A common myth about aging is that older adults are sick and feel bad most of the time. In fact, the opposite is usually the case. Most seniors say they feel very positive about their health.
Consider data from the 2017 National Health Interview Survey (the most recent available) conducted by Centers for Disease Control and Prevention. Eighty-two percent of adults aged 65-74 rated their health status as excellent (18 percent), very good (32 percent) or good (32 percent) – positive. In contrast, 18 percent of this age group had a negative outlook and described their health as fair (1
This trend toward positivity is also evident in adults aged 75+: 73 percent. This group said their health status was excellent (12 percent), very good (28 percent) or good (33 percent), while only 27 percent a fair (20 percent) or bad (7 percent) rating.
How could this be? Is it true that the majority of older adults – about 60 percent – suffer from two or more chronic diseases such as diabetes, arthritis, high blood pressure, heart or kidney disease, and that physical impairment is more common than other age groups?
The answer lies in how older adults think about their health. For many, good health means more than the absence of illness or disability. The health components that they tend to value more are vitality, emotional well-being, positive social relationships, activity and life satisfaction, while physical dysfunction plays a less important role What I like: going to the theater, organizing programs, enjoying the arts "Go for a walk," said Lorelei Goldman, 80, of Evanston, Illinois, who had ovarian and breast cancer. She also describes her health as "good."
"I have all my skills and good, long-term friendships," said Goldman. "I used to be a bad sleeper, but now I'm sleeping much better, there are moments of clarity and joy almost every day, and I'm involved in a lot of activities that last."
Even though older adults are done with illness and disability They can usually think of people their own age who are in a worse state – people who have died or gone to nursing home, said Ellen Idler, a professor of sociology at Emory University in Atlanta and a leading researcher In the field of "self-rated health." By comparison, seniors who are still able to live alone may feel "I'm doing pretty well."
At some point, mere survival may be interpreted as a sign of good health "People are between 80 and 90 years old, look around and feel pretty comfortable when they're just alive," Idler said.
This does not apply to younger adults who measure their health by an ideal. "There should be nothing wrong with me" standard. But the expectations of what constitutes good health change when people enter a later life.
"Elderly people expect some deterioration in their health and are not going the wrong way in the same way," said Jason Schnittker, a professor of sociology at the University of Pennsylvania, who has been working on health.
Resilience also plays a role. As older adults get used to illness and other physical changes, they tend to adjust their perspective. "I am handicapped, but I can walk anyway," said an 86-year-old woman to Swiss researchers, after she was hospitalized after a fall and forced to use a cane to get around. She felt happy and rated her health positively. "As long as you're in church, as long as you can walk, you can say that everything is alright," a man in the 80s said after suffering a severe disability due to a herniated disc and an embolism. He also felt good about his health.
If you believe that the propensity of older adults to positivity is a sign of rejection or lack of objectivity, a large body of research shows that this is highly significant. "Self-rated health is a strong indicator of longevity," as well as other outcomes such as cognitive health and health service utilization, Schnittker says.
Idler and Yael Benyamini, Professor at the Bob Shapell School of Tel Aviv University Social Work was one of the first scientists to examine the relationship between research in a much-cited 1997 study, which looked at research reports from around the world self-rated health and mortality. The link was consistent even when adjustments were made to health, drug use, health care utilization, socioeconomic status and other factors.
In a telephone conversation Benyamini made two statements for this widespread finding. People may be acutely sensitive to subtle changes in their body, such as increased pain or fatigue, which in the end are significant but difficult for doctors to identify. In addition, it can happen that people consider the interaction and influence of multiple diseases – something that is not noticeable in medical tests.
"Suppose you suffer from diabetes, angina and osteoarthritis. How does this affect your life? It's very individual – nobody can judge it from the outside – and it's hard to put a finger on it as a doctor.
Another possible explanation is that people who feel healthy are more likely to be active and take care of them. Benyamini said they would probably survive longer.
This positivity is not universal. African Americans, Hispanics, low-income and educated people, and people with poor social relationships tend to rate their health negatively as they age. In recent years, women's health status is worse than that of men, but this changes later in life, with men more likely to be in poorer health and women more optimistic.
Some surveys separate self-assessed mental health and assess results separately Elderly adults rescind the usual assumptions about age-related negativity. The National Social Life, Health and Aging Project, led by University of Chicago investigators, found that less than 1 percent of adults (ages 57 to 97) rated their mental health as poor. almost 8 percent thought it was fair; Nearly 23 percent thought it was good. Almost 41 percent thought it was very good. and 28 percent said it was excellent. These data, based on a representative sample of 3,101 respondents in 2015, were provided on request and have not yet been published.
"Mental health becomes an even more important component of self-rated health as we age," said Schnittker. Depression in particular seems to have a negative effect on the perception of life circumstances.
Laurie Brock, 69, of Denver, is suffering from severe arthritis and systemic lupus erythematosus but considers her health to be "very good" and speaks of optimism, close relationships and "extremely active life". Poor health would mean being bedridden, "not being able to go out or being as mobile as I am" or suffering longer, she said.
"My attitude is now" I have lived 70 good years and hope the next few years will be rich too, "said Brock. "I think most people are afraid of old age. But when they get there, it says, "Oh, I'm still walking, I'm still fine." And fear is accepted.
This column is published by Kaiser Health News, an editorially independent news service, not related to Kaiser Permanente.