Health and Illness

Changes in sensory abilities are a part of normal aging, but so, unfortunately, is susceptibility to certain kinds of diseases and injuries. The percentage of people with health problems rises steadily with advancing age. All four indicators of health status— mortality (death rate), morbidity (disease frequency), disability (inability to perform normal activities), and vitality (energetic feelings)—are affected by aging. In addition to the increased likelihood of developing physical disorders, recuperating from the effects of such conditions becomes more difficult as one grows older. Although they may not be fatal or even incapacitating, many disorders are chronic, or of long duration, persisting at a certain level despite sustained efforts to treat and cope with them.

Young adults are, of course, not totally free of illness; in particular, they may suffer from various acute conditions (eg , infective and parasitic illness, respiratory ailments, accidental injuries). However, people in their twenties and thirties typically rebound fairly quickly from an illness or injury and spend little time worrying about their health. This is true of young adults in general, and particularly so for those who take good care of themselves. Young adulthood is the time when vigor, vitality, strength, fitness, and stamina—all synonyms of "health"—are taken for granted.

Nine out of 10 adults between the ages of 17 and 44 describe their health as "good or excellent," and when they are hospitalized, it is usually due to an accident or childbirth (National Center for Health Statistics, 1992). By middle age, however, declines in physical functioning and health become increasingly more apparent, serving as a reminder of personal mortality and that we are not what we used to be. Both middle-aged and older adults are more vulnerable than younger adults to disease and hence more likely to require hospitalization and incur physical disability. Influenza and similar illnesses, which may be perceived as only uncomfortable nuisances by young adults, can lead to pneumonia and death in older adults. In fact, at one time, pneumonia caused the deaths of so many older people who were afflicted with other chronic illnesses that it was referred to as "the old man's friend." Final relief from the nonfatal chronic illnesses was provided by death from pneumonia.

Most middle-aged and older adults maintain that they are in good health, but, beginning in their forties and fifties, illness typically begins to take its toll in terms of energy, ability, productivity, and enjoyment of life. The number of people suffering from some chronic ailment, as well as the number of chronic illnesses that a typical person has, increase significantly after age 50. The debilitating effects of disease begin ever so slightly to affect the enjoyment of living, the sense of well-being, participation in most social roles, and treatment by other people, as well as one's interests, cognitive abilities, and overall attitude toward life. Then, the meanings of the terms "disease" and "dis-order," in terms of their effects on personal feelings and the ability to get things done, become ever more apparent.

Although the probability of disease increases with age, it is unfair to characterize later adulthood as synonymous with "sickness." Only about 5% of all adults over age 65 reside in nursing homes or other institutions designed for long-term health care. Also incorrect is the popular notion that older people are hypochondriacs who needlessly complain without end about how sick they are. It was a middle-aged hypochondriac who arranged to have "Now do you believe me?" inscribed on his tombstone.

Sensible lifestyles and improved medical care have resulted in today's older adults being healthier than those of previous generations (Lentzner, Pamuk, Rhodenhiser, Rothberg, & Powell-Griner, 1992; Manton, Corder, & Stallard, 1993). In particular, individuals who have suffered heart attacks, cancer, and stroke—the three principal causes of death in middle- and late adulthood—are surviving longer than ever before.

This chapter and the next one deal with two of the three folk requirements for a happy life-health and wisdom. The third ingredient of the time-honored recipe for happiness—wealth—is considered in Chapter 11. Health, wealth, and wisdom are, of course, not independent states: Each ingredient is related to and interacts with the others in attaining the goal of a good, long life. Nevertheless, it would seem that "health" is more crucial than the other two parts of the mixture. No matter how wise or affluent one is, happiness is difficult to attain when one's health is poor.

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