Posted by katie at 10:27 am
TRENDS IN THE ELDERLY POPULATION
The size and character of the elderly population in the United States is rapidly changing. These major demographic shifts have prompted numerous concerns in US social and health policy. Aging “baby boomers” (the generation born between 1940 and 1960) are expected to have major effects on our health and social service systems.
Increasing Numbers of Seniors
The number of senior citizens in the United States is rapidly increasing. During the 20th century, the US population under age 65 tripled, but those 65 and older increased by a factor of 11. The actual number of seniors grew from 3.1 million in 1900 to 33.2 million in 1994. Plus, this number is expected to more than double by the middle of the next century, to 80 million people. By the year 2030, about one out of every five Americans, or 20% of our population, will be a senior citizen.
The United States is not unique in its growing share of seniors. In many other developed countries, including Italy, Japan, Germany, Sweden, and the United Kingdom, the proportion of seniors to the rest of the population is even greater.
Half of the people 65 or older live in nine states, led by California, Florida, and New York. Currently, the senior US population is mostly white, but the fraction from other races is growing rapidly. Within the next 50 years, the number of elderly black Americans is expected to triple. The elderly Hispanic American population is growing at an even faster rate and may exceed that of the elderly black population within 30 years.
Trends in Lifestyle
Income
Improvements in the Social Security system and the introduction of Medicare have had important effects on the economic well-being of senior citizens in the United States. In the early 1960s, 35% of people 65 or older had incomes below the federal poverty level, and only 60% received Social Security pensions.
By the early 1990s, 93% of older people received Social Security retirement benefits, and 97% were covered by Medicare. Today, the percentage of seniors with incomes below the poverty line is about 10%.
Although the overall economic position of older people in the United States has improved significantly over the past 30 years, these gains have not been shared by all. For example, poverty rates are higher among certain groups of senior citizens, including:
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- Black Americans (26%)
- Hispanic Americans (21%)
- People who never finished high school (21%)
- People living alone (21%)
- People 85 and older (20%)
- People living in central cities (14%)
- People living in rural areas (13%)
Older workers continue to make up a smaller and smaller part of the US work force, and this trend is expected to continue. In 1950, 60% of men 65-69 years old worked; in 1990, only 28% of men in this same age group worked. Overall, in the early 1990s, just 16% of senior men and 8% of senior women were working. Today, more than half of those who continue to work do so part time, and mostly by choice rather than because of restricted opportunities for full-time work.
Education
One of the most dramatic changes among US senior citizens in the future will be level of education. Between 1970 and 1998, the percentage of those 65 and older who completed high school increased from 28% to 67%. By 2030, 83% of seniors will have completed high school. The percentage with a bachelor’s degree or more will have increased to 24% from the current level of 15%. Education is closely related to lifetime income, and people with more education generally are in better health and at lower risk of disability.
These better-educated seniors will likely be more demanding health care consumers. Personal computers and the Internet are being used more and more by baby boomers as a source of medical information. Of course, the accuracy and reliability of all information on the Internet, including information on health care and disease prevention, is a concern. Is the information being posted by a credible source? Is it up to date? These and similar questions should always be considered.
Marital Status and Living Arrangements
Most elderly people in the United States under the age of 85 are married and living with their spouse. Not surprisingly, because women in general have a longer life expectancy, elderly men are twice as likely to be married as are elderly women. Conversely, widowhood is much more common among elderly women.
Elderly people who live alone, often having lost a spouse, usually prefer to remain independent and continue living alone as long as their health (and finances) allow it. Many who live alone have families or friends nearby, and about three in five have lived in the same place for 10 years or more. However, these elderly people are more likely than those who live with others to feel lonelier and more isolated.
Life Expectancy
The maximum life span is the theoretical, longest length of life, excluding premature “unnatural” death. Life expectancy is defined as the average number of additional years of life that is expected for a member of a population. It can be a useful predictor of actual lifespan for a given individual. People almost always die of disease or accident before they reach their biologic limit.
The average life expectancy in the United States is currently highest for white women, followed by black women, white men, and black men. On average, women live longer than men, and whites live longer than blacks. Based on 1996 statistics, women who live until age 65 can, on average, expect to live to age 84. Those who live to age 85 can expect to live to age 92. The number of people living to 100 in the United States is difficult to estimate, but their numbers are certainly growing. For people born in 1899, the odds of living to 100 were 400 to 1. However, for people born in 1980, the odds improved substantially to 87 to 1.
Causes of Death
Nearly 75% of all deaths in the United States are deaths of elderly people. For many decades, heart disease, cancer, and stroke have been the leading causes of death among the elderly, accounting for 70% of all deaths in this age group. The next most common causes of death in people aged 65 and older are chroniclung disease, pneumonia and influenza, diabetes, accidental injuries, Alzheimer’s disease, kidney disease, and blood infections.
However, causes of death vary among subgroups. For example, in 1999, diabetes was the fourth leading cause of death among older Hispanic and black Americans, while ranking sixth for older white Americans. Alzheimer’s disease ranked sixth among all causes of death for white American women 85 and older, but was less common among black American women or American men of similar age.
Some causes of death usually associated with younger people are also of concern among elderly people. In the United States, older men die in car accidents at a rate two to three times higher than that of older women. The highest suicide rates among the elderly are in white men (43.7 per 100,000), who are more likely to commit suicide than die in a car crash.
Trends in Health and Functioning
Disease and disability is much more common in the elderly population than in people younger than 65. Some illnesses and disease, such as hip fractures or Parkinson’s disease, are virtually confined to the later stages of life. Other diseases, such as cardiovascular disease, malignant cancer, malnutrition, thyroid gland problems, and tuberculosis can be seen at any age, but are more common among the elderly.
Diseases
In the United States in 1995, 79% of people aged 70 or older had one or more of the seven chronic conditions most common among older adults:
- arthritis
- high blood pressure
- heart disease
- diabetes
- lung diseases
- stroke
- cancer
Personal Views: At the same time, personal estimates of health status vary much more widely among older people than younger people. According to a 1997 Medicare survey, 20% of white non-Hispanic Americans 65-74 years old regarded their health as excellent, 32% as very good, 13% as fair, and 5% as poor. The percentages of people who viewed their health as poor or only fair increased with age, and were higher for older black and Hispanic Americans than for older white Americans.
Multiple Diseases: The likelihood of having more than one disease also increases as we age. Among people aged 65 and older, 30% have three or more chronic diseases. Having more than one disease complicates care in several ways. Sudden change or illness in one body system may stress another body system, making the interpretation of symptoms more complex. For example, it is more difficult to evaluate mental confusion in someone who also has a fever caused by pneumonia. Sometime, the symptoms of one disease may hide those of another. For example, someone who has arthritis may never be physically active enough to show symptoms of heart disease, making the heart disease difficult to recognize.
Multiple Treatments: Unfortunately, sometimes treatment for one illness can cause a problem with another illness. For example, using an over-the-counter medication may cause bladder problems in someone who previously had normal bladder function. It is important for you and your health care provider to recognize the possibility of having two or more conditions at the same time and to be alert for possible effects that any treatment may have on other conditions.
Another reason to be alert to medications that may aggravate other conditions is that older people appear to have a greater risk of adverse reactions to drugs (See also Drug Treatment). You can reduce this risk by carefully reviewing all the medications you are taking with your doctor. This should include both nonprescription (over-the-counter) and prescription medications. Your doctor can check to make sure all the medications are necessary and effective and reduce the possibility of an adverse reaction.
Disability and Activities of Daily Living
The word function, as used in the health field, refers to your ability to manage your daily routine–a critical issue for all of us. Manual ability in particular is closely associated with the ability to live independently. A person’s manual ability reflects the skills necessary to perform basic activities of daily living (ADLs) and is helpful in making decisions related to what type of assistance, if any, is needed. This means that an evaluation of your functional abilities can be useful in defining certain health needs.
In the United States, most people younger than 85 report no difficulty in ADLs. However, this decreases with age, so that 78% of those aged 85 and older report some difficulty. Older women have more limitations at all ages than do older men. There are also differences between racial and ethnic groups. For example, among people aged 70 and older, black Americans were 1.5 times as likely as white Americans to be unable to perform one or more ADLs.
Assistance from Others: Elderly people who need assistance with routine ADLs rely first and foremost on family. In 1995, three-fourths of people who helped elderly city dwellers (aged 70 or older) were unpaid or informal caregivers. Nine out of ten of these informal caregivers were family members (one-fourth spouses and about half children), and half lived with the elderly person. The use of paid helpers is consistently higher among older adults living alone and increases with age.
Can We Recover?: In the past, it has been assumed that disability is irreversible. However, recent studies show that up to one-third of people who have a disability in a basic ADL recover. The chance of recovering from a basic ADL disability increases if the person is younger than 85, is on a healthy diet, and is able to get around.
Health Care
Function versus Disease: It’s helpful to work with your health care provider in focusing on function as well as on diagnosis of disease. In fact, knowledge of the disability, rather than the underlying disease, can be more important in getting help. Your functioning can often be improved without even having a specific diagnosis. For example, treatment for loss of bladder control focuses on determining how to improve or completely restore bladder control, as well as on improving the person’s confidence and self-esteem. This treatment does not depend on knowing whether the loss of bladder control is due to a brain injury, a stroke, dementia caused by Alzheimer’s disease, or any other irreversible process. When your problems are treated in this way, both you and your health care provider can avoid the disappointment and frustration of not being able to define or cure the primary disease.
Doctor Visits and Hospitalization: On average, older adults go to the doctor more often than younger adults. People 65-74 years old go to the doctor about 10 times per year, while those 85 and older go to the doctor nearly 15 times per year.
Older adults are also hospitalized more frequently than younger people. However, the average length of hospital stay for older patients has been decreasing for some time, from about 12 days per stay in 1964 to slightly less than 7 days per stay in 1996. Diseases of the heart were the most common discharge diagnoses in the United States for older patients. Heart disease and stroke together accounted for more than one-fourth of all hospital discharges among people 85 and older. Cancer was the next most frequent discharge diagnosis, followed by pneumonia and bronchitis. Hospitalizations for broken bones were more common among women than men and accounted for nearly one out of ten discharges among people aged 85 and older.
Home Health Care: Home-health care, including medical treatment, physical therapy, and homemaker services, is an alternative to institutional care for older adults. Nursing care is the most commonly used service.
Prescriptions: Prescription drugs are a major part of medical treatment. In the United States, at least 80% of older adults take one or more prescribed medicines.
What About the Future?
One of the important, unresolved questions is whether our increased lifespan will be “good” years–in other words, can we live longer while still being active and free of disability? It is unlikely that one answer to this question can be applied to all older adults because of great variations in health and functioning, from the bedridden Alzheimer’s patient to the marathon runner.
Many other unresolved questions can also be answered only by the passage of time. For example, will the increasing numbers of older people with more education and longer lives contribute to the larger society, and in what ways? Also, can our health care system handler greater numbers of older adults? Some analysts fear that the great increase in the numbers of older people may strain our medical care system and the public programs that finance health care and retirement to the breaking point. However, others believe that improvements in health behavior, medical breakthroughs, and financial prosperity will diminish these threats.
For more information visit http://www.healthinaging.org/agingintheknow/chapters_ch_trial.asp?ch=2