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1. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
CHAPTER 29
Public Health
and the
Aging Population

2. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Issues for the Aging Population
 Average age of Americans is increasing.
– Baby boomers are starting to retire.
 Older people tend to be in poorer health and require more medical care.
– Growth in cost of Medicare is unsustainable.
 Quality of life in later years depends on lifestyle in youth and middle age.
 Challenge for public health is two-fold.
– Improve health of older people by prevention of disease and disability.
– Confront the issue of how costs can be controlled in an equitable and humane way.

3. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Trends in Aging of the Population
 Median age has increased from 22.9 in 1900 to 38.2 in 2018.
 Causes of death in elderly are similar to causes of death in overall population.
 Percentages of people in good, very good, or excellent health are:
– 80% of the “young old” (65 to 74)
– 78% of the “aged” (75 to 84)
– 68% of the “oldest old” (85 and older)
• 12% live in nursing homes.
• This is the fastest growing age group.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Trends in Aging of the Population (cont.)
 Females outnumber males in older age groups.
 After age 80:
– Most women are widowed and live alone.
– Most men are married and living with wives.
 Men are more likely to die at a younger age; women are more likely to have
chronic, disabling conditions.
 Percentage of people over 65 living in poverty has declined from 15% in 1974
to 10% in 2014.
– Poverty rates are higher for older women than men.
– Poverty rates are higher for older blacks and Hispanics.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Compression of Mortality
 More people live closer to the biological limit of our life span.
 Compression of morbidity?
– Does longer life mean more years of healthy life or more years of chronic disease?
– Some evidence exists that older people are healthier now than in the past.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Factors That Affect Health in Old Age
 Smoking
– It causes cardiovascular disease, cancer, lung disease, osteoporosis, disorders of
the mouth.
– Prevalence of smoking declines in older people.
 Nutrition and physical activity
– Obesity causes cardiovascular disease, cancer, diabetes, arthritis.
– Prevalence of obesity declines in older people.
 Medical care
– Secondary prevention is significant.
 Hormone replacement therapy

7. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Preventing Disease and Disability in Old Age
 Immunization against pneumonia and influenza
 Medications
– Elderly often take drugs for many conditions.
– They metabolize drugs less actively.
– Risk of drug interactions is higher.
 Osteoporosis
– Increases risk for broken bones leading to disability
– Is common especially in women
– Is exacerbated by bone loss being greatest in the years following menopause
– Risk is increased by smoking and alcohol consumption
 Falls
– Have many risk factors in older people
– Result in a serious injury 1 out of 10 times
– Risk factors include use of four or more medications

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Preventing Disease and Disability (cont.)
 Impairment of vision and hearing
– Sensory loss leading to social isolation
– Glaucoma, diabetic retinopathy, macular degeneration, cataracts from exposure to
sunlight
– Hearing loss from exposure to noise
 Oral health
– Tooth loss, periodontal disease, etc.
– May lead to social isolation
 Medicare does not cover dental care, eyeglasses, or hearing aids.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Alzheimer’s and Other Dementias
 Risk increases with increasing age.
 Tremendous burden is carried by caregivers.
– Dementia long-term care costs nearly $300 billion per year.
– Even delaying onset by a few years could substantially reduce the financial and
personal burden.
 Research is beginning to give clues on risk factors.
– Genetic and nongenetic factors play a role.
– Physical exercise has been found to be protective.
 No cure exists, but some medications delay progression.
– Experimental vaccine was halted due to side effects.

10. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Medical Costs of the Elderly
 Medicare enrollment has more than tripled since 1966 and will continue to
grow.
 Cost per enrollee is rising, even faster than healthcare costs in general.
– More of costs are being shifted to the individual.
– Medicare does not pay for long-term care; Medicaid does, straining state budgets.
 Changes in family structure mean families are less able to care for elderly
relatives.
 Only hope is for baby boomers to be healthier and more independent than past
generations.

11. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Reducing Medical Costs in Aging Population
 There are proposals to ration care, but they are unrealistic.
 It is preferable to gain control of medical costs overall.
 Integration of public health and medical services to reduce demand for medical
care:
– Prevents and postpones chronic illness
– Reduces risk factors

12. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 1
 Where do you fit in the age distribution of the population?
 How do you expect to pay for your medical care when you reach retirement
age?

13. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 2
 In what ways can public health save medical care costs for elderly patients of
the future?

14. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 3
 If present trends continue, Medicare will be bankrupt in the near future.
 How do you think the nation should deal with this problem?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 4
 Visit the website of the U.S. Census and find the publication, The 65 Years and
Older Population: 2005, www.census.gov/prod/2006pubs/p23-209.pdf.
 In Table 3, there is information for each state and region on the percentage of
the population 65 and older.
 What is the percentage for your state?
 How did it change between 1990 and 2000?
 Do you have any ideas why this change occurred?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 5
 Visit the website of the National Institute on Aging, www.nia.nih.gov.
 Review news releases for the past several months.
 What research findings has the NIA recently publicized?
 What are the implications for public health?
 What are the implications for medical care costs?