Older Adults - What Is Geriatrics?

Geriatrics is the medical subspecialty concerned with the prevention and treatment of diseases in the elderly. In

TABLE 10.6
Death rates for cerebrovascular diseases, by sex, race, Hispanic origin, and age, selected years 1950–2001
[Data are based on death certificates]

Sex, race, Hispanic origin, and age	1950	1960	1970	1980	1990	1995	2000	2001
American Indian or Alaska Native male3	Deaths per 100,000 resident population
All ages, age adjusted2	- - -	- - -	- - -	66.4	44.3	51.7	46.1	37.5
All ages, crude	- - -	- - -	- - -	23.1	16.0	18.4	16.8	14.2
45–54 years	- - -	- - -	- - -	*	*	25.5	13.3	12.6
55–64 years	- - -	- - -	- - -	72.0	39.8	42.6	48.6	24.1
65–74 years	- - -	- - -	- - -	170.5	120.3	156.4	144.7	131.5
75–84 years	- - -	- - -	- - -	523.9	325.9	351.2	373.3	247.8
85 years and over	- - -	- - -	- - -	1,384.7	949.8	1,072.4	834.9	833.0
Asian or Pacific Islander male3
All ages, age adjusted2	- - -	- - -	- - -	71.4	59.1	64.0	58.0	55.3
All ages, crude	- - -	- - -	- - -	28.7	23.3	27.5	27.2	27.5
45–54 years	- - -	- - -	- - -	17.0	15.6	16.5	15.0	15.9
55–64 years	- - -	- - -	- - -	59.9	51.8	59.6	49.3	46.2
65–74 years	- - -	- - -	- - -	197.9	167.9	155.6	135.6	134.7
75–84 years	- - -	- - -	- - -	619.5	483.9	521.9	438.7	409.8
85 years and over	- - -	- - -	- - -	1,399.0	1,196.6	1,382.1	1,415.6	1,327.7
Hispanic or Latino male3,5
All ages, age adjusted2	- - -	- - -	- - -	- - -	46.5	51.2	50.5	48.9
All ages, crude	- - -	- - -	- - -	- - -	15.6	16.2	15.8	15.7
45–54 years	- - -	- - -	- - -	- - -	20.0	20.3	18.1	18.7
55–64 years	- - -	- - -	- - -	- - -	49.2	46.9	48.8	43.5
65–74 years	- - -	- - -	- - -	- - -	126.4	138.1	136.1	127.2
75–84 years	- - -	- - -	- - -	- - -	356.6	373.3	392.9	386.3
85 years and over	- - -	- - -	- - -	- - -	866.3	1,079.5	1,029.9	1,005.6
White, not Hispanic or Latino male5
All ages, age adjusted2	- - -	- - -	- - -	- - -	66.3	62.8	59.9	56.5
All ages, crude	- - -	- - -	- - -	- - -	50.6	51.9	53.9	52.0
45–54 years	- - -	- - -	- - -	- - -	14.9	13.9	13.0	11.9
55–64 years	- - -	- - -	- - -	- - -	45.1	43.3	38.7	35.1
65–74 years	- - -	- - -	- - -	- - -	154.5	141.4	133.1	128.0
75–84 years	- - -	- - -	- - -	- - -	547.3	506.2	482.3	460.5
85 years and over	- - -	- - -	- - -	- - -	1,578.7	1,544.8	1,505.9	1,399.0
White female3
All ages, age adjusted2	169.7	165.0	135.5	89.0	60.3	58.6	57.3	54.5
All ages, crude	103.3	110.1	109.8	88.6	71.6	75.1	76.9	74.0
45–54 years	55.0	33.8	30.5	18.6	13.5	12.6	11.2	10.2
55–64 years	156.9	103.0	78.1	48.6	35.8	33.3	30.2	27.6
65–74 years	498.1	383.3	303.2	172.5	116.1	111.7	107.3	99.9
75–84 years	1,471.3	1,444.7	1,176.8	728.8	456.5	443.4	434.2	421.6
85 years and over	3,017.9	3,795.7	3,167.6	2,362.7	1,685.9	1,656.7	1,646.7	1,563.5
Black or African American female3
All ages, age adjusted2	238.4	232.5	189.3	119.6	84.0	79.4	76.2	73.7
All ages, crude	128.3	127.7	112.2	77.8	60.7	59.1	58.3	56.9
45–54 years	248.9	166.2	119.4	61.8	44.1	36.0	38.1	37.3
55–64 years	567.7	452.0	272.4	138.4	96.9	85.6	76.4	74.4
65–74 years	754.4	830.5	673.5	361.7	236.7	222.3	190.9	189.5
75–84 years4	1,496.7	1,413.1	1,338.3	917.5	595.0	565.1	549.2	530.3
85 years and over	- - -	2,578.9	2,210.5	1,891.6	1,495.2	1,518.4	1,556.5	1,491.2

1909 Dr. Ignatz L. Nascher coined the term geriatrics from the Greek "geras" (old age) and "iatrikos" (physician). Geriatricians are physicians trained in internal medicine or family practice who obtain additional training and certification in the diagnosis and treatment of older adults. Geriatricians rely on the findings of researchers and gerontologists (nonphysician professionals who conduct scientific studies of aging and older adults) to help older adults "maintain the highest possible degree of function and independence and avoid unnecessary and costly institutionalization."

Gerontology was unheard of before the nineteenth century, when most people died at an early age. Those who reached old age accepted their deteriorating health as a part of aging. In the early twentieth century gerontology was born when scientists began to investigate the pathological changes that accompany the aging process.

While many developed countries have recognized the need for more geriatrics education, the United States continues to lag in offering geriatrics courses in its medical schools. The latest review of the curricula of

TABLE 10.6
Death rates for cerebrovascular diseases, by sex, race, Hispanic origin, and age, selected years 1950–2001
[Data are based on death certificates]

Sex, race, Hispanic origin, and age	1950	1960	1970	1980	1990	1995	2000	2001
American Indian or Alaska Native female3	Deaths per 100,000 resident population
All ages, age adjusted2	- - -	- - -	- - -	51.2	38.4	46.3	43.7	44.0
All ages, crude	- - -	- - -	- - -	22.0	19.3	22.0	21.5	23.3
45–54 years	- - -	- - -	- - -	*	*	*	14.4	15.1
55–64 years	- - -	- - -	- - -	*	40.7	41.5	37.9	30.4
65–74 years	- - -	- - -	- - -	128.3	100.5	114.8	79.5	133.3
75–84 years	- - -	- - -	- - -	404.2	282.0	364.4	391.1	359.9
85 years and over	- - -	- - -	- - -	1,095.5	776.2	983.9	931.5	830.5
Asian or Pacific Islander female3
All ages, age adjusted2	- - -	- - -	- - -	60.8	54.9	48.3	49.1	48.2
All ages, crude	- - -	- - -	- - -	26.4	24.3	24.2	28.7	29.8
45–54 years	- - -	- - -	- - -	20.3	19.7	15.6	13.3	11.3
55–64 years	- - -	- - -	- - -	43.7	42.1	37.6	33.3	35.2
65–74 years	- - -	- - -	- - -	136.1	124.0	101.0	102.8	113.2
75–84 years	- - -	- - -	- - -	446.6	396.6	381.8	386.0	359.6
85 years and over	- - -	- - -	- - -	1,545.2	1,395.0	1,197.0	1,246.6	1,236.8
Hispanic or Latino female3, 5
All ages, age adjusted2	- - -	- - -	- - -	- - -	43.7	42.7	43.0	41.6
All ages, crude	- - -	- - -	- - -	- - -	20.1	19.4	19.4	19.1
45–54 years	- - -	- - -	- - -	- - -	15.2	15.1	12.4	13.1
55–64 years	- - -	- - -	- - -	- - -	38.5	36.5	31.9	28.2
65–74 years	- - -	- - -	- - -	- - -	102.6	102.3	95.2	89.6
75–84 years	- - -	- - -	- - -	- - -	308.5	307.3	311.3	310.7
85 years and over	- - -	- - -	- - -	- - -	1,055.3	1,021.0	1,108.9	1,061.2
White, not Hispanic or Latino female5
All ages, age adjusted2	- - -	- - -	- - -	- - -	61.0	58.7	57.6	54.8
All ages, crude	- - -	- - -	- - -	- - -	77.2	81.5	85.5	82.6
45–54 years	- - -	- - -	- - -	- - -	13.2	12.3	10.9	9.8
55–64 years	- - -	- - -	- - -	- - -	35.7	32.6	29.9	27.4
65–74 years	- - -	- - -	- - -	- - -	116.9	111.4	107.6	100.3
75–84 years	- - -	- - -	- - -	- - -	461.9	445.9	438.3	425.6
85 years and over	- - -	- - -	- - -	- - -	1,714.7	1,666.8	1,661.6	1,577.4
- - - Data not available.
*Based on fewer than 20 deaths.
1Includes deaths of persons who were not residents of the 50 states and the District of Columbia.
2Age-adjusted rates are calculated using the year 2000 standard population.
3The race groups, white, black, Asian or Pacific Islander, and American Indian or Alaska Native, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Death rates for the American Indian or Alaska Native and Asian or Pacific Islander populations are known to be underestimated.
4In 1950 rate is for the age group 75 years and over.
5Prior to 1997, excludes data from states lacking an Hispanic-origin item on the death certificate.
SOURCE: "Table 37. Death Rates for Cerebrovascular Diseases, according to Sex, Race, Hispanic Origin, and Age: United States, Selected Years 1950–2001," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, HyattsvilleMD, 2003

the 126 medical schools in the nation (as cited in the 1996 AAR report Will You Still Treat Me When I'm 65?) showed only 14 schools with required coursework in geriatrics.

Decline in Numbers of Geriatricians in the United States

The Alliance for Aging Research has reported that a tremendous shortage of physicians specializing in geriatrics exists, including those in the field of psychiatry known as geropsychiatrists. The Institute for Health Policy and Health Services Research (IHPHSR) at the University of Cincinnati and the Association of Directors of Geriatric Academic Programs (ADGAP) estimated that there were only 6,776 active certified geriatricians practicing in the United States in 2004.

In its May 2003 Training and Practice Update, the ADGAP notes that Medicare, the primary payer for most clinical services provided by geriatricians, reduced the average reimbursement to physicians by 5.4 percent in 2002. The ADGAP suggested that "the growing gap between Medicare reimbursement and the actual costs of delivering medical care may affect the willingness of physicians to continue focusing their careers in geriatric medicine and geriatric psychiatry." In 2004 the American Geriatrics Society was continuing to work with Congress to pass the Geriatric Care Act, which would help improve payment for geriatricians.

FIGURE 10.1
Prevalence of severe, moderate, and mild Alzheimer's disease, in each of 3 age groups, 2003

Specialized Care

Physicians who specialize in geriatrics are trained to recognize characteristics that differentiate older patients from other age groups. Geriatricians also realize that aging is not a disease, and that declining health does not necessarily accompany aging. Furthermore, in geriatrics, diseases may manifest symptoms different from those found in a younger person. Frequently, older patients have several co-existing chronic disorders, some of which may be caused by psychological and/or socioeconomic problems.

What is more important is that geriatricians and other caregivers realize that aging does not change the basic personality. The Baltimore Longitudinal Study of Aging has found that psychological stereotypes—that some people become crankier with age while others mellow with age—have been disproved by scientific studies. (Longitudinal investigations involve studying changes in the same individuals over time, as they grow older.) This finding is significant for health professionals because a personality change may signal a change in a patient's health. For example, experts have found that personality change may be an early indication of dementia.

TABLE 10.7
Current and projected number of persons with Alzheimer's disease (in millions) older than 65 years by 3 age subgroups, 2000

	Age group, years
Year and series	65–74	75–84	≥85	Total
2000	0.3	2.4	1.8	4.5
2010
Low	0.3	2.4	2.4	5.1
Middle	0.3	2.4	2.4	5.1
High	0.3	2.5	2.5	5.3
2020
Low	0.3	2.5	2.7	5.5
Middle	0.3	2.6	2.8	5.7
High	0.4	2.7	3.1	6.2
2030
Low	0.4	3.6	3.2	7.2
Middle	0.5	3.8	3.5	7.7*
High	0.5	4.1	4.0	8.6
2040
Low	0.4	4.6	5.0	10.0
Middle	0.4	5.0	5.6	11.0
High	0.5	5.6	6.7	12.8
2050
Low	0.4	4.2	6.7	11.3
Middle	0.4	4.8	8.0	13.2
High	0.5	5.6	9.9	16.0
*Value does not total precisely because of rounding.
SOURCE: Liesi E. Hebert, et al., "Current and Projected Number of Persons with Alzheimer Disease (in Millions) Older Than 65 Years in the US Population by 3 Age Subgroups," in "Alzheimer Disease in the U.S. Population: Prevalence Estimates Using the 2000 Census," Archives of Neurology, vol. 60, no. 8, August 2003

Finally, it is vital for geriatricians and others involved in providing health and social services to older adults to appreciate that their values and beliefs may be quite different from those of their patients. Many older adults grew up in an era that was quite different—they may have seen the advent of air travel, automobiles, telephones, television, Medicare, and Social Security. The United States was previously largely rural and opportunities for college education were more limited, especially for women. In the early to mid-twentieth century young people were stricken by polio (a viral infection that can cause paralysis and death), antibiotics had not yet been discovered, and hospitals were seen as places where people went to die. By understanding cultural and societal influences affecting older adults, health professionals will be better able to reduce the functional impact of illness in old age and treat all patients, including those at the end of life, with respect and compassion.

TABLE 10.8
Life expectancy at birth, at 65 years of age, and at 75 years of age, by race and sex, selected years 1900–2001
[Data are based on death certificates]

	All races			White			Black or African American1
Specified age and year	Both sexes	Male	Female	Both sexes	Male	Female	Both sexes	Male	Female
At birth	Remaining life expectancy in years
19002,3	47.3	46.3	48.3	47.6	46.6	48.7	33.0	32.5	33.5
19503	68.2	65.6	71.1	69.1	66.5	72.2	60.8	59.1	62.9
19603	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
20004	77.0	74.3	79.7	77.6	74.9	80.1	71.9	68.3	75.2
20015	77.2	74.4	79.8	77.7	75.0	80.2	72.2	68.6	75.5
At 65 years
19503	13.9	12.8	15.0	- - -	12.8	15.1	13.9	12.9	14.9
19603	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
20004	18.0	16.2	19.3	18.0	16.3	19.4	16.2	14.2	17.7
20015	18.1	16.4	19.4	18.2	16.5	19.5	16.4	14.4	17.9
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
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
20004	11.4	10.1	12.3	11.4	10.1	12.3	10.7	9.2	11.6
20015	11.5	10.2	12.4	11.5	10.2	12.3	10.8	9.3	11.7
1Data shown for 1900–60 are for the nonwhite population.
2Death registration area only. The death registration area increased from 10 states and the District of Columbia in 1900 to the coterminous United States in1933.
3Includes deaths of persons who were not residents of the 50 states and the District of Columbia.
4Life 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.
5Life expectancies for 2001 were computed using 2000-based postcensal estimates.
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 1900–2001," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Hyattsville, MD, 2003

TABLE 10.9
Sex ratio for population 25 years and over by age, 2000 and 2030
(Men per 100 women)

	2000						2030
Country	25 to 54 years	55 to 64 years	65 to 69 years	70 to 74 years	75 to 79 years	80 years and over	25 to 54 years	55 to 64 years	65 to 69 years	70 to 74 years	75 to 79 years	80 years and over
United States	98	91	85	79	72	52	98	92	89	86	81	64
SOURCE: Adapted from Kevin Kinsella and Victoria A. Velkoff, "Table 6. Sex Ratio for Population 25 Years and Over by Age: 2000 and 2030," in An Aging World: 2001, series P95/01–1, U.S. Census Bureau, U.S. Government Printing Office, Washington, DC, 2001