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Globally, the population has been aging and is anticipated to continue to age. This was characteristic of the United States until COVID-19 when the average lifespan decreased. Despite this, 16.5% of the population in the United States is over 65 years of age. Aging is a universal, developmental gift of 20th-century science and technology. Prior to COVID-19, the introduction of antibiotics, insulin, vaccinations, modern surgical techniques, and other medical advancements, resulted in adults living longer.

The oldest region of the world population is southern Europe, where 21% of the population is 65 years of age or older.187 In the United States, life expectancy at birth for 2019 was 78.8 years, 76.3 for men, and 81.4 for women.40 Sixteen percent of the 329.9 million citizens of the United States are over 65 years of age. Thus, 1.6 out of every 10 Americans is considered old.187 This is in comparison to 28% of the Japanese and 23% of the Italian populations and only 3% in Nigeria.187 The population pyramid of the world has changed from expansive (broad base, narrow top) where the population is young and growing, to a more constrictive (beehive) shape in which the number of the older population is growing.35 Today, people live longer than any prior generation. From a global perspective, the world is aging. In 2015, 12% of the world’s population was over 60 years of age; by 2050 this number will increase to 22%.240 Thus, in the profession of physical therapy (PT), most clinicians can anticipate working with the older adult in some capacity, presenting with new opportunities and challenges.

In isolation or together, the impact of aging, inactivity, illness, and injury may result in a loss of strength, impaired functional mobility, and potentially an associated loss of independence.54 Physical therapists are uniquely positioned to meet the needs of the older adult and enable them to optimize their functional potential through physical activity, exercise, functional training, and education. The importance of this is addressed throughout this chapter.

Definitions and Descriptions Applied to Older Adults

At what age are people considered old? The answer is quite variable! Historically in the United States, the standard has been 65 years of age, based on Medicare eligibility. The World Health Organization (WHO) designation is 60 years and older.240 “Dependent age,” 65 and older, is used by the Population Reference Bureau to describe the older adult.187 The concept of “prospective age,” reflects the average number of years a person has to live. A 65-year old person can be expected to live an average of an additional 19.5 years.247 With one in five US workers being over 65 years of age, previously accepted definitions of “old” may become more blurred.42 There is great variability in the views of what is old, in the United States and around the ...

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