1. 1. EldersChapter 9
2. 2. Introduction Number of elders and the proportion to thetotal population increased significantly in the20th century Represent 12.8% of population 1 in every 8 Americans age 65+ Young old 65-74 Middle old 75-84 Old old 85+
3. 3. Definitions Aged Aging Gerontology multidisciplinary study Geriatrics branch of medicine Geriatrician Terms seniors, older adults, mature adults,elderly, aged, etc.
4. 4. Aging Myths Ageism prejudice and discrimination againstthe aged Common myths not accurate representation ofelders Majority of elders today are active and well Many still working Many strongly engaged in community,volunteer, and advocacy programs
5. 5. Demography of Aging Size and growth of the elder population Population pyramids describe aging ofpopulations Americas pyramid shape has drasticallyshifted Other countries have had shifts as well 85+ fastest growing segment of olderpopulation Growth in median age from 35 ( 2000) to 39( 2035)
6. 6. Symbolic Age Pyramid
7. 7. Population Pyramids, U.S.
8. 8. 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
9. 9. Fertility rates = births/1000 women ofchildbearing age High beginning of 1900s Low during depression Rebound after WW 2 This population bulge moves up us agepyramid
10. 10. Mortality rates: down in 20th century Life expectancy up Therefore older population
11. 11. Dependency and Labor Force Ratios Dependency ratio economicallyunproductive to economically productive Traditionally defined by age Can be used for social policy decision making Labor force ratio number of people actuallyworking and those who are not, independent oftheir ages Ratio of workers to dependants will be lowerin the future than today
12. 12. Unproductive are 0-19 years and 65+ Both together are total dependency ratio Youth dependency ratio =youth/productive Old age dependency ratio= old/productive
13. 13. Dependency Ratio, U.S., 2010-2050
14. 14. TR total dependency ratio is climbing up to85% driven by elder segment.
15. 15. What factors cause easy transition to seniorliving for Papa
16. 16. Other Demographic Variables Affect community health programs for olderAmericans Marital status: men married but1/2 women Living arrangements divorces up..lessbenefits. 2/3 elders live with others. Racial and ethnic composition more hispanic Geographic distribution changing. Economic status Housing
17. 17. Who lives longest? Who lives least long ? Who is in the middle?
18. 18. Marital Status of elder men are married; just over half ofelder women are married Elder women 3xs more likely to be widowed Men have shorter life expectancies Men tend to marry women younger than selves Men more likely to remarry after loss of spouse Number of divorced elders continues to rise New concerns: lack of retirement benefits,insurance, lower net worth assets
19. 19. Living Arrangements Closely linked to income, health status, andavailability of caregivers 2/3 of noninstitutionalized elders live withsomeone else Women more likely to live alone Only 5% of elders live in nursing homes of nursing home residents are women More than half of nursing home residents are85+
20. 20. Racial and Ethnic Composition U.S. older population growing more diverse 2010 elders: 80% white, 9% black, 7% of Hispanic origin,3% Asian 2050 projection of elders: White 58%, Hispanic origin 15%, black 11%,Asian 8%
21. 21. Geographic Distribution 2/5 live in southern states More than half live in 10 states: CA, FL, IL,MI, NJ, NY, NC, OH, PA, TX California greatest number; Florida greatestproportion Reasons some states age Inward migration (FL), young people leave(farm belt states)
22. 22. Economic Status 1970 25% of elders lived in poverty 2006 less than 9% lived in poverty Income 37% of elder income from Social Security 15% asset income 18% pension income 28% earnings
23. 23. What is SES?
24. 24. Housing Most live in adequate, affordable housing 80% own, 20% rent Elder homes are more likely to be older, morelikely to have lower value, in great need forrepairs, less likely to have central heat/air 30% of elders pay more for housing than theycan afford
25. 25. Health Profile Health status of elders has improved over theyears (living longer and functional health) Chronically disabled has been decreasing Health status usually not as good as youngercounterparts
26. 26. Mortality Top causes of death for elders (responsible for2/3 of deaths) Heart disease Cancer Stroke CLRD Alzheimers Disease Decline in CVD deaths causes less mortality
27. 27. Medicare enrollees > 65 1 in 5 men and 1 in 3 women cant Walk 2 blocks Write Kneel Reach overhead Lift 10 lbs
28. 28. Morbidity Activity limitations increase with age Chronic conditions Substantial burden on health and economicstatus of individuals, families, and nation 1/3 report limitation of activity due to chronicconditions Impairments Very prevalent in older adults May be sensory, physical, memory
29. 29. Health Behaviors and Lifestyle Choices Generally have more favorable healthbehaviors than younger counterparts Less likely to consume large amounts ofalcohol, smoke cigarettes, or be overweight Areas for improvement Physical activity, immunizations and nutrition
30. 30. 22% > 65 do physical activity 10% > 85% Also vaccines
31. 31. Figure B01: Healthy People 2020U.S. Department of Health and Human Services, Office of Disease Preventionand Health Promotion (2010). Healthy People 2020. Available athttp://www.healthypeople.gov/2020/default.aspx. Accessed December 2, 2010.
32. 32. 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 benefitchecks
33. 33. Instrumental Needs of Elders Six instrumental needs that determine lifestylefor people of all ages; aging process can alterneeds in unpredictable ways Income Housing Personal care Health care Transportation Community facilities and services
34. 34. Income Change in types of expenses in elder years Social Security is major source of income for~2/3 of recipients; 90% of income for 1/3 Nonmarried women and minorities havehighest rates of poverty But need home, health $
35. 35. Housing Major needs: appropriateness, accessibility,adequacy, affordability Needs are intertwined Changing place of residence can have negativeeffect on elder and family members Group housing Nursing homes, Eden Alternative facilities,Green Houses, retirement communities,CCRCs, assisted-living
36. 36. Personal Care Four levels of tasks that may need assistance: Instrumental tasks, expressive tasks, cognitivetasks, tasks of daily living Activities of daily living (ADLs) to measurefunctional limitations Instrumental activities of daily living (IADLs)to measure more complex tasks Caregiver issues Caregiver services
37. 37. ADLs activities of daily living These measure functional limitations Examples are Eating Toilet function Bathing Walking Out of bed
38. 38. 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 forhealth care services of elders Will see major changes in future years
39. 39. Transportation Transportation allows elders to remainindependent On average, elders live 10 year after they stopdriving Greatest influence on transportation needs: income and health status Many public transportation challenges Solutions for transportation needs of elders
40. 40. Community Facilities and Services Older Americans Act of 1965 (OAA) toincrease services and protect rights of elders National nutrition programs for elders State and Area Agencies on Aging Other programs Services can vary greatly across the country
41. 41. Community Facilities and Services Meal service Homemaker service Chore and home maintenance Visitor service Adult day care Respite care Home health care Senior centers
42. 42. Discussion Questions What can happen to increase the likelihood ofelders utilizing community facilities andservices? How will the changing demographics of eldersaffect health care services?