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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,

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Presentation on theme: "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,"— Presentation transcript:

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 California at Berkeley University of Colorado University of Illinois at Chicago University of Pittsburgh University of North Carolina Texas A&M University University of South Carolina West Virginia University

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

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

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7 Rowe and Kahn Model “Healthy Aging” “and injury and promoting health” “optimizing” Managing Chronic Conditions 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 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

10 3 million 35 million 70 million 4.2 million 21 million Life expectancy = 47 years Life expectancy = 77 years

11 Living to 100 Number of Centenarians in the U.S. Source of data: US Census Bureau, Current Populations Reports, P23-199RV, July % of all seniors 17 % of all seniors

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13 Indicator 3 – Marital Status

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15 Computer and Internet Use in the United States: 2003 Source: US Census Bureau, 2005

16 Past and Projected Number of Workers Over Age 55, 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 2005 Average – $196,000 Whites – $226,900 Blacks – $37,800 Change in Median Net Worth of 65+ Households: Average – $109,900 Whites – $125,000 Blacks – $28,200 Source: Older Americans 2008, Key Indicators of Well-Being  81%  34%  79%

18 Poverty Rate by Age, U.S. (2007) Source: Statehealthfacts.org, 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 active8768 Desire to stay physically active8561 Desire to remain productive or useful7773 Need health benefits6620 Desire to help other people5944 Desire to be around people5847 Need the money5451 Desire to learn new things5037 Desire to pursue a dream3220 Source: S. Kathi Brown, "Staying Ahead of the Curve 2003: The AARP Working in Retirement Study," Washington, DC: AARP, 2003 *Respondents could choose as many factors as apply to them

20 Older Adults as Volunteers Source: U.S. Bureau of Labor Statistics, Volunteering in the United States, 2008 Age 55-64Age 65+ % who volunteer Tot. # volunteers million million Median annual hours per volunteer 58 96

21 Grandchildren in Grandparents’ Homes Where Grandparents are the Householders 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 Geriatric Social Work Initiative, San Jose State University, College of Social Work

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24 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 Mensah: Heffler et al. Health Affairs, March/April $2.8 trillion an average of $9,216 per person 2011

25 Boomers will be living longer: % people age 65 who will live to age 90 Source of data: US Census Bureau Four-fold increase

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 “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

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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 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! 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

37 Ideal Survivorship Curve: The “rectangularization” of morbidity 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

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

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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 Fit and Strong 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

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

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 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  Think “long-range” – children 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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