Chapter 9 Elders

Introduction Number of elders and the proportion to the total population increased significantly in the 20th and early 21st century Represent 13.1% of population 1 in every 8 Americans Young old – 65-74 Middle old – 75-84 Old old – 85+

Definitions Aged Aging Gerontology Geriatrics Geriatrician Terms – elders, seniors, older adults, mature adults, elderly, aged, etc.

Aging Myths Ageism – prejudice and discrimination against the aged Common myths not accurate representation of elders Reality Majority of elders today are active and well Many still working Many strongly engaged in community, volunteer, and advocacy programs

Demography of Aging Size and growth of the elder population Population pyramids describe aging of populations America’s pyramid shape has drastically shifted Other countries have had shifts as well 85+ fastest growing segment of older population Growth in median age

Symbolic Age Pyramid

Population Pyramids, U.S.

Factors Affecting Population Size and Age Fertility rates Baby boomers – 1946-1964 Mortality rates Life expectancy has continued to increase; significant increase in 20th century Migration Movement of people from one country to another can affect population size

Dependency and Labor Force Ratios Dependency ratio – economically unproductive to economically productive Traditionally defined by age Can be used for social policy decision making Labor force ratio – number of people actually working and those who are not, independent of their ages Ratio of workers to dependents will be lower in the future than today

Dependency Ratio, U.S., 2010-2050

Other Demographic Variables Affect community health programs for older Americans Marital status Living arrangements Racial and ethnic composition Geographic distribution Economic status Education Housing

Marital Status ¾ of elder men are married; just over half of elder women are married Elder women are three times more likely to be widowed Number of divorced elders continues to rise New concerns: lack of retirement benefits, insurance, lower net worth assets

Living Arrangements Closely linked to income, health status, and availability of caregivers Over ¼ non-institutionalized elders live with someone else Women more likely to live alone Only 4% of elders live in nursing homes ¾ of nursing home residents are women More than half of nursing home residents are 85+

Racial and Ethnic Composition U.S. older population growing more diverse 2010 elders: 80% white, 9% black, 7% of Hispanic origin, 3% Asian Coming decades: Percentage of elder whites will decline and older Americans of Hispanic origin will become largest minority group in the U.S.

Geographic Distribution More than half live in 11 states: CA, FL, NY, TX, PA, OH, IL, MI, NC, NJ, GA CA greatest number; FL greatest proportion Reasons some states “age” Inward migration (FL), young people leave (farm belt states) ~79% of elders age 65+ live in metropolitan areas

Economic Status 1970 – 25% of elders lived in poverty Major sources of income Social Security (reported by 87% of elders) Income from assets (reported by 53%) Private pensions (reported by 28%) Gov’t employee pensions (reported by 14%) Earnings (reported by 26%)

Education Percentage of elders who completed high school rose from 28% in 1970 to 79.5% in 2010 Just over 22% of elders had a bachelor’s degree or higher in 2010 Differences by race and ethnicity Baby boomers most educated cohort in U.S. history

Housing Most live in adequate, affordable housing 80% own, 20% rent Elder homes tend to be older, of lower value, and in greater need of repairs than the homes of younger counterparts For most elders, housing represents an asset

Health Profile of Elders Health status of elders has improved over the years (living longer and functional health) Chronically disabled has been decreasing Health status usually not as good as younger counterparts

Mortality Top causes of death for elders (responsible for 2/3 of deaths) Heart disease Cancer CLRD Stroke Alzheimer’s Disease

Morbidity Activity limitations increase with age Chronic conditions Substantial burden on health and economic status of individuals, families, and nation Impairments Very prevalent in older adults May be sensory, physical, memory

Health Behaviors and Lifestyle Choices Generally have more favorable health behaviors than younger counterparts Less likely to consume large amounts of alcohol, smoke cigarettes, or be overweight Areas for improvement Physical activity, immunizations

Physical Activity Elders are least physically active of any age group Loss of physical fitness due to aging, chronic conditions Physical activity recommendations for elders are the same as other aged adults But only about 11% of elders meet physical activity guidelines

Nutrition Dietary concerns for elders include: Reduced sodium intake Reduced caloric needs Increased vegetable consumption Increased water consumption

Obesity Number of obese elders has increased In 2010, 28% of those 65+ were obese Only 26% of elders are in healthy weight range

Cigarette Smoking Just over 9% of elders are cigarette smokers Number has decreased significantly over past few decades Special concern: elders who are former smokers

Vaccinations Immune systems tend to weaken with age Recommended immunizations for elders In 2011, 67% of elders received flu shot; ~62% received pneumococcal vaccination Vaccination rates among elders have improved over time But racial disparities occur

Elder Abuse and Neglect Reports have increased greatly in recent years All states have set up reporting systems Special problem for elders May be frail Unable to defend themselves Vulnerable to telemarketing and mail scams Most common victims of theft of benefit checks

Instrumental Needs of Elders Six instrumental needs that determine lifestyle for people of all ages; aging process can alter needs in unpredictable ways Income Housing Personal care Health care Transportation Community facilities and services

Income Change in types of expenses in elder years Achieving elder status often reduces income needs Income has improved significantly in recent years Social Security is major source of income Unmarried women and minorities have highest rates of poverty

Housing Major needs: appropriateness, accessibility, adequacy, affordability Changing residence can have negative effects Variety of housing options available Independent living Assisted living Continuing Care Retirement Communities Nursing Homes/Skilled Nursing Facilities Affordable Housing

Personal Care Four levels of tasks that may need assistance: Instrumental tasks, expressive tasks, cognitive tasks, tasks of daily living Activities of daily living (ADLs): measure functional limitations Instrumental activities of daily living (IADLs): measure more complex tasks

Caregivers Caregivers for elders face number of problems Increased financial burden, lack of privacy, demands on time and energy Need for personal care and paying for long-term care services for elders is projected to increase in coming years National Family Caregiver Support Program Eldercare support for working caregivers a growing concern

Health Care Elders heaviest users of health care services Use of health care services increases with age Most money spent on health care is in last years of life Medicare primary source of payment for health care services of elders Will see major changes in future years

Transportation Transportation allows elders to remain independent On average, elders live 10 year after they stop driving Greatest influence on transportation needs: income and health status Many public transportation challenges Solutions for transportation needs of elders

Community Facilities and Services Older Americans Act of 1965 (OAA) to increase services and protect rights of elders National nutrition programs for elders State Departments on Aging and Area Agencies on Aging Other programs Services can vary greatly across the country

Community Facilities and Services Meal service Homemaker service Chore and home maintenance Visitor service Adult day care Respite care Home health care Senior centers Other services

Discussion Questions What can happen to increase the likelihood of elders utilizing community facilities and services? How will the changing demographics of elders affect health care services?