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AORN Journal, March, 2008 by Judith L. Clayton
The face of aging in the United States is changing dramatically and rapidly. Today's older Americans are very different from their predecessors. They live longer, have lower rates of disability, have achieved higher levels of education, and live in poverty less often. The first of the Baby Boomers, approximately 2.9 million people, celebrated their 60th birthdays in 2006. (1) A substantial increase in the number of older adults will occur from 2010 to 2030 after the first Baby Boomers turn 65 in 2011. (2) The population of older adults in 2030 is projected to be twice as large as in 2000, growing from 35 million to 72 million. This age group is anticipated to represent nearly 20% of the total United States population. (2)
Older adults are at higher risk than younger individuals for complications during and after surgery. Successful surgical management of an older adult's health problems depends on the nurse's understanding of the age-related factors that may affect the outcome of normal surgical procedures. Carefully planned, effective nursing care during the perioperative period will help reduce surgical morbidity in older adults.
LIFE EXPECTANCY
The average life expectancy is increasing every year in the United States as Baby Boomers are fast approaching old age. (2) These increases can be attributed to a focus on prevention of disease and illness with increased socialization and advancements in disease control and health technology.
During the past century, improvements that have affected life expectancy in the United States occurred in two stages. First, death during childhood became less likely, largely because sanitation processes improved and vaccines and treatments for childhood diseases were developed. Second, disease and disability are less likely to develop or have been postponed in older adults because health care and disease prevention have improved.
Historically, female life expectancy has been higher than male life expectancy at most ages. (2) Gender differences in life expectancy can be attributed to differences in attitudes, behaviors, social roles, and biological risks between men and women. In 2000, life expectancy at birth was 79.5 years for women and 74.1 years for men. (2) This was largely a result of reductions in mortality at older ages. Not only are more people surviving past the age of 65, but they also have more years of productive life remaining than people did a century ago. (2) Like their younger counterparts, members of the "old-old" generation also have better survival prospects today than at any other point in the past century. (2)
Confusion exists regarding age category definitions. According to the AARP, the categories are
* middle age--40 to 59 years of age,
* young old--60 to 74 years of age, and
* old old--75 to 100+ years of age. (3)
Centenarians [ie, people who are 100 years of age and older] are the fastest growing segment of the US population. (4) In 1990, there were approximately 37,000 centenarians; in 1998, there were 61,000 centenarians; and in the year 2000, 50,454 people were 100 years of age or older. (2) About 80% of all centenarians are women. (2)
FACTORS AFFECTING THE HEALTH OF OLDER ADULTS
Smoking, overuse of alcohol, being overweight, lack of exercise, and inadequate consumption of fruits and vegetables are some of the risk factors researchers associate with morbidity and mortality at older ages. Evidence suggests, however, that positive behavior change, even at older ages, can provide health benefits and improve quality of life. Smoking cessation, following a nutritious diet, exercising regularly, taking prescribed medications to control illness, and staying mentally active have proven to reduce the risk of developing several disorders that commonly occur as people age. As centenarian and legendary jazz musician Eubie Blake said, "If I'd known I was gonna live this long, I'd have taken better care of myself."
FALLS. Older adults, who currently represent 12% of the population, account for 75% of deaths from falls. (3) The number of falls increases progressively with age in both genders and in all racial and ethnic groups. (5) The injury rate for falls is highest among adults 85 years of age and older. (5) In 2003, more than 1.8 million adults 65 years of age and older were treated in emergency departments for fall-related injuries, and more than 421,000 were hospitalized. (5) The most common fractures are of the hip, vertebrae, shoulder, and wrist. (6)
Fall-related injuries account for approximately 5% of hospitalizations in patients older than 65 years. Approximately 5% of the falls result in a fracture of the humerus, wrist, or pelvis. (6) Other serious injuries, such as head and internal injuries and lacerations, occur in about 5% of the falls. (6) Approximately 2% of falls result in a hip fracture, (6) and about 5% of older adults with hip fractures die while hospitalized. (5)
Annually, 1,800 falls directly result in death, and approximately 9,500 deaths in older Americans are associated with falls each year (Figure 1). (5) The overall mortality in the 12 months after a hip fracture ranges from 18% to 33%. (6) Many older adults who fall are frail and have preexisting deficits in activities of daily living (eg, personal care tasks such as bathing, eating, toileting, dressing) and instrumental activities of daily living (eg, preparing one's own meals, doing light housework, managing one's own money, using the telephone, shopping). (2,5) These people are at risk for other complications after a fall in which a fracture occurs (ie, increased risk of pneumonia, thrombus formation, pressure ulcers, renal calculi, fecal impaction, contractures). About 50% of those who fall cannot get up without help. (5) The risk of dehydration, pressure ulcers, rhabdomyolysis, hypothermia, and pneumonia increases when an older adult remains on the floor for longer than two hours after a fall. (5)
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