Nonagenarians and Centenarians

There is an expanding group of the very old, those now older than 90 years (nonagenarians), who remain mobile and active. They are genetically hardy. These are an extraordinarily select group of individuals who have managed to survive the numerous dangers and diseases of childhood and, with the advancement of medical science, have overcome disorders that would have killed their parents. Some remember the influenza pandemic of 1918 in which numerous young and vital individuals died within a few hours of developing influenza. Many of these present elders, because of the rigorous conditions of survival in their youth, are now living well into their 90s.

This generation raised their families during the depths of the Great Depression. Desperation was prevalent in the country at the time. Few were able to achieve a higher education, and many did not even complete grade school. The bulk of the working population were farmers, agricultural workers, factory workers, miners, and clerks. Unemployment was rampant. Individuals worked very hard for the essentials of existence and felt fortunate if they were employed. Henry Ford became famous for offering wages of $5 a day and producing assembly-line cars that made automobiles available to the common person. These individuals, who are the last to remember traveling by horse and wagon, have also flown across the nation in supersonic jet airplanes. Older people of today have been catapulted through socioscientific periods too numerous to mention. The shifts in human thought, technical capacities, and modes of life that have occurred within the single lifetime of the very old are stunning. These include the agrarian age, the industrial age, the atomic age, the space age, the microelectronic age, and the cyberspace age as we are all connected by the World Wide Web.

This generation has experienced more hardship and more lifestyle disruption and change than any of which we are aware. Federal aid, Social Security, the Works Progress Administration, and numerous other New Deal programs were instituted as survival measures during the depths of the Great Depression. Few of these individuals thought much about old age, and many say they are surprised to have lived so long. These elders rarely throw anything away because every scrap has potential value when one has known early deprivation. Many of them arrived in the United States in early childhood as steerage passengers, emigrating with their parents from Europe.

Centenarians, the “elite-old,” are approached with some awe as our society seeks routes to longevity. The number of centenarians in the United States has doubled every decade since 1970, and they are the fastest growing segment of our population. One in 26 Americans can expect to live to be 100 by 2025, compared with only one in 500 in 2000 (Administration on Aging, 2009). There are 221,500 supercentenarians (those older than 110). Many of the “elite-old” are bright and alert and have an unequaled personal history. However, although centenarians appear to be healthy for a longer period of time, almost 50% live in nursing homes. In part this may be due to the absence of living children, siblings, or spouses (Hooyman and Kiyak, 2011).

Most centenarians are female (85%) and come from families in which longevity is common. Although there are fewer male centenarians, they are less likely than women to have significant mental or physical disabilities at that age, and older men who survive to age 90 represent the hardiest segment of their birth cohort (Christensen, 2001; Hooyman and Kiyak, 2011). Persons of color who live to age 85 are “hardier” than their white counterparts (racial crossover effect). Thirty percent of centenarians have no evidence of dementia (Silver et al., 2001). They are often sought for their opinions on the key to longevity. The supposition is that because they have lived so long they know the secrets to learning, growing, and thriving. Various centenarians have recommended such things as a daily highball, hard work, church attendance, healthy diets, or the continuation of sexual activity. Unfortunately, few agree and the myths abound. Lifestyle factors that do seem significant include diet, maintaining proper weight, exercise, avoidance of smoking, social connections, and how well a person handles stress (Mentes, 2006). Researchers all over the world are studying centenarians. Many questions and conflicting findings still exist regarding both the physiological and psychological adaptation of centenarians. Several websites offer a fascinating look at centenarians, including pictures: http://www.adlercentenarians.org/ and http://www.grg.org/calment.html.

Life Expectancy

An American’s average life expectancy at birth has trended upward as a result of reduced death rates for children and young adults, new drugs, medical technology, and better disease prevention. Between 1985 and 2005, the death rates for the population aged 65 to 84 dropped, especially for men. For men aged 65 to 74, the death rate has dropped by 32.3% and by 23.5% for men aged 75 to 84. Life expectancy at age 65 increased by only 2.5 years between 1900 and 1960 but has increased by 4.2 years from 1960 to 2007 (Administration on Aging, 2009). In 2010, the life expectancy for infant girls in the United States was 80.8 years, whereas for boys it was 75.7 years. However, among African-Americans, life expectancy was 70.2 years for men and 77.2 years for women, evidence of an important health disparity (U.S. Census Bureau, 2010) (Figure 1-2). Hispanics in the United States outlive whites by 2.5 years and blacks by nearly 8 years (CDC, 2010).

A 2008 report comparing the United States with 18 other industrialized countries reported that in 2002-2004, the United States had among the highest death rates from causes amenable to health care of the countries studied. The report attributed the slow decline in U.S. amenable mortality to the increase in the uninsured population (American Medical Association, 2008).

Marital Status

The majority of people over the age of 80 live independently in the community. Older men are more likely to be married than older women, and 42% of all older women are widowed. There are more than four times as many widows as widowers (Figure 1-3). The number of older people who are divorced or separated is increasing and can be expected to rise as the baby boomers age. In the United States, 39% of women and 19% of men over the age of 65 live alone (Figure 1-4).

Living Arrangements

Florida has the highest proportion of people over the age of 65 (17.6%) followed by West Virginia (15.7%), Pennsylvania (15.3%), Maine (15.1%), and Iowa (14.8%). Between 1998 and 2008, the 65 years-and-older population increased 25% or more in Alaska, Nevada, Arizona, Utah, New Mexico, Idaho, Georgia, South Carolina, Colorado, and Delaware (Administration on Aging, 2009) (Figure 1-5). Most persons 65 years of age and older live in metropolitan areas (80.6%) (Administration on Aging, 2009). In the comparatively mobile population of the United States, the experience of aging is greatly influenced by where one lives.

Education

The educational level of the older population is increasing (Figure 1-6). Between 1970 and 2008, the percentage of older persons who had completed high school rose from 28% to 77.4%. In 2008, about 20.5% had a bachelor’s degree or higher. Completion of high school varies considerably by race and ethnic origin: 82.3% of the white population, 73.9% of Asians and Pacific Islanders, 59.7% of African Americans, and 45.9% of Hispanics. However, the increase in educational levels is also evident within these groups. In 1970, only 30% of older white individuals and 9% of African Americans had completed high school (Administration on Aging, 2009). The baby boomers, and people currently 65 to 69 years of age, are more educated than the current old-old and future generations will continue this educational trend.

Income and Employment

In 2008 households headed by persons 65 and over reported a median income of $44,188. Median income varies as follows by race and culture: $46,527 for non-Hispanic whites, $32,901 for Hispanics, $35,025 for African Americans, and $38,859 for Asians. The percentage of people living below the poverty level was 9.7% in 2008. However, a recent report by the Alliance for Children and Families (2010) notes that 18% of Americans will have experienced poverty by the age of 70, 29% by the age of 80, and 41% by the age of 90. Longer life expectancies, fluctuating economic conditions, and rising health care costs contribute to increasing concerns about poverty in old age in this country.

Gender, racial, and cultural disparities exist. One of every 14 older white individuals was poor in 2008, compared with 20% of older African Americans and 19.3% of Hispanics. Women make up 6 or the 10 older people at risk or already living in poverty (Alliance for Children and Families, 2010). The highest poverty rates were experienced by older Hispanic women (43%) and older African American women (34.7%) who lived alone. Women, particularly culturally and ethnically diverse women, face great challenges as they age. The United States has one of the highest poverty rates for older women among industrialized countries. The problems of aging are largely problems of older women. Factors influencing the poverty status of older women include pay inequity, occupational segregation, caregiving responsibilities, longer life expectancy, rising health care costs, and women’s work patterns, all of which reduce pension earnings, public assistance benefits, and personal savings (Hounsell and Riojas, 2006).

An increasing number of people over the age of 65 are remaining in or returning to the workforce. Between 2006 and 2016, the number of people age 55 to 64 who are working is expected to climb by 36.5%. The number of workers over the age of 75 will rise by more than 80% during that time period. By 2016, workers over the age of 65 will account for 6.1% of the total labor force, up sharply from their 2006 rate of 3.6%. Some of this is because of a desire to continue their careers but is more frequently out of economic necessity (Administration on Aging, 2009; Hooyman and Kiyak, 2011) (Figure 1-7).