Historical Perspective on the Study of Aging

Until the middle of the nineteenth century, only two stages of human growth and development were identified: childhood and adulthood. In many ways, children were treated like small adults. No special attention was given to them or to their needs. Families had to produce many children to ensure that a few would survive and reach adulthood. In turn, children were expected to contribute to the family’s survival. Little or no concern was given to those characteristics and behaviors that set one child apart from another.

As time passed, society began to view children differently. People learned that there were significant differences between children of different ages and that children’s needs changed as they developed. Childhood is now divided into substages (e.g., infant, toddler, preschool, school age, and adolescence). Each stage is associated with unique challenges related to the individual child’s stage of growth and development. Because the substages are related to obvious physical changes or to significant life events, this classification method is now accepted as logical and necessary.

Until recently, society also viewed adults of all ages interchangeably. Once you became an adult, you remained an adult. Perhaps society perceived dimly that older adults were different from younger adults, but it was not greatly concerned with these differences because few people lived to old age. In addition, the physical and developmental changes during adulthood are more subtle than those during childhood; therefore, these changes received little attention.

Until the 1960s, sociologists, psychologists, and health care providers focused their attention on meeting the needs of the typical or average adult: people between 20 and 65 years of age. This group was the largest and most economically productive segment of the population; they were raising families, working, and contributing to the growth of the economy. Only a small percentage of the population lived beyond 65 years of age. Disability, illness, and early death were accepted as natural and unavoidable.

In the late 1960s, research began to indicate that adults of all ages are not the same. At the same time, the focus of health care shifted from illness to wellness. Disability and disease were no longer considered unavoidable parts of aging. Increased medical knowledge, improved preventive health practices, and technologic advances helped more people live longer, healthier lives.

Older adults now constitute a significant group in society, and interest in the study of aging is increasing. The study of aging is expected to be a major area of attention for years to come.

What’s in a Name: Geriatrics, Gerontology, and Gerontics

The term geriatric comes from the Greek words “geras,” meaning old age, and “iatro,” meaning relating to medical treatment. Thus, geriatrics is the medical specialty that deals with the physiology of aging and with the diagnosis and treatment of diseases affecting the aged. Geriatrics, by definition, focuses on abnormal conditions and the medical treatment of these conditions.

The term gerontology comes from the Greek words “gero,” meaning related to old age, and “ology,” meaning the study of. Thus, gerontology is the study of all aspects of the aging process, including the clinical, psychologic, economic, and sociologic problems of older adults and the consequences of these problems for older adults and society. Gerontology affects nursing, health care, and all areas of our society—including housing, education, business, and politics.

The term gerontics, or gerontic nursing, was coined by Gunter and Estes in 1979 to define the nursing care and the service provided to older adults. The aim of gerontic nursing is “to safeguard and increase health to the extent possible and to provide comfort and care to the extent necessary.” This textbook focuses on gerontic nursing. It addresses ways to promote high-level functioning and methods of providing care and comfort for older adults.

The dictionary defines old as “having lived or existed for a long time.” The meaning of old is highly subjective; to a great degree, it depends on how old we ourselves are. Few people like to consider themselves old. Old age seems to come later as we become older. A recent study reveals that people younger than 30 years view those older than 63 as “getting older.” People 65 years of age and older do not think people are “getting older” until they are 75.

Aging is a complex process that can be described chronologically, physiologically, and functionally. Chronologic age, the number of years a person has lived, is most often used when we speak of aging because it is the easiest to identify and measure. Unfortunately, chronologic age is probably the least meaningful measurement of aging. Many people who have lived a long time remain functionally and physiologically young. These individuals remain physically fit, stay mentally active, and are productive members of society. Others are chronologically young but physically or functionally old.

Scope of the Aging Population

Gender and Ethnic Disparity

The Administration on Aging projects that minority populations will represent 26.4% of the older population by 2030, an increase from 16% in 2000. It is projected that by 2030, the white non-Hispanic population will increase by 77%. During the same time period, the percentage of minority persons of the same age cohort is expected to grow by 223% (Hispanics, 342%; African Americans, 164%; American Indians, Eskimos, and Aleuts, 207%; and Pacific Islanders, 302%).

The life expectancy is variable within the U.S. population. The populations of men and women are not equal, and in the older-than-65 age group, this disproportion is very noticeable. There are 22.4 million older women to 16.5 million older men. Women currently outlive men by approximately 7 years. Women tend to live longer than men, and whites tend to live longer than blacks, although disparities seem to be declining.

White women have the longest life expectancy, about 81 years. Black women have a life expectancy of about 76.9 years; white men, 76 years; and black men, 70 years. Because of the lack of precision in defining a Hispanic status (surname, country of origin, etc.), statistics for a Hispanic life expectancy are unclear and often contradictory. Some studies show Hispanics living longer than other groups, whereas other studies show shorter life spans. This is sometimes called the Hispanic Paradox.

In 2008, almost 20% of those over age 65 were identified as minorities. Approximately 9% were black, 3% Asian, and 7% Hispanic of any race. It is projected that by 2050 the population will be almost 40% minority: 20% Hispanic, 12% black, and 9% Asian.

The Baby Boomers

A major contributing factor to this rapid explosion in the elderly is the aging of the cohort, commonly called the Baby Boomers. Age cohort is a term used by demographers to describe a group of people born within a specified time period. The most significant cohort today is the group known as Baby Boomers. This cohort consists of people who were born after World War II between 1946 and 1964. Baby Boomers account for approximately one-third of all Americans today. Because of its size, this group has had, and will continue to have, a significant influence in all areas of society. It remains to be seen whether this group will experience aging in the same way that previous generations have experienced changes or whether they will reinvent the aging and retirement experience. The oldest Baby Boomers are now in their sixties. The oldest reached age 65 in 2011. By 2029 all Baby Boomers will be age 65 or older. Based on the sheer size of this group, the older population in 2030 will be twice the number it was in 2000. The implications of this for all areas of society, particularly health care, are unprecedented.

Geographic Distribution of the Elderly Population

Statistical evaluation of minority populations reveals that groups tend to concentrate in a limited number of states. Half of elderly blacks live in New York, Florida, California, Texas, Georgia, North Carolina, Illinois, and Virginia; 70% of the Hispanic elderly live in California, Texas, Florida, and New York; and 60% of elderly persons of Asian, Hawaiian, or Pacific Island descent favor California, Hawaii, and New York. The majority of elderly people of Native American or Native Alaskan descent live in California, Oklahoma, Arizona, New Mexico, Texas, and North Carolina.

Marital Status

In 2008 three-fourths (75%) of men over age 65 were married compared to 57% of older women. The percentage of married individuals drops significantly as age progresses, but the percentage of the oldest old men who are married remains high at 55%. At age 65, 42% of women were widows compared with only 14% of men. By age 85, 76% of women were widows compared to only 38% of men. The percentage of older adults who are separated or divorced has increased significantly to 11%. An increase in the number of divorced elders is predicted as a result of a higher incidence of divorce in the population approaching age 65.

The number of single, never-married seniors remains somewhat consistent at about 4% of the older-than-65 population.

Educational Status

The educational level of the older adult population in the United States has changed dramatically over the past three decades. In 1970, only 28% of senior citizens had graduated from high school. By 2008, 78% were high school graduates or more, and 21% had a bachelor’s degree or higher. Twenty-seven percent of older men hold bachelor’s degrees as contrasted with 16% of older women.

In addition to being better educated, today’s older adult population is more technologically sophisticated. A Pew research study conducted in 2004 revealed that 23% of Americans over age 65 use the Internet. In 2006 the same group reported that Internet use among Americans over age 65 had increased to 34%, and by 2008 had further increased to 43%. This will most likely continue to increase in the near future because, as of 2009, more than 77% of Baby Boomers have reported that they are Internet users.

Poverty

In 2007 approximately 10% of the elderly population was statistically determined to be at or below the poverty level. Older women were more likely to be impoverished than older men. Those over age 75 were slightly more likely to experience poverty. Elderly minorities, particularly blacks, were slightly more likely to live in poverty. Although they have declined over time, as of 2008, poverty rates are still highest in the South. Mississippi, Louisiana, Alabama, Arkansas, Tennessee, New Mexico, West Virginia, and the District of Columbia have poverty rates in excess of 17%. Of the remaining elderly, 26% were statistically determined to have a low-income status, 33% were in the middle-income range, and 31% had a high-income status.

Income