aging of the u.s. population: trends and implications mary altpeter, phd, msw, mpa institute on...

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

Thank You!

Mary Altpeter

UNC Institute on Aging

Mary_Altpeter@unc.edu