{"id":3538,"date":"2019-06-17T15:26:48","date_gmt":"2019-06-17T15:26:48","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/?post_type=chapter&#038;p=3538"},"modified":"2024-04-30T19:52:10","modified_gmt":"2024-04-30T19:52:10","slug":"health-in-late-adulthood-secondary-aging","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-lifespandevelopment\/chapter\/health-in-late-adulthood-secondary-aging\/","title":{"raw":"Health in Late Adulthood: Secondary Aging","rendered":"Health in Late Adulthood: Secondary Aging"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Outcomes<\/h3>\r\n<ul>\r\n \t<li>Explain secondary aging concerns that are common in late adulthood, including illnesses and diseases<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Secondary Aging<\/h2>\r\n<strong>Secondary aging<\/strong>\u00a0refers to changes that are caused by illness or disease. These illnesses reduce independence, impact quality of life, affect family members and other caregivers, and bring financial burden.\u00a0The major difference between primary aging and secondary aging is that p<span style=\"font-size: 1em;\">rimary aging is irreversible and is due to genetic predisposition; secondary aging is potentially reversible and is a result of illness, health habits, and other individual differences.<\/span>\r\n<h2>Chronic Illnesses <del><\/del><del><\/del><\/h2>\r\n[caption id=\"attachment_3541\" align=\"alignleft\" width=\"430\"]<img class=\"wp-image-3541\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2019\/06\/17152045\/man-person-photography-old-monument-male-1046462-pxhere.com_.jpg\" alt=\"Older man resting his head in his hand.\" width=\"430\" height=\"306\" \/> <strong>Figure 1<\/strong>. Secondary aging refers to the aspects of aging that are not universally shared by everyone, but are brought about by disease or chronic illness.[\/caption]\r\n\r\nIn the United States, nearly one in two Americans (133 million) has at least one chronic medical condition, with most subjects (58%) between the ages of 18 and 64.<sup id=\"cite_ref-RobertWood_27-0\" class=\"reference\"><\/sup>\u00a0The number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million.<sup id=\"cite_ref-RobertWood_27-1\" class=\"reference\"><\/sup>\u00a0The most common chronic conditions are\u00a0high blood pressure,\u00a0arthritis, respiratory diseases like\u00a0emphysema, and\u00a0high cholesterol.\r\n\r\nAccording to research by the Centers for Disease Control and Prevention, chronic disease is also especially a concern with older populations in America. Chronic diseases like stroke, heart disease, and cancer are among the leading causes of death among Americans aged 65 or older. While the majority of chronic conditions are found in individuals between the ages of 18 and 64, it is estimated that at least 80% of older Americans are currently living with some form of a chronic condition, with 50% of this population having two or more chronic conditions.\u00a0The two most common chronic conditions are high blood pressure and arthritis, with diabetes, coronary heart disease, and cancer also being reported at high rates among older populations.\u00a0The presence of type 2 diabetes, high blood pressure, and obesity, is termed \"metabolic syndrome\" and impacts 50% of individuals over the age of 60.[footnote]Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the Metabolic Syndrome in the United States, 2003-2012. JAMA. 2015;313(19):1973\u20131974. doi:10.1001\/jama.2015.4260[\/footnote]\r\n\r\nHeart disease is the leading cause of death from chronic disease for adults older than 65, followed by cancer, stroke, diabetes, chronic lower respiratory diseases, influenza and pneumonia, and, finally, Alzheimer\u2019s disease (which we'll examine further when we talk about cognitive decline).\u00a0Though the rates of chronic disease differ by race for those living with chronic illness, the statistics for leading causes of death among people over 65 are nearly identical across racial\/ethnic groups.\r\n<h3>Heart Disease<\/h3>\r\nAs stated above, heart disease is the leading cause of death from chronic disease for adults older than 65.\u00a0Cardiovascular disease\u00a0(CVD) is a class of diseases that involve the\u00a0heart\u00a0or\u00a0blood vessels.<sup id=\"cite_ref-WHO2011_2-3\" class=\"reference\"><\/sup>\u00a0CVD includes\u00a0coronary artery diseases\u00a0(CAD) such as\u00a0angina\u00a0and\u00a0myocardial infarction\u00a0(commonly known as a heart attack).<sup id=\"cite_ref-WHO2011_2-4\" class=\"reference\"><\/sup>\u00a0Other CVDs include\u00a0stroke,\u00a0heart failure,\u00a0hypertensive heart disease,\u00a0rheumatic heart disease,\u00a0cardiomyopathy,\u00a0heart arrhythmia,\u00a0congenital heart disease,\u00a0valvular heart disease,\u00a0carditis,\u00a0aortic aneurysms,\u00a0peripheral artery disease,\u00a0thromboembolic disease, and\u00a0venous thrombosis.\r\n\r\nThe underlying mechanisms vary depending on the disease.\u00a0Coronary artery disease, stroke, and peripheral artery disease involve\u00a0atherosclerosis.\u00a0<sup id=\"cite_ref-WHO2011_2-7\" class=\"reference\"><\/sup>This may be caused by\u00a0high blood pressure,\u00a0smoking,\u00a0diabetes mellitus, lack of\u00a0exercise,\u00a0obesity,\u00a0high blood cholesterol, poor diet, and excessive\u00a0alcohol\u00a0consumption, among others.<sup id=\"cite_ref-WHO2011_2-8\" class=\"reference\"><\/sup>\u00a0High blood pressure is estimated to account for approximately 13% of CVD deaths, while tobacco accounts for 9%, diabetes 6%, lack of exercise 6% and obesity 5%.<sup id=\"cite_ref-WHO2011_2-10\" class=\"reference\"><\/sup>\r\n\r\nIt is estimated that up to 90% of CVD may be preventable. Prevention of CVD involves improving risk factors through:\u00a0healthy eating, exercise, avoidance of tobacco smoke and limiting alcohol intake.\u00a0Treating risk factors, such as high blood pressure, blood lipids and diabetes is also beneficial. The use of\u00a0aspirin\u00a0in people, who are otherwise healthy, is of unclear benefit.\r\n<h3>Cancer<\/h3>\r\nAge in itself is one of the most important risk factors for developing cancer. Currently, 60% of newly diagnosed malignant tumors and 70% of cancer deaths occur in people aged 65 years or older. Many cancers are linked to aging; these include breast, colorectal, prostate, pancreatic, lung, bladder and stomach cancer<span style=\"color: #333333;\">s.\u00a0Men over 75 have the highest rates of cancer at 28 percent.\u00a0Women 65 and older have rates of 17 percent.\u00a0Rates for older non-Hispanic Whites are twice as high as for Hispanics and non-Hispanic Blacks.\u00a0The\u00a0most common types of cancer found in men are prostate and lung cancer.\u00a0Breast and lung cancer are the most common forms in women.<\/span>\r\n\r\n[caption id=\"attachment_2777\" align=\"aligncenter\" width=\"657\"]<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2019\/01\/26121003\/Screen-Shot-2019-04-26-at-8.09.49-AM.png\"><img class=\"wp-image-2777 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2019\/01\/26121003\/Screen-Shot-2019-04-26-at-8.09.49-AM.png\" alt=\"Rate of new cancers by age group showing that the risk of cancer increases with age, with those above age 70 being diagnosed with cancer roughly 2,000 out of 100,000 people.\" width=\"657\" height=\"485\" \/><\/a> <strong>Figure 2<\/strong>. Age is a risk factor for cancer development. Source: https:\/\/gis.cdc.gov\/Cancer\/USCS\/DataViz.html.[\/caption]\r\n\r\nFor many reasons, older adults with cancer have different needs than younger adults with the disease. For example, older adults:\r\n<ul>\r\n \t<li>May be less able to tolerate certain cancer treatments.<\/li>\r\n \t<li>Have a decreased reserve (the capacity to respond to disease and treatment).<\/li>\r\n \t<li>May have other medical problems in addition to cancer.<\/li>\r\n \t<li>May have functional problems, such as the ability to do basic activities (dressing, bathing, eating) or more advanced activities (such as using transportation, going shopping or handling finances), and have less available family support to assist them as they go through treatment.<\/li>\r\n \t<li>May not always have access to transportation, social support or financial resources.<\/li>\r\n \t<li>May have different views of quality versus quantity of life<\/li>\r\n<\/ul>\r\n[caption id=\"attachment_931\" align=\"aligncenter\" width=\"506\"]<img class=\"wp-image-931\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/17011755\/cancer-prevalence.png\" alt=\"Line graph of respondent-reported lifetime cancer prevalence. Over 25% of men over 75 report cancer, around 15% between 65 and 74 report cancer, less than 5% of men between 45 and 64 report cancer, and around 1 percent of 18 to 44 year old men report cancer. Around 18% of women over 75 report cancer, and nearly 15% of those between 65 and 74. About 8% of 45 to 64 year old women report cancer and about 4% of 18 to 44 year old women report cancer. \" width=\"506\" height=\"375\" \/> <strong>Figure 3<\/strong>. Cancer rates are significantly higher for those above age 65, and is more common in men than in women.[\/caption]\r\n<h3><strong>Hypertension and Stroke<\/strong><\/h3>\r\n<strong>Hypertension<\/strong> or high blood pressure and associated heart disease and circulatory conditions increase with age.\u00a0Stroke\u00a0is a leading cause of death and severe, long-term disability. Most people who\u2019ve had a first stroke also had\u00a0high blood pressure\u00a0(HBP or hypertension).High blood pressure damages arteries throughout the body, creating conditions where they can burst or clog more easily. Weakened arteries in the brain, resulting from high blood pressure,\u00a0increase the\u00a0risk for stroke\u2014which is why\u00a0managing high blood pressure\u00a0is critical to reduce\u00a0the\u00a0chance of having a stroke. Hypertension disables 11.1 percent of 65 to 74 year olds and 17.1 percent of people over 75.\u00a0Rates are higher among women and Black people.\u00a0Rates are highest for women over 75. Coronary disease and stroke are higher among older men than women. The incidence of stroke is lower than that of coronary disease, but\u00a0it is the No. 5 cause of death and a leading cause of disability in the United States.[footnote]How High Blood Pressure Can Lead to Stroke. Retrieved from\u00a0https:\/\/www.heart.org\/en\/health-topics\/high-blood-pressure\/health-threats-from-high-blood-pressure\/how-high-blood-pressure-can-lead-to-stroke.[\/footnote][footnote]About Stroke. American Stroke Association. Retrieved from <a href=\"https:\/\/www.strokeassociation.org\/en\/about-stroke\" target=\"_blank\" rel=\"noopener\">https:\/\/www.strokeassociation.org\/en\/about-stroke<\/a>.[\/footnote]\r\n<h3><b>Arthritis\u00a0<\/b><\/h3>\r\nWhile <strong>arthritis<\/strong> can affect children, it is predominantly a disease of people over 65. Arthritis is more common in women than men at all ages and affects all races,\u00a0ethnic groups\u00a0and cultures. In the United States a CDC survey based on data from 2007\u20132009 showed 22.2% (49.9 million) of adults aged \u226518 years had self-reported doctor-diagnosed arthritis, and 9.4% (21.1 million or 42.4% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population, this number is expected to increase.<sup id=\"cite_ref-61\" class=\"reference\"><\/sup>\r\n\r\nArthritis\u00a0is a term often used to mean any disorder that affects\u00a0joints.\u00a0<sup id=\"cite_ref-NIH2014_2-1\" class=\"reference\"><\/sup>Symptoms\u00a0generally include\u00a0joint pain\u00a0and stiffness.\u00a0<sup id=\"cite_ref-NIH2014_2-2\" class=\"reference\"><\/sup>Other symptoms may include redness, warmth,\u00a0swelling, and decreased\u00a0range of motion\u00a0of the affected joints.\u00a0<sup id=\"cite_ref-NIH2014_2-3\" class=\"reference\"><\/sup><sup id=\"cite_ref-CDC2016_3-1\" class=\"reference\"><\/sup>In some types\u00a0of arthritis, other organs are also affected.\u00a0<sup id=\"cite_ref-NIH2014Liv_6-2\" class=\"reference\"><\/sup>Onset can be gradual or sudden.<sup id=\"cite_ref-CDC2016Bas_5-1\" class=\"reference\"><\/sup>\r\n\r\nThere are over 100 types of arthritis.\u00a0<sup id=\"cite_ref-Ath2013_4-1\" class=\"reference\"><\/sup>The most common forms are\u00a0osteoarthritis\u00a0(degenerative joint disease) and\u00a0rheumatoid arthritis.\u00a0<sup id=\"cite_ref-NIH2014Liv_6-3\" class=\"reference\"><\/sup>Osteoarthritis usually\u00a0increases in frequency with age and affects the fingers, knees, and hips.\u00a0<sup id=\"cite_ref-NIH2014Liv_6-4\" class=\"reference\"><\/sup>Rheumatoid arthritis is an\u00a0autoimmune disorder\u00a0that often affects the hands and feet.\u00a0<sup id=\"cite_ref-NIH2014Liv_6-5\" class=\"reference\"><\/sup>Other types include\u00a0gout,\u00a0lupus,\u00a0fibromyalgia, and\u00a0septic arthritis.\u00a0They are all types of\u00a0rheumatic disease<sup id=\"cite_ref-NIH2014_2-4\" class=\"reference\"><\/sup>\r\n\r\nTreatment may include resting the joint and alternating between applying ice and heat.\u00a0Weight loss and exercise may also be useful.\u00a0Pain medications such as\u00a0ibuprofen\u00a0and\u00a0paracetamol (acetaminophen) may be used.\u00a0In some a\u00a0joint replacement\u00a0may be useful.\r\n\r\n[caption id=\"attachment_933\" align=\"aligncenter\" width=\"525\"]<img class=\"wp-image-933\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/17011803\/jointpain.png\" alt=\"percentage of people who complain of joint pain within the past 30 days. Around 50% of adults 75 years and older experienced joint pain, and between 45-50% of adults between 65-74, around 40% of adults between 44-64, and around 20% between ages 18 and 44.\" width=\"525\" height=\"388\" \/> <strong>Figure 4<\/strong>. Joint pain increases with age.[\/caption]\r\n\r\n<div class=\"textbox tryit\">\r\n<h3>Older Americans &amp; Cardiovascular Diseases<\/h3>\r\nVisit this\u00a0<a href=\"https:\/\/www.heart.org\/idc\/groups\/heart-public\/@wcm\/@sop\/@smd\/documents\/downloadable\/ucm_483970.pdf\" target=\"_blank\" rel=\"noopener\">statistical fact sheet from the American Heart Association<\/a> to learn more about some facts and figures related to heart disease.\r\n\r\n<\/div>\r\n<h3><strong>Diabetes<\/strong><del><\/del><\/h3>\r\n<strong>Type 2 diabetes (T2D<\/strong>), formerly known as adult-onset diabetes, is a form of diabetes characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.\r\n\r\nType 2 diabetes primarily occurs as a result of obesity and lack of exercise. Some people are more genetically at risk than others. Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to type 1 diabetes and gestational diabetes. In type 1 diabetes there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas. Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).\r\n\r\nType 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly. Treatment involves exercise and dietary changes. If blood sugar levels are not adequately lowered, the medication metformin is typically recommended. Many people may eventually also require insulin injections. In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills. Bariatric surgery often improves diabetes in those who are obese.\r\n\r\nRates of type 2 diabetes have increased markedly since 1960 in parallel with obesity. As of 2015 there were approximately 392 million people diagnosed with the disease compared to around 30 million in 1985. Typically it begins in middle or older age, although rates of type 2 diabetes are increasing in young people. Type 2 diabetes is associated with a ten-year-shorter life expectancy.\r\n\r\n[caption id=\"attachment_3539\" align=\"aligncenter\" width=\"790\"]<img class=\"wp-image-3539\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2019\/06\/17150307\/45543831991_383508462a_o.jpg\" alt=\"Number and percentage of U.S. Population with diagnosed diabetes from 1958 to 2015. This graph shows a dramatic increase of diagnosed diabetes in the U.S. population from the percentage of around 1% in 1958, to 7% in 2015. About 2.5 million people had diabetes in the U.S. in 1958 and in 2015 that number had risen to approximately 23 million people.\" width=\"790\" height=\"610\" \/> <strong>Figure 5<\/strong>. In 1990, 2.52% of the total population had diabetes. It\u2019s now 9% of total, 12% of adults. It\u2019s estimated that 25% of adults will have diabetes in the US by 2030, 33% by 2050.<br \/><br \/>[\/caption]\r\n<h3><strong>Osteoporosis<\/strong><\/h3>\r\n<strong>Osteoporosis<\/strong> comes from the Greek word for \"porous bones\" and is a disease in which bone weakening increases the risk of a broken bone.\u00a0It is defined as having a bone density of 2.5 standard deviations below that of a healthy young adult. Osteoporosis increases with age as bones become brittle and lose minerals. It is the most common reason for a broken bone among older women.\r\n\r\nOsteoporosis becomes more common with age. About 15% of white people in their 50s and 70% of those over 80 are affected. It is four times more likely to affect women than men\u2014in the developed world, depending on the method of diagnosis, 2% to 8% of males and 9% to 38% of females are affected. In the United States in 2010, about eight million women and one to two million men had osteoporosis. White and Asian people are at greater risk are more likely to have osteoporosis than non-Hispanic blacks.\r\n<h3>Parkinson's Disease<\/h3>\r\n<strong>Parkinson's disease<\/strong> (PD) is a long-term degenerative disorder of the central nervous system\u00a0which\u00a0mainly affects the motor system, although as the disease worsens, non-motor symptoms become increasingly common. Early in the disease, the most obvious symptoms are shaking, rigidity, slowness of movement, and difficulty with walking, but thinking and behavioral problems may also occur.\u00a0Dementia becomes common in the advanced stages of the disease, and depression and anxiety also occur in more than a third of people with PD.\r\n\r\nThe cause of Parkinson's disease is generally unknown, but believed to involve both genetic and environmental factors. Those with a family member affected are more likely to get the disease themselves. There is also an increased risk in people exposed to certain pesticides and among those who have had prior head injuries, while there is a reduced risk in tobacco smokers (though smokers are at a substantially greater risk of stroke)\u00a0and those who drink coffee or tea. The motor symptoms of the disease result from the death of cells in the substantia nigra, a region of the midbrain, which results in not enough dopamine in these areas. The reason for this cell death is poorly understood, but involves the build-up of proteins into Lewy bodies in the neurons.\r\n\r\nIn 2015, PD affected 6.2 million people and resulted in about 117,400 deaths globally. Parkinson's disease typically occurs in people over the age of 60, of which about one percent are affected. Males are more often affected than females at a ratio of around 3:2. The average life expectancy following diagnosis is between 7 and 14 years. People with Parkinson's who have increased the public's awareness of the condition include actor Michael J. Fox, Olympic cyclist Davis Phinney, and professional boxer Muhammad Ali.\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<span style=\"color: #800000;\">\u00a0<\/span><\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/acf61196-70f4-40b6-8f54-9e35aec06179\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Glossary<\/h3>\r\n[glossary-page]\r\n[glossary-term]arthritis:[\/glossary-term]\r\n[glossary-definition]arthritis is inflammation of one or more of the joints, characterized by joint pain and stiffness, which typically worsen with age[\/glossary-definition]\r\n\r\n[glossary-term]hypertension:[\/glossary-term]\r\n[glossary-definition]high blood pressure that can lead to severe complications and increases the risk of heart disease, stroke, and death[\/glossary-definition]\r\n\r\n[glossary-term]secondary aging:[\/glossary-term]\r\n[glossary-definition]refers to changes that are caused by illness or disease[\/glossary-definition]\r\n\r\n[glossary-term]osteoporosis:[\/glossary-term]\r\n[glossary-definition]a condition in which the bones become brittle, fragile, and thin, often brought about by a lack of calcium in the diet[\/glossary-definition]\r\n\r\n[glossary-term]Parkinson's disease:[\/glossary-term]\r\n[glossary-definition]long-term degenerative disorder of the central nervous system which mainly affects the motor system, first characterized by shaking, rigidity, slowness of movement, and difficulty with walking, but thinking and behavioral problems may also occur[\/glossary-definition]\r\n\r\n[glossary-term]type 2 diabetes (T2D):[\/glossary-term]\r\n[glossary-definition]diabetes characterized by high blood sugar, insulin resistance, and relative lack of insulin primarily from obesity or lack of exercise[\/glossary-definition]\r\n[\/glossary-page]\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Outcomes<\/h3>\n<ul>\n<li>Explain secondary aging concerns that are common in late adulthood, including illnesses and diseases<\/li>\n<\/ul>\n<\/div>\n<h2>Secondary Aging<\/h2>\n<p><strong>Secondary aging<\/strong>\u00a0refers to changes that are caused by illness or disease. These illnesses reduce independence, impact quality of life, affect family members and other caregivers, and bring financial burden.\u00a0The major difference between primary aging and secondary aging is that p<span style=\"font-size: 1em;\">rimary aging is irreversible and is due to genetic predisposition; secondary aging is potentially reversible and is a result of illness, health habits, and other individual differences.<\/span><\/p>\n<h2>Chronic Illnesses <del><\/del><del><\/del><\/h2>\n<div id=\"attachment_3541\" style=\"width: 440px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3541\" class=\"wp-image-3541\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2019\/06\/17152045\/man-person-photography-old-monument-male-1046462-pxhere.com_.jpg\" alt=\"Older man resting his head in his hand.\" width=\"430\" height=\"306\" \/><\/p>\n<p id=\"caption-attachment-3541\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Secondary aging refers to the aspects of aging that are not universally shared by everyone, but are brought about by disease or chronic illness.<\/p>\n<\/div>\n<p>In the United States, nearly one in two Americans (133 million) has at least one chronic medical condition, with most subjects (58%) between the ages of 18 and 64.<sup id=\"cite_ref-RobertWood_27-0\" class=\"reference\"><\/sup>\u00a0The number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million.<sup id=\"cite_ref-RobertWood_27-1\" class=\"reference\"><\/sup>\u00a0The most common chronic conditions are\u00a0high blood pressure,\u00a0arthritis, respiratory diseases like\u00a0emphysema, and\u00a0high cholesterol.<\/p>\n<p>According to research by the Centers for Disease Control and Prevention, chronic disease is also especially a concern with older populations in America. Chronic diseases like stroke, heart disease, and cancer are among the leading causes of death among Americans aged 65 or older. While the majority of chronic conditions are found in individuals between the ages of 18 and 64, it is estimated that at least 80% of older Americans are currently living with some form of a chronic condition, with 50% of this population having two or more chronic conditions.\u00a0The two most common chronic conditions are high blood pressure and arthritis, with diabetes, coronary heart disease, and cancer also being reported at high rates among older populations.\u00a0The presence of type 2 diabetes, high blood pressure, and obesity, is termed &#8220;metabolic syndrome&#8221; and impacts 50% of individuals over the age of 60.<a class=\"footnote\" title=\"Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the Metabolic Syndrome in the United States, 2003-2012. JAMA. 2015;313(19):1973\u20131974. doi:10.1001\/jama.2015.4260\" id=\"return-footnote-3538-1\" href=\"#footnote-3538-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<p>Heart disease is the leading cause of death from chronic disease for adults older than 65, followed by cancer, stroke, diabetes, chronic lower respiratory diseases, influenza and pneumonia, and, finally, Alzheimer\u2019s disease (which we&#8217;ll examine further when we talk about cognitive decline).\u00a0Though the rates of chronic disease differ by race for those living with chronic illness, the statistics for leading causes of death among people over 65 are nearly identical across racial\/ethnic groups.<\/p>\n<h3>Heart Disease<\/h3>\n<p>As stated above, heart disease is the leading cause of death from chronic disease for adults older than 65.\u00a0Cardiovascular disease\u00a0(CVD) is a class of diseases that involve the\u00a0heart\u00a0or\u00a0blood vessels.<sup id=\"cite_ref-WHO2011_2-3\" class=\"reference\"><\/sup>\u00a0CVD includes\u00a0coronary artery diseases\u00a0(CAD) such as\u00a0angina\u00a0and\u00a0myocardial infarction\u00a0(commonly known as a heart attack).<sup id=\"cite_ref-WHO2011_2-4\" class=\"reference\"><\/sup>\u00a0Other CVDs include\u00a0stroke,\u00a0heart failure,\u00a0hypertensive heart disease,\u00a0rheumatic heart disease,\u00a0cardiomyopathy,\u00a0heart arrhythmia,\u00a0congenital heart disease,\u00a0valvular heart disease,\u00a0carditis,\u00a0aortic aneurysms,\u00a0peripheral artery disease,\u00a0thromboembolic disease, and\u00a0venous thrombosis.<\/p>\n<p>The underlying mechanisms vary depending on the disease.\u00a0Coronary artery disease, stroke, and peripheral artery disease involve\u00a0atherosclerosis.\u00a0<sup id=\"cite_ref-WHO2011_2-7\" class=\"reference\"><\/sup>This may be caused by\u00a0high blood pressure,\u00a0smoking,\u00a0diabetes mellitus, lack of\u00a0exercise,\u00a0obesity,\u00a0high blood cholesterol, poor diet, and excessive\u00a0alcohol\u00a0consumption, among others.<sup id=\"cite_ref-WHO2011_2-8\" class=\"reference\"><\/sup>\u00a0High blood pressure is estimated to account for approximately 13% of CVD deaths, while tobacco accounts for 9%, diabetes 6%, lack of exercise 6% and obesity 5%.<sup id=\"cite_ref-WHO2011_2-10\" class=\"reference\"><\/sup><\/p>\n<p>It is estimated that up to 90% of CVD may be preventable. Prevention of CVD involves improving risk factors through:\u00a0healthy eating, exercise, avoidance of tobacco smoke and limiting alcohol intake.\u00a0Treating risk factors, such as high blood pressure, blood lipids and diabetes is also beneficial. The use of\u00a0aspirin\u00a0in people, who are otherwise healthy, is of unclear benefit.<\/p>\n<h3>Cancer<\/h3>\n<p>Age in itself is one of the most important risk factors for developing cancer. Currently, 60% of newly diagnosed malignant tumors and 70% of cancer deaths occur in people aged 65 years or older. Many cancers are linked to aging; these include breast, colorectal, prostate, pancreatic, lung, bladder and stomach cancer<span style=\"color: #333333;\">s.\u00a0Men over 75 have the highest rates of cancer at 28 percent.\u00a0Women 65 and older have rates of 17 percent.\u00a0Rates for older non-Hispanic Whites are twice as high as for Hispanics and non-Hispanic Blacks.\u00a0The\u00a0most common types of cancer found in men are prostate and lung cancer.\u00a0Breast and lung cancer are the most common forms in women.<\/span><\/p>\n<div id=\"attachment_2777\" style=\"width: 667px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2019\/01\/26121003\/Screen-Shot-2019-04-26-at-8.09.49-AM.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-2777\" class=\"wp-image-2777 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2019\/01\/26121003\/Screen-Shot-2019-04-26-at-8.09.49-AM.png\" alt=\"Rate of new cancers by age group showing that the risk of cancer increases with age, with those above age 70 being diagnosed with cancer roughly 2,000 out of 100,000 people.\" width=\"657\" height=\"485\" \/><\/a><\/p>\n<p id=\"caption-attachment-2777\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. Age is a risk factor for cancer development. Source: https:\/\/gis.cdc.gov\/Cancer\/USCS\/DataViz.html.<\/p>\n<\/div>\n<p>For many reasons, older adults with cancer have different needs than younger adults with the disease. For example, older adults:<\/p>\n<ul>\n<li>May be less able to tolerate certain cancer treatments.<\/li>\n<li>Have a decreased reserve (the capacity to respond to disease and treatment).<\/li>\n<li>May have other medical problems in addition to cancer.<\/li>\n<li>May have functional problems, such as the ability to do basic activities (dressing, bathing, eating) or more advanced activities (such as using transportation, going shopping or handling finances), and have less available family support to assist them as they go through treatment.<\/li>\n<li>May not always have access to transportation, social support or financial resources.<\/li>\n<li>May have different views of quality versus quantity of life<\/li>\n<\/ul>\n<div id=\"attachment_931\" style=\"width: 516px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-931\" class=\"wp-image-931\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/17011755\/cancer-prevalence.png\" alt=\"Line graph of respondent-reported lifetime cancer prevalence. Over 25% of men over 75 report cancer, around 15% between 65 and 74 report cancer, less than 5% of men between 45 and 64 report cancer, and around 1 percent of 18 to 44 year old men report cancer. Around 18% of women over 75 report cancer, and nearly 15% of those between 65 and 74. About 8% of 45 to 64 year old women report cancer and about 4% of 18 to 44 year old women report cancer.\" width=\"506\" height=\"375\" \/><\/p>\n<p id=\"caption-attachment-931\" class=\"wp-caption-text\"><strong>Figure 3<\/strong>. Cancer rates are significantly higher for those above age 65, and is more common in men than in women.<\/p>\n<\/div>\n<h3><strong>Hypertension and Stroke<\/strong><\/h3>\n<p><strong>Hypertension<\/strong> or high blood pressure and associated heart disease and circulatory conditions increase with age.\u00a0Stroke\u00a0is a leading cause of death and severe, long-term disability. Most people who\u2019ve had a first stroke also had\u00a0high blood pressure\u00a0(HBP or hypertension).High blood pressure damages arteries throughout the body, creating conditions where they can burst or clog more easily. Weakened arteries in the brain, resulting from high blood pressure,\u00a0increase the\u00a0risk for stroke\u2014which is why\u00a0managing high blood pressure\u00a0is critical to reduce\u00a0the\u00a0chance of having a stroke. Hypertension disables 11.1 percent of 65 to 74 year olds and 17.1 percent of people over 75.\u00a0Rates are higher among women and Black people.\u00a0Rates are highest for women over 75. Coronary disease and stroke are higher among older men than women. The incidence of stroke is lower than that of coronary disease, but\u00a0it is the No. 5 cause of death and a leading cause of disability in the United States.<a class=\"footnote\" title=\"How High Blood Pressure Can Lead to Stroke. Retrieved from\u00a0https:\/\/www.heart.org\/en\/health-topics\/high-blood-pressure\/health-threats-from-high-blood-pressure\/how-high-blood-pressure-can-lead-to-stroke.\" id=\"return-footnote-3538-2\" href=\"#footnote-3538-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><a class=\"footnote\" title=\"About Stroke. American Stroke Association. Retrieved from https:\/\/www.strokeassociation.org\/en\/about-stroke.\" id=\"return-footnote-3538-3\" href=\"#footnote-3538-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<h3><b>Arthritis\u00a0<\/b><\/h3>\n<p>While <strong>arthritis<\/strong> can affect children, it is predominantly a disease of people over 65. Arthritis is more common in women than men at all ages and affects all races,\u00a0ethnic groups\u00a0and cultures. In the United States a CDC survey based on data from 2007\u20132009 showed 22.2% (49.9 million) of adults aged \u226518 years had self-reported doctor-diagnosed arthritis, and 9.4% (21.1 million or 42.4% of those with arthritis) had arthritis-attributable activity limitation (AAAL). With an aging population, this number is expected to increase.<sup id=\"cite_ref-61\" class=\"reference\"><\/sup><\/p>\n<p>Arthritis\u00a0is a term often used to mean any disorder that affects\u00a0joints.\u00a0<sup id=\"cite_ref-NIH2014_2-1\" class=\"reference\"><\/sup>Symptoms\u00a0generally include\u00a0joint pain\u00a0and stiffness.\u00a0<sup id=\"cite_ref-NIH2014_2-2\" class=\"reference\"><\/sup>Other symptoms may include redness, warmth,\u00a0swelling, and decreased\u00a0range of motion\u00a0of the affected joints.\u00a0<sup id=\"cite_ref-NIH2014_2-3\" class=\"reference\"><\/sup><sup id=\"cite_ref-CDC2016_3-1\" class=\"reference\"><\/sup>In some types\u00a0of arthritis, other organs are also affected.\u00a0<sup id=\"cite_ref-NIH2014Liv_6-2\" class=\"reference\"><\/sup>Onset can be gradual or sudden.<sup id=\"cite_ref-CDC2016Bas_5-1\" class=\"reference\"><\/sup><\/p>\n<p>There are over 100 types of arthritis.\u00a0<sup id=\"cite_ref-Ath2013_4-1\" class=\"reference\"><\/sup>The most common forms are\u00a0osteoarthritis\u00a0(degenerative joint disease) and\u00a0rheumatoid arthritis.\u00a0<sup id=\"cite_ref-NIH2014Liv_6-3\" class=\"reference\"><\/sup>Osteoarthritis usually\u00a0increases in frequency with age and affects the fingers, knees, and hips.\u00a0<sup id=\"cite_ref-NIH2014Liv_6-4\" class=\"reference\"><\/sup>Rheumatoid arthritis is an\u00a0autoimmune disorder\u00a0that often affects the hands and feet.\u00a0<sup id=\"cite_ref-NIH2014Liv_6-5\" class=\"reference\"><\/sup>Other types include\u00a0gout,\u00a0lupus,\u00a0fibromyalgia, and\u00a0septic arthritis.\u00a0They are all types of\u00a0rheumatic disease<sup id=\"cite_ref-NIH2014_2-4\" class=\"reference\"><\/sup><\/p>\n<p>Treatment may include resting the joint and alternating between applying ice and heat.\u00a0Weight loss and exercise may also be useful.\u00a0Pain medications such as\u00a0ibuprofen\u00a0and\u00a0paracetamol (acetaminophen) may be used.\u00a0In some a\u00a0joint replacement\u00a0may be useful.<\/p>\n<div id=\"attachment_933\" style=\"width: 535px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-933\" class=\"wp-image-933\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/1496\/2016\/03\/17011803\/jointpain.png\" alt=\"percentage of people who complain of joint pain within the past 30 days. Around 50% of adults 75 years and older experienced joint pain, and between 45-50% of adults between 65-74, around 40% of adults between 44-64, and around 20% between ages 18 and 44.\" width=\"525\" height=\"388\" \/><\/p>\n<p id=\"caption-attachment-933\" class=\"wp-caption-text\"><strong>Figure 4<\/strong>. Joint pain increases with age.<\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Older Americans &amp; Cardiovascular Diseases<\/h3>\n<p>Visit this\u00a0<a href=\"https:\/\/www.heart.org\/idc\/groups\/heart-public\/@wcm\/@sop\/@smd\/documents\/downloadable\/ucm_483970.pdf\" target=\"_blank\" rel=\"noopener\">statistical fact sheet from the American Heart Association<\/a> to learn more about some facts and figures related to heart disease.<\/p>\n<\/div>\n<h3><strong>Diabetes<\/strong><del><\/del><\/h3>\n<p><strong>Type 2 diabetes (T2D<\/strong>), formerly known as adult-onset diabetes, is a form of diabetes characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.<\/p>\n<p>Type 2 diabetes primarily occurs as a result of obesity and lack of exercise. Some people are more genetically at risk than others. Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to type 1 diabetes and gestational diabetes. In type 1 diabetes there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas. Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).<\/p>\n<p>Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly. Treatment involves exercise and dietary changes. If blood sugar levels are not adequately lowered, the medication metformin is typically recommended. Many people may eventually also require insulin injections. In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills. Bariatric surgery often improves diabetes in those who are obese.<\/p>\n<p>Rates of type 2 diabetes have increased markedly since 1960 in parallel with obesity. As of 2015 there were approximately 392 million people diagnosed with the disease compared to around 30 million in 1985. Typically it begins in middle or older age, although rates of type 2 diabetes are increasing in young people. Type 2 diabetes is associated with a ten-year-shorter life expectancy.<\/p>\n<div id=\"attachment_3539\" style=\"width: 800px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3539\" class=\"wp-image-3539\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/3707\/2019\/06\/17150307\/45543831991_383508462a_o.jpg\" alt=\"Number and percentage of U.S. Population with diagnosed diabetes from 1958 to 2015. This graph shows a dramatic increase of diagnosed diabetes in the U.S. population from the percentage of around 1% in 1958, to 7% in 2015. About 2.5 million people had diabetes in the U.S. in 1958 and in 2015 that number had risen to approximately 23 million people.\" width=\"790\" height=\"610\" \/><\/p>\n<p id=\"caption-attachment-3539\" class=\"wp-caption-text\"><strong>Figure 5<\/strong>. In 1990, 2.52% of the total population had diabetes. It\u2019s now 9% of total, 12% of adults. It\u2019s estimated that 25% of adults will have diabetes in the US by 2030, 33% by 2050.<\/p>\n<\/div>\n<h3><strong>Osteoporosis<\/strong><\/h3>\n<p><strong>Osteoporosis<\/strong> comes from the Greek word for &#8220;porous bones&#8221; and is a disease in which bone weakening increases the risk of a broken bone.\u00a0It is defined as having a bone density of 2.5 standard deviations below that of a healthy young adult. Osteoporosis increases with age as bones become brittle and lose minerals. It is the most common reason for a broken bone among older women.<\/p>\n<p>Osteoporosis becomes more common with age. About 15% of white people in their 50s and 70% of those over 80 are affected. It is four times more likely to affect women than men\u2014in the developed world, depending on the method of diagnosis, 2% to 8% of males and 9% to 38% of females are affected. In the United States in 2010, about eight million women and one to two million men had osteoporosis. White and Asian people are at greater risk are more likely to have osteoporosis than non-Hispanic blacks.<\/p>\n<h3>Parkinson&#8217;s Disease<\/h3>\n<p><strong>Parkinson&#8217;s disease<\/strong> (PD) is a long-term degenerative disorder of the central nervous system\u00a0which\u00a0mainly affects the motor system, although as the disease worsens, non-motor symptoms become increasingly common. Early in the disease, the most obvious symptoms are shaking, rigidity, slowness of movement, and difficulty with walking, but thinking and behavioral problems may also occur.\u00a0Dementia becomes common in the advanced stages of the disease, and depression and anxiety also occur in more than a third of people with PD.<\/p>\n<p>The cause of Parkinson&#8217;s disease is generally unknown, but believed to involve both genetic and environmental factors. Those with a family member affected are more likely to get the disease themselves. There is also an increased risk in people exposed to certain pesticides and among those who have had prior head injuries, while there is a reduced risk in tobacco smokers (though smokers are at a substantially greater risk of stroke)\u00a0and those who drink coffee or tea. The motor symptoms of the disease result from the death of cells in the substantia nigra, a region of the midbrain, which results in not enough dopamine in these areas. The reason for this cell death is poorly understood, but involves the build-up of proteins into Lewy bodies in the neurons.<\/p>\n<p>In 2015, PD affected 6.2 million people and resulted in about 117,400 deaths globally. Parkinson&#8217;s disease typically occurs in people over the age of 60, of which about one percent are affected. Males are more often affected than females at a ratio of around 3:2. The average life expectancy following diagnosis is between 7 and 14 years. People with Parkinson&#8217;s who have increased the public&#8217;s awareness of the condition include actor Michael J. Fox, Olympic cyclist Davis Phinney, and professional boxer Muhammad Ali.<\/p>\n<div class=\"textbox tryit\">\n<h3>Try It<span style=\"color: #800000;\">\u00a0<\/span><\/h3>\n<p>\t<iframe id=\"assessment_practice_acf61196-70f4-40b6-8f54-9e35aec06179\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/acf61196-70f4-40b6-8f54-9e35aec06179?iframe_resize_id=assessment_practice_id_acf61196-70f4-40b6-8f54-9e35aec06179\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>Glossary<\/h3>\n<div class=\"titlepage\">\n<dl>\n<dt>arthritis:<\/dt>\n<dd>arthritis is inflammation of one or more of the joints, characterized by joint pain and stiffness, which typically worsen with age<\/dd>\n<dt>hypertension:<\/dt>\n<dd>high blood pressure that can lead to severe complications and increases the risk of heart disease, stroke, and death<\/dd>\n<dt>secondary aging:<\/dt>\n<dd>refers to changes that are caused by illness or disease<\/dd>\n<dt>osteoporosis:<\/dt>\n<dd>a condition in which the bones become brittle, fragile, and thin, often brought about by a lack of calcium in the diet<\/dd>\n<dt>Parkinson&#8217;s disease:<\/dt>\n<dd>long-term degenerative disorder of the central nervous system which mainly affects the motor system, first characterized by shaking, rigidity, slowness of movement, and difficulty with walking, but thinking and behavioral problems may also occur<\/dd>\n<dt>type 2 diabetes (T2D):<\/dt>\n<dd>diabetes characterized by high blood sugar, insulin resistance, and relative lack of insulin primarily from obesity or lack of exercise<\/dd>\n<\/dl>\n<\/div>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-3538\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Sonja Ann Miller for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li><strong>Authored by<\/strong>: Laura Overstreet. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Chronic conditions. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Chronic_condition\">https:\/\/en.wikipedia.org\/wiki\/Chronic_condition<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Cardiovascular disease. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Cardiovascular_disease#cite_note-WHO2011-2\">https:\/\/en.wikipedia.org\/wiki\/Cardiovascular_disease#cite_note-WHO2011-2<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Arhritis. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Arthritis\">https:\/\/en.wikipedia.org\/wiki\/Arthritis<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Type 2 Diabetes. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Type_2_diabetes#cite_note-NIH2014Diag-3\">https:\/\/en.wikipedia.org\/wiki\/Type_2_diabetes#cite_note-NIH2014Diag-3<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>CDC image on diabetes prevalence. <strong>Authored by<\/strong>: Ted Eytan. <strong>Provided by<\/strong>: Flickr. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.flickr.com\/photos\/taedc\/45543831991\">https:\/\/www.flickr.com\/photos\/taedc\/45543831991<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Geriatric Oncology information about cancer. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Geriatric_oncology\">https:\/\/en.wikipedia.org\/wiki\/Geriatric_oncology<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Parkinson&#039;s Disease. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease\">https:\/\/en.wikipedia.org\/wiki\/Parkinson%27s_disease<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Osteoporosis. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Osteoporosis\">https:\/\/en.wikipedia.org\/wiki\/Osteoporosis<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Older man. <strong>Provided by<\/strong>: pxhere. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pxhere.com\/en\/photo\/1046462\">https:\/\/pxhere.com\/en\/photo\/1046462<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/cc0\">CC0: No Rights Reserved<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>U.S. Cancer Statistics Data Visualizations Tool. <strong>Provided by<\/strong>: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/www.cdc.gov\/cancer\/dataviz\">http:\/\/www.cdc.gov\/cancer\/dataviz<\/a>. <strong>License<\/strong>: <em>All Rights Reserved<\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li><strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-3538-1\">Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the Metabolic Syndrome in the United States, 2003-2012. JAMA. 2015;313(19):1973\u20131974. doi:10.1001\/jama.2015.4260 <a href=\"#return-footnote-3538-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-3538-2\">How High Blood Pressure Can Lead to Stroke. Retrieved from\u00a0https:\/\/www.heart.org\/en\/health-topics\/high-blood-pressure\/health-threats-from-high-blood-pressure\/how-high-blood-pressure-can-lead-to-stroke. <a href=\"#return-footnote-3538-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-3538-3\">About Stroke. American Stroke Association. 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