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Why so many older Americans rate their health as good or even excellent

Judith Graham, Kaiser Health News on

Published in Health & Fitness

A common myth about aging is that older adults are burdened by illness and feel lousy much of the time. In fact, the opposite is usually true. Most seniors report feeling distinctly positive about their health.

Consider data from the 2017 National Health Interview Survey (the most recent available), administered by the U.S. Centers for Disease Control and Prevention. When asked to rate their overall health, 82% of adults ages 65 to 74 described it as excellent (18%), very good (32%) or good (32%) -- on the positive side of the ledger. By contrast, 18% of this age group had a negative perspective, describing their health as fair (14%) or poor (4%).

This trend toward positivity is also evident among adults age 75 and older: 73% of this group said their health was excellent (12%), very good (28%) or good (33%), while only 27% gave a fair (20%) or poor (7%) evaluation.

How could this be true when the majority of older adults -- about 60% -- have two or more chronic illnesses, such as diabetes, arthritis, hypertension, heart disease or kidney disease, and higher rates of physical impairment than other age groups?

The answer lies in how older adults think about their health. For many, good health means more than the lack of illness or disability. The components of health they tend to value more are vitality, emotional well-being, positive social relationships, remaining active and satisfaction with life, while poor physical functioning plays a less important role.

"Being healthy means being able to continue doing what I like: going to the theater, organizing programs, enjoying the arts, walking," said Lorelei Goldman, 80, of Evanston, Ill., who has had ovarian and breast cancer. She also describes her health as "good."

 

"I have all my faculties and good, longtime friendships," Goldman continued. "I used to be a bad sleeper, but now I'm sleeping much better. Almost every day, there are moments of clarity and joy. I'm involved in a lot of activities that are sustaining."

Even when older adults are coping with medical conditions and impairments, they can usually think of people their age who are worse off than they -- those who have died or gone to nursing homes, 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 still able to live on their own may feel "I'm doing pretty well."

At some point, merely surviving can be interpreted as a sign of good health. "People hit their 80s and 90s, look around and feel pretty good about just being alive," Idler said.

That isn't true for younger adults, who measure their health against an ideal "there shouldn't be anything wrong with me" standard. But expectations for what constitutes good health change as people move into later life.

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