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 class1. 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

• Gerontologyo The comprehensive study of aging and the

problems of the aged

• Geriatricso A branch of medicine that deals with the

problems and diseases of old age and aging people

http://www.nlm.nih.gov/medlineplus/

Geriatrics team

• Memberso Geriatriciano Nurseo Physician assistanto Social workero Pharmacisto Nutritionisto Physical therapisto Occupational therapisto Speech therapisto Geriatric psychiatrist 

• Goalso Evaluates the patient’s

social supports and living situation

o Considers the person’s ability to perform daily activities

o Provide patient-centered 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 affairso 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 shouldo Assist an individual to achieve life satisfaction

in multiple domains—physical, psychological, and social

oReduce the disabling effects of diseaseo 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 oldero Oldest old: 85+ years and oldero Middle old: 76-84o Young old: 55-75

• “Old” - very subjective concepts!

• Chronological age ǂ Biological age

Demographics

• Americans age 65+ yearso 1990: 4% of populationo 1940: 6.9% of populationo 2010: 13% of population (40 million people)o 2030: 20% of populationo “Baby boomers” (born between 1946 and 1964) are

responsible for a sharp increase from 2010 to 2030

• Americans age 85+ yearso 2010: 5.5 milliono 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/fastats/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 ethnicityo 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 factorsoCancer screeningso VaccinationsoDieto Physical activityoObesityo Smokingo SocializingoQuality 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 characteristicso Non-Hispanic Blacks: $19,839o Hispanics: $15,362o Individuals with income <$10,000: $21,924o Individuals with income >$30,000: $13,149

• Costs varied by health statuso Individuals with no chronic conditions: $5,520o Individuals with 5+ conditions: $24,658o Residents of long-term care facilities: $61,318o 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 dimensionsowarmth — good intentions, trustworthy,

sociableo competence

• Stereotype for older peopleowell-intentioned (warm) but incompetento "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 themo Older people who adhere to them are rewarded with

sympathy and pity

• Prescriptive stereotypes center on three key issueso Successiono Identifyo 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 class1. 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?