Chapter 31: Older people^#

INTRODUCTION

Our older population is growing at an unprecedented rate. Half of the people who have ever lived beyond 65 years of age are inhabiting the planet today. Fifteen per cent of the planet’s population is expected to be aged over 65 years by 2050.¹

Physical inactivity increases with age,² and with increasing age there is also an elevated risk of developing chronic diseases, such as cardiovascular disease, cancer and diabetes.³ There is a decline in many physiological systems, balance ability and cognitive performance, as well as a loss of muscle mass (sarcopenia), strength and endurance. Of people aged over 75 years in the UK, 30% report chronic musculoskeletal conditions, 32% report cardiovascular conditions and 13% report metabolic conditions.⁴

These increasing levels of physical inactivity and chronic disease create a vicious cycle. Disease and subsequent disability reduce levels of physical activity, which impairs functional independence and exacerbates disability. Regular physical activity can help older adults break this cycle.

Despite the fact that ‘physical activity is medicine for older adults’,⁵ few older adults meet the recommended levels of physical activity. In the USA, more than one in four adults aged 50 years or older are completely sedentary.⁶ Comprehensive public health action on physical activity in older adults is needed urgently. We must find effective ways to support older adults to increase their physical activity levels, by overcoming barriers to participation. This will reduce the burden of chronic disease and improve the quality of life for all.

In this chapter we explore:

• what constitutes an older person

• evidence for the physiological and psychological benefits of physical activity for older adults (healthy ageing)

• risks associated with physical activity for older adults

• exercise prescription for older adults

• potential interactions between physical activity and medications commonly used by older adults.

WHAT DEFINES AN OLDER PERSON?

Defining ‘older person’ by chronology is flawed because of increasing variability in health and functional status with increasing age. While most developed countries have accepted the chronological age of 65 as the definition of an older adult, equivalent to the approximate retirement ages in these countries, that cut-off is arbitrary. Socially constructed definitions of old age based on assigned roles within society are more important.

A more appropriate, universal definition of old age is one that considers functional limitation ...