90110 pp tx_ch09-1


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90110 pp tx_ch09-1

  1. 1. EldersChapter 9
  2. 2. Introduction• Number of elders and the proportion to the total population increased significantly in the 20th century• Represent 12.8% of population • 1 in every 8 Americans age 65+• Young old – 65-74• Middle old – 75-84• Old old – 85+
  3. 3. Definitions• Aged• Aging• Gerontology multidisciplinary study• Geriatrics branch of medicine• Geriatrician• Terms – seniors, older adults, mature adults, elderly, aged, etc.
  4. 4. Aging Myths• Ageism – prejudice and discrimination against the aged• Common myths not accurate representation of elders • Majority of elders today are active and well • Many still working • Many strongly engaged in community, volunteer, and advocacy programs
  5. 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 from 35 ( 2000) to 39 ( 2035)
  6. 6. Symbolic Age Pyramid
  7. 7. Population Pyramids, U.S.
  8. 8. Factors Affecting Population Size and Age• Fertility rates • Baby boomers – 1946-1964• 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. 9. • Fertility rates = births/1000 women of childbearing age• High beginning of 1900s• Low during depression• Rebound after WW 2• This population bulge moves up us age pyramid
  10. 10. • Mortality rates: down in 20th century• Life expectancy up• Therefore older population
  11. 11. 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 dependants will be lower in the future than today
  12. 12. • Unproductive are 0-19 years and• 65+• Both together are total dependency ratio• Youth dependency ratio =youth/productive• Old age dependency ratio= old/productive
  13. 13. Dependency Ratio, U.S., 2010-2050
  14. 14. • TR total dependency ratio is climbing up to 85% driven by elder segment.
  15. 15. • What factors cause easy transition to senior living for Papa
  16. 16. Other Demographic Variables• Affect community health programs for older Americans • Marital status: ¾ men married but1/2 women • Living arrangements divorces up…..less benefits. 2/3 elders live with others. • Racial and ethnic composition more hispanic • Geographic distribution changing. • Economic status • Housing
  17. 17. • Who lives longest?• Who lives least long ?• Who is in the middle?
  18. 18. Marital Status• ¾ of elder men are married; just over half of elder women are married• Elder women 3x’s more likely to be widowed • Men have shorter life expectancies • Men tend to marry women younger than selves • Men more likely to remarry after loss of spouse• Number of divorced elders continues to rise • New concerns: lack of retirement benefits, insurance, lower net worth assets
  19. 19. Living Arrangements• Closely linked to income, health status, and availability of caregivers• 2/3 of noninstitutionalized elders live with someone else • Women more likely to live alone• Only 5% of elders live in nursing homes • ¾ of nursing home residents are women • More than half of nursing home residents are 85+
  20. 20. Racial and Ethnic Composition• U.S. older population growing more diverse• 2010 elders: • 80% white, 9% black, 7% of Hispanic origin, 3% Asian• 2050 projection of elders: • White 58%, Hispanic origin 15%, black 11%, Asian 8%
  21. 21. Geographic Distribution• 2/5 live in southern states• More than half live in 10 states: CA, FL, IL, MI, NJ, NY, NC, OH, PA, TX• California greatest number; Florida greatest proportion• Reasons some states “age” • Inward migration (FL), young people leave (farm belt states)
  22. 22. Economic Status• 1970 – 25% of elders lived in poverty• 2006 – less than 9% lived in poverty• Income • 37% of elder income from Social Security • 15% asset income • 18% pension income • 28% earnings
  23. 23. • What is SES?
  24. 24. Housing• Most live in adequate, affordable housing• 80% own, 20% rent• Elder homes are more likely to be older, more likely to have lower value, in great need for repairs, less likely to have central heat/air• 30% of elders pay more for housing than they can afford
  25. 25. Health Profile• 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
  26. 26. Mortality• Top causes of death for elders (responsible for 2/3 of deaths) • Heart disease • Cancer • Stroke • CLRD • Alzheimer’s Disease • Decline in CVD deaths causes less mortality
  27. 27. • Medicare enrollees > 65• 1 in 5 men and 1 in 3 women can’t• Walk 2 blocks• Write• Kneel• Reach overhead• Lift 10 lbs
  28. 28. Morbidity• Activity limitations increase with age• Chronic conditions • Substantial burden on health and economic status of individuals, families, and nation • 1/3 report limitation of activity due to chronic conditions• Impairments • Very prevalent in older adults • May be sensory, physical, memory
  29. 29. 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 and nutrition
  30. 30. • 22% > 65 do physical activity• 10% > 85%• Also vaccines
  31. 31. Figure B01: Healthy People 2020U.S. Department of Health and Human Services, Office of Disease Preventionand Health Promotion (2010). Healthy People 2020. Available athttp://www.healthypeople.gov/2020/default.aspx. Accessed December 2, 2010.
  32. 32. 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
  33. 33. 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
  34. 34. Income• Change in types of expenses in elder years• Social Security is major source of income for ~2/3 of recipients; 90% of income for 1/3• Nonmarried women and minorities have highest rates of poverty• But need home, health $
  35. 35. Housing• Major needs: appropriateness, accessibility, adequacy, affordability • Needs are intertwined• Changing place of residence can have negative effect on elder and family members• Group housing • Nursing homes, Eden Alternative facilities, Green Houses, retirement communities, CCRCs, assisted-living
  36. 36. 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) to measure functional limitations• Instrumental activities of daily living (IADLs) to measure more complex tasks• Caregiver issues• Caregiver services
  37. 37. • ADLs activities of daily living• These measure functional limitations• Examples are• Eating• Toilet function• Bathing• Walking• Out of bed
  38. 38. 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
  39. 39. 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
  40. 40. Community Facilities and Services• Older Americans Act of 1965 (OAA) to increase services and protect rights of elders • National nutrition programs for elders • State and Area Agencies on Aging • Other programs• Services can vary greatly across the country
  41. 41. Community Facilities and Services• Meal service• Homemaker service• Chore and home maintenance• Visitor service• Adult day care• Respite care• Home health care• Senior centers
  42. 42. 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?