Chapter 1 The Aging Population

Terms to Know Life expectancy: the length of time that a person can be predicted to live Life span: the maximum years that a person has the potential to live Compression of mortality: delaying or compressing the years in which serious illness and decline occur so that an extended life expectancy results in more functional, healthy years Comorbidity: the presence of multiples chronic conditions simultaneously

Introduction Myths of aging Misinformation as an injustice Role of the gerontological nurse: Know the facts Educate the public

Views of Older Adults Through History Current older population offered sacrifice, strength, and spirit making the country great Older adults currently viewed with positivism versus prejudice; knowledge versus myth; concern versus neglect

Views of Aging by Societies Confucius: correlation of age and respected Chinese: attaining old age was an accomplishment Egyptians: dreaded growing old Greeks: struggles between the old and the young Ancient Romans: limited respect for elders The Bible: well-being of family; desire to respect elders Medieval times: rise of superiority of youth Industrial revolution: persons of advanced age left unprotected

Historical Changes for Older Adults 1914: first geriatric textbook written by Dr. I.L. Nascher (known as “Father of Geriatrics”) 1935: significant step: Federal Old Age Insurance Law under the Social Security Act Provision of some financial security for older adults 1965: formation of the Administration on Aging; enactment of Older Americans Act; introduction of Medicare and Medicaid

Question Is the following statement true or false? The first significant step in improving the lives of older adults during the 20th century was the publication of the first geriatric textbook in 1914.

Answer False Rationale: The first significant step in improving the lives of older adults was the passage of the Federal Old Age Insurance Law under the Social Security Act in 1935.

Subsets of the Older Adult Population Young-old: 60 to 74 years Middle-old: 75 to 84 years Old-old: 85 to 100 years Centenarians: over 100 years Profile, interests, and health care challenges vary with each subset

Population Growth and Increasing Life Expectancy Persons 65+ currently represent more than 13% of the U.S. population By 2020, older adults will grow to 120% of the population Life expectancy has increased: 1930: 59.7 years 1965: 70.2 years Present: 78.2 years Population over 85 years. Double by year 2036 and triple by 2049 Centenarians increasing

Factors Influencing Increased Life Expectancy Advancements in disease control and health technology Lower infant and child mortality rates Improved sanitation Better living conditions

Life Expectancy: Race and Gender Gap widening between white people and black people Nurses should be concerned with health and societal issues Gap narrowing between males and females

Marital Status and Living Arrangements Half of women over 65 are widowed. The majority of men are married. Most older adults live with spouse or other family member. Twice the number of women than men live alone in later life. The potential for living alone increases with age of both men and women.

Geographic Distribution Varies with state population and location.

Income of Older Adults Percentage of older adults living below the poverty level has declined. Most depend on Social Security for more than half of their income. High prevalence of home ownership by older adults. “Asset rich and cash poor” Women and minority groups have less income than white men.

Question “Asset rich and cash poor” relates to which of the following statements regarding older adults? Net worth of older adults is half the national average of middle-age adults. Homes are paid for, but there is not enough money available for monthly expenses. The majority of older adults live below the poverty level. Financial problems in the older adult population are due to level of debt.

Answer B. Homes are paid for, but there is not enough money available for monthly expenses. Rationale: Median net worth of older households is nearly twice the national average because of the high prevalence of home ownership, but many older adults are “asset rich and cash poor”−they live in a house that has appreciated in value over the years, but they barely have sufficient monthly income to meet basic expenses.

Employment and the Older Adult Population Percentage of older workers in labor force declining Men leaving workforce at earlier age Number of middle-age women employed increasing Baby boomers desire to continue to work at the age of retirement

Education Trend toward increased education of older adults. Advanced degrees are more prevalent than in the past and have higher incomes. Older adults will be more informed health care consumers.

Health Status Chronic illnesses are major problems. Most older adults have at least one chronic illness. Chronic conditions limit ADLs and IADLs: major source of disability. Leading chronic conditions: arthritis, hypertension, hearing issues, heart conditions, visual impairments, orthopedic issues, diabetes, sinusitis, allergies, and varicose veins.

Question Is the following statement true or false? Chronic disorders most prevalent in the older adult population are ones that can have a significant impact on independence and the quality of life.

Answer True Rationale: Chronic illness is a major problem for the older population and results in limitations in ADLs, IADLs, and quality of life.

Health Insurance Medicare: health insurance program Part A: hospital and other services Part B: medical visit services and other services Part C: Medicare Advantage Plans Part D: drug plan Affordable Care Act

Implications of an Aging Population Approximately one in four older adults will spend some time in a nursing home. Increasing need for gerontological nurses. Health and social agencies must anticipate future needs. Government payment of services in jeopardy in age of budget cuts. Baby boomers are the next wave of older adults.

Baby Boomers Individuals born between 1946 and 1964 January 1, 2011, beginning of baby boomers turning 65 Diverse group Better educated Enamored with “high-tech” products Inventors of “fitness movement” Informed consumers Will demand changes in long-term care

Provision and Payment of Services Higher rates of hospitalization, surgery, and physician visits Paid by federal dollars, most often Less than 5% of older adults live in a nursing home, assisted living, or other institutions Long-term care payment Role of the gerontological nurse

Gerontological Nurses Need to be advocates in ensuring that cost-containment efforts do not jeopardize the welfare of older adults