Chapter 1

The Aging Population

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction
Myths of aging
Misinformation as an injustice Role of the gerontological nurse: Know the facts Educate the public

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Views of Older Adults Through History

Current older population:
Positivism, intelligence, concern Historically: Age of Confucius, Taoism, Ancient Chinese, Early Egyptians, Greeks, Aristotle, Ancient Romans, Dark Ages, Middle Ages, and Medieval Times
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Improvements for Older Adults

1914: Dr. I. L. NascherFather of Geriatrics first geriatric textbook
1935: Federal Old Age Insurance Law under the Social Security Act 1965: formation of the Administration on Aging, Older Americans Act, Medicare, and Medicaid

Continued growing concern for older adults

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Is the following statement true or false?

The first significant step in improving the lives of older adults during the 20th century was the publication of the first geriatric textbook in 1914.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer

False.
The first significant step in improving the lives of older adults was the passage of the Federal Old Age Insurance Law under the Social Security Act in 1935.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Subsets of the Older Adult Population

Young-old
Old-old Middle-old Centenarians Diversity rather than homogeneity

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Population Growth and Increasing Life Expectancy

Persons 65+ currently represent more than 12% of the U.S. population
By the year 2020 older adults will grow to 17% of the population Increasing life expectancy: 1930: 59.7 years

1965: 70.2 years

Present: 77.8 years
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Factors Influencing Increased Life Expectancy

Advancements in disease control and health technology
Lower infant and child mortality rates

Improved sanitation
Better living conditions
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Life Expectancy: Race and Gender

Gap between white people and black people Societal issues Concern for nurses Gap is narrowing between males and females

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Marital Status and Living Arrangements

Older women are more likely than men to be married
Most older adults live with a spouse or other family member More women than men live alone Potential for living alone increased with age Most older adults have family contact
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Geographic Distribution
States with the greatest number of older adults: California, Florida, New York, Texas, and Pennsylvania

States with dramatic increases in the past decade: Nevada, Alaska, Hawaii, and Arizona
States with the lowest percentage of total population over age 65: Alaska, Utah, and Georgia
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Income of Older Adults

10% of older adults live below the poverty level Older adults dependent on Social Security for more than half of their income Median net worth is twice the national average related to home ownership Asset rich and cash poor Women and minority groups are poorer than white men
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Asset rich and cash poor relates to which of the following statements related to older adults?
a.Net worth of older adults is half the national average of middle-age adults b.Homes are paid for but there is not enough money available for monthly expenses c. The majority of older adults live below the poverty level d.Financial problems in the older adult population are due to level of debt
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer b. Homes are paid for but there is not enough money available for monthly expenses Median net worth of older households is nearly twice the national average because of the high prevalence of home ownership, but many older adults are asset rich and cash poor; they live in a house that has appreciated in value over the years, but they barely have sufficient monthly income to meet basic expenses.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Employment and the Older Adult Population

Declining percentage of workers in the labor force

Men leaving the workforce at an earlier age

Increase in the number of middle-aged women who are employed Increased desire to work at the age of retirement
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Education
Increasing levels of education in the older adult population
Advanced degrees and higher income

Impact on health care:

Older adults will be more informed consumers

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Status of Older Adults: Acute Conditions

Fewer acute illnesses Lower death rates

Longer period of recovery

More complications

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Status of Older Adults: Chronic Conditions

Major problem that increases with age Most have at least one chronic disease; many have several Result in limitations in ADLs and IADLs Leading cause of disability and death
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Is the following statement true or false?

Chronic disorders most prevalent in the older adult population are ones that can have a significant impact on independence and the quality of life.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
True. Chronic illness is a major problem for the older population and results in limitations in ADLs, IADLs, and quality of life.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Implications of an Aging Population

Impact on health and social service agencies Need for gerontological nurses Future needs Payment of services Impact and characteristics of the baby boomers
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WHAT MAKES A BABY BOOMER??

NEXT WAVES OF INCOMING SENIORS HIGHLY DIVERSE EXAMPLES - BILL GATES, BILL CLINTON, CHER, BONO

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

CHARACTERISTICS OR BABY BOOMERS

FEWER BIOLOGICAL CHILDREN TO ASSIST BETTER EDUCARED THAT PREVIOUS GENERATIONS HIGHER HOUSEHOLD INCOMES (MOST A 2+ INCOMES)

LESS FORMAL DRESS CODES

COMPUTER SAVVY < LEISURE /FREETIME EQUALS GREATER #S EXPEREINCING STRESS MORE LIKELY TO EXERCISE (these group invented the fitness movement)

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Provision and Payment of Services

Higher rates of hospitalization, surgery, and physician visits Paid by federal dollars most often Less than 5% of older adults live in a nursing home, assisted living, or other institutions Long-term care payment Role of the gerontological nurse
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins