The Age Factor:The Age Factor:Recent Trends, Current Recent Trends, Current

Challenges & Future Challenges & Future DirectionsDirections

Maria C. Hernandez-Peck, PhD

Center for Studies in Aging

Eastern Washington University

As We Enter the 21st Century

An aging population of 35 million in 2000

1 in every 8, or 12.4% an older American

5,574 individuals reaching age 65 each day

Those reaching age 65 have an average life expectancy of an additional 17.9 years

Categories of Older People

Young old (65 to 74) 18.4 million

Middle Old (75 to 84) 12.4 million

Old-Old (85+) 4.2 million, the fastest growing group

Centenarians (100+) 50,545

Some Current Statistics Older women outnumbering older men 20.6 million to

14.4 million

143 women for every 100 men at age 65+; this ration increases from 117 for the 65 to 69 age group, & to 245 for the 85+

Almost 400,00 grandparents age 65+ having primary responsibility for their grandchildren who live with them

One Baby Boomer turning 50 every 7.5 seconds

Projections for 2030

The older population will more than double to 70 million

The 85+ population will increase from 4.2 million in 2000 to 8.9 million

Members of minority groups will represent 25% of the older population, up from 16% in 2000

The Older Foreign Born

Accounted for 3.1 million of persons 65+

1/3 from Europe; 31% from Latin America; 22% from Asia, and 8% from other parts of the world

Anticipated future foreign born elders will be from Latin America or Asia

2/3 of all foreign born elders have been in the U. S. over 30 years

In Spokane County

60+ accounted for 66,242 in 2000

65+ estimate for 2005 is at 72,332

80+ accounted for 14,840 in 2000

80+ estimate for 2005 is 26,699

Projected Numbers for 2030

60+ will account for 120,826

75+ will account for 33,903

Elders Accessing Services

13 to 15% of frail elders access services funded through the Aging and Long Term Care of Eastern Washington

The typical client is 75+, female and living alone

The Challenge Ahead for Our Community

How to utilize the gifts of those persons reaching the later years in better health with a desire to continue to contribute to community enhancement and well-being, through either paid employment or volunteer opportunities

How to maintain a safety-net to protect the most frail and vulnerable

Four Major Areas of Concern

Maintaining and Enhancing Economic Security of Older Persons

Promoting Physical and Mental Well-being (Healthy Aging)

Creating Elder Friendly Communities

Avoiding the Caregiving Crunch

Maintaining & Enhancing Economic Security

Rethinking the need and timing of Social Security Reform

Unhinging old age from the obsolete marker of 65 and index entitlements to rising longevity

Let people chose to retire when they are ready and when they can afford to , instead of holding everyone to uniform standards

Smash the silver ceiling and make it easier for people to pursue meaningful employment in maturity

Maintaining & Enhancing Economic Security

Replace the “linear” life paradigm with a new “cyclic” one that takes maturity into account as a time of new life pursuits and passions

Create job sharing opportunities for older persons needing and wanting to return to work

Promoting Healthy Aging

Involves both physical and emotional well being

Increase in health promotion and disease prevention programs

Increasing availability of service providers

knowledgeable about issues and challenges confronting elderly today

Facts About Mental Health in the Later Years

The majority of older Americans cope constructively with the physical limitations, cognitive changes, and various losses, such as bereavement, that frequently are associated with late life

On the other hand, a substantial proportion of the population age 55 and older, almost 20% of this age group, experience specific mental disorders that are not part of “normal” aging

Severely Impairing Conditions If Unrecognized or Untreated

Depression Alzheimer’s Disease Alcohol and Drug Abuse and Misuse Anxiety Late-life Schizophrenia

Substance Abuse Issues

As many as half of all people with serious mental illnesses develop alcohol or other drug abuse problems at some point in their lives

15% of older men and 12% of older women treated in primary care clinics regularly drink in excess of limits recommended by the National Institute on Alcohol Abuse and Alcoholism

An estimated 17% of older adults misuse and abuse alcohol and medications

Suicide and Depression

Older people have the highest rate of suicide in the U.S. population

Suicide rates increase with age, with older white men having a rate of suicide up to six times that of the general population

Depression is neither well recognized nor treated in primary care settings, where most older adults seek and receive health care

Difficulties in Assessment

Detection of mental disorders in older adults is further complicated by high co-morbidity with other medical disorders

The symptoms of somatic disorders may mimic or mask psychopathology, making diagnosis more taxing

Older individuals are more likely to report somatic symptoms than psychological ones, leading to further under identification of mental disorders

Difficulties in Assessment

More than half, or 51% of older individuals who have committed suicide have seen their primary care physician within one month of the suicide (Caine, et. al. 1996)

Almost half had psychiatric symptoms. However, symptoms were recognized in less than one third

Treatment was offered in less than 1/4 of the cases Treatment rendered was considered adequate in on

2% of the cases

The Role of Primary Health Care Providers

Primary care providers carry much of the burden for diagnosis of mental disorders in older adults

However, the rates at which they recognize and properly identify disorders often are low

With respect to depression, a significant number of depressed adults are neither diagnosed nor treated in primary care

The Role of Primary Health Care Providers

One study of primary care physicians, only 55% of internists felt confident in diagnosing depression, and even fewer (35% of the total) felt confident in prescribing antidepressants to older persons

Researchers estimate that an unmet need for mental health services may be experienced by up to 63% of older adults aged 65 years and older with a mental disorder

Current Challenges

Transitioning to a Medicaid only system in providing Mental Health Services

The fact that older persons in greatest need of mental health services will not self-refer

. Inadequate ways of identifying older

persons in need mental health services

Inability of primary health care providers in identifying depression in older persons

Inadequate reimbursement for psychiatric and/or mental health services and its impact in community based systems

Downsizing of geriatric beds in State Mental Hospitals and relocating those patients to community based settings

Definition of medically needy as those with an income of $582 per month

Current Challenges

Some Potential Solutions

Achieving Mental Health Parity Increasing the income level for medically

needy from $582 to $771 per month Increasing State funding for mental health

services to non-Medicaid eligible older persons

Integrating aging and mental health services at the community level

Some Potential Solutions

Implementing ways of identifying frail elders at risk (e.g., Gatekeeper Program)

Educating primary health care providers on how to identify depression and other mental disabling conditions in older persons

Additional Potential Solutions

Providing Extended Community Services to older persons who have been discharged from State Mental Hospitals

Increasing health promotion and disease prevention efforts in mental health services to older persons (e.g., depression screening programs)

Additional Potential Solutions

Co-locating mental health service providers in primary care physicians’ offices

Postponing premature hospitalization by funding counseling and other support services to caregivers of Alzheimer's patients

Developing an Elder Friendly Community

Creating communities that enable elder choice and involvement with ready access to necessary services in all living arrangements , whether at home, supported living or in long term care facilities

Affordable housing options for the elderly within new developments and as we attempt to rebuild our downtown area

Transportation systems that take into consideration elder needs

Elder Friendly Communities

Learning and Productivity centers within local institutions of higher learning for those wanting a second career or further learning

Courses for high school students on what it means to have an older relative

Supermarkets that adjust to an aging population Aggregation of services for convenience

purposes Technology enabling services Integrated home services

Challenges of Family Caregiving

1 in every 4 households in caregiving, half of them with no outside help

25% of all workers provide elder care, with most of them being employed full time

Most have to rearrange their work schedule

--Take unpaid leave

-- Decrease working hours

Value & Cost of Informal of Caregiving

The value of informal caregiving is estimated at $196 billion per year

Informal caregiving exceeds nursing home and home care expenses by $81 billion a year

Caregiving costs US businesses $114 billion annually

Caregivers lose up to $659,139 in earned income over a lifetime

Avoiding the Caregiving Crunch

Finance long-term care through private insurance and reverse mortgages

Establish new eldercare-oriented employee benefits

Expand and integrate community based long-term care services (i.e., respite, adult day services, special transportation services, case management, caregiver support groups, etc.)

Alzheimer’s Disease

8 to 15% of people over age 65 have Alzheimer’s disease

The prevalence of dementia (most of which is accounted for by Alzheimer’s disease) nearly doubles with every 5 years of age after 60.

Studies also reveal age-related increases in Alzheimer’s disease with the 85+ accounting for 48% of those with Alzheimer’s disease

The Cost

An estimated 4 million individuals diagnosed with Alzheimer’s disease

The estimated cost of Alzheimer’s disease to Medicare and Medicaid totaled $50 billion in 2000 and is projected to be $72 billion in 2010.

In Conclusion

Thus, while people are living healthier into old age and doing so on a mass scale, there remain many difficulties, both psychic and physical, that eventually come with growing old. Many are living long enough to suffer age-related diseases like Alzheimer’s and Parkinson’s -- diseases that involve long term care decline and thus the need for long term care.

In Conclusion

And, precisely because many individuals have taken advantage of modern freedom’s opportunities for education, careers and geographic mobility, many elderly will live in greater isolation from loved ones, separated from children and grandchildren who have settled elsewhere or whose lives are defined primarily by work and school.

In Conclusion

Smaller and less stable families will likely compound these problems, as the burdens of caregiving fall on one or two adult children, who in many cases are called upon to care for parents who did not always cared well for them.

Many among the growing population of childless elderly will have no relatives at all to look after them.

The Question Remains Can a society that values self-reliance, personal

freedom, and careerism reconcile itself to the realities of dependence, diminished autonomy, and responsibility for others?

How we care for the dependent elderly will test whether modern life has not only made things better for us but also made us better human beings, more willing to accept the obligations to care and more able to cope with the burdens of caregiving.

THE AGE FACTOR

Questions and Discussion

Dr. Peck’s presentation can be viewed and downloaded at www.ewu.edu/easternedge