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Elders
Chapter 9
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+
Definitions
• Aged
• Aging
• Gerontology
• Geriatrics
• Geriatrician
• Terms – seniors, older adults, mature adults, elderly, aged, etc.
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
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
Symbolic Age Pyramid
Population Pyramids, U.S.
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
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
Dependency Ratio, U.S., 2010-2050
Other Demographic Variables• Affect community health programs for older
Americans• Marital status
• Living arrangements
• Racial and ethnic composition
• Geographic distribution
• Economic status
• Housing
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
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+
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%
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)
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
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
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
Mortality
• Top causes of death for elders (responsible for 2/3 of deaths)• Heart disease
• Cancer
• Stroke
• CLRD
• Alzheimer’s Disease
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
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
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
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
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
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
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
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
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
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
• Meal service
• Homemaker service
• Chore and home maintenance
• Visitor service
• Adult day care
• Respite care
• Home health care
• Senior centers
Community Facilities and Services
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?
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