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What are the health and well-being issues facing seniors?

What should be done to improve senior health and well-being? (policies, attitudes, etc.)

Trends for Elders Ageing society  baby boomers retiring. Rising concerns about health care, retirement support, living costs. Increasing poverty for elders. Shorter lifespans than in other countries. Fraying of the social contract?  threatened cuts to Medicare, Social Security. Importance of community supports for elders.

An Aging America Americans are living longer. The aging of America is creating economic, social, political, and health care issues. Age is a relative concept.

Aging Definitions Aged: state of being old. Aging: changes that occur when growing older. Ageism: prejudice against seniors. Gerontology: study of aging. Geriatrics: Medical treatment of the aged. Seniors: the elderly, over 65.

Myths surrounding aging Life goes downhill after 65. Old people are all the same. Old people are lonely and ignored by their families. Old age used to be better. Old people are senile. Old people have a good life. Most old people are sickly. Old people no longer have sexual interest/ability. Most end up in nursing homes. Old people are unproductive.

Demography of aging Increasing proportion of population who are seniors, since 1900  1 in 7 over 65 (1995). Median age in 1994  34 and rising. Fertility rate high after WWII  baby boom. Mortality rates are declining. Migration to U.S. increases the population.

Demography: Support and Labor- Support Ratios Support ratio = comparison between the “unproductive” ( 64) and the “productive” (20-64). As population ages  total support ratio increases. Ratio of those not working to those who are. Labor-force support ratio  some who are considered “unproductive” are really working.

Other Aging Demographics Marital status: senior men likely to be married; senior women likely to be widowed. 70% of seniors live another person; 4 out of 5 living alone. Most seniors are white, but this is changing. Large senior populations: California, Florida. Economic status: improving, but below group.

Other Aging Demographics Housing is variable: –22% of all households headed by seniors. –77% of senior households owner occupied. –Housing is heavy burden for some.

Health Profile of Seniors Health not as good as younger people. Heart disease, cancer, stroke  70% of senior deaths. 40% of seniors have some morbidity. Seniors report more favorable health behaviors than younger people. 42 states have laws requiring reporting of elder abuse.

Instrumental Needs of Seniors Income needs of seniors are generally less than for younger Americans. Income needs drop at retirement: expenses drop; medical expenses, home maintenance increase. Sources of income: retirement benefits; job earnings; asset income; public assistance. 28% of seniors are below 150% of poverty line.

Housing Needs of Seniors Housing is important: shelter, source of continuity, symbol of independence. Need for physical modification of housing. Decisions to relocate from independent to group housing are difficult. Specially designed retirement communities. Continuing-care retirement community.

Retirement Communities

Personal Care Tasks that need assistance: –Instrumental tasks: housekeeping, transport –Expressive tasks: socializing, emotional support. –Cognitive tasks: scheduling, reminding. –Daily living tasks: eating, bathing, dressing = Activities of Daily Living (ADLs) Types of caregivers: –informal (unpaid); care-providers; care- managers.

Health Care Needs: A Major Issue Seniors are heaviest users of health care system, spend most money. –Most visits to physicians, more hospitalization, longer hospital stays, more dental care, eye care. Most have health care paid by Medicare. Health care costs are escalating.

Access to transportation: prime importance  independence Levels of transport needs: need no help; use available transport with help; need special services. Solutions to transport problems: –Fare reductions –Subsidies to mass transit –Subsidies for taxis –Funds for senior centers to buy special vehicles.

Community facilities/services Meal services available. Homemaker services  stay in own home. Chore, home maintenance service. Visitor service: homebound, institutionalized. Adult day care. Respite care: families leave senior in supervised setting, short time. Home health care: preventive, primary, rehabilitative, therapeutic services  at home.

Solidarity and Elder Health Providing a decent life for elders: who’s responsible? Solidarity: “From each according to his/her ability; to each according to his/her need.” ( Louis Blanc, Karl Marx) Solidarity: Helping each other when one is in need. Lending full support (against injustice and unfairness). A commitment to a cause (of justice). Not charity. I help you now, you help me later when I need it.

Solidarity and Elder Health Social solidarity: Community, government providing for its members. Commitment by members of society to support all: universal health care, humane immigration policy. Opposite of rugged individualism (up by your own bootstraps), such as trickle down economics (=benefiting the wealthy, who will then employ the less wealthy, etc.)

Summary Median age is at all time high. Taking care of aged parents: responsibility for ever more Americans. Reduction in independence. Increasing economic burden of ageing population: Soc.Sec., pensions, medicare. Communities face special needs of elders: housing, income, personal care, health care, transportation. Growth of adult care services industry. Challenge to social safety net and Social Contract. Political power of elderly is significant: AARP, etc.

Summary Seniors live beyond/contrary to many myths: they are active, not isolated. Social contract: society has a commitment to those that contributed so much; to the vulnerable and the weak. Senior health should reflect the highest values of civilized society, including the UN Declaration of Human Rights Ideal: commit national/state resources to maintain the dignity of seniors.