are 85 and older. This group is less likely to require long-term care, to be dependent or poor, and more likely to be married, working for pleasure rather than income, and living independently. Chronic diseases, such as cardiovascular disease, hypertension, and cancer, are most common (especially later in this period), but because they are linked to lifestyle choices, they typically can be prevented, lessened, or managed (Barnes, 2011b). 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, Fung, & Charles, 2003; George, 2009; Robins & Trzesniewski, 2005). 

Oldest-old

Most research done with older adults tends to focus on young-old individuals, whereas efforts to study the dimensions of advanced age are less frequent. This older 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, Goodkind, & Kowal, 2016). This age group is one of the fastest growing worldwide and is projected to increase more than 300% over current levels (NIA, 2015b). The oldest-old are likely to be nearly 18 million by 2050, or about 4.5% of the U. S. population, compared to less than 2% of the population today. Females comprise more than 60% of those 85 and older but also suffer from more chronic illnesses and disabilities than older males (Gatz et al., 2016). 

Those 85 and older are more likely to require long-term care and to be in nursing homes than the youngest-old. In Canada, Ontario‘s long-term care homes provide care and support to more than 115,000 people and their families every year. Long-term care homes provide 24/7 nursing care and supervision, primary medical care, help with daily activities and interests, and a safe, caring environment. Most people who live in long-term care have some form of cognitive impairment and physical frailty, along with chronic health conditions that have seriously compromised their health. As part of the health care system, long-term care homes are licensed and funded by the Ministry of Health and Long-Term Care to provide care for people who need support beyond what is possible at home. 

In the U.S., 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 1.6.2 (Stepler, 2016b). The oldest-old are less likely to be married and live with a spouse compared with most young-old (APA, 2016; Stepler, 2016c). Gender is also an important factor in the likelihood of being married or living with one‘s spouse.

Centenarians

Figure 1.6.1: Jean Louise Calment, from France, was recorded to live over 122 years (deceased 1997). 

Source: 089-JeanneLouiseCalment122yo is licensed under an All Rights Reserved license

A segment of the oldest-old are centenarians, 100 and older; some are also called supercentenarians, 110 and older (Wilcox, Wilcox & Ferrucci, 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 number of Canadians living to 100 and beyond reached a record high in 2021. Some centenarians say getting there is all about keeping your hands busy, having a loving family, and enjoying life‘s small pleasures. Canadians are living much longer now thanks to improved drug therapies, vaccines, and a more active lifestyle. 

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 grew 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 like 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 compared 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. 

References