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Aging of the U.S. Population: Trends and Implications

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1 Aging of the U.S. Population: Trends and Implications
Mary Altpeter, PhD, MSW, MPA Institute on Aging, University of North Carolina at Chapel Hill NC-HAN, Member campus of the PRC-Healthy Aging Research Network (HAN) CDC, May 11, 2009

2 Presentation Overview
The PRC-Healthy Aging Research Network (HAN) approach to healthy aging Multiple aspects of health and well-being for older adults The health status and future of Boomers What’s happening in health promotion and aging Summing it up: Challenges we face

3 Sites of the CDC PRC-Healthy Aging Research Network (HAN)
University of Washington University of Colorado University of Illinois at Chicago University of Pittsburgh University of California at Berkeley West Virginia University University of North Carolina University of South Carolina Texas A&M University 3

4 Activities of the PRC-HAN
Better understand the determinants of healthy aging in older adults Identify interventions that promote healthy aging Assist in the translation of such research into sustainable community-based programs throughout the nation 4

5 Examples of PRC-HAN Resources
Conference Series (Physical Activity, Depression, Environmental and Policy Factors) Written materials such as conference monograph and RE-AIM issue brief On-line modules for Provider Training 5


7 Rowe and Kahn Model “Healthy Aging” Managing Chronic Conditions
“and injury and promoting health” “optimizing” In their widely known 1998 book about “Successful Aging,” Rowe and Kahn describe the structure of successful aging as being the integration of three elements in one’s life: the maintenance of high physical and mental functioning, the avoidance of disease, and social engagement. This has been a commonly used definition and graphic among those interested in healthy aging, but it seems to be a bit simplified and limited to disease prevention. It is possible to improve on that model in four ways: First, by avoiding the term “successful aging”, and favoring “healthy aging” instead. Second, the goal of “avoiding disease” is too narrow, and should be expanded to include “avoiding injury” and “promoting health”. One only needs to consider the importance of falls and broken hips in the elderly to justify this addition. Injury is not disease yet it deserves attention. Third, when applying health promotion to the later years, it is crucial to recognize the prevalence and impact of chronic conditions in later life. Thus, it is a worthy goal to effectively manage functional limitations to facilitate self-care and independence and Fourth, instead of settling for “maintaining” high cognitive and physical function, it is more realistic, particularly in very late life, to seek to “optimize” function. Declines in different dimensions of cognitive function do occur as part of aging – but social workers and other health professionals can nevertheless take steps to optimize cognitive capacity for any age. Also this schema could be improved by adding a community and environmental context, that is placing it in a socioecological framework. Source: Marshall, V.M. & Altpeter, M. (2005). Cultivating social work leadership in health promotion and aging: Strategies for active aging interventions. Health & Social Work, 30(2),

8 PRC-HAN Definition of Healthy Aging
Healthy aging is the development and maintenance of optimal physical, mental and social well-being and function in older adults. It is most likely to be achieved by individuals who live in physical environments and communities that are safe and support the adoption and maintenance of attitudes and behaviors known to promote health and well-being; the effective use of health services to prevent or minimize the impact of acute and chronic disease on function About 7 years ago HAN formulated a newer definition of healthy aging that articulates this larger context. Our definition is… Note that our definition, like Rowe and Kahn’s, also includes physical and mental and well-being and optimal functioning. But it is a more holistic definition. While the first sentence focuses on what healthy aging is in individual terms, the second sentence indicates that to tackle healthy aging, we need to consider “socio-ecological approaches,” that is activities and supports at the level of the built and physical environment, community service systems and policies and social networks – areas that may be of particular interest to you. The thrust of this definition is that healthy aging is joint venture shared by individuals and the communities in which they live. We need to think about aging from multiple facets including social issues and economic needs. What I’m going to talk about next is a more rounded picture – if you will, I’m going to talk about “social gerontology” with only a nod to geriatrics. CDC-funded PRC Healthy Aging Research Network

9 Multiple aspects of older adult health and well-being
Population trends Marital status Health literacy, internet use Wealth Workforce participation Volunteerism Caregiving So, in order to give the bigger picture of the aging experience in the US, and using the definition I just gave you as a guide to consider vital or healthy or successful aging, I’m going to briefly review these seven areas: the population trends, social and economic areas, and certain health issues of an older adult’s life that impact the sense of living well and of well-being. I will speak briefly about the health status and health issues of an older adult’s, but more from an economic and family perspective. Bill will cover long term care and issues of elder abuse. Where I have the data, I’ll make comparisons by age group, gender and race and ethnicity. You have the more slides in your handout that I can cover today.

10 70 million 35 million 3 million 4.2 million
Life expectancy = 77 years 35 million Life expectancy = 47 years 21 million Americans are living longer than ever before. This slides shows the steady increase in life expectancy for older adults during the past century. It’s not shown on this slide, so I’ve added it, In 1900, life expectancy at birth was 47 years; in 2000 life expectancy at birth was 77 years What is the impact of life expectancy on the growth of the older adult age group within the total population? This slide shows the growth of the older population from 1900 to the present and projects that growth to 2050. Over the 20th century, the population of adults age 65 and over (shown here in orange) grew from 3 million to 35 million or 12% of the population. During the same time period, the oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 4.2 million in 2000. However, in 2011, the Baby Boomers (those born between 1946 and 1964) will start turning 65. The number of older people will increase dramatically during the period. The size of the older population in 2030 is projected to be twice as large as their counterparts in 2000, representing nearly 20 percent of the total U.S. population. After 2030, the growth rate of the older population is projected to slow down and stabilize at around 20 percent of the total population when the last Baby Boomers enter the ranks of the older population. However, the oldest-old population is projected to continue to grow rapidly after 2030, when the Baby Boomers move into this age group. The U.S. Census Bureau projects that the population age 85 and over could grow from 4.2 million in 2000 to nearly 21 million by 2050. Not shown on this slide, there are gender differences in the make up of the older population. Older women outnumber older men in both age groups. In 2003, women accounted for 58 percent of the population age 65 and over and for 69 percent of the population age 85 and over. From a global perspective, two-thirds of all seniors in the world who have ever lived are alive today. The United States is fairly young for a developed country, with just over 12 percent of its total population age 65 and over. The older population made up more than 15 percent of the population in most European countries and nearly 19 percent in both Italy and Japan in 2003. 3 million 4.2 million

11 Living to 100 Number of Centenarians in the U.S.
17 % of all seniors 10% of all seniors And the age limits of the oldest old is increasing. This slide is not about life expectancy, it’s about the actual number and predicted number of centenarians in the US. Currently, there are about 96,548 centenarians; 80% of them are women. (Census publication, 65+ In The United States, 2005). In 2000 centenarians made up about 10% of the older population. The US Census projects that in 2050, nearly 1 out of 5 older adults will live to the age of 100. Source of data: US Census Bureau, Current Populations Reports, P23-199RV, July 1999

12 This chart shows the current and strong projected growth of the minority older population in Overall, the minority population will grow by 39% by Black elderly are project to grow to 12% in 2050 and Hispanic elderly are projected to grow to 18%t. While the White population will grow by 68% in 2030 the minority aging population will grow by 184%.

13 Indicator 3 – Marital Status
Now, I”ll shift to discussing socioeconomic aspects of the aging population. Marital status is related not only to one’s emotional well-being, but also to one’s social engagement, living arrangements, economic status and the availability of caregiving. This chart shows that most older men are married but a lower percent of older women are married. These percentages of married elderly decline with aging, especially among women. Over half of older women aged 75 to 85 are widows and 76 percent of those over the proportion of married older adults decreases with age. However, even among the oldest old, nearly 60% of men were married. (Notes: 36 percent of women age and 14 percent of women age 85 and over were married. For men, the proportion married also is lower at older ages but not as low as for older women.) You have a slide showing living arrangements, which is another factor contributing to health. The majority of men over 65, (57-84%) regardless of race live with spouses while only 39% of women live with their spouses.

14 You have the slide on educational attainment, but I’’m not showing it
You have the slide on educational attainment, but I’’m not showing it. In 1950, only 17 percent of the older population had graduated from high school as compared to 76% in in 1950, only 3 percent had at least a Bachelor’s degree as compared to about 20% 2007 But despite the overall increase in educational attainment among older Americans, substantial educational differences exist among racial and ethnic groups.  The educational levels of Whites and Asians is considerably higher than that of Blacks and Hispanics of any race. This isn’t shown on the slide but educational differences also exist by gender. In 2003, about one-quarter (23%) of older men attained at least a Bachelor’s degree as compared to about one in ten (13%) older women. However, the gender gap in completion of a college education will narrow in the future because men and women in younger cohorts are earning college degrees at roughly the same rate. However, despite the increases in education, this chart on Health Literacy shows that older adults are proportionately more likely to have below basic health literacy than any other age group. Almost two-fifths (39 percent) of people age 75 and over have a health literacy level of below basic compared with 23 percent of people age 65–74 and 13 percent of people age 50–64.

15 Computer and Internet Use in the United States: 2003
A myth about older adults is that “you can’t teach an old dog new tricks”. This slide shows that computer ownership and home Internet access is being adopted widely by all ages. This chart is based on 2003 survey of householders by age; therefore numbers of older adults with access to computers and internet may be underestimated as younger age groups may have older adults living in residence and having access. Source: US Census Bureau, 2005

16 Past and Projected Number of Workers Over Age 55, 1970-2025
Workforce participation is a component of social engagement and economic well-being. Workforce participation, is the percentage of a group that is in the labor force—that is, either working (employed) or actively looking for work (unemployed). According to the BLS, in 2000, 18.4 million persons over age 55, or about one-third of the over-55 population, were in the labor force. Now, about 16% of the workforce is 65 or older -- levels unseen since the 1970s, according to the Bureau of Labor Statistics. And the number of older workers will grow rapidly over the next two decades. BLS estimates that there will be 31.8 million older labor force participants in 2015, an average annual increase of 4.0 percent from 2000. However, this rapid growth is expected to level off by the mid-2020s. BLS estimates that 33.3 million older persons will be in the labor force in 2025, an average annual increase of only 0.5 percent from Source: US Census Bureau, 2008; GAO Report to the Ranking Minority Member, Subcommittee on Employer-Employee Relations, Committee on Education and the Workforce, House of Representatives, Nov. 2001

17 Change in Median Net Worth of 65+ Households: 1984 - 2005
Average – $109,900 Whites – $125,000 Blacks – $28,200 2005 Average – $196,000 Whites – $226,900 Blacks – $37,800 79% 81% I want to say a little more about the economic situation of older adults because net worth (the value of real estate, stocks, bonds, and other assets minus outstanding debts) is an important indicator of economic security and well-being. Greater net worth allows an older family to maintain its standard of living when income falls because of job loss, health problems, or family changes such as divorce or widowhood. From 1984 to 2005 the average net worth of older adult households increased 79% from $109,900 to $196,000. However these numbers mask racial differences. The median net worth of households headed by whites increased 81 percent from $125,000 to $226,900, but the median net worth of households headed by African Americans age 65 and over increased only 34% percent from $28,200 to $37,800. So although the rate of growth of wealth between 1984 and 2005 has been substantial for both older African American households and older white households, large differences continue to exist. As you will see later, the net worth of older adults can be greatly compromised by health care costs. 34% Source: Older Americans 2008, Key Indicators of Well-Being

18 Poverty Rate by Age, U.S. (2007)
We’ve seen that there’s considerable differences in the median net worth of older adults, but where do older adults stand in relation to the total population? As you can see here, younger populations carry about twice the burden of poverty. Persons in poverty are defined here as those living in "health insurance units" with incomes less than 100% of the Federal Poverty Level (FPL) as measured by the U.S. Census Bureau's poverty thresholds. Health insurance units are related individuals who would be eligible as a group for "family" coverage in a health plan. The federal poverty threshold for a family of four in the 48 contiguous states and D.C. was $20,614 in 2006 and $20,650 in 2007.  The U.S. Department of Health and Human Services (HHS) produces simplified - but very similar - versions of federal poverty thresholds called "poverty guidelines" for use in determining financial eligibility for many government programs.  Source:, retrieved 4/15/09

19 Factors in the Decision to Work in Retirement (%)
Pre-retirees who plan to work in retirement Working Retirees Desire to stay mentally active 87 68 Desire to stay physically active 85 61 Desire to remain productive or useful 77 73 Need health benefits 66 20 Desire to help other people 59 44 Desire to be around people 58 47 Need the money 54 51 Desire to learn new things 50 37 Desire to pursue a dream 32 I’m going to speak a bit about older adult’s views about work and retirement. In 2003, AARP conducted a nationwide telephone survey of 2,001 individuals between the ages of 50 and 70 years old who were employed on a full-time or part-time basis to explore their vision of retirement and to better understand the types of jobs that workers who plan to work in retirement imagine holding and the types of jobs currently held by today’s “working retirees.” For purposes of this survey, a working retiree is an individual who reports that he or she has retired from a job and is now employed on either a full-time or part-time basis. What’s interesting to note is that money is not the driving factor; rather it’s being mentally and physically active and productive. This finding suggests that the older population may be a growing pool of resources to enfold into our staffing for hp programming. Source: S. Kathi Brown, "Staying Ahead of the Curve 2003: The AARP Working in Retirement Study," Washington, DC: AARP, *Respondents could choose as many factors as apply to them

20 Older Adults as Volunteers
Age 55-64 Age 65+ % who volunteer 28.1 23.5 Tot. # volunteers  9.456 million  8.749 million Median annual hours per volunteer    58  96 These findings are consistent with what we know older adult views about social engagement. Dr. William Thomas describes in, “What are Old People For?” (VanderWyk & Burnham, 2004), a theory of senescence, or the process of growing into old age, as a time of transition from a “have to do” to “want to do” focus in life. That is a change from doing, out of work and family obligation, to being and reaching out for something new and different. In this transition, as many older adults leave the work environment, or are freed up from household or caregiving tasks, they seek avenues to contribute back to society or to contribute at a higher level than they had in earlier years. Civic engagement is a form of “wanting to do” and it reflects the social engagement component of healthy aging. We know that many older adults define their sense of wellness through their social connectedness. In his book, Prime Time, Marc Freedman talks in-depth about the role of seniors’ as a resource for expertise and volunteerism in our communities. I will just briefly note that seniors find meaning and a sense of wellness through volunteerism. Even though a significant proportion of older adults continue to work for pay, this slide shows that at least one out of 4 Americans age 55 and over volunteered at least once in the past year. Even among Compared with the U.S. median commitment of 58 volunteer hours annually for those ages 55+, those 65 and over contributed 96 hours. (U.S. Department of Labor's Bureau of Labor Statistics) And there’s potential for this level of volunteerism increasing with the newly passed Edward M. Kennedy Serve America Act. The bill will strengthen and expand the federally supported service initiatives, making it possible for more Americans to serve through programs like AmeriCorps, Senior Corps, and Habitat for Humanity. In addition, the measure updates the full-time education award service members receive. Source: U.S. Bureau of Labor Statistics, Volunteering in the United States, 2008

21 Grandchildren in Grandparents’ Homes Where Grandparents are the Householders
While I’m on the subject of the social engagement and voluntary contributions of older adults, I want to point out that grandparents are being called upon more and more to help raise their grandchildren. As you can see in this chart, the US Census data reveals that by 2008, nearly 1.5 million children were being raised by their grant parents alone, an increase of 58% since 1970 and nearly 3 million children lived in households headed by a grandparent, with one or more parents also present, an increase of 125% from 1970. A 2004 study by the Urban Institute caculates that the economic value of grandparent care of children in 2004 = ~$65 billion Source: US Census Bureau, Current Population Survey, March and Annual Socieconomic Supplements, 2008 and earlier.

22 Value and Cost of Informal Caregiving
12.8 million Americans need care 7.3 million are 65 and older The value of informal caregiving is estimated at $196 billion per year Informal caregiving exceeds nursing home and home care expenses by $81 billion Caregiving costs U.S. businesses $11.4 billion annually Caregivers lose up to $659,139 over a lifetime Caregiving encompasses health, living arrangements, economics, social and health needs. This slide shows some selected statistics underlying the significant and growing demand for caregiving. As you can see, more than 7 million older adults need help with every day activities. Caregivers are providing substantial unpaid, informal help with these basic tasks of personal care as well as household maintenance chores. However, as this slide shows, informal caregiving is a major cost to families, businesses, communities and our society and with the projected future growth of the older population, these costs are also expected to increase. Geriatric Social Work Initiative, San Jose State University, College of Social Work

23 I’ve briefly covered some social and economic characteristics of older adults that impact their health and quality of life, so now I want to turn to the question – Do older adults think of themselves as being in good health? I’ll give a very broad overview of health issues. This slide presents findings from the National Health Interview Survey. It shows that during the period , at least half of older adults, regardless of ethnicity, say “yes” to being in good health.. However, as this slides shows, the proportion of people reporting positive health does decreases among the older age groups, but good health is reported by at least half the age group. And this slide shows that regardless of age, older non-Hispanic white men and women are more likely to report good health than their non-Hispanic black and Hispanic counterparts.

24 $245 billion an average of $1,066 per person
Chronic diseases account for 75% of the $1.4 trillion we spend on health care $245 billion an average of $1,066 per person 1980 $1.4 trillion an average of $5,039 per person 2001 $2.8 trillion an average of $9,216 per person 2011 Older adults’ generally positive view of their health status is an interesting finding, given that today, about 80% of older adults have at least one chronic condition, and 50% have at least two. 1980 to 2011 the cost of chronic care has increase 700-fold Bill is going to talk a bout long term care, so I’m going to focus on chronic disease. Mensah: Heffler et al. Health Affairs, March/April 2002.

25 Boomers will be living longer: % people age 65 who will live to age 90
Four-fold increase What’s also driving these costs is the fact that Boomers will be living longer. The leading edge of the boomers will reach the age of 65 by This chart shows the likelihood that an American who is age 65 will survive to the age of 90 has quadrupled since 1940.  By 2050, 2 out of 5 65 years old are likely to reach the age of 90. I’m going to discuss a bit more about boomers… 1940 1960 1980 2000 2050 Source of data: US Census Bureau

26 Boomers are relatively wealthier but are also worried about future health care costs
Wealthy - possess ¾ of nation’s financial assets + estimated $1trillion in annual disposable income Yet, 44% those fearful of not having sufficient resources to live beyond age 85 Currently possess ¾ of nation’s financial assets plus estimated $1trillion in annual disposable income Yet 44% those fearful of not having sufficient resources to live beyond age 85 > “When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007

27 Boomers provide a substantial amount of caregiving
>70% have at least one living parent 25 million live with an aging parent 13 million provide parental caregiving “When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007

28 What’s the health picture for Boomers?
By 2030 More than 6 of every 10 will be managing more than one chronic condition 14 million (1 out of 4) will be living with diabetes >21 million (1 out of 3) will be considered obese Their health care will cost Medicare 34% more than others 26 million (1 out of 2) will have arthritis Knee replacement surgeries will increase 800% by 2030 “When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007

29 What’s the health care picture for Boomers?
Cause significant shift in health care: By 2020, Boomers will make 40% of all physician office visits By 2030 hospital admissions among Boomers will increase more than 100%, totaling half of all admissions in the US “When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007

30 Indicator 28 – Use of Time Some factors affecting health conditions of boomers is the quality of their healthy behaviors and how they use their time – This chart shows that in 2006 watching TV was the activity that occupied the most leisure time—about one-half the total—for Americans age 55 and over. No more than 4% of time was spent participating in sports, exercise or other recreation

31 In 2008, NCOA with funding from the Atlantic Philanthropies conducted a survey, of over 1,000 Americans 44 and older with chronic conditions to examine their attitudes and to explore their quality of life, health needs and experiences with the health care system. The survey also identified barriers to self-care and what is needed to better manage overall health.

32 NCOA Survey Key Findings
Americans 44 and older with chronic conditions are diverse One in four has delayed health care due to cost Most rely on health care system for help, but it’s not working well for many Many are not getting help and support they need Cost, confidence, lack of knowledge are barriers to managing conditions Americans 44 and Older with Chronic Conditions Are Diverse More than two-thirds (68%) of respondents have two or more chronic conditions – and 20% have four or more chronic conditions. Those with one chronic condition are healthier, have higher incomes, and have more support at home; while those with multiple conditions tend to have low incomes and less support. The data show low-income individuals consistently face the most challenges to managing their health, and have the greatest needs. Latinos, in particular, confront more challenges than white Americans, and are especially interested in support from people and places in their community. One in Four Has Delayed Health Care Due to Cost Latinos (43%) and Baby-Boomer women (39%) are most likely to report delayed care because of cost. While low-income individuals are among the most likely to have put off care, even 22% of those with household incomes of $50,000 or more have made decisions to delay care. Most Rely on Health Care System for Help, But Not Working Well for Many 44% say they frequently or occasionally wish their doctor had more time to spend talking to them, and 45% feel tired of explaining their health problems every time they see a health care provider. 30% say they frequently or occasionally leave a doctor’s office or hospital feeling confused about what they should do. Close to four in ten (38%) say they feel tired of feel like they’re on their own when it comes to taking care of their health. Those most likely to feel tired of feeling on their own include: Many Not Getting Help and Support They Need Four in ten (39%) say they never, rarely, or only occasionally get the help and support they need to manage their conditions and improve their health. Daily Life a Struggle for Some Besides experiencing physical pain and lack of energy, 32% have had to cut back on social activities; 26% have cut back on helping family and friends, 27% have had to cut back on helping others in their community. More than one in four (28%) of those with low household incomes have felt strains on family relationships due to their health problems. One in four who are currently employed (26%) have had to miss work due to their health. Source: Re-forming Healthcare: Americans Speak Out About Chronic Conditions & the Pursuit of Healthier Lives, NCOA, March 2009

33 Types of support NCOA survey respondents identified:
71% - Learn how to exercise or eat better in a way that is realistic and works with your limitations 68% - Get practical tips and advice from other people who have health problems similar to yours 59% - Set goals and work together with other people who are trying to improve their health 58% - Learn how to manage work, family and other responsibilities and still take care of your health Source: Re-forming Healthcare: Americans Speak Out About Chronic Conditions & the Pursuit of Healthier Lives, NCOA, March 2009

34 The prevention imperative
Only 30% of physical aging is attributable to genetic heritage! But here is an amazing statistic! We are not doomed after all! Indeed, there is an explosive growth of new research calling into question our longheld assumptions about the inevitability of decline in aging. Instead, the culprits are familiar…physical inactivity, smoking, poor diet, social isolation. Prevention – it’s for EVERYONE! Slide from Becky Hunter, UNC CAH

35 Threats to Health Among Seniors
73% age report no regular physical activity 81% age 75+ report no regular physical activity 61% - unhealthy weight ~35% - fall each year 20% - clinically significant depression; age group at highest risk for suicide 32% - no flu shot in past 12 months 35% - never had pneumococcal vaccine 20% - prescribed “unsuitable” medications Also at greatest risk for fire-related injuries, and traumatic brain injury (age 75+) Sources: State of Aging and Health, 2007;

36 Health promotion and disease prevention does work for older adults
Longer life Reduced disability Later onset Fewer years of disability prior to death Fewer falls Improved mental health Positive effect on depressive symptoms, social connectedness Delays in loss of cognitive function Lower health care costs A report by Trust for America's Health, entitled Prevention for a Healthier America, found that investing $10 per person per year in proven community-based programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use, could save the country more than $16 billion annually within five years.

37 Ideal Survivorship Curve: The “rectangularization” of morbidity
Trauma plays a large and potentially reversible role. Chronic disease accounts for almost all of the approximately ten year- wide area of premature death remaining over ages 60–90. Source: J.F. Fries and L.M. Crapo, Vitality and Aging (San Francisco:W.H. Freeman, 1981).

38 National level partnerships for health promotion advocacy: A growing list…
Centers for Disease Control and Prevention Administration on Aging Centers for Medicare and Medicaid Services Agency for Healthcare Research and Quality Environmental Protection Agency Robert Wood Johnson Foundation Archstone Foundation John A. Hartford Foundation Atlantic Philanthropies National Council on Aging American Society on Aging National Association of State Units on Aging National Association of Area Agencies on Aging National Association of Chronic Disease Directors “Disease-specific” Associations 13 ORGS

39 Some common approaches used in health promotion and aging
Socio-ecological theory Chronic Care Model RE-AIM Framework

40 The Social-Ecological Perspective
The health and well-being of older adults will be improved only if we work from a broad perspective. Comprehensive planning and partnerships at all levels are required. Changes at the individual level will come with improvements at the organizational, community and policy levels. Adapted: Prevention: Why Does It Matter? PowerPoint presentation by Nancy Whitelaw, March 2007, available at:

41 Chronic Care Model Self-management support Community resources
Organization of health care Interdisciplinary teams Decision support Clinical information systems

42 RE-AIM framework Analyze epidemiological data to target health issues and populations Develop common core of practical process and outcome measures Build partnerships across multiple sectors Implement evidence-based health promotion programs with fidelity Maintain individual-level benefits and sustain ongoing programming

43 43

44 A short list of evidence-based health promotion programs for older adults
Chronic Disease Self-management Program Diabetes Self-Management Active Living Every Day Active Options Enhance Wellness/Enhance Fitness Matter of Balance Fit and Strong AF Exercise Program AF Aquatics Program Arthritis Self-Help Program Healthy IDEAS PEARLS

45 What the data tell us Older adult population is the fastest growing sector of the overall population and older adults are becoming more racially and ethnically diverse. Increased demand for tailored programming for reaching oldest old and minority elders Race, class and gender compound aging effects, resulting in higher risks for health, poverty and other social problems. Health literacy is an issue for a significant portion of the boomer and older adult populations In summary, the data I’ve presented tells us that…

46 What the data tell us (continued)
The majority of older adults report good health and many are able to work and contribute to family and society Cost related to health care are growing out of control Exponentially higher expenditures for health care and services “Costs” to caregivers is staggering direct out-of-pocket expenses, economic insecurity caused by changes in work patterns, and health effects Unprecedented demand by older adults and boomers for caregiving and other support services long term care solutions health promotion/disease prevention, falls prevention and chronic care programs In summary, the data I’ve presented tells us that…

47 Challenges confronting health promotion and disease prevention for older adults
Science not shared – growing body of evidence of interventions that can positively impact health, disability and quality of life Fragmented systems and services across aging, medical care, mental health and public health Untapped assets of 29,000 organizations currently reaching 7-10 million older adults Lack of common conceptual “language” Much work to be done in expanding the evidence base in health promotion/disease prevention and chronic disease self-management for diverse older populations AOA spends $22 million on IIID health promotion activities – which equates to 43 cents per person for the 50,603,476 million people 60+ Adapted: Prevention: Why Does It Matter? PowerPoint presentation by Nancy Whitelaw, March 2007, available at:

48 Challenges (cont’d) Untapped creative approaches to reaching older adults, e.g., through worksites, libraries, grandparent groups and intergenerational programming Under-developed health information technology to help older adults and boomers manage their conditions and participate in health promotion, falls prevention and chronic disease self-management programming Under-developed mechanisms to tap into and train boomer and older adult populations as valuable resources in delivering health promotion programs

49 The message for all us It’s never too late to start and it’s always too early to quit But, it’s also never too early to start - life course perspective Think “immediate” – those currently 65+ Think “intermediate” – those 35-64 Think “long-range” – children I hope my aging and health overview has given you some sense of the growth and diversity of the aging population and some insights into current and future health needs. Here’s some key “take-home” points Third bullet - NC has new just approved legislation piloting for 150 minutes of physical activity per week for K-8 and NC in 8 schools where more nutritious foods are served for lunch and are made available in vending machines. Adapted from: Robert Butler, “Maintaining Healthy Lifestyles,” International Longevity Center, 2000 and “Reimagining America: AARP’s Blueprint for the Future”, 2005

50 Thank You! Mary Altpeter UNC Institute on Aging

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