The Age Factor:The Age Factor:Recent Trends, Current Recent Trends, Current
Challenges & Future Challenges & Future DirectionsDirections
Maria C. Hernandez-Peck, PhDCenter for Studies in Aging
Eastern Washington University
As We Enter the 21st Century
An aging population of 35 million in 2000
1 in every 8, or 12.4% an older American
5,574 individuals reaching age 65 each day
Those reaching age 65 have an average life expectancy of an additional 17.9 years
Categories of Older People
Young old (65 to 74) 18.4 million
Middle Old (75 to 84) 12.4 million
Old-Old (85+) 4.2 million, the fastest growing group
Centenarians (100+) 50,545
Some Current Statistics Older women outnumbering older men 20.6 million to
14.4 million
143 women for every 100 men at age 65+; this ration increases from 117 for the 65 to 69 age group, & to 245 for the 85+
Almost 400,00 grandparents age 65+ having primary responsibility for their grandchildren who live with them
One Baby Boomer turning 50 every 7.5 seconds
Projections for 2030
The older population will more than double to 70 million
The 85+ population will increase from 4.2 million in 2000 to 8.9 million
Members of minority groups will represent 25% of the older population, up from 16% in 2000
The Older Foreign Born
Accounted for 3.1 million of persons 65+
1/3 from Europe; 31% from Latin America; 22% from Asia, and 8% from other parts of the world
Anticipated future foreign born elders will be from Latin America or Asia
2/3 of all foreign born elders have been in the U. S. over 30 years
In Spokane County
60+ accounted for 66,242 in 2000
65+ estimate for 2005 is at 72,332
80+ accounted for 14,840 in 2000
80+ estimate for 2005 is 26,699
Projected Numbers for 2030
60+ will account for 120,826
75+ will account for 33,903
Elders Accessing Services
13 to 15% of frail elders access services funded through the Aging and Long Term Care of Eastern Washington
The typical client is 75+, female and living alone
The Challenge Ahead for Our Community
How to utilize the gifts of those persons reaching the later years in better health with a desire to continue to contribute to community enhancement and well-being, through either paid employment or volunteer opportunities
How to maintain a safety-net to protect the most frail and vulnerable
Four Major Areas of Concern
Maintaining and Enhancing Economic Security of Older Persons
Promoting Physical and Mental Well-being (Healthy Aging)
Creating Elder Friendly Communities
Avoiding the Caregiving Crunch
Maintaining & Enhancing Economic Security
Rethinking the need and timing of Social Security Reform
Unhinging old age from the obsolete marker of 65 and index entitlements to rising longevity
Let people chose to retire when they are ready and when they can afford to , instead of holding everyone to uniform standards
Smash the silver ceiling and make it easier for people to pursue meaningful employment in maturity
Maintaining & Enhancing Economic Security
Replace the “linear” life paradigm with a new “cyclic” one that takes maturity into account as a time of new life pursuits and passions
Create job sharing opportunities for older persons needing and wanting to return to work
Promoting Healthy Aging
Involves both physical and emotional well being
Increase in health promotion and disease prevention programs
Increasing availability of service providersknowledgeable about issues and challenges confronting elderly today
Facts About Mental Health in the Later Years
The majority of older Americans cope constructively with the physical limitations, cognitive changes, and various losses, such as bereavement, that frequently are associated with late life
On the other hand, a substantial proportion of the population age 55 and older, almost 20% of this age group, experience specific mental disorders that are not part of “normal” aging
Severely Impairing Conditions If Unrecognized or Untreated
Depression Alzheimer’s Disease Alcohol and Drug Abuse and Misuse Anxiety Late-life Schizophrenia
Substance Abuse Issues
As many as half of all people with serious mental illnesses develop alcohol or other drug abuse problems at some point in their lives
15% of older men and 12% of older women treated in primary care clinics regularly drink in excess of limits recommended by the National Institute on Alcohol Abuse and Alcoholism
An estimated 17% of older adults misuse and abuse alcohol and medications
Suicide and Depression
Older people have the highest rate of suicide in the U.S. population
Suicide rates increase with age, with older white men having a rate of suicide up to six times that of the general population
Depression is neither well recognized nor treated in primary care settings, where most older adults seek and receive health care
Difficulties in Assessment
Detection of mental disorders in older adults is further complicated by high co-morbidity with other medical disorders
The symptoms of somatic disorders may mimic or mask psychopathology, making diagnosis more taxing
Older individuals are more likely to report somatic symptoms than psychological ones, leading to further under identification of mental disorders
Difficulties in Assessment
More than half, or 51% of older individuals who have committed suicide have seen their primary care physician within one month of the suicide (Caine, et. al. 1996)
Almost half had psychiatric symptoms. However, symptoms were recognized in less than one third
Treatment was offered in less than 1/4 of the cases Treatment rendered was considered adequate in on
2% of the cases
The Role of Primary Health Care Providers
Primary care providers carry much of the burden for diagnosis of mental disorders in older adults
However, the rates at which they recognize and properly identify disorders often are low
With respect to depression, a significant number of depressed adults are neither diagnosed nor treated in primary care
The Role of Primary Health Care Providers
One study of primary care physicians, only 55% of internists felt confident in diagnosing depression, and even fewer (35% of the total) felt confident in prescribing antidepressants to older persons
Researchers estimate that an unmet need for mental health services may be experienced by up to 63% of older adults aged 65 years and older with a mental disorder
Current Challenges
Transitioning to a Medicaid only system in providing Mental Health Services
The fact that older persons in greatest need of mental health services will not self-refer
. Inadequate ways of identifying older
persons in need mental health services
Inability of primary health care providers in identifying depression in older persons
Inadequate reimbursement for psychiatric and/or mental health services and its impact in community based systems
Downsizing of geriatric beds in State Mental Hospitals and relocating those patients to community based settings
Definition of medically needy as those with an income of $582 per month
Current Challenges
Some Potential Solutions
Achieving Mental Health Parity Increasing the income level for medically
needy from $582 to $771 per month Increasing State funding for mental health
services to non-Medicaid eligible older persons
Integrating aging and mental health services at the community level
Some Potential Solutions
Implementing ways of identifying frail elders at risk (e.g., Gatekeeper Program)
Educating primary health care providers on how to identify depression and other mental disabling conditions in older persons
Additional Potential Solutions
Providing Extended Community Services to older persons who have been discharged from State Mental Hospitals
Increasing health promotion and disease prevention efforts in mental health services to older persons (e.g., depression screening programs)
Additional Potential Solutions
Co-locating mental health service providers in primary care physicians’ offices
Postponing premature hospitalization by funding counseling and other support services to caregivers of Alzheimer's patients
Developing an Elder Friendly Community
Creating communities that enable elder choice and involvement with ready access to necessary services in all living arrangements , whether at home, supported living or in long term care facilities
Affordable housing options for the elderly within new developments and as we attempt to rebuild our downtown area
Transportation systems that take into consideration elder needs
Elder Friendly Communities
Learning and Productivity centers within local institutions of higher learning for those wanting a second career or further learning
Courses for high school students on what it means to have an older relative
Supermarkets that adjust to an aging population Aggregation of services for convenience
purposes Technology enabling services Integrated home services
Challenges of Family Caregiving
1 in every 4 households in caregiving, half of them with no outside help
25% of all workers provide elder care, with most of them being employed full time
Most have to rearrange their work schedule--Take unpaid leave-- Decrease working hours
Value & Cost of Informal of Caregiving
The value of informal caregiving is estimated at $196 billion per year
Informal caregiving exceeds nursing home and home care expenses by $81 billion a year
Caregiving costs US businesses $114 billion annually
Caregivers lose up to $659,139 in earned income over a lifetime
Avoiding the Caregiving Crunch
Finance long-term care through private insurance and reverse mortgages
Establish new eldercare-oriented employee benefits
Expand and integrate community based long-term care services (i.e., respite, adult day services, special transportation services, case management, caregiver support groups, etc.)
Alzheimer’s Disease
8 to 15% of people over age 65 have Alzheimer’s disease
The prevalence of dementia (most of which is accounted for by Alzheimer’s disease) nearly doubles with every 5 years of age after 60.
Studies also reveal age-related increases in Alzheimer’s disease with the 85+ accounting for 48% of those with Alzheimer’s disease
The Cost
An estimated 4 million individuals diagnosed with Alzheimer’s disease
The estimated cost of Alzheimer’s disease to Medicare and Medicaid totaled $50 billion in 2000 and is projected to be $72 billion in 2010.
In Conclusion
Thus, while people are living healthier into old age and doing so on a mass scale, there remain many difficulties, both psychic and physical, that eventually come with growing old. Many are living long enough to suffer age-related diseases like Alzheimer’s and Parkinson’s -- diseases that involve long term care decline and thus the need for long term care.
In Conclusion
And, precisely because many individuals have taken advantage of modern freedom’s opportunities for education, careers and geographic mobility, many elderly will live in greater isolation from loved ones, separated from children and grandchildren who have settled elsewhere or whose lives are defined primarily by work and school.
In Conclusion
Smaller and less stable families will likely compound these problems, as the burdens of caregiving fall on one or two adult children, who in many cases are called upon to care for parents who did not always cared well for them.
Many among the growing population of childless elderly will have no relatives at all to look after them.
The Question Remains Can a society that values self-reliance, personal
freedom, and careerism reconcile itself to the realities of dependence, diminished autonomy, and responsibility for others?
How we care for the dependent elderly will test whether modern life has not only made things better for us but also made us better human beings, more willing to accept the obligations to care and more able to cope with the burdens of caregiving.
THE AGE FACTOR
Questions and Discussion
Dr. Peck’s presentation can be viewed and downloaded at www.ewu.edu/easternedge