Posts Tagged ‘National Institute on Aging’

90-Year-Olds Growing in Numbers

Tuesday, November 29th, 2011

Is 90 the new 85? The number of Americans over the age of 90 has skyrocketed from 720,000 in the year 1980 to more than 1.9 million in 2010, according to the Census Bureau, which notes that “over the next four decades, this population is projected to more than quadruple.”  Driven by improvements in healthcare, the trend presents challenges.  The Census Bureau notes that “a nation’s oldest-old population consumes resources disproportionately to its overall population size, and its growth has a significant impact on societal and family resources, including pension and retirement income, healthcare costs, and intergenerational relationships.”

According to the study, “People at very old ages are also expected to live longer.  Today a person 90 years of age is expected to live on average another 4.6 years (versus 3.2 years in 1929–1931), and those who pass the century mark are projected to live another 2.3 years.  Women aged 90+ outnumber 90+ men nearly 3 to 1.”

The downside is that people aged 90-plus are more likely to live in poverty or have disabilities, creating a new challenge to already strained retiree income and healthcare programs.

Richard Suzman, director of behavioral and social research at the National Institute on Aging, said “A key issue for this population will be whether disability rates can be reduced.  We’ve seen to some extent that disabilities can be reduced with lifestyle improvements, diet and exercise.  But it becomes more important to find ways to delay, prevent or treat conditions such as Alzheimer’s disease.”

“Given its rapid growth, the 90-and-older population merits a closer look,” said Wan He, a Census Bureau demographer and one of the report’s authors.  “The older people get, the more resources they consume because of healthcare, and disability rates significantly increase.  This creates demands for daily care, and for families the care burden increases dramatically.”

People in this demographic are more likely to have at least one disability, live alone or live in a nursing home.  They’re also more likely to be female, because women typically are longer-lived than men, and are likely to be poor.  “But increasingly people are living longer and the older population itself is getting older.  Given its rapid growth, the 90-and-older population merits a closer look.  The implications for the family and our society of this growing population are likely to be significant,” according to the authors.

The poverty issue cannot be understated because it becomes more likely as a person ages.  From 2006 to 2008, 14.5 percent of people 90 and older lived in poverty, drastically more than the 9.6 percent of those 65 to 89 who were considered poor.  The annual median income for people aged 90 and older was $14,760, as measured in inflation adjusted dollars.  Nearly half of that income — 47.9 percent — came from Social Security, and 18.3 percent came from retirement pensions.  Fully 92.3 percent of those 90 and older received Social Security income.

And where do these nonagenarians live? According to Census figures, smaller states had the highest shares of their older Americans who were at least 90.  North Dakota had approximately seven percent of its 65-plus population older than 90.  It was followed by Connecticut, Iowa and South Dakota.  When considering absolute numbers, the retirement havens of California, Florida and Texas led the nation in the 90-plus population, each with more than 130,000.

By 2050 – just 39 years from now – the number of Americans 90 or older could total nine million. “I think it’s going to grow even faster than predicted in the report,” Suzman said.  Someone who lives to 90 today is likely to live almost another five years, the study noted.  Additionally, a person who lives to celebrate a 100th birthday is likely to live another 2.3 years.  Women aged 90 and older outnumbered men by 3 to 1, according to the study.  Nearly 80 percent of those women are widows, while more than 40 percent of the men are married.

Edmund H. Duthie, a professor of medicine and chief of the division of geriatrics and gerontology at the Medical College of Wisconsin, said the census numbers point to a sobering fact: Retirement may be longer than people expect.  “Are you going to outlive whatever you put aside?”  Duthie said.  “Most people wouldn’t think that if you retired at 60, you may have a third of your life to live.”  Duthie said it was unclear how the nation’s obesity epidemic might affect longevity as well as chronic illness.  America, he said, remains concerned with rates of dementia and how society will cope with the problem.  “The science base of what we do with the oldest old is something that we’re lacking,” he said.  “We can measure cholesterol and blood pressure, but what does it mean in a 90-year-old?  We need to be enrolling these oldest old in studies to understand more about what to do.”

Revised Alzheimer’s Guidelines Help Us Catch It In Time

Wednesday, May 4th, 2011

Will revised guidelines for Alzheimer’s disease diagnosis help physicians identify the illness sooner than was previously possible?  For the first time in 30 years, scientists have created guidelines to advance the diagnosis of Alzheimer’s disease and help doctors identify the earliest signs of the degenerative condition, even before memory loss begins with the goal of helping patients prepare early, and eventually treat, the disease.

The National Institute on Aging/Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease outline new approaches and give scientists more advanced instructions for moving forward with research on diagnosis and treatments.  The revised guidelines also have the potential to more than double the number of people being diagnosed with Alzheimer’s in a given year.  “The new guidelines reflect today’s understanding on how key changes in the brain lead to Alzheimer’s disease, said Creighton Phelps of the National Institute of Health’s (NIH) National Institute on Aging.

Writing in Time, Alice Park says that “Currently, Alzheimer’s disease can be definitively diagnosed only at autopsy, when pathologists can confirm the presence of protein plaques and tangles in the brain of a patient who has shown signs of memory loss and cognitive deficits.  The new guidelines tease apart three different stages of the disease that are meant to help doctors better identify affected patients while they are alive.  The phases also reflect the latest research, which suggests that Alzheimer’s develops in the brain over a long period of time — perhaps years or even decades before the first cognitive deficits are noticeable.”

Approximately 5.4 million Americans have Alzheimer’s, which dims memory and other cognitive abilities.  People with Alzheimer’s can undergo dramatic personality changes and ultimately are confused, unable to take care of themselves or recognize family members.  An aging population equals more Alzheimer’s cases.  This has made it more important for scientists to develop early diagnosis and treatment tools, as well means to distinguish Alzheimer’s from other types of dementia.  “At this time, we don’t know enough to be able to advise patients properly about what their risk for later dementia might be,” said John C. Morris of the Washington University School of Medicine.  “Even if we do determine what that risk might be, we don’t have treatment to reduce that risk.”

In 1984, Alzheimer’s was diagnosed based on a single symptom – dementia. The updated guidelines reflect a more advanced understanding of the disease: Alzheimer’s can begin as many as 10 years before signs of dementia.  For clinicians, the guidelines reflect how many doctors already diagnose the disease.  For example, memory isn’t always the initial casualty; vision, literary skills and speech can decline while memory remains intact.  Although Alzheimer’s is unusual in people younger than 40, the disease progresses in the same way as a 90-year-old.  Testing for mutations in three genes can determine whether a patient has early onset of Alzheimer’s (though 10 related genes are known).

According to the new guidelines, Alzheimer’s is recognized as a continuum of stages: Alzheimer’s itself with clear symptoms; mild cognitive impairment (MCI) with mild symptoms; and also the “preclinical” stage, when there are no symptoms but when recognizable brain changes may already be occurring.  Additionally, the revised guidelines use what are known as biomarkers – as an example, the levels of certain proteins in blood or spinal fluid — to diagnose the disease and measure its progress.  “It will not change practice,” said Dr. Guy M. McKhann, one of the guideline authors.

Older adults with this impairment progress to dementia at a higher rate than those with no impairment, but progression is not inevitable,” according to the Alzheimer’s Association. “Not everyone diagnosed with MCI goes on to develop Alzheimer’s,” the association noted.

According to William Thies, chief medical and scientific officer of the Alzheimer’s Association, the new guidelines “will result in little change in current clinical practice of medicine as applied to Alzheimer’s disease.  The new criteria are really extending the range of our ability to investigate this disease and eventually to find treatments that will be so necessary to avoid the epidemic of Alzheimer’s that we see facing us.”