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1. EldersChapter 9
2. Introduction Number of elders and the proportion to thetotal
population increased significantly in the20th 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. Definitions Aged Aging Gerontology multidisciplinary study
Geriatrics branch of medicine Geriatrician Terms seniors, older
adults, mature adults,elderly, aged, etc.
4. Aging Myths Ageism prejudice and discrimination againstthe
aged Common myths not accurate representation ofelders Majority of
elders today are active and well Many still working Many strongly
engaged in community,volunteer, and advocacy programs
5. Demography of Aging Size and growth of the elder population
Population pyramids describe aging ofpopulations Americas pyramid
shape has drasticallyshifted Other countries have had shifts as
well 85+ fastest growing segment of olderpopulation Growth in
median age from 35 ( 2000) to 39( 2035)
6. Symbolic Age Pyramid
7. Population Pyramids, U.S.
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. Fertility rates = births/1000 women ofchildbearing age High
beginning of 1900s Low during depression Rebound after WW 2 This
population bulge moves up us agepyramid
10. Mortality rates: down in 20th century Life expectancy up
Therefore older population
11. Dependency and Labor Force Ratios Dependency ratio
economicallyunproductive to economically productive Traditionally
defined by age Can be used for social policy decision making Labor
force ratio number of people actuallyworking and those who are not,
independent oftheir ages Ratio of workers to dependants will be
lowerin the future than today
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. Dependency Ratio, U.S., 2010-2050
14. TR total dependency ratio is climbing up to85% driven by
elder segment.
15. What factors cause easy transition to seniorliving for
Papa
16. Other Demographic Variables Affect community health
programs for olderAmericans Marital status: men married but1/2
women Living arrangements divorces up..lessbenefits. 2/3 elders
live with others. Racial and ethnic composition more hispanic
Geographic distribution changing. Economic status Housing
17. Who lives longest? Who lives least long ? Who is in the
middle?
18. Marital Status of elder men are married; just over half
ofelder women are married Elder women 3xs 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. Living Arrangements Closely linked to income, health
status, andavailability of caregivers 2/3 of noninstitutionalized
elders live withsomeone else Women more likely to live alone Only
5% of elders live in nursing homes of nursing home residents are
women More than half of nursing home residents are85+
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. 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 greatestproportion Reasons some
states age Inward migration (FL), young people leave(farm belt
states)
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. What is SES?
24. Housing Most live in adequate, affordable housing 80% own,
20% rent Elder homes are more likely to be older, morelikely to
have lower value, in great need forrepairs, less likely to have
central heat/air 30% of elders pay more for housing than theycan
afford
25. Health Profile Health status of elders has improved over
theyears (living longer and functional health) Chronically disabled
has been decreasing Health status usually not as good as
youngercounterparts
26. Mortality Top causes of death for elders (responsible
for2/3 of deaths) Heart disease Cancer Stroke CLRD Alzheimers
Disease Decline in CVD deaths causes less mortality
27. Medicare enrollees > 65 1 in 5 men and 1 in 3 women cant
Walk 2 blocks Write Kneel Reach overhead Lift 10 lbs
28. Morbidity Activity limitations increase with age Chronic
conditions Substantial burden on health and economicstatus of
individuals, families, and nation 1/3 report limitation of activity
due to chronicconditions Impairments Very prevalent in older adults
May be sensory, physical, memory
29. Health Behaviors and Lifestyle Choices Generally have more
favorable healthbehaviors than younger counterparts Less likely to
consume large amounts ofalcohol, smoke cigarettes, or be overweight
Areas for improvement Physical activity, immunizations and
nutrition
30. 22% > 65 do physical activity 10% > 85% Also
vaccines
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. 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 benefitchecks
33. Instrumental Needs of Elders Six instrumental needs that
determine lifestylefor people of all ages; aging process can
alterneeds in unpredictable ways Income Housing Personal care
Health care Transportation Community facilities and services
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 havehighest rates of
poverty But need home, health $
35. Housing Major needs: appropriateness,
accessibility,adequacy, affordability Needs are intertwined
Changing place of residence can have negativeeffect on elder and
family members Group housing Nursing homes, Eden Alternative
facilities,Green Houses, retirement communities,CCRCs,
assisted-living
36. Personal Care Four levels of tasks that may need
assistance: Instrumental tasks, expressive tasks, cognitivetasks,
tasks of daily living Activities of daily living (ADLs) to
measurefunctional limitations Instrumental activities of daily
living (IADLs)to measure more complex tasks Caregiver issues
Caregiver services
37. ADLs activities of daily living These measure functional
limitations Examples are Eating Toilet function Bathing Walking Out
of bed
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 forhealth care services of elders Will see major changes in
future years
39. Transportation Transportation allows elders to
remainindependent On average, elders live 10 year after they
stopdriving Greatest influence on transportation needs: income and
health status Many public transportation challenges Solutions for
transportation needs of elders
40. Community Facilities and Services Older Americans Act of
1965 (OAA) toincrease 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. 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. Discussion Questions What can happen to increase the
likelihood ofelders utilizing community facilities andservices? How
will the changing demographics of eldersaffect health care
services?