Chapter 9 Elders Introduction Number of elders and

Chapter 9 Elders

Introduction • Number of elders and the proportion to the total population increased significantly in the 20 th and early 21 st 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 20 th 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 • 2010 – 9% 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 longterm 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?