1. The elderly population is growing significantly due to increased life expectancy and the aging of the baby boom generation. Elders now represent 12.8% of the total US population. 2. Elders face challenges related to health, income, housing, transportation and accessing community services. While health has improved, most elders have multiple chronic conditions and disabilities that increase with age. 3. The aging of the population will strain health care services and increase the economic burden on working populations. It will also shift the geographic distribution and diversity of the elderly population in the US.

1. Elders
Chapter 9

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+

4. Definitions
• Aged
• Aging
• Gerontology multidisciplinary study
• Geriatrics branch of medicine
• Geriatrician
• Terms – seniors, older adults, mature adults,
elderly, aged, etc.

6. 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

7. 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)

9. Symbolic Age Pyramid

10. Population Pyramids, U.S.

11. 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

12. • 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

13. • Mortality rates: down in 20th century
• Life expectancy up
• Therefore older population

14. 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

16. • Unproductive are 0-19 years and
• 65+
• Both together are total dependency ratio
• Youth dependency ratio =youth/productive
• Old age dependency ratio= old/productive

17. Dependency Ratio, U.S., 2010-2050

18. • TR total dependency ratio is climbing up to
85% driven by elder segment.

20. • What factors cause easy transition to senior
living for Papa

21. 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

22. • Who lives longest?
• Who lives least long ?
• Who is in the middle?

23. 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

24. 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+

25. 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%

26. 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)

27. 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

28. • What is SES?

29. 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

30. 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

31. 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

32. • Medicare enrollees > 65
• 1 in 5 men and 1 in 3 women can’t
• Walk 2 blocks
• Write
• Kneel
• Reach overhead
• Lift 10 lbs

33. 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

34. 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

35. • 22% > 65 do physical activity
• 10% > 85%
• Also vaccines

36. Figure B01: Healthy People 2020
U.S. Department of Health and Human Services, Office of Disease Prevention
and Health Promotion (2010). Healthy People 2020. Available at
http://www.healthypeople.gov/2020/default.aspx. Accessed December 2, 2010.

38. 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

39. 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

40. 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 $

41. 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

42. 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

43. • ADLs activities of daily living
• These measure functional limitations
• Examples are
• Eating
• Toilet function
• Bathing
• Walking
• Out of bed

44. 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

45. 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

46. 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

47. Community Facilities and Services
• Meal service
• Homemaker service
• Chore and home maintenance
• Visitor service
• Adult day care
• Respite care
• Home health care
• Senior centers

48. 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?