Study Guide 7 SOCIOECONOMIC AND ENVIRONMENTAL

INFLUENCES

Topic Outline
1. SOCIOECONOMIC FACTORS
A. Age Cohorts
B. Income Sources
C. Ages 55 to 64
D. Ages 65 to 74
E. Ages 75 to 84
F. Ages 85 and Older
G. Poverty
H. Education
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I. Health Status
J. Insurance Coverage
K. Support Systems
L. Benefits and Entitlements
M. Area Agencies on Aging
N. Conservators and Guardians
2. ENVIRONMENTAL INFLUENCES
A. Geographic Location of Residence
B. Transportation
C. Housing
D. Criminal Victimization
E. ADVOCACY

Learning Objectives
After studying this module, you will be able to:
 1. Identify the major socioeconomic and environmental factors that influence the health of older
adults.
 2. Explain the importance of age cohorts in understanding older adults.
 3. Describe the economic factors that influence the lives of older persons.
 4. Identify components of the Medicare health insurance programs.
 5. Discuss the influence of support systems on the health and well-being of older adults.
 6. Distinguish between a conservator, guardian, and durable power of attorney.
 7. Discuss environmental factors that affect the safety and security of older adults.
 8. Compare and contrast the housing options available for older adults.
 9. Compare the influences of income, education, and health status on quality of life.
 10. Relate strategies for protecting older persons in the community from criminal victimization.
 11. Assess the ability of older adults to be their own advocate.

Introduction

Each person is a unique design of genetic inheritance, life experiences, education, and environment. Social
status, economic conditions, and environment influence our health and response to illness. This chapter
discusses the socioeconomic and environmental conditions that influence the way older adults interact
with the health care system.

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 Activating Prior Knowledge
Older adult health care consumers often depend on the health care professional for advocacy.
How to become an effective advocate?
Does the nurse understand the factors that shape the older consumer’s perceptions of environment,
socioeconomic status, and access to health care?

1.1 Discussion of Key Concepts

SOCIOECONOMIC FACTORS
Age Cohorts
Persons who share the experience of a particular event or time in history are grouped together in what is
called a cohort. They shared certain experiences at similar stages of physical, psychological, and social
development that influenced the way they perceive the world. Therefore, they develop attitudes and
values that are similar (Cox, 1986; Richardson, 1996).

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Cohort classifications include age, historical events, and geographic area of residence. Today’s
older Americans have shared many momentous experiences. The “Roaring Twenties,” the Great
Depression, World War II, and the Korean War made impressions on everyone who lived through those
events, but especially on those who were young at the time. Values and the pace of life, which vary
between communities and regions of the country, influence the perceptions of the residents of each
region.
The age cohort that reached young adulthood in the postWorld War II and Korean War era benefited from
a very productive time in American history. The late 1940s, 1950s, and 1960s were times of rapidly
increasing earnings and heavy spending. Strong unions negotiated for better pension plans and medical
benefits.

Ages 55 to 64
Those in the preretirement age cohort of 55 to 64 are generally in their peak earning years. Most are
married, but few have children younger than 18 still residing in the family home. The heavy expenses of
child rearing are over, and homeowners have completely or nearly paid for their homes. This age cohort
tends to have increased disposable income yet is acutely aware of impending retirement; thus, priorities
change and spending begins to decrease

AGE TO RECEIVE FULL SOCIAL SECURITY BENEFITS

YEAR OF BIRTH FULL RETIREMENT AGE

1937 or earlier 65
1938 65 and 2 months
1939 65 and 4 months
1940 65 and 6 months
1941 65 and 8 months
1942 65 and 10 months
1943–1954 66
1955 66 and 2 months
1956 66 and 4 months
1957 66 and 6 months
1958 66 and 8 months
1959 66 and 10 months
1960 or later 67

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 Ages 65 to 74
Retirement ordinarily causes income to decrease, most recently by over 40%. The median income before
taxes for households ages 65 and older is a little over $33,000, which is approximately $22,000 less than
the median income of households in the 55 to 64 cohort (DeNavas-Walt et al., 2013)
Ages 75 to 84

After age 75, women outnumber men in American society. Many persons in this age group live alone,
which affects their average household income. Although this age group has shown a slight

VETERANS’ BENEFITS
Benefits for eligible veterans include the following:
• Disability compensation
• Pension
• Education and training
• Home loan guaranties
• Life insurance
• Burial benefits Course Code and Title
• Health care benefits

Ages 85 and Older

This group is the fastest growing segment of our population (Table 7–2), with over 5.5 million persons 85
years and over in 2008.
By 2050, those over 85 years old are expected to account for over 4% of the population. Although
medical and social advances have prolonged the life span of Americans, this age cohort is at risk for
increased chronic disease, resulting in decreased ability to perform activities of daily living (ADLs) and
increased expenses for assistance, assistive devices, and medication (DeNavas-Walt et al., 2013; Federal
Interagency Forum on Aging-Related Statistics, 2012)

Poverty
The following information looks at poverty at various times over the past 20 to 30 years. Updates to all
statistics take place periodically and can be found by checking with the U.S. Census Bureau
athttp://www.census.gov/ or with the AOA at http://www.aoa.gov/

Low income may affect the quality of life for older adults. For example, basics such as housing and diet
may be inadequate. A worn out wardrobe and lack of transportation may cause the older adult to avoid
social contact, leading to isolation. Older adults may delay seeking medical help or may not follow through
with the prescribed treatment or medications because of limited income.

Education
Education has been shown to have a strong relationship to health risk factors (Brown, 1995). The level of
education influences earning ability, information absorption, problem-solving ability, value systems, and
lifestyle behaviors. The more educated person often has greater access to wellness programs and
preventive health options (Land, Guralnik, & Blater, 1994)

The educational level of the older population has increased steadily between 1970 and 2012, reflecting
increased mandatory education and better educational opportunities in the last 40 years. The percentage
of individuals who completed high school varies by race and ethnic origin; however, 81% of older adults
have completed high school, and 24% have earned a bachelor’s degree or higher (AOA, 2012)
Many older adults continue their education in their later years. Some complete high school or take college
courses.

Erikson’s seventh stage of development stresses how important generativity versus stagnation is to the
individual’s sense of achievement and fulfillment in life (Cox, 1986). Education provides an opportunity to
avoid stagnation and isolation and adds to the enjoyment of later life. Teaching older adults with

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transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 disabilities may be a challenge for nurses when the teaching is a part of health education
PATIENT TEACHING STRATEGIES

Older adults often have short-term memory deficits or limited vision or hearing abilities that affect
teaching. To improve comprehension and adherence, consider the following suggestions:
• Provide a comfortable environment with adequate lighting and minimal distractions.
• Repeat important information at least three times.
• Present information in several forms: written material, discussion, videotape and audiotape, and photos
and pictures.
• With written material, use large print and clear black letters on a contrasting background.
• Speak at a moderate pace and volume with a low tone of voice. Check for understanding by asking the
patient to explain in his or her own words.
• Use appropriate gestures to enhance understanding.
• Check back later to assess understanding.

Health Status
The health status of older adults influences their socioeconomic status.Course Code and
Eighty percent Title adults have
of older
at least one chronic health condition; 50% have two. The most common chronic health problems leading
to death in 2011 were heart disease, cancer, stroke (accounting for 50% of deaths), followed by chronic
obstructive pulmonary disease (COPD), Alzheimer disease, and diabete

Functional status is affected by chronic conditions. The CDC reports in Healthy Aging for Older
Americans (CDC, 2004) that functional status is important because it serves as an indicator of an older
adult’s ability to remain independent in the community. Functional ability is measured by the individual’s
ability to perform ADLs and instrumental activities of daily living (IADLs). ADLs include six personal care
activities:
(1) eating,
(2) toileting,
(3) bathing,
(4) transferring,
(5) dressing, and
(6) continence.
A quarter of persons with at least one chronic disease experience a decrease in the ability to perform one
or more ADLs. The term IADLs refers to the following home-management activities: preparing meals,
shopping, managing money, using the telephone, doing light housework, doing laundry, using
transportation, and taking medications appropriately

Insurance Coverage
Older Americans should review their insurance coverage often to determine whether the coverage they
have is necessary, appropriate, and adequate. Residential insurance purchased several years ago may be
inadequate today. For example, home insurance should cover at least 80% of the replacement cost;
however, many older adult homeowners are insured for the assessed value of the home at the time of
purchase. Content and liability coverage may also be inadequate. Older homeowners may be unaware that
policies are outdated, or they may not be able to afford the premiums an update would require. Insurance
checkups reveal inadequacies. Older adults may wish to investigate several insurance companies to find
the best coverage for the least cost.

Part A, the hospital insurance, helps pay for inpatient hospital care and some follow-up care such as a
skilled nursing facility, home health services, and hospice care. A person is eligible for Medicare Hospital
Insurance if he or she is age 65 or older and;
(1) is eligible for any type of monthly Social Security benefit or railroad retirement system benefit or
(2) is retired from or the spouse of a person who was employed in a Medicare-covered position.

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transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 Part A, a monthly premium may be paid, as long as the person meets citizenship or residency
requirements and is age 65 or older or disabled. The 2014 premium amount for people who buy Part A is
$426 each month (“Medicare 2014 costs at a glance,” n.d.).
Part A, the hospital insurance, helps pay for the following:
• Home health care (including durable medical equipment)
• Hospice care • Hospital inpatient stay
• Mental health inpatient stay
• Skilled nursing facility stay Part B is medical insurance coverage. Most Medicare recipients pay a
premium that is deducted from monthly Social Security income. In addition, they pay an annual deductible
on hospital and skilled nursing care benefits. The 2014 premium amount for Part B ranges from $104.90
to $335.70 each month, based on income, with a $147 deductible per year (“Medicare 2014 costs at a
glance,” n.d.). Part B, the medical insurance, helps pay for the following:
• Home health services (including durable medical equipment)
• Medical and other services (including inpatient doctor services and outpatient therapies)
• Outpatient mental health services and partial hospitalization for mental health services
• Outpatient hospital services Medicare Part D refers to the prescription

Support Systems Course Code and Title

Throughout life people make new acquaintances, develop friendships, and form family circles. People
identify with schools, churches or synagogues, clubs, neighborhoods, and towns. These are the places and
people they turn to when they need advice or help, want to celebrate, or are grieving. With age a person
loses some of these support systems. Family and friends move away or die, and organizations and
neighborhoods change.

In a study of how age and gender affect the perception of quality of support, Lynch (1998) found that men
appear to perceive spousal support as the most positive, whereas women perceive the support received
from children as the most positive. Traditionally, men have not engaged in cooking, cleaning house,
mending clothes, and doing the laundry and thus miss these services when they lose their spouses.

Benefits and Entitlements

Social Security, Supplemental Security Income, Medicare, and Medicaid, a variety of other benefits
and entitlements are available to older Americans, and these affect their socioeconomic status.
Entitlement programs require the beneficiary meet certain guidelines of income or disability, whereas all
older Americans may enjoy other benefits such as senior discounts. Subsidized housing is available in
almost every community the nation. Most programs are supervised by the U.S. Department of Housing
and Urban Development, but one major program is under the authority of the Farmers Home
Administration of the U.S. Department of Agriculture. Once a person establishes eligibility, he or she may
find suitable housing in existing rental buildings or public housing developments.

Area Agencies on Aging

Local AAAs provide several services for older adults. AAAs were created in 1973 as an amendment to the
Older Americans Act. The purpose of the agencies is to plan and implement social service programs at the
local level. Benefits available through these agencies include the following:
• Nutrition services through congregate meal sites and homedelivered meals
• Recreational opportunities
• Chore service
• Legal assistance
• Transportation
• Information and referral

Conservators and Guardians

When older adults are unable to handle their own financial affairs, a conservator may be appointed. This
does not necessarily indicate that older persons are incompetent. For example, if a person is visually
impaired, he or she may voluntarily select a conservator. However, if an older person is incompetent, the
court selects the conservator.

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 ENVIRONMENTAL INFLUENCES
Environment contributes to a person’s perception of life. Although the environment might not be
noticeable unless it is uncomfortable, it does significantly affect emotional and physical health and well-
being. Environment may be described as hot or cold, dark or light, hard or soft, and safe or dangerous.
Environmental factors such as adequate shelter, safety, and comfort contribute to a person’s ability to
function well.

DEFINITIONS
Conservator—manages an older person’s financial resources. An annual report must be filed with the
court detailing how the funds were spent on the person’s behalf.
Guardian—is appointed to make personal care decisions for the disabled individual. Personal care includes
medical treatment and other decisions promoting comfort, safety, and health. The guardian must file an
annual report with the court on the individual’s condition.
Durable power of attorney—is a document by which one person (the principal) gives legal authority to
another (the agent or attorney-in-fact) to act on behalf of the principal. It is called durable because it
continues to be effective even after the principal has lost capacity as aCourse Code
result of and
illness orTitle
injury. The two
types of durable power of attorney are:
• Durable power of attorney for financial matters—this authority to handle financial affairs may be as
broad or limited as the parties agree upon.
• Durable power of attorney for health care decisions—the agent or attorney-in-fact is not required to
report actions on behalf of the principal to the court

Geographic Location of Residence

Geographic factors influence individuals differently. Climate is important to older adults because they are
susceptible to temperature extremes. Those who live in cold climates need adequate heat and clothing;
those in temperate areas need cooling systems during warm seasons. Because older adults are concerned
about accidental injuries, weather extremes such as snow and ice may contribute to isolation

Transportation
For many older adults, an automobile is a symbol of independence. In 2009, 33 million older adults still
had their drivers’ licenses (“Older adult drivers,” 2013).

Housing A person’s home is a true reflection of the individual, and for the older person it signifies
independence. After World War II, home ownership was encouraged by offers of insured mortgages and
reductions in property taxes and mortgage interest to stimulate the postwar economy. Therefore, home
ownership was a goal many in the older generation sought to achieve (Burke & Flaherty, 1993). A
person’s house is often his or her major asset and, in fact, may be the only asset. The older person may
have been born and raised there and then raised his or her own children. More often, a young married
couple would have bought the house, raised the family in that same house, then continued to live there as
a couple or after the death of the spouse.

Criminal Victimization
Elder victimization frequently goes unreported. Often, the perpetrator of the crime is someone known to
the older adult: an acquaintance, family member, or friend (Box 7–4). While older adults experience the
lowest rates of victimization (2.4 victims per 1000 population, compared to 33.9 per 1000 population of
18-20 year olds in 2010), older adults appear to be

TYPES OF CRIMES COMMITTED AGAINST OLDER ADULTS

The types of crimes most often committed against older adults include the following:
A.Financial/Material exploitation:
b. illegal or improper use of funds, property, or assets Sexual abuse or assault:

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 c. sexual contact without consent Murder/Homicide:
d. taking of another person’s life Internet crime:
e. illegal activity committed through the Internet (cybercrime) Identity theft:
f. stealing another’s identity or personal data Emotional/Psychological abuse:
g. verbal or nonverbal means of inflicting pain and suffering Physical abuse:
h. physical force resulting in injury Neglect: intentional or unintentional failure to fulfil obligations
i. Abandonment:
j. desertion

OLDER ADULT CRIME VICTIMS

• Victimization rates are higher among older men than among older women. However, the rates of
personal larceny with contact such as purse snatching are higher among older women.
• The rates of victimization are higher among older adults ages 65 to 74 than among those ages 75 or
older.
• Older blacks are more likely than older whites to be victims of crime. However, rates of personal larceny
that do not involve contact between the victim and offender are greater among whites.
• Older adults with the lowest incomes experience higher violence than Course
those Code and Title
with higher family incomes.
The highest rates of personal theft or household crime are seen among older adults with the highest
family income.
• The highest rates of victimization for all types of crime are seen among older persons who are either
separated or divorced (from among all marital statuses).
• Rates of victimization for all types of crime are highest among older residents in cities compared with
suburban or rural older adults.
• Older renters are more likely than owners to experience both violence and personal theft. However,
older homeowners are more likely than renters to be victims of household crime

CONSUMER FRAUDS PERPETRATED MOST AGAINST OLDER ADULTS

Health and medical frauds—quackery or merchandising of drugs, health aids, or insurance
• Mail order frauds—merchandising through the mail that includes false or misleading information about
the product
• Income creation and investment frauds—get-rich-quick schemes such as pyramid selling, work-at-home
scams, the sale of fraudulent franchises, and real estate investment opportunities
• Social psychological frauds—merchandising of products and services that exploit fears by promising
solutions to problems and loneliness
• Con games—schemes such as “pigeon drop,” vacation lure, bank swindle, or oil well investment; usually
perpetrated by professional con operators
• Telemarketing scams—sweepstakes or contests that require payment in advance to enter or claim a
prize, with payment usually by credit card; merchandising that pressures people to buy without being sent
written information about the products or services that are being sold BOX 7–6 C

REASONS OLDER ADULTS ARE VICTIMS OF FRAUD

1. Older adults are often lonely and isolated. They are more likely to be at home and therefore available to
both door-to-door and phone scams. They welcome con artists who are willing to spend time visiting.
2. Older adults have fewer resources to turn to for advice. They may be reluctant to “bother” friends,
family, or professionals.
3. Older adults may be more susceptible to con artists who are polite, who appear knowledgeable, or who
represent authority.
4. Older adults often have concerns about maintaining a comfortable lifestyle on a fixed income, affording
good medical and long-term care, and providing for spouse and children.
5. Chronic illness leads many older adults to consider medical remedies offered by health fraud promoters.
6. Many older adults believe it is impolite to hang up on a caller or turn some

ADVOCACY

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transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 Older adults as a group are good advocates for their own special needs and interests. They write to
legislators, consumer protection groups, government agencies, and other groups that control issues
affecting older adults. By advocating for themselves, older adults are taking charge of their environment,
their resources, their mental and physical health, and the future of all older adults. Ol

Advocacy is basic to professional nursing because it seeks to protect the human rights of patients within
the health care system (Segesten & Fagring, 1996

HOME CARE
Socioeconomic Influences
• Assess older adults’ outside sources of income. Many supplemental policies cover excess costs that
Medicare does not cover, thus ensuring more equipment and supplies for older adults.
• The goal of home care is to restore older adults’ independence by teaching self-management of chronic
conditions.
• Use social workers to identify community resources for financial assistance for homebound older adults.
• Arrange for meals to be delivered to homebound older adults, if necessary.
• Contact the Area Agency on Aging for referral to employment and legal services and social opportunities
for older adults.
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Environmental Influences
• Many meal delivery services provide food that has been prepared and frozen. Assess the functional
ability and environment of older adults to ensure they can prepare the food that has been delivered (e.g.,
make certain they have a stove or microwave and electricity).
• Use a social worker to identify community resources for housing options for homebound older adults
with multiple problems.
• Refer to the Area Agency on Aging for resources for home repair and transportation.
• Assess for signs of older adult abuse that may be manifested by consumer frauds. Report any suspicion
of consumer fraud.
• Reduce potential for consumer fraud by decreasing social isolation in homebound older adults. H

Activity (can also be Critical Thinking and Review Questions)

ACTIVITY 1: Critical Thinking
1. . A 69-year-old chronically ill woman has few financial resources, no formal education, and only
one child who can assist her. Her son is married, has four children, and has a job that barely manages
to support him and his family. Speculate how the woman’s situation may affect her perception of her
health care. In what ways can the nurse intervene to assist her?
2. A 78-year-old man is a retired banker whose wife died several years ago. He is able to perform
all ADLs but needs help with meal preparation and transportation. He lives in a deteriorating
neighborhood and no longer feels safe. He does not want to live with family members or completely
give up his independence. What housing options would be appropriate for him? What advantages
would such housing options offer over living alone?

Interactive Link
http://www.aoa.gov/AoARoot/Aging_Statistics/ Profile/index.aspx.
http://www.aarp.org/lite/drive/. American veterans by the numbers

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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 Everyday Connection
Synchronous and asynchrous learning

Summary
KEY POINTS
• Socioeconomic factors such as income level, income sources, insurance coverage, benefits and entitlements, and
educational level influence older adults’ perceptions of their health and approach to health care.

• Environmental factors such as geographic location, housing, transportation, and perception of safety influence the
availability of services, as well as older adults’ knowledge and use of those services.

• The strength of the formal and informal support systems, including community services, medical care, spiritual
resources, and family and friends, may affect the maintenance of independence Course
for olderCode and Title
adults.

• Experience has a strong influence on shaping value systems, coping skills, and perceptions. It is important to
understand the events that occurred early in older adults’ lives to understand their values and perceptions.

• Education has a strong positive influence on economic wellbeing and health status. Education prepares persons to
make positive decisions that contribute to a higher perceived quality of life.

• Medicare is a federal program that provides health insurance for older adults. It consists of two parts: Part A is
hospital insurance that helps pay for inpatient care and some followup care, and Part B is medical insurance that
helps pay for physician services and some outpatient services.

• Medicaid is a state-administered program that uses federal funds to provide some medical expenses not covered
by Medicare. Each state has different coverage and requirements. Medicaid is designed for persons with very low
incomes and minimal assets.

• Older adults who are no longer able to handle their affairs or make decisions about their lives may benefit from a
conservator, guardian, or durable power of attorney. A conservator manages financial resources, a guardian makes
personal decisions, and a durable power of attorney is a document that names an agent to act on behalf of a person
for a specific function, such as in making financial or health care decisions.

• The condition of homes and furnishings, the composition of neighborhoods, and the availability and type of
transportation affect the security and safety of older adults. Aging and outdated homes and appliances, worn
furniture, and unreliable transportation may lead to accidents and injury. Deteriorating neighborhoods with
changing populations may foster feelings of insecurity in older adults.

• Most communities in America have a variety of housing options to meet the needs of older adults, including single
family residences, apartments, congregate housing, shared housing, retirement communities, assisted living
facilities, and nursing facilities. Each option provides a differentlevel of service to help older adults maintain
maximum independence.

• Perceived victimization in older adults may result in increased suspicion and eventual withdrawal and isolation,
which may have negative effects on health and well-being.

• A strong support system helps protect older adults from criminal victimization. Professional service providers,
friends, and family may monitor older adults’ environments and offer guidance when necessary. Community

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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programs such as neighborhood watch programs and educational programs on victimization help older adults
actively participate in crime prevention.

• Through advocacy, nurses can protect the dignity of older adults and improve their quality of lif

Readings and References

Administration on Aging. (2012). A profile of older Americans: 2012. Retrieved from,
http://www.aoa.gov/AoARoot/Aging_Statistics/ Profile/index.aspx.
American Association of Retired Persons. (1991). A matter of choice. Washington, DC: The Association.
American Association of Retired Persons. (1997). A profile of older Americans. Washington, DC: The
Association.
American Association of Retired Persons. (2005). Driver safety program. from,
http://www.aarp.org/lite/drive/. American veterans by the numbers. (n.d.). Retrieved January 6, 2014,
from, http://www.infoplease.com/spot/veteranscensus1.html
Course Code and Title

All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or
transmitting in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
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