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CHAPTER FOURTEENCHAPTER FOURTEEN Successful Aging

Adulthood and Aging, 6eJohn C. CavanaughFredda Blanchard-Fields

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Demographic Trends and Social Policy

Learning Objectives

• What key demographic changes will occur by 2030?

• What are the challenges facing Social Security and Medicare?

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Demographic Trends and Social Policy

Demographic Trends: 2030

• Potential for intergenerational conflict exists.

– Controversy over the rate and growth of Medicare and Social

Security

– Future issues when the last baby boomer reaches 65 (2030)• The proportion of older adults will have nearly doubled.• Older adults will be politically sophisticated and organized.• Will want to keep their affluent lifestyle, Social Security benefits,

health care, comfortable retirement• Ratio of workers to retirees will fall from 3:1 to 2:1.• Lowered sense of obligation toward elderly parents• Rapid increase of ethnic minority older adults

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Demographic Trends and Social Policy

Social Security and Medicare• Political Landscape

– 1970s: older adults began to be portrayed as scapegoats

concerning government resources• Because of tremendous growth of federal dollars expended on them• Older adults portrayed as highly politically active, fiscally

conservative, and selfish.

– 1983: Congress made considerable changes in the name of

intergenerational fairness.• Changes in Social Security, Medicare, the Older Americans Act, and

other programs and policies

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Poverty RatesPoverty Rates

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Social Security & MedicareSocial Security & Medicare

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Demographic Trends and Social Policy

Social Security and Medicare

Social Security

– 1935: initiative by FDR to “frame a law which will give some

measure of protection to the average citizen and to his family

against the loss of a job and against poverty-ridden old age.”

– Revisions to the law have changed SS so it now represents the

primary financial support after retirement to many Americans.

– In the 21ST century, other plans, 401(k), 403(b), 457, mutual funds,

IRAs, savings option, may change SS back to being the supplement

it was supposed to be.

– Primary challenge to SS is the large cohort of baby boomers

drawing benefits and a smaller generation paying into the system.

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Demographic Trends and Social Policy

Social Security and Medicare

Medicare

– 40 million U.S. citizens depend on Medicare for medical insurance.

– Eligibility for Medicare• Over 65• Be disabled• Have permanent kidney failure

– Consists of three parts• Part A – inpatient hospital services, etc.• Part B – outpatient services, etc.• Part D – some coverage for prescription medications

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Health Issues and Quality of Life

Learning Objectives

• What are the key issues in health promotion and quality of life?

• What are the major strategies for maintaining and enhancing competence?

• What are the primary considerations in designing health promotion and disease prevention programs?

• What are the principle lifestyle factors that influence competence?

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Health Promotion and Quality of Life

Changing Unhealthy Habits Increase Functional Capability

• Little research on health programs specifically for the

elderly, however:

– Taking possibility of injury into account, exercise is key to health

– Health education programs minimize effects of emotional stress

– Health screening programs are effective in identifying chronic

diseases that impact quality of life

• Quality of Life

– One’s well-being and life satisfaction

– State of health has major influence

– Best studied from the point of view of the person

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Health Promotion and Quality of Life

A Framework for Maintaining and Enhancing Competence

• Use of computers is one way in which technology can enhance competence of older adults.– Websites dedicated to older persons.

– Email as a way to keep in touch with friends and family.

• Considering the life-span perspective, changes occur with age result from:– Multiple biological, psychological, sociocultural, and life-cycle forces

• Mastering tasks of daily living contributes to a sense of competence.– Key is to apply the three adaptive mechanisms for aging:

• Selection – Optimization – Compensation (SOC)

– Differentiate usual or typical aging from successful aging.

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Health Promotion and Quality of Life

Health Promotion and Disease Prevention• No magic potion or set of steps to successful aging but table

14.1 suggests a strategy.

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Health Promotion and Quality of Life

Health Promotion and Disease Prevention

U. S. Department of Health and Human Services created a national initiative to improve health of all Americans.

– U.S Government allocates funds appropriated by the Older Americans Act through the Administration on Aging (AoA) to support programs such as:

• Health risk assessments and screening

• Health promotion programs on chronic disabling conditions

• Nutrition screening and education

• Physical fitness

• Counseling regarding social services

• Home injury control services • Follow-up health services

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Health Promotion and Quality of Life

Health Promotion and Disease Prevention (cont.)

Issues in Prevention

– Primary preventionIntervention that prevents a disease or condition from occurring

– Secondary preventionInstituted after a condition has begun

– Tertiary PreventionEfforts to avoid complications or secondary chronic conditions

– Quaternary preventionAimed at improving functional capacities of people with chronic conditions

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Health Promotion and Quality of Life

Lifestyle Factors

• Exercise– Aerobic exercise: places moderate stress on the heart by

maintaining a pulse rate between 60 and 90% of the person’s maximum heart rate

• Nutrition

– Metabolism: how much energy the body needsMetabolism and digestive process slow down with age.

– Low-density lipoproteins (LDL): cause fatty deposits to accumulate in arteries

– High-density lipoproteins (HDL): help keep arteries clear by breaking down LDLs

– Body mass index (BMI): ratio of body weight and height (w/h2)

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Overweight & ObesityOverweight & Obesity

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Successful Aging

Learning Objectives

• What is successful aging?

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What is “Successful Aging?”

The absence of disease and disability makes it easier to maintain mental and physical function. And maintenance of mental and physical function, in turn, enables (but does not guarantee) active engagement with life.

It is the combination of all three—avoidance of disease and disability, maintenance of cognitive and physical function, and sustained engagement with life—that represents the concept of successful aging most fully

(Rowe & Kahn, 1998, p. 39).

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Successful Aging

Vaillant (2002) proposes three criteria related to health:1. No physical disability at age 752. Good subjective health3. Length of undisabled life

and three related to social and productive activity:– Good mental health– Objective social support– Self-rated life satisfaction in eight domains

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Successful Aging

Vaillant’s eight domains of life satisfaction:1. Marriage

2. Income-producing work

3. Children

4. Friendship and social contacts

5. Hobbies

6. Community service activities

7. Religion

8. Recreation/sports

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Successful Aging

Successful Aging Theories

The Selection, Optimization, and Compensation (SOC) model

SelectionThe choosing and developing goals

OptimizationThe refinement of goal-related actions

Compensationthe substitution of means when previous ones are no longer available

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Successful Aging

Successful Aging Theories

• Successful aging requires that people:– Have the resources to live a healthy life

– Have access to health care

– Have life experiences that support individual decision making

• Negatives– Poverty, widowhood, differential social expectations based

on gender influence

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Successful Aging

When you are old, will you be able to look back and say,

“I lived long and prospered”