Older Adults - Leading Causes Of Death Among The Elderly

More than six out of every ten people age sixty-five and over who died in 2002 were the victims of diseases of the heart, cancer (malignant neoplasms), or stroke (cerebrovascular diseases). (See Table 10.3.)

Coronary Heart Disease

Coronary heart disease (CHD) is the leading cause of death in the United States and remains the leading cause of death among older Americans. Approximately four out of five people who died of CHD in 2002 were age sixty-five years or older. In 2002, 576,301 people age sixty-five and older died of heart disease. (See Table 10.3.)

The risk of dying from heart disease increases as we age. The death rate from CHD in 2002 for those age seventy-five to eighty-four (1,677.2 deaths per one hundred thousand population) was almost three times the rate for those age sixty-five to seventy-four (615.9 per one hundred thousand). For those age eighty-five and older, the death rate rose sharply to 5,446.8 deaths per one hundred thousand population—nearly nine times the rate for those age sixty-five to

TABLE 10.1 Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex, selected years 1900–2002

TABLE 10.1
Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex, selected years 1900–2002
[Data are based on death certificates]
Specified age and year	All races			White			Black or African Americana
	Both sexes	Male	Female	Both sexes	Male	Female	Both sexes	Male	Female
At birth	Remaining life expectancy in years
1900b,c	47.3	46.3	48.3	47.6	46.6	48.7	33.0	32.5	33.5
1950c	68.2	65.6	71.1	69.1	66.5	72.2	60.8	59.1	62.9
1960c	69.7	66.6	73.1	70.6	67.4	74.1	63.6	61.1	66.3
1970	70.8	67.1	74.7	71.7	68.0	75.6	64.1	60.0	68.3
1980	73.7	70.0	77.4	74.4	70.7	78.1	68.1	63.8	72.5
1985	74.7	71.1	78.2	75.3	71.8	78.7	69.3	65.0	73.4
1990	75.4	71.8	78.8	76.1	72.7	79.4	69.1	64.5	73.6
1991	75.5	72.0	78.9	76.3	72.9	79.6	69.3	64.6	73.8
1992	75.8	72.3	79.1	76.5	73.2	79.8	69.6	65.0	73.9
1993	75.5	72.2	78.8	76.3	73.1	79.5	69.2	64.6	73.7
1994	75.7	72.4	79.0	76.5	73.3	79.6	69.5	64.9	73.9
1995	75.8	72.5	78.9	76.5	73.4	79.6	69.6	65.2	73.9
1996	76.1	73.1	79.1	76.8	73.9	79.7	70.2	66.1	74.2
1997	76.5	73.6	79.4	77.1	74.3	79.9	71.1	67.2	74.7
1998	76.7	73.8	79.5	77.3	74.5	80.0	71.3	67.6	74.8
1999	76.7	73.9	79.4	77.3	74.6	79.9	71.4	67.8	74.7
2000d	77.0	74.3	79.7	77.6	74.9	80.1	71.9	68.3	75.2
2001	77.2	74.4	79.8	77.7	75.0	80.2	72.2	68.6	75.5
2002	77.3	74.5	79.9	77.7	75.1	80.3	72.3	68.8	75.6
At 65 year
1950c	13.9	12.8	15.0—		12.8	15.1	13.9	12.9	14.9
1960c	14.3	12.8	15.8	14.4	12.9	15.9	13.9	12.7	15.1
1970	15.2	13.1	17.0	15.2	13.1	17.1	14.2	12.5	15.7
1980	16.4	14.1	18.3	16.5	14.2	18.4	15.1	13.0	16.8
1985	16.7	14.5	18.5	16.8	14.5	18.7	15.2	13.0	16.9
1990	17.2	15.1	18.9	17.3	15.2	19.1	15.4	13.2	17.2
1991	17.4	15.3	19.1	17.5	15.4	19.2	15.5	13.4	17.2
1992	17.5	15.4	19.2	17.6	15.5	19.3	15.7	13.5	17.4
1993	17.3	15.3	18.9	17.4	15.4	19.0	15.5	13.4	17.1
1994	17.4	15.5	19.0	17.5	15.6	19.1	15.7	13.6	17.2
1995	17.4	15.6	18.9	17.6	15.7	19.1	15.6	13.6	17.1
1996	17.5	15.7	19.0	17.6	15.8	19.1	15.8	13.9	17.2
1997	17.7	15.9	19.2	17.8	16.0	19.3	16.1	14.2	17.6
1998	17.8	16.0	19.2	17.8	16.1	19.3	16.1	14.3	17.4
1999	17.7	16.1	19.1	17.8	16.1	19.2	16.0	14.3	17.3
2000d	18.0	16.2	19.3	18.0	16.3	19.4	16.2	14.2	17.7
2001	18.1	16.4	19.4	18.2	16.5	19.5	16.4	14.4	17.9
2002	18.2	16.6	19.5	18.2	16.6	19.5	16.6	14.6	18.0
At 75 years
1980	10.4	8.8	11.5	10.4	8.8	11.5	9.7	8.3	10.7
1985	10.6	9.0	11.7	10.6	9.0	11.7	10.1	8.7	11.1
1990	10.9	9.4	12.0	11.0	9.4	12.0	10.2	8.6	11.2
1991	11.1	9.5	12.1	11.1	9.5	12.1	10.2	8.7	11.2
1992	11.2	9.6	12.2	11.2	9.6	12.2	10.4	8.9	11.4
1993	10.9	9.5	11.9	11.0	9.5	12.0	10.2	8.7	11.1
1994	11.0	9.6	12.0	11.1	9.6	12.0	10.3	8.9	11.2

seventy-four. In 2002 women had a lower incidence of death from heart disease than did men at all ages. However, at age eighty-five and over, the death rate for women from heart disease approaches that of men. (See Table 10.4)

Since the 1950s, deaths from heart disease have consistently declined. (See Table 10.4.) Several factors account for this decrease, including better control of hypertension (high blood pressure) and cholesterol levels in the blood, although the relationship between high cholesterol and heart disease lessens with age and in older age reverses its relation to mortality (B. A. Golomb, "Implications of Statin Adverse Effects in the Elderly," Expert Opinion on Drug Safety, vol 4, no. 3, May 2005). Changes in lifestyle, such as the inclusion of physical exercise and a healthy diet, help decrease the incidence of heart disease. The expanding use of trained mobile emergency personnel (paramedics) in most urban areas has also contributed to the decrease, and widespread use of cardiopulmonary resuscitation (CPR) and new drugs have increased the likelihood of surviving an initial heart attack.

TABLE 10.1 Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex, selected years 1900–2002 [CONTINUED] "Table 27. Life Expectancy at Birth, at 65 Years of Age, and at 75 Years of Age, according to Race and Sex: United States, Selected Years 1900–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed February 27, 2006)

TABLE 10.1
Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex, selected years 1900–2002 [CONTINUED]
[Data are based on death certificates]
Specified age and year	All races			White			Black or African Americana
	Both sexes	Male	Female	Both sexes	Male	Female	Both sexes	Male	Female
aData shown for 1900–60 are for the nonwhite population.
bDeath registration area only. The death registration area increased from 10 states and the District of Columbia in 1900 to the coterminous United States in 1933.
cIncludes deaths of persons who were not residents of the 50 states and the District of Columbia.
dLife expectancies (LEs) for 2000 were revised and may differ from those shown previously. LEs for 2000 were computed using population counts from census 2000 and replace LEs for 2000 using 1990-based postcensal estimates.
Notes: "—" = Data not available. Populations for computing life expectancy for 1991–99 are 1990-based postcensal estimates of U.S. resident population. In 1997 life table methodology was revised to construct complete life tables by single years of age that extend to age 100. Previously abridged life tables were constructed for 5-year age groups ending with 85 years and over. Life table values for 2000 and later years were computed using a slight modification of the new life table method due to a change in the age detail of populations received from the U.S. Census Bureau.
SOURCE: "Table 27. Life Expectancy at Birth, at 65 Years of Age, and at 75 Years of Age, according to Race and Sex: United States, Selected Years 1900–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed February 27, 2006)
1995	11.0	9.7	11.9	11.1	9.7	12.0	10.2	8.8	11.1
1996	11.1	9.8	12.0	11.1	9.8	12.0	10.3	9.0	11.2
1997	11.2	9.9	12.1	11.2	9.9	12.1	10.7	9.3	11.5
1998	11.3	10.0	12.2	11.3	10.0	12.2	10.5	9.2	11.3
1999	11.2	10.0	12.1	11.2	10.0	12.1	10.4	9.2	11.1
2000d	11.4	10.1	12.3	11.4	10.1	12.3	10.7	9.2	11.6
2001	11.5	10.2	12.4	11.5	10.2	12.3	10.8	9.3	11.7
2002	11.5	10.3	12.4	11.5	10.3	12.3	10.9	9.5	11.7

Until the 1990s almost all research on heart disease focused on white, middle-aged males. Researchers, physicians, and public health officials agree that more research as well as prevention efforts should be directed toward women, racial and ethnic minorities, and older adults. According to the American Heart Association (AHA), 38% of women who have heart attacks die within the first year after the incident, compared with only 25% of men. The AHA also notes that in recent years physicians and researchers have discovered that the symptoms of heart attack can be significantly different for women than for men, suggesting the need for further research and public education efforts.

Cancer

Cancer (malignant neoplasms) is the second-leading cause of death among older adults. In 2002, 391,001 people sixty-five and older died of cancer. (See Table 10.3.) The risk of developing many cancers increases with age and varies by race and ethnicity. (See Table 10.5 and Table 10.6.)

For example, the older a man gets, the more likely he is to develop prostate cancer. The chance of a fatality from prostate cancer also rises with age. The American Cancer Society (Cancer Facts & Figures 2006, Atlanta, GA, 2006) reports that each year more than 65% of men newly diagnosed with prostate cancer are older than sixty-five. The probability of developing prostate cancer is one in 10,149 for men who are younger than forty; one in thirty-eight for forty- to fifty-nine-year-olds; and one in fourteen for men ages sixty to sixty-nine. (See Table 10.5.)

Stroke

Stroke (cerebrovascular disease) is the third-leading cause of death and the principal cause of serious disability among older adults, and its incidence increases markedly with age. In 2002, 143,293 people age sixty-five and older died of a stroke. (See Table 10.3.) In 2002 the death rate from stroke for those age sixty-five to seventy-four was 120.3 deaths per one hundred thousand. This rate more than triples for each successive decade of age after that, to 431 deaths from stroke per one hundred thousand for ages seventy-five to eighty-four, and 1,445.9 deaths per one hundred thousand population for those eighty-five and older. (See Table 10.7.)

Stroke is also responsible for late-life dementia, which, together with Alzheimer's disease, accounts for 90% of all dementia (the other 10% are reversible dementias caused by conditions such as head injury, alcoholism, and pernicious anemia). Death rates from stroke have declined since the 1950s. (See Table 10.7.) Stroke, however, leaves approximately one-third of the survivors with severe disabilities, and they require continued care.