Elders

Chapter 9

Introduction

• Number of elders and the proportion to the total population increased significantly in the 20th century

• Represent 12.8% of population• 1 in every 8 Americans age 65+

• Young old – 65-74

• Middle old – 75-84

• Old old – 85+

Definitions

• Aged

• Aging

• Gerontology

• Geriatrics

• Geriatrician

• Terms – seniors, older adults, mature adults, elderly, aged, etc.

Aging Myths

• Ageism – prejudice and discrimination against the aged

• Common myths not accurate representation of elders• 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 dependants 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

• Housing

Marital Status

• ¾ of elder men are married; just over half of elder women are married

• Elder women 3x’s 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

Living Arrangements

• Closely linked to income, health status, and availability of caregivers

• 2/3 of noninstitutionalized elders live with someone else• Women more likely to live alone

• Only 5% 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

• 2050 projection of elders:• White 58%, Hispanic origin 15%, black 11%,

Asian 8%

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 greatest proportion

• Reasons some states “age”• Inward migration (FL), young people leave

(farm belt states)

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

Housing

• Most live in adequate, affordable housing

• 80% own, 20% rent

• Elder homes are more likely to be older, more likely to have lower value, in great need for repairs, less likely to have central heat/air

• 30% of elders pay more for housing than they can afford

Health Profile

• 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

• Stroke

• CLRD

• Alzheimer’s Disease

Morbidity

• Activity limitations increase with age

• Chronic conditions• Substantial burden on health and economic

status of individuals, families, and nation

• 1/3 report limitation of activity due to chronic conditions

• 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

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

• Social Security is major source of income for ~2/3 of recipients; 90% of income for 1/3

• Nonmarried women and minorities have highest rates of poverty

Housing

• Major needs: appropriateness, accessibility, adequacy, affordability

• Needs are intertwined

• Changing place of residence can have negative effect on elder and family members

• Group housing• Nursing homes, Eden Alternative facilities,

Green Houses, retirement communities, CCRCs, assisted-living

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) to measure functional limitations

• Instrumental activities of daily living (IADLs) to measure more complex tasks

• Caregiver issues

• Caregiver services

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 and Area Agencies on Aging

• Other programs

• Services can vary greatly across the country

• Meal service

• Homemaker service

• Chore and home maintenance

• Visitor service

• Adult day care

• Respite care

• Home health care

• Senior centers

Community Facilities and 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?