Aging is a gradual, continuous process of natural change that begins in early adulthood. During early middle age, many bodily functions begin to gradually decline.
People do not become "older" or "elderly" at any specific age. Traditionally, age 65 has been designated as the beginning of older age. But the reason was based in history, not biology. Many years ago, age 65 was chosen as the age for retirement in Germany, the first nation to establish a retirement program. In 1965 in the United States, age 65 was designated as the eligibility age for Medicare insurance. This age is close to the actual retirement age of most people in economically advanced societies.
When a person becomes an older adult can be answered in different ways:
Chronologic age is based solely on the passage of time. It is a person’s age in years. Chronologic age has limited significance in terms of health. Nonetheless, the likelihood of developing a health problem increases as people age, and it is health problems, rather than normal aging, that are the primary cause of functional loss during older age. Because chronologic age helps predict many health problems, it has some legal and financial uses.
Biologic age refers to changes in the body that commonly occur as people age. Because these changes affect some people sooner than others, some people are biologically older at 65, and others not until a decade or more later. However, most noticeable differences in apparent age among people of similar chronologic age are caused by lifestyle, habit, and subtle effects of disease rather than by differences in actual aging.
Psychologic age is based on how people act and feel. For example, an 80-year-old who works, plans, looks forward to future events, and participates in many activities is considered psychologically younger.
Most healthy and active people do not need the expertise of a geriatrician (a doctor who specializes in the care of older adults) until they are 70, 75, or even 80 years old. However, some people need to see a geriatrician at a younger chronologic age because of their medical conditions.
Normal aging
People often wonder whether what they are experiencing as they age is normal or abnormal. Although people age somewhat differently, some changes result from internal processes, that is, from aging itself. Thus, such changes, although undesired, are considered normal and are sometimes called "pure aging." These changes occur in everyone who lives long enough, and that universality is part of the definition of pure aging. The changes are to be expected and are generally unavoidable. For example, as people age, the lens of the eye thickens, stiffens, and becomes less able to focus on close objects, such as reading materials (a disorder called presbyopia). This change occurs in virtually all older adults. Thus, presbyopia is considered normal aging. Other terms used to describe these changes are "usual aging" and "senescence."
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Exactly what constitutes normal aging is not always clear. Changes that occur with normal aging make people more likely to develop certain disorders. However, people can sometimes take actions to compensate for these changes. For example, older adults are more likely to lose teeth. But seeing a dentist regularly, eating fewer sweets, and brushing and flossing regularly may reduce the chances of tooth loss. Thus, tooth loss, although common with aging, is an avoidable part of aging.
Also, functional decline that is part of aging sometimes seems similar to functional decline that is part of a disorder. For example, with advanced age, a mild decline in mental function is nearly universal and is considered normal aging. This decline includes increased difficulty learning new things such as languages, decreased attention span, and increased forgetfulness. In contrast, the decline that occurs in dementia is much more severe. For example, people who are aging normally may misplace things or forget details, but people who have dementia forget entire events. People with dementia also have difficulty doing normal daily tasks (such as driving, cooking, and handling finances) and understanding the environment, including knowing what year it is and where they are. Thus, dementia is considered a disorder, even though it is common later in life. Certain kinds of dementia, such as Alzheimer disease, differ from normal aging in other ways as well. For example, brain tissue (obtained during autopsy) in people with certain kinds of dementia looks different from that in older adults without the disease. So the distinction between normal aging and dementia is often clear.
Sometimes the distinction between functional decline that is part of aging and functional decline that is part of a disorder seems arbitrary. For example, as people age, blood sugar levels increase more after eating carbohydrates than they do in younger people. This increase is considered normal aging. However, if the increase exceeds a certain level, diabetes, a disorder, is diagnosed. In this case, the difference is one of degree only.
Healthy (successful) aging
Healthy aging refers to postponement of or reduction in the undesired effects of aging. The goals of healthy aging are maintaining physical and mental health, avoiding disorders, and remaining active and independent. For most people, maintaining general good health requires more effort as they age. Developing certain healthy habits can help, such as
Following a nutritious diet
Avoiding cigarette smoking and excessive alcohol use
Exercising regularly
Staying mentally active
The sooner a person develops these habits, the better. However, it is never too late to begin. In this way, people can have some control over what happens to them as they age.
Some evidence suggests that in the United States, healthy aging is on the rise:
A decrease in the percentage of people aged 75 to 84 who report impairments
A decrease in the percentage of people over age 65 with debilitating disorders
An increase in the oldest old—people age 85 and older, including those who have reached 100 (centenarians)
Life Expectancy
The average life expectancy of Americans has been increasing dramatically over the past century. A male child born in 1900 could expect to live only 46 years, and a female child, 48 years. In 2021, the average life expectancy in the United States for the total population was 76 years. Although much of this gain can be attributed to the significant decrease in childhood mortality, life expectancy at every age beyond 40 has also increased dramatically. For example, a 65-year-old man can now expect to live to about age 83, and a 65-year-old woman, to about age 86. Overall, women live about 4 to 5 years longer than men. This difference in life expectancy between men and women has changed little, despite late 20th-century and early 21st-century changes in women’s lifestyle, including smoking more and experiencing more stress.
Despite the increase in average life expectancy, the maximum life span—the oldest age to which people can live—has changed little since records have been kept. Despite the best genetic makeup and healthiest lifestyle, the chance of living to be 120 is tiny. Madame Jeanne Calment had the longest documented lifespan: 122 years (1875 to 1997).
Several factors influence life expectancy:
Heredity: Heredity influences whether a person will develop a disorder. For example, a person who inherits genes that increase the risk of developing high cholesterol levels is likely to have a shorter life. A person who inherits genes that protect against coronary artery disease and cancer is likely to have a longer life. There is good evidence that living to a very old age—to 100 or older—runs in families.
Lifestyle: Avoiding smoking, not abusing illicit drugs and alcohol, maintaining a healthy weight and diet, exercising, and getting recommended vaccinations and screening examinations help people function well and avoid disorders.
Exposure to toxins in the environment: Such exposure can shorten life expectancy even among people with the best genetic makeup.
Health care: Preventing disorders or treating disorders after they are contracted, especially when the disorder can be cured (as with infections and sometimes cancer), helps increase life expectancy.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
American Association of Retired People (AARP): This resource focuses on issues pertaining to people 50 years of age and older (for example, health care, caregiving, and access to affordable, quality long-term care).
American Federation for Aging Research (AFAR): This resource provides information about ongoing biomedical research dedicated to the support and advancement of healthy aging.
Benefits Check Up: This resource helps older adults find local benefits they may be eligible for.
Older Adult Health: This resource from the Centers for Disease Control and Prevention provides health statistics for Americans age 65 and older.
National Council on Aging and National Institute on Aging: These resources provide information for older adults regarding topics ranging from health care and nutrition to caregiving to research.
Administration for Community Living and National Association of Area Agencies on Aging: These resources provide information about independent living for older adults and people of all ages with disabilities.
