1. Chapter 9 Elders

2. Introduction
Number of elders and the proportion to the total population increased significantly in the 20th and early 21st century
Represent 13.1% of population
1 in every 8 Americans
Young old – 65-74
Middle old – 75-84
Old old – 85+

3. Definitions Aged Aging Gerontology Geriatrics Geriatrician
Terms – elders, seniors, older adults, mature adults, elderly, aged, etc.

4. 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

5. 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

6. Symbolic Age Pyramid

7. Population Pyramids, U.S.

8. Factors Affecting Population Size and Age
Fertility rates
Baby boomers –
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. 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

10. Dependency Ratio, U.S.,

11. Other Demographic Variables
Affect community health programs for older Americans
Marital status
Living arrangements
Racial and ethnic composition
Geographic distribution
Economic status
Education
Housing

12. 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

13. 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+

14. 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.

15. 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

16. Economic Status 1970 – 25% of elders 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%)

17. 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

18. 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

19. 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

20. Mortality
Top causes of death for elders (responsible for 2/3 of deaths)
Heart disease
Cancer
CLRD
Stroke
Alzheimer’s Disease

21. 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

22. 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

23. 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

24. Nutrition Dietary concerns for elders include: Reduced sodium intake
Reduced caloric needs
Increased vegetable consumption
Increased water consumption

25. Obesity Number of obese elders has increased
In 2010, 28% of those 65+ were obese
Only 26% of elders are in healthy weight range

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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 long-term care services for elders is projected to increase in coming years
National Family Caregiver Support Program
Eldercare support for working caregivers a growing concern

34. 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

35. 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

36. 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

37. 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

38. 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?