A common myth about aging is that older adults are burdened by illness and feel lousy of the time. In fact, the opposite is usually true.
Consider the data from the 2017 National Health Interview Survey (the most recent available), administered by the Centers for Disease Control and Prevention. When asked about their overall health, 82 percent of adults aged 65 to 74 described it as excellent (18 percent), very good (32 percent) or good (32 percent) – on the positive side of the book. By contrast, 18 percent of this age group had a negative perspective, describing their health as fair (1
This trend toward positivity is also evident among adults aged 75 and older: 73 percent of this group said their health was excellent (12 percent), very good (28 percent) or good (33 percent), while only 27 percent gave a fair (20 percent) or poor (7 percent) be true when the majority of older adults – about 60 percent – 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
lies in how older people 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, long friendships," Goldman said. "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 am 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 their age who are worse off – 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, just 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's not true for younger adults with me "standard.
"Older people expect some deterioration in health and are not thrown off course in the same way when it occurs," said Jason Schnittker, a professor of sociology at University of Pennsylvania who has studied self-rated health.
Resilience is also at play. As older adults adapt to illness and other physical changes, they tend to adjust their outlook. "I can be handicapped, but I can still walk," one 86-year-old woman told Swiss researchers after being hospitalized from a fall and forced to use a stick to get around. She considered herself fortunate and rated her health positively. "As long as you can get to church, as long as you can walk, you can say all of it well," and a man in his 80s declared after becoming severely disabled because of a slipped disc in his spine and an embolism.
Lest you think older adults' bias towards positivity is a sign of denial or lack of objectivity, and a large body of research shows it's highly meaningful. "Self-rated health is very predictive of longevity" as well as other outcomes such as cognitive health and the use of health care services, Schnittker said.
Idler and Yael Benyamini, professor at Tel Aviv University's Bob Shapell School of Social Work, were among the first scholars to highlight the association between self-assessed health and mortality in a much-cited 1997 study that examined research reports from around the world.
In a telephone conversation, Benyamini offered two explanations for this finding, which has been widely replicated . People may be acutely attuned to subtle changes in their bodies, such as increased pain or fatigue, which is significant but may be difficult for doctors to detect. Also, people may factor in how multiple medical conditions interact and affect them – something that medical tests do not pick up.
"Say you have diabetes, angina and osteoarthritis. How does this affect your life? It's very individual – no one can tell from the outside – and it's hard to put your finger on as a doctor, "she said.
Another possible explanation is that people who feel healthy are more likely to be active and take care of they are likely to survive longer, Benyamini said.
This positivity is not universal. African Americans, Hispanics, people with lower levels of income and education, and individuals with poor social connections are more likely to rate their health negatively as they age. At younger ages, women rate their health more poorly than men, but this changes in later life, with men becoming more likely to report worse health and women becoming more optimistic.
Sometimes surveys assess self-assessed mental health separately, and results for older adults, overturn common assumptions about negativity associated with older age. The National Social Life, Health and Aging Project, spearheaded by investigators at the University of Chicago, found that less than 1 percent of adults (ages 57 to 97) rated their mental health as poor; just under 8 percent considered it fair; almost 23 percent thought it was good; almost 41 percent believed it was very good; and 28 percent judged it excellent. This data, based on a representative sample of 3,101 individuals surveyed in 2015, was provided on request and has not yet been published
"Mental health becomes an even more important component of self-rated health with age," Schnittker said.
Although Laurie Brock, 69, of Denver, has severe arthritis and systemic lupus erythematosus, she considers her health "very good" and credits her optimism, close relationships and "extremely active life." Poor health would mean being bedridden, "not being able to go out or be as mobile as I am" or extended suffering, she said
"My attitude now is' I 'lived 70 good years, and I hope the next years are rich as well,' "Brock said. "I think most people fear old age. But once they get there, it's like, 'Oh, I'm still going, I'm still okay.' And fear becomes acceptance. "
This column is produced by Kaiser Health News, an editorially independent news service that is not related to Kaiser Permanente.