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.
4. Definitions
• Aged
• Aging
• Gerontology multidisciplinary study
• Geriatrics branch of medicine
• Geriatrician
• Terms – seniors, older adults, mature adults,
elderly, aged, etc.
5.
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)
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
15.
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
18. • TR total dependency ratio is climbing up to
85% driven by elder segment.
19.
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
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.
37.
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?
