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Health Issues for Aging Health Issues for Aging PopulationsPopulations

Instructors:Instructors:Lynda Burton, Sc.D.Lynda Burton, Sc.D.

Bruce Leff, M.D.Bruce Leff, M.D.

Overview of Class, 2007Overview of Class, 2007

Biological Basis and Clinical Biological Basis and Clinical Aspects of AgingAspects of Aging

Physiologic changesPhysiologic changesLoss of homeostatic reserveLoss of homeostatic reserveIncreased vulnerability to diseaseIncreased vulnerability to diseaseComorbid conditionsComorbid conditionsLife expectancy Life expectancy Maximum life span potentialMaximum life span potential----upper upper limit to human life?limit to human life?Theories to explain process of agingTheories to explain process of aging

Demography of AgingDemography of Aging

Effect of fertility, mortality, Effect of fertility, mortality, migrationmigration““Demographic imperativeDemographic imperative””•• 13% of population in 1990s13% of population in 1990s•• 24% in 203024% in 2030•• increase in number of oldest oldincrease in number of oldest old

Aged dependency ratio:Aged dependency ratio:•• 38 persons age 65 and over per 100 persons aged 38 persons age 65 and over per 100 persons aged

1818--6464

Figure 1: Number of Persons 65+, 1900 - 2030 (numbers in millions)

3.1 4.9 916.7

25.731.2 35

40.2

54.6

71.5

01020304050607080

1900 1920 1940 1960 1980 1990 2000 2010 2020 2030

Year (as of July 1)

A profile of Older Americans: 2006, AOA, US, DHHS

Physical Disorders Associated with Physical Disorders Associated with AgingAging

Normal aging versus diseaseNormal aging versus diseaseChronic illnessChronic illnessPrevalent diseasesPrevalent diseasesDiseases associated with health care Diseases associated with health care use, mortalityuse, mortality

Mental Disorders of Older PersonsMental Disorders of Older Persons

Dementia, depression, delirium Dementia, depression, delirium most prevalentmost prevalentPrevalence of dementia Prevalence of dementia •• in nursing homes: 40in nursing homes: 40--67%; 67%;

community 4community 4--5%5%•• Implications for costs of careImplications for costs of care•• Behavior problems associated with Behavior problems associated with

dementiadementia•• Risk factorsRisk factors

Functional Capacity and DisabilityFunctional Capacity and Disability

Measurement of health statusMeasurement of health status•• number of diseasesnumber of diseases•• severityseverity•• health services utilizationhealth services utilization•• functional capacityfunctional capacity

Measurement of functional capacityMeasurement of functional capacity

Projected Disabled Population

0123456789

10

1985 1990 1995 2000 2005 2010 2015 2020 2025 2030

longer life, higher disabilityconstant

Preventive Health for Older PersonsPreventive Health for Older Persons

Primary, secondary and tertiary Primary, secondary and tertiary preventionpreventionPreventive servicesPreventive servicesLife style changeLife style change•• Physical activityPhysical activity•• DietDiet•• Smoking, excessive alcohol intakeSmoking, excessive alcohol intake•• PsychoPsycho--social, selfsocial, self--masterymastery

Total Life Expectancy, Active Life Expectancy and Disabled Life Expectancy

19.5

15.6

18.0

15.2

3.3

2.7

3.0

2.6

0 5 10 15 20 25

High Education

Low Education

High Education

Low Education

Total LifeExpectancy

17.8

21.0

18.3

22.8

Piedmont Health Survey of the Elderly; Women, Age 65

White Women

Black Women

Active life expectancy Disabled life expectancy

Data Source: Guralnik, et al. Educational status and active life expectancy among older blacks and whites. New Engl J Med 1993;329:110.

Health Services for Older Persons: Health Services for Older Persons: Ambulatory Ambulatory

Ambulatory visits: Ambulatory visits: Chronic care follow upChronic care follow up

hypertension, chronic obstructive hypertension, chronic obstructive pulmonary disease, diabetes, pulmonary disease, diabetes, congestive heart failurecongestive heart failure

Preventive carePreventive careIntegrated, coordinated careIntegrated, coordinated care

Health Services: Hospital CareHealth Services: Hospital Care

About 3,549 hospitalized per 10,000 About 3,549 hospitalized per 10,000 persons age 65+persons age 65+Trend toward decrease in days 5.8 days,Trend toward decrease in days 5.8 days,Problems with hospitalizing older Problems with hospitalizing older personspersons•• ““cascade iatrogenesiscascade iatrogenesis””

New types of hospital servicesNew types of hospital servicesRole of managed care in reducing Role of managed care in reducing hospitalizationshospitalizations

Health Services: CommunityHealth Services: Community--based and based and institutional longinstitutional long--term careterm care

Home health care: acute vs long termHome health care: acute vs long termAdult day careAdult day careHospiceHospiceNew servicesNew services•• Continuing Care Retirement CommunitiesContinuing Care Retirement Communities•• Assisted Living (Board and Care)Assisted Living (Board and Care)•• PACE, PACE, SHMOsSHMOs

Institutional careInstitutional care

Psychosocial Aspects of Health and AgingPsychosocial Aspects of Health and Aging

Issues for family caregiversIssues for family caregivers•• Who are they?Who are they?•• How do you define How do you define ““caregiver burden?caregiver burden?””How How

do you measure it?do you measure it?•• Does this burden affect health, mental Does this burden affect health, mental

health?health?•• Research to relieve caregiver burdenResearch to relieve caregiver burden

Changing roles of older personsChanging roles of older personsSense of control, selfSense of control, self--masterymasterySocial isolationSocial isolation

Federal Health Policies Related toFederal Health Policies Related to Older PersonsOlder Persons

MedicareMedicare•• Benefits, adding prescription drugsBenefits, adding prescription drugs•• Reimbursement to providersReimbursement to providers

MedicaidMedicaid•• LongLong--term careterm care

PACE, SHMOPACE, SHMO

State Health Policies Related toState Health Policies Related to Older PersonsOlder Persons

Regulatory policyRegulatory policy•• Nursing homesNursing homes•• Assisted livingAssisted living•• CCRCsCCRCs

Financing of careFinancing of care•• Move to managed careMove to managed care•• nursing home paymentnursing home payment•• PACEPACE--type programstype programs

Ethical Issues in Providing Health Care to Ethical Issues in Providing Health Care to Older PersonsOlder Persons

Principles: beneficence, autonomy, Principles: beneficence, autonomy, justice, nonjustice, non--malfeasancemalfeasanceInformed consent for care, researchInformed consent for care, researchEqual access to resources vs. Equal access to resources vs. rationingrationingIssues surrounding death and dying, Issues surrounding death and dying, longlong--term careterm care

Data Sources for Study of Health Data Sources for Study of Health of Older Personsof Older Persons

Claims data (Medicare and Medicaid)Claims data (Medicare and Medicaid)Interview dataInterview dataMedical recordsMedical recordsEncounter dataEncounter dataHospital discharge summariesHospital discharge summariesNational LongNational Long--term Care Surveyterm Care SurveyNational Nursing Home SurveyNational Nursing Home Survey

Data Sources for Study of Health Data Sources for Study of Health of Older Persons, continuedof Older Persons, continued

Medicare Current Beneficiary SurveyMedicare Current Beneficiary Survey

Medical Expenditure Panel SurveyMedical Expenditure Panel Survey