As much as we tell ourselves and each other that 80 is the new 60, or 60 is the new 40, we are kidding ourselves, and setting up a future in which the needs of very frail elders are unseen, misunderstood, and unmet. Popular culture and its pressure to be forever young ignores the reality of aging: That those of us lucky to survive chronic conditions, such as cancer and heart disease, will just grow very old. There are benefits to living—look how many of us prefer to do just that—but there are challenges to aging. We will change: physically, mentally, emotionally and spiritually. Our circumstances will change: independence may give way to dependence, our homes may give way to nursing homes, our working income may give way to financial uncertainty. Very frail elders, like very young children, have unique and particular circumstances that require attention and care from family and friends, and from communities and government. To understand these needs, it helps to first understand who frail elders are—or who we mean when we speak of them.
The last century heralded major changes in American health, and in public health. These, in turn, have led to longer lives; the average US life expectancy for a child born in 2010 was 78.7 years, a thirty-year gain from 1900. There are simply millions more of us! alive. Since 1900 the number of Americans over 65 has increased from 3.1 to 41.4 million persons. The increase among the older population will accelerate as the Baby Boomer generation ages. In fact, the Baby Boomers are estimated to reach 80 million persons by 2040.
It is not just that people are aging, but that they are aging into very long lives. In 2011, the 75-84 group (12.8 million) was 16 times larger and the over 85 group (5 million) was 40 times larger than their populations than at the turn of the 20th century. Those over 85 is projected to triple from 5.7 million in 2011 to 14.1 million in 2040. This is an unprecedented rate of growth for those over 65.
The very old face challenges of inhabiting such old bodies. More than half of older adults have three or more chronic diseases. Alzheimer’s and related dementias also plays a role in increasing illness and disability. Over 5 million persons over the age of 65 report having Alzheimer’s or a related dementia disease. By 2050, the number of people age 65 and older with Alzheimer’s disease will nearly triple to 16 million. Currently, nearly one in three deaths are attributable to Alzheimer’s or dementia-related diseases, and Alzheimer’s is the sixth leading cause of death.
People who are frail and have multiple chronic conditions experience problems in completing tasks of daily living, and almost one third of adults over 65 have problems with tasks such as eating, dressing or bathing. Increasing age comes with increasing struggles; almost half of those over 85 report difficulty walking and a quarter report difficulty bathing and showering.
We say that these people are frail, but what is frailty and why does it matter? Geriatricians define frailty as “a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity.” (Fried et al, 2001). A person with none of the indicators is robust, a person with 1 or 2 indicators is pre-frail, and a person with 3 or more indicators is frail.
As we develop and test MediCaring, it is important to have a standard way to identify frail elders, and to coordinate and deliver the array of services they need. Doing so is imperative: Millions of Americans will now experience an extended period of frailty. We have unprecedented change on the horizon—and an urgent need to respond to the challenges change brings.
LP Fried et al. J Gerontol A Biol Sci Med Sci(2001) 56 (3):M146-M157. doi:10.1093/gerona/ 56.3.M146
key words: MediCaring book, Joanne Lynn, Janice Lynch Schuster, aging, frailty
 Life expectancy at birth, at age 65, and at age 75, by sex, race, and Hispanic origin: United States, selected years 1900–2010. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/data/hus/hus12.pdf#018