Older Adults - Leading Causes Of Death Among The Elderly

More than six out of every ten people age 65 and over who died in 2001 were the victims of diseases of the heart, cancer (malignant neoplasms), or stroke (cerebrovascular diseases). (See Table 10.2.)

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 die of CHD are age 65 years and older. In 2001, 582,730 people age 65 and older died of heart disease. (See Table 10.2.)

The risk of dying from heart disease increases as we age. The death rate from CHD in 2001 for those 75 to 84 years old (1,725.7 deaths per 100,000 population) was almost three times the rate for those 65 to 74 years old

TABLE 10.1
Projected population by age and sex, 2000–50
(In thousands except as indicated. As of July 1. Resident population.)

Population or percent, sex, and age	2000	2010	2020	2030	2040	2050
Population
Total
Total	282,125	308,936	335,805	363,584	391,946	419,854
0–4	19,218	21,426	22,932	24,272	26,299	28,080
5–19	61,331	61,810	65,955	70,832	75,326	81,067
20–44	104,075	104,444	108,632	114,747	121,659	130,897
45–64	62,440	81,012	83,653	82,280	88,611	93,104
65–84	30,794	34,120	47,363	61,850	64,640	65,844
85	4,267	6,123	7,269	9,603	15,409	20,861
Male
Total	138,411	151,815	165,093	178,563	192,405	206,477
0–4	9,831	10,947	11,716	12,399	13,437	14,348
5–19	31,454	31,622	33,704	36,199	38,496	41,435
20–44	52,294	52,732	54,966	58,000	61,450	66,152
45–64	30,381	39,502	40,966	40,622	43,961	46,214
65–84	13,212	15,069	21,337	28,003	29,488	30,579
85	1,240	1,942	2,403	3,340	5,573	7,749
Female
Total	143,713	157,121	170,711	185,022	199,540	213,377
0–4	9,387	10,479	11,216	11,873	12,863	13,732
5–19	29,877	30,187	32,251	34,633	36,831	39,632
20–44	51,781	51,711	53,666	56,747	60,209	64,745
45–64	32,059	41,510	42,687	41,658	44,650	46,891
65–84	17,582	19,051	26,026	33,848	35,152	35,265
85	3,028	4,182	4,866	6,263	9,836	13,112
Percent of total
Total
Total	100.0	100.0	100.0	100.0	100.0	100.0
0–4	6.8	6.9	6.8	6.7	6.7	6.7
5–19	21.7	20.0	19.6	19.5	19.2	19.3
20–44	36.9	33.8	32.3	31.6	31.0	31.2
45–64	22.1	26.2	24.9	22.6	22.6	22.2
65–84	10.9	11.0	14.1	17.0	16.5	15.7
85	1.5	2.0	2.2	2.6	3.9	5.0
Male
Total	100.0	100.0	100.0	100.0	100.0	100.0
0–4	7.1	7.2	7.1	6.9	7.0	6.9
5–19	22.7	20.8	20.4	20.3	20.0	20.1
20–44	37.8	34.7	33.3	32.5	31.9	32.0
45–64	21.9	26.0	24.8	22.7	22.8	22.4
65–84	9.5	9.9	12.9	15.7	15.3	14.8
85	0.9	1.3	1.5	1.9	2.9	3.8
Female
Total	100.0	100.0	100.0	100.0	100.0	100.0
0–4	6.5	6.7	6.6	6.4	6.4	6.4
5–19	20.8	19.2	18.9	18.7	18.5	18.6
20–44	36.0	32.9	31.4	30.7	30.2	30.3
45–64	22.3	26.4	25.0	22.5	22.4	22.0
65–84	12.2	12.1	15.2	18.3	17.6	16.5
85	2.1	2.7	2.9	3.4	4.9	6.1
SOURCE: "Table 2a. Projected Population of the United States, by Age and Sex: 2000–2050," in U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin, U.S. Census Bureau, Washington, DC, March 18, 2004 [Online] http://www.census.gov/ipc/www/usinterimproj/natprojtab02a.pdf [accessed May 2, 2004]

(635.1 per 100,000). For those 85 years and older, the death rate rose sharply to 5,664.2 deaths per 100,000 population. Women have a lower incidence of death from heart disease than do men until age 85. At that age the death rate from heart disease in women approaches that of men. (See Table 10.3.)

Since the 1950s deaths from heart disease have consistently declined. (See Table 10.3.) Several factors account for this decrease, including better control of hypertension (high blood pressure) and cholesterol levels in the blood. The Baltimore Longitudinal Study of Aging, "America's longest running scientific examination of human aging," found that even at the end of life, high cholesterol continues to be a risk factor in heart disease. Changes in lifestyle, such as 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 10.2
Leading causes of death and numbers of deaths, by age, 1980–2001
[Data are based on death certificates]

	1980		20011
Age and rank order	Cause of death	Deaths	Cause of death	Deaths
Under 1 year
…	All causes	45,526	All causes	27,568
1	Congenital anomalies	9,220	Congenital malformations, deformations and chromosomal abnormalities	5,513
2	Sudden infant death syndrome	5,510	Disorders related to short gestation and low birth weight, not elsewhere classified	4,410
3	Respiratory distress syndrome	4,989	Sudden infant death syndrome	2,234
4	Disorders relating to short gestation and Newborn affected by maternal complications unspecified low birthweight	3,648	Newborn affected by maternal complications of pregnancy	1,499
5	Newborn affected by complications of of pregnancy	1,572	placenta, cord and membranes	1,018
6	Intrauterine hypoxia and birth asphyxia	1,497	Respiratory distress of newborn	1,011
7	Unintentional injuries	1,166	Unintentional injuries	976
8	Birth trauma	1,058	Bacterial sepsis of newborn	696
9	Pneumonia and influenza	1,012	Diseases of circulatory system	622
10	Newborn affected by complications of placenta, cord, and membranes	985	Intrauterine hypoxia and birth asphyxia	534
1–4 years
…	All causes	8,187	All causes	5,107
1	Unintentional injuries	3,313	Unintentional injuries	1,714
2	Congenital anomalies	1,026	Congenital malformations, deformations and chromosomal abnormalities	557
3	Malignant neoplasms	573	Malignant neoplasms	420
4	Diseases of heart	338	Homicide	415
5	Homicide	319	Diseases of heart	225
6	Pneumonia and influenza	267	Influenza and pneumonia	112
7	Meningitis	223	Septicemia	108
8	Meningococcal infection	110	Certain conditions originating in the perinatal period	72
9	Certain conditions originating in the perinatal period	84	In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior	58
10	Septicemia	71	Cerebrovascular diseases	54
5–14 years
…	All causes	10,689	All causes	7,095
1	Unintentional injuries	5,224	Unintentional injuries	2,836
2	Malignant neoplasms	1,497	Malignant neoplasms	1,008
3	Congenital anomalies	561	Congenital malformations, deformations and chromosomal abnormalities	376
4	Homicide	415	Homicide	326
5	Diseases of heart	330	Suicide	279
6	Pneumonia and influenza	194	Diseases of heart	272
7	Suicide	142	In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior	105
8	Benign neoplasms	104	Chronic lower respiratory diseases	104
9	Cerebrovascular diseases	95	Influenza and pneumonia	92
10	Chronic obstructive pulmonary diseases	85	Cerebrovascular diseases	80
15–24 years
…	All causes	49,027	All causes	32,252
1	Unintentional injuries	26,206	Unintentional injuries	14,411
2	Homicide	6,537	Homicide	5,297
3	Suicide	5,239	Suicide	3,971
4	Malignant neoplasms	2,683	Malignant neoplasms	1,704
5	Diseases of heart	1,223	Diseases of heart	999
6	Congenital anomalies	600	Congenital malformations, deformations and chromosomal abnormalities	505
7	Cerebrovascular diseases	418	Human immunodeficiency virus (HIV) disease	225
8	Pneumonia and influenza	348	Cerebrovascular diseases	196
9	Chronic obstructive pulmonary diseases	141	Influenza and pneumonia	181
10	Anemias	133	Chronic lower respiratory diseases	171

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 percent of women who have heart attacks die within the first year after the incident, compared with only 25 percent 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.

TABLE 10.2
Leading causes of death and numbers of deaths, by age, 1980–2001
[Data are based on death certificates]

	1980		20011
Age and rank order	Cause of death	Deaths	Cause of death	Deaths
25–44 years
…	All causes	108,658	All causes	133,357
1	Unintentional injuries	26,722	Unintentional injuries	27,784
2	Malignant neoplasms	17,551	Malignant neoplasms	20,563
3	Diseases of heart	14,513	Diseases of heart	16,486
4	Homicide	10,983	Suicide	11,705
5	Suicide	9,855	Homicide	9,472
6	Chronic liver disease and cirrhosis	4,782	Human immunodeficiency virus (HIV) disease	7,968
7	Cerebrovascular diseases	3,154	Chronic liver disease and cirrhosis	3,723
8	Diabetes mellitus	1,472	Cerebrovascular diseases	3,092
9	Pneumonia and influenza	1,467	Diabetes mellitus	2,553
10	Congenital anomalies	817	Influenza and pneumonia	1,322
45–64 years
…	All causes	425,338	All causes	412,204
1	Diseases of heart	148,322	Malignant neoplasms	139,785
2	Malignant neoplasms	135,675	Diseases of heart	98,885
3	Cerebrovascular diseases	19,909	Unintentional injuries	21,002
4	Unintentional injuries	18,140	Cerebrovascular diseases	15,518
5	Chronic liver disease and cirrhosis	16,089	Diabetes mellitus	14,913
6	Chronic obstructive pulmonary diseases	11,514	Chronic lower respiratory diseases	14,490
7	Diabetes mellitus	7,977	Chronic liver disease and cirrhosis	13,009
8	Suicide	7,079	Suicide	9,259
9	Pneumonia and influenza	5,804	Human immunodeficiency virus (HIV) disease	5,437
10	Homicide	4,019	Nephritis, nephrotic syndrome and nephrosis	5,106
65 years and over
…	All causes	1,341,848	All causes	1,798,420
1	Diseases of heart	595,406	Diseases of heart	582,730
2	Malignant neoplasms	258,389	Malignant neoplasms	390,214
3	Cerebrovascular diseases	146,417	Cerebrovascular diseases	144,486
4	Pneumonia and influenza	45,512	Chronic lower respiratory diseases	106,904
5	Chronic obstructive pulmonary diseases	43,587	Influenza and pneumonia	55,518
6	Atherosclerosis	28,081	Diabetes mellitus	53,707
7	Diabetes mellitus	25,216	Alzheimer's disease	53,245
8	Unintentional injuries	24,844	Nephritis, nephrotic syndrome and nephrosis	33,121
9	Nephritis, nephrotic syndrome, and nephrosis	12,968	Unintentional injuries	32,694
10	Chronic liver disease and cirrhosis	9,519	Septicemia	25,418
… Category not applicable.
1Figures for homicide and suicide include September 11, 2001 related deaths for which death certificates were filed as of October 24, 2002.
SOURCE: "Table 32. Leading Causes of Death and Numbers of Deaths, according to Age: United States, 1980 and 2001," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Hyattsville, MD, 2003

Cancer

Cancer (malignant neoplasms) is the second leading cause of death among older adults. In 2001, 390,214 people 65 and older died of cancer. (See Table 10.2.) The risk of developing many cancers increases with age and varies by race and ethnicity. (See Table 10.4 and Table 10.5.)

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 and Figures 2004, Atlanta, GA, 2004) reports that each year more than 70 percent of men newly diagnosed with prostate cancer are older than 65. The probability of developing prostate cancer is less than 1 in 12,000 men who are younger than 40; 1 in 44 for 40- to 59-year-olds; and 1 in 7 for men ages 60 to 79. (See Table 10.4.)

Stroke

Stroke (cerebrovascular diseases) 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 2001, 144,486 people age 65 and older died of a stroke. (See Table 10.2.) In 2001 the death rate from stroke for those ages 65 to 74 was 123.4 deaths per 100,000. This rate more than triples for each successive decade of age after that, to 443.9 deaths from stroke per 100,000 for ages 75 to 84, and 1,500.2 deaths per 100,000 population for those 85 and older. (See Table 10.6.)

Stroke is also responsible for late-life dementia, which, together with Alzheimer's disease, accounts for 90 percent of all dementia (the other 10 percent are reversible dementias caused by conditions such as head injury, alcoholism, and pernicious anemia). Death rates from stroke have declined since the 1960s. (See Table 10.6.)

TABLE 10.3
Death rates for diseases of the heart, by sex, race, Hispanic origin, and age, 1950–2001
[Data are based on death certificates]

Sex, race, Hispanic origin, and age	19501	19601	1970	1980	1990	1995	2000	2001
All persons	Deaths per 100,000 resident population
All ages, age adjusted2	586.8	559.0	492.7	412.1	321.8	293.4	257.6	247.8
All ages, crude	355.5	369.0	362.0	336.0	289.5	277.0	252.6	245.8
Under 1 year	3.5	6.6	13.1	22.8	20.1	17.4	13.0	11.9
1–4 years	1.3	1.3	1.7	2.6	1.9	1.6	1.2	1.5
5–14 years	2.1	1.3	0.8	0.9	0.9	0.8	0.7	0.7
15–24 years	6.8	4.0	3.0	2.9	2.5	2.8	2.6	2.5
25–34 years	19.4	15.6	11.4	8.3	7.6	8.2	7.4	8.0
35–44 years	86.4	74.6	66.7	44.6	31.4	31.8	29.2	29.6
45–54 years	308.6	271.8	238.4	180.2	120.5	109.6	94.2	92.9
55–64 years	808.1	737.9	652.3	494.1	367.3	320.1	261.2	246.9
65–74 years	1,839.8	1,740.5	1,558.2	1,218.6	894.3	795.4	665.6	635.1
75–84 years	4,310.1	4,089.4	3,683.8	2,993.1	2,295.7	2,050.5	1,780.3	1,725.7
85 years and over	9,150.6	9,317.8	7,891.3	7,777.1	6,739.9	6,391.5	5,926.1	5,664.2
Male
All ages, age adjusted2	697.0	687.6	634.0	538.9	412.4	371.0	320.0	305.4
All ages, crude	423.4	439.5	422.5	368.6	297.6	278.5	249.8	242.5
Under 1 year	4.0	7.8	15.1	25.5	21.9	17.7	13.3	11.8
1–4 years	1.4	1.4	1.9	2.8	1.9	1.7	1.4	1.5
5–14 years	2.0	1.4	0.9	1.0	0.9	0.8	0.8	0.7
15–24 years	6.8	4.2	3.7	3.7	3.1	3.5	3.2	3.2
25–34 years	22.9	20.1	15.2	11.4	10.3	11.0	9.6	10.3
35–44 years	118.4	112.7	103.2	68.7	48.1	46.9	41.4	41.7
45–54 years	440.5	420.4	376.4	282.6	183.0	166.1	140.2	136.6
55–64 years	1,104.5	1,066.9	987.2	746.8	537.3	460.1	371.7	349.8
65–74 years	2,292.3	2,291.3	2,170.3	1,728.0	1,250.0	1,095.3	898.3	851.3
75–84 years	4,825.0	4,742.4	4,534.8	3,834.3	2,968.2	2,622.9	2,248.1	2,177.3
85 years and over	9,659.8	9,788.9	8,426.2	8,752.7	7,418.4	6,993.5	6,430.0	6,040.5
Female
All ages, age adjusted2	484.7	447.0	381.6	320.8	257.0	236.6	210.9	203.9
All ages, crude	288.4	300.6	304.5	305.1	281.8	275.5	255.3	249.0
Under 1 year	2.9	5.4	10.9	20.0	18.3	17.0	12.5	12.0
1–4 years	1.2	1.1	1.6	2.5	1.9	1.5	1.0	1.4
5–14 years	2.2	1.2	0.8	0.9	0.8	0.7	0.5	0.7
15–24 years	6.7	3.7	2.3	2.1	1.8	2.1	2.1	1.8
25–34 years	16.2	11.3	7.7	5.3	5.0	5.4	5.2	5.6
35–44 years	55.1	38.2	32.2	21.4	15.1	17.0	17.2	17.6
45–54 years	177.2	127.5	109.9	84.5	61.0	55.4	49.8	50.7
55–64 years	510.0	429.4	351.6	272.1	215.7	192.6	159.3	151.8
65–74 years	1,419.3	1,261.3	1,082.7	828.6	616.8	554.9	474.0	455.9
75–84 years	3,872.0	3,582.7	3,120.8	2,497.0	1,893.8	1,692.7	1,475.1	1,428.9
85 years and over	8,796.1	9,016.8	7,591.8	7,350.5	6,478.1	6,159.6	5,720.9	5,506.8
White male3
All ages, age adjusted2	700.2	694.5	640.2	539.6	409.2	367.0	316.7	301.8
All ages, crude	433.0	454.6	438.3	384.0	312.7	294.4	265.8	257.8
45–54 years	423.6	413.2	365.7	269.8	170.6	153.9	130.7	127.0
55–64 years	1,081.7	1,056.0	979.3	730.6	516.7	439.2	351.8	330.8
65–74 years	2,308.3	2,297.9	2,177.2	1,729.7	1,230.5	1,071.8	877.8	829.1
75–84 years	4,907.3	4,839.9	4,617.6	3,883.2	2,983.4	2,625.6	2,247.0	2,175.8
85 years and over	9,950.5	10,135.8	8,818.0	8,958.0	7,558.7	7,125.1	6,560.8	6,157.2
Black or African American male3
All ages, age adjusted2	639.4	615.2	607.3	561.4	485.4	451.3	392.5	384.5
All ages, crude	346.2	330.6	330.3	301.0	256.8	239.1	211.1	209.0
45–54 years	622.5	514.0	512.8	433.4	328.9	308.6	247.2	242.6
55–64 years	1,433.1	1,236.8	1,135.4	987.2	824.0	740.5	631.2	602.2
65–74 years	2,139.1	2,281.4	2,237.8	1,847.2	1,632.9	1,514.1	1,268.8	1,245.8
75–84 years4	4,106.1	3,533.6	3,783.4	3,578.8	3,107.1	2,908.7	2,597.6	2,569.3
85 years and over	- - -	6,037.9	5,367.6	6,819.5	6,479.6	6,088.5	5,633.5	5,459.9

Stroke, however, leaves approximately one-third of the survivors with severe disabilities, and they require continued care. Though many admissions involve multiple diagnoses, it is estimated that approximately 180,000 older adults are admitted annually to nursing homes as a result of stroke.