I do look for good news, for promising trends for our elders and ourselves, honest. Whenever I can, I report on things like the potential health benefits of caregiving.
But there’s a whole lot of the other kind of news, and — sorry! — here’s a bit more: The Centers for Disease Control and Prevention has reported stiff increases in the proportion of older adults with “multiple chronic conditions” — more than one of the diseases that commonly affect this population. During the decade that ended in 2010, according to the agency’s large national survey, the percentage of adults over age 65 who reported both hypertension (high blood pressure) and diabetes jumped to 15 percent from 9 percent; those with hypertension and heart disease bumped up to 21 percent from 18 percent; and the prevalence of hypertension and cancer climbed to 11 percent from 8 percent.
These are statistically significant increases, found across all racial and ethnic groups examined — blacks, whites, Hispanics — and most income groups. By 2009-10, 45 percent of the respondents older than 65 had two or more chronic diseases, including stroke, emphysema, asthma and kidney disease. A decade earlier, only 37 percent did.
That’s alarming, because people with more than one chronic disease have a harder time managing their health. They’re more likely to be hospitalized. They fill more prescriptions and make more doctors’ visits. They cost themselves and the nation more.
Yet this is hardly a problem restricted to the elderly, as the C.D.C. reports. Among adults ages 45 to 64, rates of multiple chronic conditions climbed significantly as well, also crossing racial and income categories. In the middle-aged group, the proportion with multiple diseases rose to 21 percent from 16 percent a decade earlier.
C.D.C. researchers speculated that widespread obesity could contribute to the change. So may the improved medical care that keeps people alive with multiple diseases that, in previous generations, might have killed them.
But money appears to play a role, too. Look at this vast difference in the proportion of people who reported delaying or forgoing medical care in the past year because of costs: Only about 7 percent of those over age 65 did so, not a significant increase from a decade before. But nearly a quarter of those ages 45 to 64 said they had, a significant jump. They’ve also grown more likely to forgo prescription drugs.
Score one for the nearly universal health insurance that older people have through Medicare. Without it, the numbers might be even scarier.
Yet a separate study recently published in The Journals of Gerontology suggests another factor: We largely fail to take certain obvious steps to improve our health, even after a diagnosis of a serious chronic disease. Some of the most common and dangerous diseases in the United States are modifiable or preventable by changes in the way we live.
This picture also emerges from a broad national database — the United States Health and Retirement Study — which tracks those ages 50 to 85. Led by Jason Newsom, a health psychologist at Portland State University in Oregon, the researchers looked at three key health behaviors over 10 to 14 years after a diagnosis of heart disease, diabetes, cancer, stroke or lung disease.
The biggest change came in smoking after a heart disease diagnosis; 40 percent of smokers quit at that point. Of course, that means that most smokers with heart disease didn’t. Fewer than 20 percent of smokers with lung disease gave up cigarettes. The decrease in excessive alcohol consumption was small. Rates of regular vigorous exercise (at least three times a week), though it’s recommended for those conditions, didn’t improve at all.
Over all, the study concluded, “the vast majority of individuals do not make major lifestyle changes following diagnosis of a serious chronic disease, either in the short term or in the long term.”
Let’s not pile all the blame on sick people for failing to do what might make them less sick. “Changing your daily behavior is one of the hardest things you can do,” Dr. Newsom acknowledged in an interview. “We’re creatures of habit.”
Yet smoking cessation (which Medicare covers) and other behavioral programs do enable people to change. In this study, most of those who stopped smoking, curbed excessive drinking or exercised regularly were able to maintain those behaviors; relapse rates were low.
Even after a frightening diagnosis, especially after one, these are changes worth making. “If you’ve had a heart attack and you stop smoking, you cut your risk of another heart attack in half,” said Dr. Newsom.
The C.D.C. data suggests that people are more apt to get treatment when they can pay for drugs and doctors. Maybe, 10 years hence, we’ll see that broader health insurance coverage has made a difference. Meanwhile, we can help ourselves — although the Oregon study shows how seldom we do.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”