Chapter Overview

1. Why has poor health become associated with old age, and how are recent improvements in health care changing that association?
Poor health has become associated with old age because of the epidemiologic transition. The epidemiologic transition is defined as a change in the leading cause of death from infectious diseases to chronic diseases. Recent improvements in health care and prevention now mean that most older people will remain in relatively good health and that the years spent being disabled are likely to be compressed into the final years of life. This is termed the compression of morbidity thesis.

2. How do people's lifestyles and social support systems affect their health in old age?
Lifestyles have a large impact on health over the life course. People who don't smoke and who exercise, drink in moderation, and keep their weight in the normal range are less likely to become disabled than those who do not. The increasing significance of healthy lifestyles means that medicine is no longer the sole answer to dealing with threats to health. Social support systems also play a role in health outcomes. Having a strong social support system improves morale, reduces the risk of depression, and even enhances recovery from surgery.

3. What is the best measure of an el-derly person's socioeconomic status, and how is SES connected to a person's health?
The best measure of an elderly person's socioeconomic status is education. People of higher SES have better health in old age than people of lower SES. One reason is that they have better access to health care. People of lower SES are more likely to have worked in stressful jobs where they could be injured. They also have more resources that give them the opportunity to engage in positive health practices.

4. How do gender, race, and ethnicity affect an older person's health?
Women have poorer health and higher levels of disability than do men. This is not only true for the United States but for other countries as well. Both biological and behavioral factors appear to account for the differences. Older minorities have poorer health than whites on several measures. As they age, they are more likely to develop a serious illness and more likely to rate their health poorly.

5. How have changes in Medicare and the health care industry affected older Americans?
Medicare is one of the fastest growing federal programs. Costs will rise sixfold as the baby boom generation approaches retirement age. As political pressures increase to cut Medicare expenditures, more elderly are likely to be treated by physicians affiliated with health maintenance organizations. The danger is that efforts to save costs may reduce the quality of care. And recently many HMOs have begun pulling out of the Medicare program. One of the main political issues for the future will be determining how best to control the costs of Medicare while maintaining quality health care for the aged.