Transcript Demographics of Aging

Demographics of Aging
Min H. Huang, PT, PhD, NCS
Reading Assignments
• Guccione: Ch 2 (review Ch 1)
Learning Objectives
• Explain what successful aging constitutes
• Describe demographics of the aging
population in the United States
• Examine the implications of these
demographics for physical therapy
practice
• Discuss the impact of ageism on the care
for the geriatrics patients
Introduction to Geriatrics Paper
• Write down your answers to the following
questions and turn it in by the end of the
class
1. What constitutes successful aging?
2. How do physical therapist promote optimal
aging while working with the geriatric clients?
3. What are the implications of changing
demographic of aging in the U.S. for physical
therapy?
4. What might be a strategy to combat ageism?
Gerontology vs. Geriatrics
http://www.nlm.nih.gov/medlineplus/
• Gerontology
o The comprehensive study of aging and the
problems of the aged
• Geriatrics
o A branch of medicine that deals with the
problems and diseases of old age and aging
people
Geriatrics team
• Members
o
o
o
o
o
o
o
o
o
o
Geriatrician
Nurse
Physician assistant
Social worker
Pharmacist
Nutritionist
Physical therapist
Occupational therapist
Speech therapist
Geriatric psychiatrist
• Goals
o Evaluates the patient’s
social supports and
living situation
o Considers the
person’s ability to
perform daily activities
o Provide patientcentered plan of care
Slippery slope of aging
World oldest marathon runner at 101
year old!
Successful aging
• Multidimensional
concept
• Disease and
disability were not
inevitable
consequences of
aging
• What is the role of
PT in successful
aging?
Rowe & Kahn. The Gerontologist. 1997;37(4):433-440.
Active ageing
• The process of optimizing opportunities for
health, participation and security in order to
enhance quality of life as people age – WHO
• “Active”
o Continuing participation in social, economic, cultural,
spiritual and civic affairs
o Not just the ability to be physically active or to
participate in the labor force
Optimal aging
• For people with disease and disability,
physical therapist should
o Assist an individual to achieve life satisfaction
in multiple domains—physical, psychological,
and social
o Reduce the disabling effects of disease
o Stop a vicious cycle of “disease–disability–
new incident disease” to maintain quality of
life
Defining older adults
• Older adults are defined as persons 65 years
of age and older
o Oldest old: 85+ years and older
o Middle old: 76-84
o Young old: 55-75
• “Old” - very subjective concepts!
• Chronological age ǂ Biological age
Demographics
• Americans age 65+ years
o
o
o
o
o
1990: 4% of population
1940: 6.9% of population
2010: 13% of population (40 million people)
2030: 20% of population
“Baby boomers” (born between 1946 and 1964) are
responsible for a sharp increase from 2010 to 2030
• Americans age 85+ years
o 2010: 5.5 million
o 2050: 19 million people
By 2050, the age
structure “pyramid” is
relatively rectangular
except among the
older age groups
Aging around the world
• The number of people today aged 60+ has
doubled since 1980.
• The number of people aged 80+ years will
almost quadruple to 395 million between now
and 2050.
• By 2050, these older adults will outnumber all
children under the age of 14.
• By 2050, 80% of older people will be from
low- or middle-income countries.
Race and ethnicity
Marital status: by men and women
Living arrangements: by sex and race
Economic status: source of income
Economic status: household
expenditure
Economic status: poverty rate
Mortality: leading causes of death
Mortality: by men and women
Life expectancy
• U.S. 2010 data
http://www.cdc.gov/nchs/fastat
s/lifexpec.htm
Life expectancy: by sex,1900-2009
Morbidity
Morbidity
• The prevalence of certain chronic health
conditions differed by sex.
o Women reported higher levels of asthma, arthritis and
hypertension than men.
o Men reported higher levels of heart disease, cancer,
and diabetes.
• The prevalence of certain chronic health
conditions differed by race and ethnicity
o Non-Hispanic Blacks reported higher levels of
hypertension and diabetes than non-Hispanic Whites
Functional limitations caused by
chronic health conditions
Functional limitations in Medicare
enrollees age 65+ years
Health risks and behaviors
• Social and lifestyle factors
o Cancer screenings
o Vaccinations
o Diet
o Physical activity
o Obesity
o Smoking
o Socializing
o Quality of the air
Health risks and behaviors: use of
time
Health risks and behaviors: use of
time
Health risks and behaviors: physical
activity
• 11% of people age 65+ years reported
participating in leisure-time aerobic and
muscle-strengthening activities in 2010
• Even among frail and very old adults,
mobility and functioning can be improved
through physical activity.
• Strengthening is recommended as part of
a physical activity program in older adults
and may help to improve balance and
decrease risk of falls.
Health care expenditure
• In 2010, national health care expenditure was
estimated to reach $2.6 trillion
• In 2010, Medicare spending was estimated to
reach $525.0 billion
• By 2020, national health spending is
expected to reach $4.6 trillion and comprise
19.8 percent of GDP
• Average annual Medicare spending growth is
anticipated to be 6.3% from 2013 to 2020
Health care expenditure: by age,
1992-2008
After adjustment for inflation, health care costs increased
significantly among older Americans from $9,850 in 1992 to
$15,709 in 2008.
Health care expenditure in people age
65+ years
• Costs varied by demographic characteristics
o Non-Hispanic Blacks: $19,839
o Hispanics: $15,362
o Individuals with income <$10,000: $21,924
o Individuals with income >$30,000: $13,149
• Costs varied by health status
o Individuals with no chronic conditions: $5,520
o Individuals with 5+ conditions: $24,658
o Residents of long-term care facilities: $61,318
o Community-living residents: $13,150
The top 5% of the health care spenders accounted
for 49% of overall U.S. medical spending
Percent of Total Health Care Expenses Incurred
by Top 5 Percent of Health Care Spenders Within
Different Age Groups: United States, 2002
Health care workforce
• Although 11.9% of workforce in the U.S. was
in health care industries in 2008, the
concentration of workers in these industries
varied from state to state.
• Current health care workforce is not
sufficiently trained to meet existing demands
of older patients, let alone higher future
demands.
• The total number of certified geriatricians is
7,162, less than 1% of health care workforce
Relative to the United States as a whole, states
with older populations tend to have larger shares
of employees in health care industries.
APTA Workforce Data: Patient Type
and Time Management
http://www.apta.org/WorkforceData/
End of Life
• A substantial rise in the use of hospice
services among older Americans in the last
decade
• A smaller increase in the use of ICU and
CCU services at the end of life
• A decline in the percent of deaths in hospitals
over the last 20 years, with an increase in the
percent of older Americans dying at home
End of Life: use of hospice or ICU in
Medicare decedents age 65+
End of Life: by place of death
Ageism
Ageism
• In a survey of 84 people ages 60 and older
(Erdman Palmore, Gerontologist, 41(5), 2001)
o 80% reported experiencing ageism – others
assuming they had memory or physical
impairments due to their age
o 58% reported being told a joke that pokes fun
at older people (#1 type of ageism)
o 31% reported being ignored or not taken
seriously because of their age
Ageism
• People make sense of each other along
two dimensions
o warmth — good intentions, trustworthy,
sociable
o competence
• Stereotype for older people
o well-intentioned (warm) but incompetent
o "I thought they would be really boring. I
thought they would smell. I thought they
would make me feel weird. “
Ageism arises from ‘prescriptive
prejudice’
• Prescriptive prejudice dictates what older
people 'should be‘
o Older people who 'violate' these 'prescriptions' are
punished by those who discriminate against them
o Older people who adhere to them are rewarded with
sympathy and pity
• Prescriptive stereotypes center on three key
issues
o Succession
o Identify
o Consumption
Ageism: How Healthcare Fails the
Elderly
• Healthcare professionals do not receive
sufficient training in geriatrics
• Older patients are less likely to receive
vaccines and other preventive care
• Older patients are less likely to be tested or
screened for common health problems
• Effective medical interventions beneficial for
older patients are often ignored
• Older people are consistently excluded from
clinical trials
How to combat ageism
• Ageism must be opposed with political
and organizational reforms
• Recognize the deep psychological roots of
the prejudice
• Dr. Butler: “the underlying basis of ageism is
the dream and fear of growing older,
becoming ill and dependent, and approaching
death. People are afraid, and that leads to
profound ambivalence.”
Ill health is not an inevitable
consequence of growing older
Chronological age ǂ Biological age
Introduction to Geriatrics Paper
• Write down your answers to the following
questions and turn it in by the end of the
class
1. What constitutes successful aging?
2. How do physical therapist promote optimal
aging while working with the geriatric clients?
3. What are the implications of changing
demographic of aging in the U.S. for physical
therapy?
4. What might be a way to avoid ageism?