aging of the u.s. population: trends and implications mary altpeter, phd, msw, mpa institute on...
TRANSCRIPT
Aging of the U.S. Population: Trends and
Implications Mary Altpeter, PhD, MSW, MPAInstitute on Aging, University of North Carolina at Chapel Hill
NC-HAN, Member campus of the PRC-Healthy Aging Research Network (HAN)
CDC, May 11, 2009
Presentation Overview The PRC-Healthy Aging Research Network
(HAN) approach to healthy aging Multiple aspects of health and well-being for
older adults The health status and future of Boomers What’s happening in health promotion and
aging Summing it up: Challenges we face
Sites of the CDC PRC-Healthy Aging Research Network (HAN)
University of Washington
University of California at
Berkeley
University of Colorado
University of Illinois at Chicago
University of Pittsburgh
University of North Carolina
Texas A&M University
University of South Carolina
West Virginia University
Activities of the PRC-HAN
Identify interventions that promote healthy aging
Assist in the translation of such research into sustainable community-based programs throughout the nation
Better understand the determinants of healthy aging in older adults
Examples of PRC-HAN Resources
Conference Series (Physical Activity, Depression, Environmental and Policy Factors)
Written materials such as conference monograph and RE-AIM issue brief
On-line modules for Provider Training
www.prc-han.org
Rowe and Kahn Model
“Healthy Aging”
“and injury and promoting health”
“optimizing”
Managing Chronic Conditions
Source: Marshall, V.M. & Altpeter, M. (2005). Cultivating social work leadership in health promotion and aging: Strategies for active aging interventions. Health & Social Work, 30(2), 135-144.
PRC-HAN Definition of Healthy Aging
Healthy aging is the development and maintenance of optimal physical, mental and social well-being and function in older adults.
It is most likely to be achieved by
individuals who live in
physical environments and communities that are safe and support the adoption and maintenance of attitudes and behaviors known to promote health and well-being;
the effective use of health services to prevent or minimize the impact of acute and chronic disease on function
CDC-funded PRC Healthy Aging Research Network CDC-funded PRC Healthy Aging Research Network http://depts.washington.edu/harn/http://depts.washington.edu/harn/
Multiple aspects of older adult health and well-being
Population trends Marital status Health literacy, internet use Wealth Workforce participation Volunteerism Caregiving
3 million
35 million
70 million
4.2 million
21 millionLife expectancy = 47 years
Life expectancy = 77 years
Living to 100Number of Centenarians in the U.S.
Source of data: US Census Bureau, Current Populations Reports, P23-199RV, July 1999
72,000131,000
214,000
324,000
447,000
601,000
96,548
2000 2008 2010 2020 2030 2040 2050
10% of all seniors
17 % of all seniors
Indicator 3 – Marital Status
Computer and Internet Use in the United States: 2003
0
5,000
10,000
15,000
20,000
15-24 25-34 35-44 45-54 55-64 65+ Age
in thousands
computer use
internetaccess
Source: US Census Bureau, 2005
Past and Projected Number of Workers Over Age 55, 1970-2025
14,505 15,039 15,02618,437
31,851 33,346
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
1970 1980 1990 2000 2015 2025
in thousands
Source: US Census Bureau, 2008; GAO Report to the Ranking Minority Member, Subcommittee on Employer-Employee Relations, Committee on Education and the Workforce, House of Representatives, Nov. 2001
2005
Average – $196,000
Whites – $226,900
Blacks – $37,800
Change in Median Net Worth of 65+ Households: 1984 - 2005
1984
Average – $109,900
Whites – $125,000
Blacks – $28,200
Source: Older Americans 2008, Key Indicators of Well-Being
81%
34%
79%
Poverty Rate by Age, U.S. (2007)
0
5
10
15
20
25
Age group
Perc
ent <18 years
19 - 64 years
65+ years
Source: Statehealthfacts.org, retrieved 4/15/09
Factors in the Decision to Work in Retirement (%)
Pre-retirees who plan to work in retirement
Working Retirees
Desire to stay mentally active 87 68
Desire to stay physically active 85 61
Desire to remain productive or useful 77 73
Need health benefits 66 20
Desire to help other people 59 44
Desire to be around people 58 47
Need the money 54 51
Desire to learn new things 50 37
Desire to pursue a dream 32 20
Source: S. Kathi Brown, "Staying Ahead of the Curve 2003: The AARP Working in Retirement Study,"
Washington, DC: AARP, 2003 *Respondents could choose as many factors as apply to them
Older Adults as Volunteers
Source: U.S. Bureau of Labor Statistics, Volunteering in the United States, 2008
Age 55-64 Age 65+
% who volunteer
28.1 23.5
Tot. # volunteers
9.456 million 8.749 million
Median annual hours per volunteer
58 96
Grandchildren in Grandparents’ Homes Where Grandparents are the Householders
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
1970 1980 1990 2008
No parent present
One or more parentspresent
Source: US Census Bureau, Current Population Survey, March and Annual Socieconomic Supplements, 2008 and earlier.
http://www.census.gov/population/socdemo/hh-fam/ch7.xls
Value and Cost of Informal Caregiving
12.8 million Americans need care 7.3 million are 65 and older
The value of informal caregiving is estimated at $196 billion per year
Informal caregiving exceeds nursing home and home care expenses by $81 billion
Caregiving costs U.S. businesses $11.4 billion annually
Caregivers lose up to $659,139 over a lifetime
Geriatric Social Work Initiative, San Jose State University, College of Social Work
Chronic diseases account for 75% of the $1.4 trillion we spend on health care
$245 billionan average of $1,066 per person
1980
$1.4 trillionan average of $5,039 per person
2001
Mensah: www.nga.org/Files/ppt/0412academyMensah.ppt#21Heffler et al. Health Affairs, March/April 2002.
$2.8 trillionan average of $9,216 per person
2011
42%
7%
14%
25%28%
0
5
10
15
20
25
30
35
40
45
1940 1960 1980 2000 2050
Decade
Per
cen
t
Boomers will be living longer: % people age 65 who will live to age 90
Source of data: US Census Bureau
Four-fold increase
1940 1960 1980 2000 2050
Boomers are relatively wealthier but are also worried about future health care costs Wealthy - possess ¾ of nation’s financial
assets + estimated $1trillion in annual disposable income
Yet, 44% those 55-59 fearful of not having sufficient resources to live beyond age 85
“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
Boomers provide a substantial amount of caregiving
>70% have at least one living parent
25 million live with an aging parent
13 million provide parental caregiving
“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
What’s the health picture for Boomers?
By 2030 More than 6 of every 10 will be managing more than
one chronic condition 14 million (1 out of 4) will be living with diabetes >21 million (1 out of 3) will be considered obese
Their health care will cost Medicare 34% more than others
26 million (1 out of 2) will have arthritis Knee replacement surgeries will increase 800% by 2030
“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
What’s the health care picture for Boomers?
Cause significant shift in health care:
By 2020, Boomers will make 40% of all physician office visits
By 2030 hospital admissions among Boomers will increase more than 100%, totaling half of all admissions in the US
“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
Indicator 28 – Use of Time
NCOA Survey Key Findings
Americans 44 and older with chronic conditions are diverse
One in four has delayed health care due to cost
Most rely on health care system for help, but it’s not working well for many
Many are not getting help and support they need
Cost, confidence, lack of knowledge are barriers to managing conditions
Source: Re-forming Healthcare: Americans Speak Out About Chronic Conditions & the Pursuit of Healthier Lives, NCOA, March 2009
Types of support NCOA survey respondents identified:
71% - Learn how to exercise or eat better in a way that is realistic and works with your limitations
68% - Get practical tips and advice from other people who have health problems similar to yours
59% - Set goals and work together with other people who are trying to improve their health
58% - Learn how to manage work, family and other responsibilities and still take care of your health
Source: Re-forming Healthcare: Americans Speak Out About Chronic Conditions & the Pursuit of Healthier Lives, NCOA, March 2009
The prevention imperative
Only 30% of physical aging is attributable to genetic heritage!
Prevention – it’s for EVERYONE!
Slide from Becky Hunter, UNC CAH
Threats to Health Among Seniors
73% age 65 - 74 report no regular physical activity 81% age 75+ report no regular physical activity 61% - unhealthy weight ~35% - fall each year 20% - clinically significant depression; age group at highest risk
for suicide 32% - no flu shot in past 12 months 35% - never had pneumococcal vaccine 20% - prescribed “unsuitable” medications Also at greatest risk for fire-related injuries, and traumatic brain
injury (age 75+)
Sources: State of Aging and Health, 2007; www.cdc.gov/nchs; www.cdc.gov/ncipc/olderadults.htm
Health promotion and disease prevention does work for older adults
Longer life Reduced disability
Later onset Fewer years of disability prior to death Fewer falls
Improved mental health Positive effect on depressive symptoms,
social connectedness Delays in loss of cognitive function
Lower health care costs
www.healthyagingprograms.org/content.asp?sectionid=85&ElementID=304
Ideal Survivorship Curve: The “rectangularization” of morbidity
Source: J.F. Fries and L.M. Crapo, Vitality and Aging (San Francisco:W.H. Freeman, 1981).
National level partnerships for health promotion advocacy: A growing list… Centers for Disease Control and Prevention Administration on Aging Centers for Medicare and Medicaid Services Agency for Healthcare Research and Quality Environmental Protection Agency
Robert Wood Johnson Foundation Archstone Foundation John A. Hartford Foundation Atlantic Philanthropies
National Council on Aging American Society on Aging National Association of State Units on Aging National Association of Area Agencies on Aging National Association of Chronic Disease Directors “Disease-specific” Associations
Some common approaches used in health promotion and aging
Socio-ecological theory Chronic Care Model RE-AIM Framework
The Social-Ecological Perspective The health and well-being of older adults will
be improved only if we work from a broad perspective.
Comprehensive planning and partnerships at all levels are required.
Changes at the individual level will come with improvements at the organizational, community and policy levels.
Adapted: Prevention: Why Does It Matter? PowerPoint presentation by Nancy Whitelaw, March 2007, available at: www.healthyagingprograms.org
Chronic Care Model
Self-management support
Community resources
Organization of health care
Interdisciplinary teams
Decision support Clinical
information systems
RE-AIM framework Analyze epidemiological data to
target health issues and populations
Develop common core of practical process and outcome measures
Build partnerships across multiple sectors
Implement evidence-based health promotion programs with fidelity
Maintain individual-level benefits and sustain ongoing programming
www.healthyagingprograms.org
43
A short list of evidence-based health promotion programs for older adults Chronic Disease Self-management
Program Diabetes Self-Management Active Living Every Day Active Options Enhance Wellness/Enhance
Fitness Matter of Balance Fit and Strong AF Exercise Program AF Aquatics Program Arthritis Self-Help Program Fit and Strong Healthy IDEAS PEARLS
What the data tell us
• Older adult population is the fastest growing sector of the overall population and older adults are becoming more racially and ethnically diverse. Increased demand for tailored programming for reaching
oldest old and minority elders
• Race, class and gender compound aging effects, resulting in higher risks for health, poverty and other social problems.
• Health literacy is an issue for a significant portion of the boomer and older adult populations
What the data tell us (continued)
• The majority of older adults report good health and many are able to work and contribute to family and society
• Cost related to health care are growing out of control• Exponentially higher expenditures for health care and services• “Costs” to caregivers is staggering
• direct out-of-pocket expenses, economic insecurity caused by changes in work patterns, and health effects
• Unprecedented demand by older adults and boomers for • caregiving and other support services• long term care solutions• health promotion/disease prevention, falls prevention and chronic
care programs
Challenges confronting health promotion and disease prevention for older adults Science not shared – growing body of evidence of
interventions that can positively impact health, disability and quality of life
Fragmented systems and services across aging, medical care, mental health and public health Untapped assets of 29,000 organizations currently reaching 7-10
million older adults Lack of common conceptual “language”
Much work to be done in expanding the evidence base in health promotion/disease prevention and chronic disease self-management for diverse older populations
Adapted: Prevention: Why Does It Matter? PowerPoint presentation by Nancy Whitelaw, March 2007, available at: www.healthyagingprograms.org
Challenges (cont’d) Untapped creative approaches to reaching older adults,
e.g., through worksites, libraries, grandparent groups and intergenerational programming
Under-developed health information technology to help older adults and boomers manage their conditions and participate in health promotion, falls prevention and chronic disease self-management programming
Under-developed mechanisms to tap into and train boomer and older adult populations as valuable resources in delivering health promotion programs
The message for all us It’s never too late to start
and it’s always too early to quit
But, it’s also never too early to start - life course perspective Think “immediate” – those
currently 65+ Think “intermediate” – those
35-64 Think “long-range” – children
Adapted from: Robert Butler, “Maintaining Healthy Lifestyles,” International Longevity Adapted from: Robert Butler, “Maintaining Healthy Lifestyles,” International Longevity Center, 2000 and “Reimagining America: AARP’s Blueprint for the Future”, 2005Center, 2000 and “Reimagining America: AARP’s Blueprint for the Future”, 2005
