Aging

Facts on Aging Quiz

Revised by Linda Breytspraak1, Ph.D., and Lynn Badura, B.A., Grad. Gerontology Certificate Gerontology Program
University of Missouri-Kansas City

There have been a number of versions of quizzes on aging, patterned after Erdman Palmore’s landmark “Facts on Aging Quiz” that appeared in two issues of The Gerontologist (1977; 1981). The initial version developed at UMKC was authored by Linda Breytspraak, Ph.D., Burton Halpert, Ph.D., and Liz Kendall, M.A. The current revision of that initial version was authored by Linday Breytspraak, PhD, and Lynn Badura, B.A., Graduate Certificate in Gerontology.

About half the items in the current quiz are similar or identical to Palmore’s. The other half represent issues that have received more attention since his quiz was developed or were judged by the authors to be of significant interest now. This 2015 revision has all the same questions as the original version with a few small wording changes in several items. The authors have drawn on current research and gerontological and geriatric texts to answer the questions. We provide a reference list, divided into (1) general sources and (2) sources used to document data or specific trends discussed in answers to particular questions.

The authors of the 2015 version grant permission for anyone to use the Facts on Aging Quiz for educational purposes as long as credit is given using the following citation:

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). Retrieved from http://info.umkc.edu/aging/quiz/.

1 Contact information for first author: breytspraakl@umkc.edu

Facts on Aging Quiz

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1. The majority of old people (past 65 years) have Alzheimer’s disease. 2. As people grow older, their intelligence declines significantly.
3. It is very difficult for older adults to learn new things.
4. Personality changes with age.

5. Memory loss is a normal part of aging.

6. As adults grow older, reaction time increases.

7. Clinical depression occurs more frequently in older than younger people.

8. Older adults are at risk for HIV/AIDS.

9. Alcoholism and alcohol abuse are significantly greater problems in the adult population over age 65 than that under age 65.

10. Older adults have more trouble sleeping than younger adults do.
11. Older adults have the highest suicide rate of any age group.
12. High blood pressure increases with age.
13. Older people perspire less, so they are more likely to suffer from hyperthermia. 14. All women develop osteoporosis as they age.

15. A person’s height tends to decline in old age.

16. Physical strength declines in old age.

17. Most old people lose interest in and capacity for sexual relations.

18. Bladder capacity decreases with age, which leads to frequent urination.

19. Kidney function is not affected by age.

20. Increased problems with constipation represent a normal change as people get older.

21. All five senses tend to decline with age.

22. As people live longer, they face fewer acute conditions and more chronic health conditions.

23. Retirement is often detrimental to health–i.e., people frequently seem to become ill or die soon after retirement.

24. Older adults are less anxious about death than are younger and middle-aged adults.

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 2

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25. People 65 years of age and older currently make up about 20% of the U.S. population. 26. Most older people are living in nursing homes.
27. The modern family no longer takes care of its elderly.
28. The life expectancy of men at age 65 is about the same as that of women.

29. Remaining life expectancy of blacks at age 85 is about the same as whites.

30. Social Security benefits automatically increase with inflation.

31. Living below or near the poverty level is no longer a significant problem for most older Americans.

32. Most older drivers are quite capable of safely operating a motor vehicle. 33. Older workers cannot work as effectively as younger workers.
34. Most old people are set in their ways and unable to change.
35. The majority of old people are bored.

36. In general, most old people are pretty much alike.

37. Older adults (65+) have higher rates of criminal victimization than adults under 65 do.

38. Older people tend to become more spiritual as they grow older.

39. Older adults (65+) are more fearful of crime than are persons under 65.

40. Older people do not adapt as well as younger age groups when they relocate to a new environment.

41. Participation in volunteering through organizations (e.g., churches and clubs) tends to decline among older adults.

42. Older people are much happier if they are allowed to disengage from society.

43. Geriatrics is a specialty in American medicine.

44. All medical schools now require students to take courses in geriatrics and gerontology.

45. Abuse of older adults is not a significant problem in the U.S.
46. Grandparents today take less responsibility for rearing grandchildren than ever before. 47. Older persons take longer to recover from physical and psychological stress.
48. Most older adults consider their health to be good or excellent.
49. Older females exhibit better health care practices than older males.
50. Research has shown that old age truly begins at 65.

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 3

Answers to Facts on Aging Quiz

1. The majority of old people (past 65 years) have Alzheimer’s disease. False. According to the 2014 Alzheimer’s Disease Facts and Figures Report published by the Alzheimer’s Association, one in nine people 65 and older (11%) have Alzheimer’s disease. About one-third of people age 85 and older (32%) have Alzheimer’s disease. Of those with Alzheimer’s disease, the vast majority (82%) are age 75 or older.
2. As people grow older, their intelligence declines significantly. False. Although there are some circumstances where the statement may hold true, current research evidence suggests that intellectual performance in healthy individuals holds up well into old age. The average magnitude of intellectual decline is typically small in the 60s and 70s and is probably of little significance for competent behavior. There is more average decline for most abilities observed once the 80s are reached, although even in this age range there are substantial individual differences. Little or no decline appears to be associated with being free of cardiovascular disease, little decline in perceptual speed, at least average socioeconomic status, a stimulating and engaged lifestyle, and having flexible attitudes and behaviors at mid-life. The good news is that research data now indicate that this is a life stage programmed for plasticity and the development of unique capacities and that intellectual decline can be modified by life-style interventions, such as physical activity, a healthy diet, mental stimulation, and social interaction.
3. It is very difficult for older adults to learn new things. False. Although learning performance tends on average to decline with age, all age groups can learn. Research studies have shown that learning performances can be improved with instructions and practice, extra time to learn information or skills, and relevance of the learning task to interests and expertise. It is well established that those who regularly practice their learning skills maintain their learning efficiency over their life span.
4. Personality changes with age. False. Personality remains consistent in men and women throughout life. Personality impacts roles and life satisfaction. Particular traits in youth and middle age will not only persist but may be more pronounced in later life.

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 4

5. Memory loss is a normal part of aging. True. As one ages there is modest memory loss, primarily short-term memory (recent events). Older adults are more likely to retain past or new information that is based on knowledge acquired or builds upon their life course or events. Retrieval of information may slow with age. The causes of these changes are unknown, but may include stress, loss, physical disease, medication effects, depression, and age-related brain changes. Lack of attention, fatigue, hearing loss, and misunderstanding are among factors impacting memory loss in persons of all ages. Strategies such as activity and exercise, association, visualization, environmental cueing, organization by category and connection to a place may help to prompt memory.
6. As adults grow older, reaction time increases.

True. Reaction time is the interval that elapses between the onset of a stimulus and the completion of a motor response, such as hitting the brake pedal of a car when the traffic light turns yellow or red. When processing ordinary stimuli, adults do show large increases in response time with increasing age.

7. Clinical depression occurs more frequently in older than younger people. False. There is no evidence that depression occurs more often in older adults than younger groups, and it should not be considered a normal part of aging. However, it is the most common mental health problem of older adults. Depression may vary from feeling “blue” from grief over a loss to a diagnosis of clinical depression by the DSM-5 criteria. Accurate diagnosis and treatment options are often hindered by the resistance to mental health intervention and by situational depression in older adults as they react to isolation, role change, illness, and medication effects.
8. Older adults are at risk for HIV/AIDS. True. Americans aged 50 and older have many of the same HIV risk factors as younger Americans. According to the Centers for Disease Control and Prevention, persons aged 55 and older accounted for 26% of the estimated 1.2 million people living with HIV infection in the U.S. in 2011, and 5% of new HIV infections were among Americans aged 55 and older in 2010.
9. Alcoholism and alcohol abuse are significantly greater problems in the adult population over age 65 than that under age 65. False. There doesn’t appear to be substantial support for this idea. However, according to the National Survey on Drug Use and Health conducted in 2010, nearly 40% of adults age 65 and older drink alcohol. According to the survey, most of them don’t have a drinking problem, but some of them drink too much. Men are more likely than women to have problems with alcohol. Research does support that older people might become more sensitive to alcohol as they age. As we grow older, our metabolism slows down so an older

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 5

person will break down alcohol more slowly than a young person and alcohol will stay in an older person’s body longer. Additionally, as we age, the amount of water in the blood decreases so older adults will have a higher percentage of alcohol in their blood than younger people after drinking the same amount of alcohol. Furthermore, aging lowers the body’s tolerance for alcohol which means that older adults might experience the effects of alcohol, such as lack of coordination and slurred speech, more readily than when they were younger. As older people are dealing with more chronic health conditions, oftentimes they are taking more medications. Drinking alcohol can cause certain medicines to not work properly and other medicines to become more dangerous or even deadly. Due to these issues, an older person is more susceptible to develop problems with alcohol even though his or her drinking habits have not changed.

10. Older adults have more trouble sleeping than younger adults do.

True. Older adults often experience sleep changes such as taking longer to fall asleep, frequent awakenings, daytime napping, circadian rhythm changes, lighter sleep (less time in deep sleep and REM sleep), more abnormal breathing events, and increased frequency of leg movements. The overall quality of sleep may decline with age even though more time may be spent in bed. Among the factors that may contribute to sleep problems in older adults are comorbidities, CNS disorders, GI disorders, or urinary disorders; pain; depression; polypharmacy; lack of exercise; life stressors; alcohol; smoking; environmental noises and institutional routines; and poor sleep hygiene.

11. Older adults have the highest suicide rate of any age group

False. The Centers for Disease Control & Prevention reported that in 2013 the highest suicide rate was among persons 45-64 years old (19.1/100,000). The second highest rate (18.6) occurred in those 85 years and older. The 65-84 age group had roughly the same rate as 25-44 year olds with the third highest rate. Adolescents and young adults aged 15- 24 had a rate of 10.9. This is a change from the past when older adults (65+) consistently had the highest rates. Males account for the majority of suicides in all age groups.

12. High blood pressure increases with age.

True and False. There is evidence that blood pressure does increase with age. However, there is controversy over the criteria for establishing high blood pressure with increasing age.

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 6

there continues to be discussion related to a cutoff of 60 years versus 80 years of age for

these revised recommendations.

13. Older people perspire less, so they are more likely to suffer from hyperthermia. True. Perspiration and quenching of thirst help to combat overheating. Older adults perspire less, are less aware of thirst and less able to feel or adapt to extremes in temperature than younger persons. Less sensitive skin sensors and less insulation of fatty deposits under the skin and the less efficient functioning of the hypothalamus (the temperature regulating mechanism in the brain) occur in older adults. Prolonged time for older adults to return to core temperature after exposure to extreme heat or cold begins at age 70 years and increases thereafter. Education and taking precautions may prevent most deaths related to temperature extremes. Increased fluid intake, gradual accommodation to climate change, rest, minimizing exertion during heat, use of fans and/or air conditioning, wearing hats and loose clothing and avoidance of alcohol are some strategies for hyperthermia.
14. All women develop osteoporosis as they age. False. Osteoporosis (“porous bone”) is associated with increasing age and is more common in women (especially White and Asian women) than men, but it is not an inevitable outcome. Gradual loss of bony tissue causes brittle bones to fracture more easily in both men and women as they age. Deficiency in bone mineral density occurs in 50% of women over 50 years to 57% of women 70 years or older, but decreases to 45% for those over 80 years. Women rarely develop osteoporosis until age 70 years. Bone mineral density (BMD) is typically measured through a DXA (dual-energy x-ray absorptiometry) test. Results are compared to the peak bone mineral density of a healthy 30-year old adult. Low bone mass that is not low enough to be diagnosed as osteoporosis is referred to as osteopenia. Prevention of osteoporosis begins with adequate calcium intake in one’s teens and thereafter with increased attention to getting adequate amounts after menopause. Adequate vitamin D (from sunlight, foods, or supplements) is essential to absorbing calcium. Weight bearing exercise, hormone replacement therapy (HRT), decreased alcohol, protein, salt and caffeine consumption, and smoking cessation can also minimize bone loss. HRT may offer some protection against heart disease, cognitive impairment and bone loss, but also may present risks for cervical cancer.
15. A person’s height tends to decline in old age.

True. Due to osteoporosis, osteoarthritis and a lifetime of wear and tear, upper vertebrae are weakened; joint spaces and buffering tissues wear, and muscles atrophy. These changes foster decreased padding between vertebral discs, which accounts for a loss of height. Starting at about age 40, people typically lose about .4 inch each decade and height loss may be even more rapid after age 70. The tendency to become shorter occurs among all races and in both sexes. You can help minimize loss of height by following a healthy diet, staying physically active, and preventing and treating bone loss (osteoporosis). Getting

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 7

enough calcium and vitamin D is also important to keeping bones strong. E

strengthen back muscles and the body’s core may be particularly beneficial. Some research

16. Physical strength declines in old age. True. Muscle mass declines, cartilage erodes, membranes fibrose (harden), and fluid thickens. These contribute to stiffness, gait problems, lessened mobility, and limited range of motion.
17. Most old people lose interest in and capacity for sexual relations.
    False. Sexuality, which Waite et al. (2009) define as “the dynamic outcome of physical capacity, motivation, attitudes, opportunity for partnership, and sexual conduct,” exists Sexuality is related to overall health with those whose health is rated as excellent or good being nearly twice as likely to be sexually active as those whose health is rated as poorer. ormal aging physical changes in both men and women sometimes affect the ability of an older adult to have and enjoy sex.

    A woman’s vagina may shorten and narrow and her vaginal walls become thinner and stiffer which leads to less vaginal lubrication and effects on sexual function and/or pleasure. As men age, impotence (also known as erectile dysfunction – ED) becomes more common. ED may cause a man to take longer to have an erection and it may not be as firm or large as it used to be. Additionally, the loss of erection after orgasm may happen more quickly or it may take longer before an erection is possible. Medications taken for chronic conditions such as arthritis, chronic pain, dementia, diabetes, heart disease, incontinence, stroke and depression might cause sexual problems leading to ED in men and vaginal dryness and difficulty with arousal or orgasm in women. Patient education and counseling and ability to clinically identify sexual problems can help resolve some of these issues.

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 8

xercises that

has suggested that yoga may be helpful in preventing spine curvature that contributes to

height loss.

18. Bladder capacity decreases with age, which leads to frequent urination. True. Symptoms in the lower urinary tract are more prevalent among the older adults, and clinical studies have demonstrated advancing age to be associated with a reduced bladder capacity. The elastic tissue becomes tough and the bladder becomes less stretchy resulting in the bladder not holding as much urine as before. Blockage of the urethra can occur which in women is due to weakened muscles that cause the bladder or vagina to fall out of position (prolapsed). In men, the urethra can become blocked by an enlarged prostate. Aging increases the risk of kidney and bladder problems and can lead to bladder control issues such as urinary incontinence or leakage, or urinary retention which means you are not able to completely empty your bladder. Urinary tract infections (UTIs) are also common as we age as well as an increased chance for chronic kidney disease.
19. Kidney function is not affected by age. False. The overall amount of kidney tissue decreases as well as the number of filtering units (nephrons). Nephrons filter waste material from the blood. Blood vessels supplying the kidneys can become hardened which causes the kidneys to filter blood more slowly. With aging, there is a decrease in glomerular filtration rate (GFR) and renal blood flow (RBF). The GFR is maintained at approximately 140 ml/min/1.73 m until the fourth decade. GFR declines by about 8 ml/min/1.73 per decade thereafter. Similar changes in RBF occur and it is well maintained at about 600 ml/min until approximately the fourth decade, and then declines by about 10 percent per decade. Additionally, as a person ages, the kidneys undergo a multitude of structural and functional changes. Structural changes include decreased renal mass, renal cortex and the number of glomeruli, and increased glomerular sclerosis. Aging also is associated with tubule-interstitial fibrosis, scarring, infarction and loss of tubular mass. These structural changes are responsible for the reduced renal size of the aging kidney. Furthermore, the age related changes in the kidneys may be further complicated by concurrent comorbidities common in old age, such as hypertension, diabetes, congestive cardiac failure, atherosclerosis, urinary tract outflow obstruction, recurrent urinary tract infections and drug-induced nephrotoxicity. It is not clear as to what extent a decline in GFR with age is physiological and what level of GFR should be considered abnormal. In summary, renal function declines physiologically with advancing age and pathologically as a result of associated diabetes and hypertension.
20. Increased problems with constipation represent a normal change as people get older. False. Although some normal changes with aging in the gastrointestinal tract (decreased GI muscle strength and motility, lax sphincters, lowered juices) may contribute to problems with constipation, studies show little difference in colon activity of healthy older and younger people. When constipation exists, it is usually the result of factors such as inadequate exercise, a diet low in fiber, inadequate fluid intake, and certain medications. Certain health conditions can contribute to constipation—such as depression, hypothyroidism, neurological diseases like Parkinson’s, or even bowel cancer. It is important to find the source of the constipation and treat it.

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 9

21. All five senses tend to decline with age. True. While there is considerable individual variation, on average sensory processes (vision, hearing, taste, smell, and touch) don’t work as well as people get older. Another way to say it is that the threshold at which we take in stimuli increases with age. The eye lens, for example, is less able to change shape so as to adjust to close and far objects, and the size of the pupil narrows so as to let in less light. Hearing loss begins at age 20, and for many involves growing inability to hear higher frequencies as sensory receptors in the ear and nerve cells in the auditory pathway to the brain are lost. Taste buds become less sensitive with aging, and after age 80 more than 75 percent of older adults show major impairment in their sense of smell. Many of these normal changes can be compensated for through increasingly sophisticated assistive devices (hearing aids, glasses, etc.) and through modifications of the older person’s environment.
22. As people live longer, they face fewer acute conditions and more chronic health conditions. True. The incidence of acute or temporary conditions, such as infections or the common cold, decreases with age, although those that do occur can be more debilitating and require more care. Older people are much more likely than the young to suffer from chronic conditions. These are long-term (more than three months), often permanent, and leave a residual disability that may require long- term management or care rather than cure.
23. Retirement is often detrimental to health–i.e., people frequently seem to become ill or die soon after retirement. False. While studies show both negative and positive correlations between retirement and health outcomes (including mortality), there is no clear evidence that retirement is actually a causal factor in health declines or mortality. The reverse is true for some as shown in the longitudinal Health and Retirement Study (HRS) where health was given as a reason for retirement among younger retirees but seldom for older retirees. With the exception of some who retire due to involuntary job loss, for most the retirement event does not appear to influence declines in either physical or mental health. Health decline is related to age or previous health problems, not retirement per se. Retirement may actually improve functional health by reducing stress on the individual. Studies based on HRS data have shown increased happiness and life satisfaction and reduced loneliness among retirees.

Breytspraak, L. & Badura, L. (2015). Facts on Aging Quiz (revised; based on Palmore (1977; 1981)). http://info.umkc.edu/aging/quiz/ 10