Selling Your Ideas

40 Key Issues for an Aging SocietyJ. James Cotter, PhDDepartment of GerontologySchool of Allied Health ProfessionsVirginia Commonwealth University

In the 1940s Uncle Sam wanted you, to join the military of the manufacture of military supplies.3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU2Boomer or Not: Aging Tide

16%3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU3Since World War II mainly due to sanitation and control of infectious diseases longevity has increased significantly, one of the fastest-growing segment of the population is that over 65 years of age.Changing structure of society

Traditional aging pyramidNew aging pyramid

Their traditional pyramid was that seen in the 1930s and 40s, developed countries are rapidly moving to the new age 6 when the paramedic is little more than a column, as in Japan3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU4Population Pyramids: 1950/2020 (US Census Bureau)

3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU5How old is old?40 - Age discrimination 50 - AARP discounts 65-67 - Medicare and Social Security 75 - frailty marker 85 - the old-old 100 The new centenariansIt is all the mind of the person being asked3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU6Centenarians

Jeanne Calment, oldest person ever, died in 1997 at the age of 122.3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU7How old is Grandpa?Grandpa says: I was born before :televisionpenicillin polio shotsfrozen foodsXeroxcontact lensesFrisbeesthe pill credit cardslaser beams ball-point penspantyhose air conditioners dishwashers clothes dryers Pizza HutMcDonald'sinstant coffee3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU8Life ExpectancyNational Vital Statistics Report, Vol. 47, No. 28, December 13, 1999National Research Council, 1988

The major change in life expectancy is due to the reduction in infant deaths3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU9

Diverse Elders

A New DiversityAgeEthnicity/RaceGenderPhysical abilitiesSexual orientationFamily structure/ Marital statusReligious beliefsEducationIncome/WealthWork/ Employment11change in age-related rolesLate adulthood has a perplexing number of possible life patternsDemographic trendsmorbidity and mortalitychanges in family structureinterruption of marital careersincreased mobilitychanges in living arrangementslabor force participationbetween 1950 and 1980 85+ quadrupled from .6 to 2.2 milVeterans Administration - Perez paperGenerations United? Yes!A 1996 Cato Institute survey found that 68 percent of the public had a favorable opinion of Social Security. About 90 percent of people below retirement age agreed that "Maybe I won't need Social Security when I retire, but I definitely want to know it's there just in case I do." (AARP, 1996) With the current concern over the financial stability the United States the second, and is particularly relevant3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU12Increase in Sq. Footage of US Homes

The move is starting to reverse with more couples looking for small but high quality space3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU13Whats your houses IQ? Smart house devices may help elderly stay home. Richmond Times-Dispatch, 5/4/03Gait monitors measure changes in persons walking and detect fallsFlorida VA uses video phones to monitor health of 1200 older personsComputer companion reminders

Source: Elderly surfing the web, 2004, San Jose Business Jrnl

Elders and the Internet

Global Aging Growth Young vs Old 2000-2035, in Billions

Healthier Older PopulationFries (1984), Compression of morbidityPalmore (1986), relative health of elderly has improvedRogers (1990), living longer and healthierManton (1995), significant decreases in prevalence of 16 medical conditionsCassel (2000), declining or postponing diseaseVarious perceptions of the older population change rapidly from year to year. From the public health point of view people are living longer as death from Sunday acute chronic diseases such as heart disease and stroke have decreased up to 70% in the last 20 years, but with the increasing epidemic of obesity the older population has more disability than in the past.3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU17% aged reporting limitation in activities of daily living

Adapted from Admin. on Aging, 19973/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU18Need for Primary Care Physicians:Geriatrics

Source: Alliance for Aging Research, 20026,7408,8003/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU19Will visit this issue again in the section on primary-care

Ronald Klatz, M.D.founding physician of the anti-aging medicine movement

Today's boomers will live, on average, to see age 100. Some boomers will celebrate their 130th birthdays healthy, happy, with full mental and physical faculties intact.New method to collect organs from non-beating heart donors, expanding the bank of organs for transplantsA genetically engineered "gene therapy" cure for male pattern baldness. At home 2-way telemedicine consultations between many elderly persons too frail, too weak, or just too busy to drive to their doctor appointment.Inhaled drug delivery systems e.g. Insulin

Welcome to the Calorie Restriction (CR) Society

Our goal is to help people of all ages live longer and healthier lives simply by: eating fewer calories and maintaining adequate nutrition.

Calorie Restriction...the only proven life-extension method known to modern science.

http://www.calorierestriction.org/May be, that doesnt necessarily mean an improved quality of life3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU22

(Photo credit: Davies + Starr)89 million American adults have limited health literacy skills.Studies published this year in health affairs and other journals has shown that the elderly use increasingly more medicines but have limited skills and understanding how they should be taken and the relationship one with another. The physicians or pharmacists seem to have the time to counsel patients and insurance system does not pay for such counseling.3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU23Bereavement CareDisease modifying therapySymptom Control/ Supportive CareHospicePalliative Care Source: Education of Physicians on End of Life Care. Robert Wood Johnson Foundationhttp://www.athealth.com/Consumer/newsletter/FPN_4_25.html#1Model of End of Life CareAnd those of the far right of the political spectrum dont believe anybody has a right to decide how they should do, or when.3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU24Tools for End-of-life CareWillAdvanced DirectivesLiving Willallows you to document your wishes concerning medical treatments at the end of life. Durable power of attorneyallows you to appoint a person you trust as your health care agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf. Organ DonationCondom Granny's safe sex pitch to Florida's active oldies

A recent study in the last couple months have shown that satiate transmissible diseases are increasing rapidly in the elderly, maybe condom granny had the right idea3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU263 glasses of wine Per WEEK

A number of recent studies suggest at least one glass of red wine a day is good for you, while others suggest a couple of drinks a day for males and one a day for females.3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU27DepressionIn a study of 3,410 older persons in an HMO, primary care physicians miss 1/2 of depression (measured by the GDS) in older persons.Garrard, Rolnick, Nitz et al, J Gerontology, April, 1998Suicide rate for older white men is double other groups (59/100,000).Alzheimers DiseaseMost common type of dementia4 million people affectedCaregivers 36 hour dayPharmacologic tx - cholinesterase inhibitors for early stages, anti-psychotics in later stages for behaviorNon-pharmcologic tx for behavior - SCUsWhich group provides 75% of LTC of older persons?Nursing homesAssisted livingHome health agenciesFriends and familyItem 4, friends and family are the majority of care givers for the old and the senior support agencies could not function without all the volunteers3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU30Institute on Medicine Reviews Quality of Health CareAdverse events: incidents resulting in, or having the potential for, physical, emotional, or financial liability for the patient (Fischer et al., 1997).Health care error: the failure of a planned action to be completed as intended or use of a wrong plan to achieve an aim by any health care provider involved in the continuum of care.96,000 unnecessary deaths per yearHospital CarePhysician servicesPrescriptionsNursing HomesHome Health ServicesMedicareMedicaidPrivate,Out of pocketLTC InsuranceMedicare Supp.And it gets more complex every day, particularly with the new affordable care act which has required for hundreds of new committees to monitor the program and assist the public. Maybe too much Granny care3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU32 Paying for health careMedian out-of-pocket expenditure by older persons on health care = $1,939Median income of older persons = $13,904

And this changes on a weekly basis. A good reason to watch the daily news in the Kaiser family foundation.3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU33Changing Family SupportA One Child Policy

Avg # of children per family is 1.87

Economic Value of Long-termCare

Source: Arno, Levine, Memmot (1999) Health AffairsFor the most part knows in homes are warehouses for the elderly, and studies in other countries show that assisted living may be more appropriate keeping people in their own residence. Most assisted living resources survey are too expensive for the majority of population as they assume that everyone will need nursing home care and the monthly costs for the potential use of such care is in the thousands of dollars.3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU35Medicaid Beneficiaries and Payments by Eligibility Group, 1999

Source: CMS, CMSO, Medicaid Statistical Information System.

UnknownAdultsChildren3%72%15%10%28%51%21%We have met those welfare mothers and they are old.How do the Aging Vote? Voting Behavior in 2000Source: MSNBC per CNN

18-29

60+

Kerry

54%

46%

Bush

45%

54%

% vote

17%

24%

11. The OAA: Wherever You Go, There We Are

Based on Torres-Gil, The New Aging, p.56The only piece missing from this picture is a block that says volunteers. For every paid member of the aging organizations the maybe 10 to 20 volunteers to keep the organization running3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU38Labor Force Participation Rates(adapted from Atchley & Barusch, 2004)

As people live longer many are moving back into the workforce, usually low-paying jobs such as beggars and groceries and in restaurants3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU39The Three-Legged Stool of Retirement FinancingAssetsPensions (401(k)s)Social SecurityPublic BenefitsSixMedical CoverageEmployment

Source: Is Demography Destiny? National Academy on an Aging Society, Feb, 1999For 2 of every 5 older persons, Social Security provides 80% of their income3/28/01J. James Cotter, PhD, Division of Quality Health Care, Department of Internal Medicine, VCU41Economic ImpactFinancial - 70% of the financial assets in America Travel - Spend 74% more on a typical vacation than 18-49 year olds Health - 42% of all MD office visits Pharmaceuticals - 74% of all prescription drugs, a $103 billion market Source: ASA Business Forum on AgingCurrent Political IssuesCost of Prescriptions & MedicareSocial Security (Deficit/Privatizing)Longevity (Financing)Health care costs (More HMOs)Long-term care (Tax Credit)Housing (Assisted Living)More of themMore types of families and kinshipMore active and involved for longerHealthier, wealthierwiser?More diverse

Future: Older People of the 21st CenturyAging America: Changing our Worldcontinuing search for a contemporary society that is at ease with its own aging as well as its aging members. Koff and Park, 1999, p. xxiJ. James Cotter, PhDAssociate Professor, Department of GerontologySchool of Allied Health Professions, Virginia Commonwealth UniversityPublic Health MissionUnderstand the social and demographic trends affecting an aging society.Reexamine the underlying principles of the present system.Examine the relationships between individuals, society and government.Assist agencies, organizations and older persons to adapt to multiple challenges

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