Aging America: Uncharted Adventures

Aging America: Aging America: Uncharted AdventuresUncharted Adventures

J. James Cotter, PhDJ. James Cotter, PhD

Associate Professor, Department of GerontologyAssociate Professor, Department of Gerontology

Virginia Commonwealth UniversityVirginia Commonwealth University

J. James Cotter, PhDJ. James Cotter, PhD

Associate Professor, Department of GerontologyAssociate Professor, Department of Gerontology

Virginia Commonwealth UniversityVirginia Commonwealth University

J. Cotter, PhD, Dept. of Gerontology, VCU 2

Objectives:

• summarize demographic characteristics of older patients

• examine challenges society as it ages

• examine opportunities of society as it ages

• explore some important, neglected health issues for older adults


PITS > TIPSPITS > TIPS

• Trend:

• Issue:

• Problems:

• Broad, general movements, courses, directions, or tendencies in the society.

• Matters under discussion, points in question.

• Circumstances that involve uncertainty.


Challenge 1: Defining the Challenge 1: Defining the AgedAged

• 40 - Age discrimination40 - Age discrimination

• 50 - AARP discounts50 - AARP discounts

• 60 - Older Americans Act60 - Older Americans Act

• 65-67 - Medicare and Social Security65-67 - Medicare and Social Security

• 75 - frailty marker75 - frailty marker

• 85 - the old-old85 - the old-old


Changing MarkersChanging Markers

• How old is old?How old is old?

• Old age is a moving target.Old age is a moving target.– Unhinge from 65Unhinge from 65

– retirement decaderetirement decade

– age discrimination - meaningful age discrimination - meaningful employmentemployment

– Linear to cyclic lifestyleLinear to cyclic lifestyle


GenerationsGenerations

Cohort Era Age -2000 Age -2020Swing 1900-25 75-100 95-120

Silent 1925-45 55-75 75-95

Baby Boom 1946-64 34-54 54-74

Baby Busters 1965-79 21-35 41-55

BabyBoomlet

1980-2000 0-20 20-40


Challenge 2: Redefining Challenge 2: Redefining AgingAging

• 84% of all Americans say they 84% of all Americans say they would be happy to live to be 90would be happy to live to be 90

• What defines old ageWhat defines old age– decline in physical ability - 41%decline in physical ability - 41%

– decline in mental functioning - 32%decline in mental functioning - 32%

– reaching a specific age - 14%reaching a specific age - 14%National Council on Aging survey, 2001National Council on Aging survey, 2001


Life ExpectancyLife Expectancy

National Vital Statistics Report, Vol. 47, No. 28, December 13, 1999National Research Council, 1988

0102030405060708090

1900 1920 1940 1960 1980 1997

At birthAt 65


Number of CentenariansNumber of Centenarians

Jeanne Calment, died Jeanne Calment, died in 1997 at the age in 1997 at the age of 122.of 122.

A 65 year old must A 65 year old must live 57 more years live 57 more years to catch her record.to catch her record.

010000200003000040000500006000070000

1900

1999


Changing structure of Changing structure of societysociety

0

20

40

60

80

100

• Traditional aging pyramidTraditional aging pyramid • New aging pyramidNew aging pyramid

0

20

40

60

80

100


Growing diversityGrowing diversity

0102030405060708090

100

1990 2030

OtherHispanicBlackWhite


Elements of DiversityElements of Diversity

• AgeAge

• Ethnicity/RaceEthnicity/Race

• GenderGender

• Physical abilitiesPhysical abilities

• Sexual Sexual orientationorientation

• Family structure/ Marital status

• Religious beliefs• Education• Income/Wealth• Work/

EmploymentBased on Griggs, 1995


Challenge 3: Dependency Challenge 3: Dependency and Supportand Support

2000 2060 2000 for75

2060 for75

ElderlyOther dependentsWorkers


Changing Family StructureChanging Family Structure

0%

20%

40%

60%

80%

100%

1970 1980 1990 2000

Married couples withown childrenMarried coupleswithout own childrenFamily - other

Living alone

Other non-family

•Source: US Census, 2000


Effects of Small Families Effects of Small Families


Healthier Older Population Healthier Older Population ??

• Fries (1984), Compression of morbidityFries (1984), Compression of morbidity

• Palmore (1986), relative health of elderly has Palmore (1986), relative health of elderly has improvedimproved

• Rogers (1990), living longer and healthierRogers (1990), living longer and healthier

• Manton (1995), significant decreases in Manton (1995), significant decreases in prevalence of 16 medical conditionsprevalence of 16 medical conditions

• Cassel (2000), declining or postponing diseaseCassel (2000), declining or postponing disease


Prevention:Prevention: Mortality, Disability and Mortality, Disability and MorbidityMorbidity

0

20

40

60

80

100

120

0 20 40 60 80 100

Compression

Mortality

Disability

Morbidity

Age

% s

urvi

ving


Improving chronic Improving chronic conditionsconditions

• Counseling/ Tx on smoking Counseling/ Tx on smoking cessationcessation

• Counseling/ Tx on dietCounseling/ Tx on diet

• Counseling/ Tx on exerciseCounseling/ Tx on exercise


Self-reported arthritis Self-reported arthritis prevalenceprevalence

0

10

20

30

40

50

60

70

Rate per100

per CDC MMWR May 04, 2001 / 50(17);334-6


Economic Value of Long-Economic Value of Long-termCaretermCare

32

83

196

0

50

100

150

200

250

BillionsHome Health CareNursing Home CareFamily and Friends

Source: Arno, Levine, Memmot (1999) Health Affairs


Aging NetworkAging Network

Local Govt

GovernorsState Leg islatures

Nat'l Aging Orgs

Congress

Consumers

Local S erviceProviders

AAAs

State Units on Aging

HHSAoA

Presidency

Based on Torres-Gil, The New Aging, p.56


Issue: Older Persons and Issue: Older Persons and the Economythe Economy

http://www.agewave.com/http://www.agewave.com/

• More than $2 trillion in income More than $2 trillion in income

• 70% of the financial assets in America 70% of the financial assets in America

• 50% of all discretionary income - $13,286 per household 50% of all discretionary income - $13,286 per household

• The 50-plus consume 74% of all prescription drugs, a The 50-plus consume 74% of all prescription drugs, a $100 billion market. $100 billion market.

• Today's 50-plus adults represent 80% of all luxury travel Today's 50-plus adults represent 80% of all luxury travel

• Number of 55-plus health club members jumped 119% Number of 55-plus health club members jumped 119% (1987-1995); the number of 65-plus members jumped (1987-1995); the number of 65-plus members jumped 669% .669% .


Percentage of Older Percentage of Older Persons by IncomePersons by Income

0%10%20%30%40%50%60%70%80%90%

100%

65+ 75+

Under $7,500Under $10,000Under $15,000Under $20,000Under $25,000Under $45,000

Source Census Bureau, 2000


Gerontographics Life-stage Gerontographics Life-stage ModelModel

Healthy Indulgers

(18%)

Health Hermits (36%)

Ailing Outgoers

(29%)

Frail Recluses

(17%)

Moschis, American Demographics, 1996


Demise of Senior Demise of Senior Discounts? Discounts? (WSJ 8/31/01)(WSJ 8/31/01)

• 1955 Retired Teachers Association - 1955 Retired Teachers Association - discounted health insurancediscounted health insurance

• to combat frugality of Depression era to combat frugality of Depression era elders, now more money, living longer elders, now more money, living longer

• ““They reneged on us.” 76 yr old They reneged on us.” 76 yr old former skier re loss of discount at Vail former skier re loss of discount at Vail and Aspenand Aspen


In Search of the Secrets of In Search of the Secrets of AgingAging

• Longevity Longevity genesgenes

• Cell senescenceCell senescence

• Oxygen radicals Oxygen radicals

• Glycation Glycation

• DNA RepairDNA Repair

• Caloric Caloric restrictionrestriction

• Syndrome XSyndrome X

• Heat Shock Heat Shock ProteinsProteins

• HormonesHormones

• Immune systemImmune system


Future: Older People of Future: Older People of the 21st Centurythe 21st Century

• GeneralGeneral– smaller families, smaller families,

reconfigured familiesreconfigured families

– suburbssuburbs

– women in the work women in the work forceforce

– social movementssocial movements

Silverstone, Gerontologist, 1996

• HealthHealth– prevention is key prevention is key

– disability disability dependencedependence

– influence of influence of lifestylelifestyle

– influence of lifetime influence of lifetime access to health access to health carecare


Baby Boomers: Then and Baby Boomers: Then and NowNow

Then: Long hair Now : Longing for hair

Then: A keg Now : An EKG

Then: Acid rock Now : Acid reflux

Then: Watching John Glenn's historic flight with your parentsNow : Watching John Glenn's historic flight with your kids

Then: The Grateful Dead Now : Dr. Kevorkian

Then: Getting out to a new, hip jointNow : Getting a new hip joint


Institute for the Future:Institute for the Future:Health Care Paradigm Health Care Paradigm Shift Shift • Biomedical modelBiomedical model

• Acute episodesAcute episodes

• IndividualIndividual

• CureCure

• DiseaseDisease

Multi-factor Multi-factor approachapproach

Chronic illnessChronic illness

CommunitiesCommunities

AdaptationAdaptation

Person /diseasePerson /disease


Current Political IssuesCurrent Political Issues• Medicare (Rx)Medicare (Rx)

• Social Security (Privatization)Social Security (Privatization)

• Generational tensions (Private)Generational tensions (Private)

• Longevity (Financing)Longevity (Financing)

• Health care reorganization (HMOs)Health care reorganization (HMOs)

• Long-term care (Tax Credit)Long-term care (Tax Credit)

• Housing (Assisted Living)Housing (Assisted Living)

JJC


Health Care FinancingHealth Care Financing

• "Soaring" prescription drug costs will likely "Soaring" prescription drug costs will likely soon lead to "large increases" in workers' soon lead to "large increases" in workers' health insurance premiums and to health insurance premiums and to "changes or cutbacks" in prescription drug "changes or cutbacks" in prescription drug benefits.benefits.

» Hartford Courant, 4/24/01Hartford Courant, 4/24/01

• HMOsHMOs

• Personal responsibilityPersonal responsibility


Percent Change per capita in Percent Change per capita in Health Care Expenditures, 1998-Health Care Expenditures, 1998-20002000

-10

0

10

20

All b

enefits

Hosp

ital

Hosp

ital

Outp

ati

ent

Physi

cian

Rx

19982000

Source: Center for Studying Health System Change, 11/00


Health Care Premium and Cost Health Care Premium and Cost Annual % Increase, 1991-2000Annual % Increase, 1991-2000

02468

10121416

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2002

Premium LargeCompaniesHealth Spending

Source: Center for Studying Health System Change, 11/00


““Workers Pay More for Care” Workers Pay More for Care” (USA Today, (USA Today, 4/5/01)4/5/01)

• % of Rx price rather than flat co-payment% of Rx price rather than flat co-payment

• Varying percents based on type of condition - Varying percents based on type of condition - chronic, acute, lifestylechronic, acute, lifestyle

• Two-tier health plans - limited benefitsTwo-tier health plans - limited benefits

• Varying co-payments - will AMC reputation Varying co-payments - will AMC reputation cost more?cost more?

• Increase share of premiums > 33%Increase share of premiums > 33%


Policy DilemmasPolicy Dilemmas• How do we involve older persons?How do we involve older persons?

• How can we break the needy/greedy How can we break the needy/greedy image cycle?image cycle?

• How do we balance public and private How do we balance public and private responsibility?responsibility?

• Where does federal control end and state Where does federal control end and state control begin?control begin?

• How can we prepare young for aging?How can we prepare young for aging?

JJC


Paths to ReformPaths to ReformBlumenthal, NEJM, 2001Blumenthal, NEJM, 2001

• Defined contribution plansDefined contribution plans

• Medical savings accountsMedical savings accounts

• Increased co-paymentsIncreased co-payments

• Increased deductiblesIncreased deductibles

• Government price controlsGovernment price controls


Changing work force - Changing work force - GeriatricsGeriatrics

• Two decades of studies and concern by policy leaders, educators and heath care providers

• “The goal of mainstreaming geriatrics into American medicine remains elusive.”

• Not have enough teachers in medical schools in geriatrics

• Not enough medical students choosing to deal with older people

Source: Alliance for Aging Research, 1996


Ronald Klatz, M.D.Ronald Klatz, M.D.founding physician of the anti-aging founding physician of the anti-aging medicine movementmedicine movement

• Today's boomers will live, on average, to see age 100. Today's boomers will live, on average, to see age 100. Some boomers will celebrate their 130th birthdays healthy, Some boomers will celebrate their 130th birthdays healthy, happy, with full mental and physical faculties intact.happy, with full mental and physical faculties intact.

• New method to collect organs from non-beating heart New method to collect organs from non-beating heart donors, expanding the bank of organs for transplantsdonors, expanding the bank of organs for transplants

• A genetically engineered "gene therapy" cure for male A genetically engineered "gene therapy" cure for male pattern baldness. pattern baldness.

• At home 2-way telemedicine consultations between many At home 2-way telemedicine consultations between many elderly persons too frail, too weak, or just too busy to drive elderly persons too frail, too weak, or just too busy to drive to their doctor appointment.to their doctor appointment.

• Inhaled drug delivery systems e.g. InsulinInhaled drug delivery systems e.g. Insulin


Geriatric Medicine UpdateGeriatric Medicine Update

• Exercise - improved walking, balance, ROM = Exercise - improved walking, balance, ROM = decreased risk of morbidity, mortality, institutionalizationdecreased risk of morbidity, mortality, institutionalization

• Exercise, dietary restriction, sodium limit - 60% of older Exercise, dietary restriction, sodium limit - 60% of older hypertensive patients weaned from medicationhypertensive patients weaned from medication

• Biophosphanates - decrease bone resorptionBiophosphanates - decrease bone resorption

• NSAIDs, estrogen = possibly effective against cognitive NSAIDs, estrogen = possibly effective against cognitive declinedecline

Applegate and Pahor, JAMA, 1997

“Loss of function from habitual inactivity, poor nutrition, disease”


Model of TelehealthModel of Telehealth

Telehealth

Telemedicine

ProvidersStudentsPatients

Tele-education

Telecommunications / Internet


Smart Garments Smart Garments (WSJ, 8/10/01)(WSJ, 8/10/01)

• Nanotechnology - Nanotechnology -

• Motorola - clothing that can ‘talk’ to washing Motorola - clothing that can ‘talk’ to washing machines; adjusting the color of the clothesmachines; adjusting the color of the clothes

• tracking wandering personstracking wandering persons

• Sense-Wear armband- monitor vital signsSense-Wear armband- monitor vital signs


Electronic mindersElectronic minders

• Infrared sensors can follow Shizue Ozasa's every Infrared sensors can follow Shizue Ozasa's every move as she maneuvers around her room. move as she maneuvers around her room.

• Chips in her shoes can trigger locks should she try Chips in her shoes can trigger locks should she try to leave. to leave.

• A database can record everything she does. A database can record everything she does.

• Big Brother at his most benevolent--and most Big Brother at his most benevolent--and most lucrative. lucrative.

• NAIS Care Owada, a nursing home in OsakaNAIS Care Owada, a nursing home in Osaka

Oldies Look Golden to Japan Inc. (WSJ)


Kaiser Permanente Home Kaiser Permanente Home Health Care Health Care (n=212)(n=212)

• average telehealth video visits are 60% shorter (18 minutes vs. 45 minutes)

• no decrease in patient satisfaction.

• total mean costs of care, excluding home health care costs, $1948 $2674

• effective, well received by patients, capable of maintaining quality of care, and to have the potential for cost savings.

Johnston, B., Wheeler, L., Deuser, J., & Sousa, K.H. (2000). Outcomes of the Kaiser Permanente Tele-Home Health Research Project. Arch.Fam.Med, 9(1), 40-45.


Technology in the home Technology in the home carecare

• Miniaturization and portabilityMiniaturization and portability

• Alarms, monitors, safety systemsAlarms, monitors, safety systems

• Self-care extenders e.g. computerSelf-care extenders e.g. computer

• Treatment: IV, chemo, dialysisTreatment: IV, chemo, dialysis

• Mechanical aidsMechanical aids

• Advantages and DisadvantagesAdvantages and Disadvantages

•Kaye & Davitt, Health and Social Work, 1995


Baby Boomers: Then and Baby Boomers: Then and NowNow

Then: Trying to look like Marlon Brando or Elizabeth Taylor

Now : Trying not to look like Marlon Brando or Elizabeth Taylor

Then: Killer weed Now : Weed killer


Special Areas for ConcernSpecial Areas for Concern

• Sex and AIDSSex and AIDS

• Depression and SuicideDepression and Suicide

• Alcohol and Substance AbuseAlcohol and Substance Abuse

• End-of-life CareEnd-of-life Care

• Alzheimer’s DiseaseAlzheimer’s Disease

• Complementary and Alternative MedicineComplementary and Alternative Medicine


Sex and agingSex and aging• 80% of people over the age of 60 are 80% of people over the age of 60 are

sexually active (at least 1x mo) sexually active (at least 1x mo) (National Council on Aging Roper Starch poll, 1998)(National Council on Aging Roper Starch poll, 1998)

• 10.2% of AIDS cases diagnosed in 1995 10.2% of AIDS cases diagnosed in 1995 over the age of 50; 3.5% over the age of over the age of 50; 3.5% over the age of 6565

• Sexual history not part of the MD profile Sexual history not part of the MD profile usually done on older personsusually done on older persons (Gaeta (Gaeta et al, J Emer Med., 1995; Feldman, Arch Int Med.,1994)et al, J Emer Med., 1995; Feldman, Arch Int Med.,1994)


DepressionDepression

• In a study of 3,410 older persons in an In a study of 3,410 older persons in an HMO, primary care physicians miss 1/2 HMO, primary care physicians miss 1/2 of depression (measured by the GDS) of depression (measured by the GDS) in older persons.in older persons.– Garrard, Rolnick, Nitz et al, J Gerontology, Garrard, Rolnick, Nitz et al, J Gerontology,

April, 1998April, 1998

• Suicide rate for older white men is Suicide rate for older white men is double other groups (59/100,000).double other groups (59/100,000).


Substance Abuse and Substance Abuse and AgingAging

• 1/3 of alcoholics are over the age of 601/3 of alcoholics are over the age of 60

• Underdiagnosis - mimics other symptoms, ageismUnderdiagnosis - mimics other symptoms, ageism

• Questioning on the quantity and frequency of drinking + Questioning on the quantity and frequency of drinking + the CAGE increases the number of problem drinkers the CAGE increases the number of problem drinkers detected. detected. (Adams, Barry, Fleming, JAMA,1996)(Adams, Barry, Fleming, JAMA,1996)

• Alcohol-related hospitalizations among elderly people Alcohol-related hospitalizations among elderly people are common; = rates for myocardial infarction (1%). are common; = rates for myocardial infarction (1%). (Adams, Yuan, Barboriak, Rimm, JAMA, 1993)(Adams, Yuan, Barboriak, Rimm, JAMA, 1993)

• Primary care physician and “Brief intervention” - the Primary care physician and “Brief intervention” - the most cost-effective intervention for alcohol problems most cost-effective intervention for alcohol problems ((Hodler et al, J Studies Alc., 1991)Hodler et al, J Studies Alc., 1991)


End-of-life careEnd-of-life care• Oregon Health Sciences University Oregon Health Sciences University

study (P. Bascom, MD) study (P. Bascom, MD) – 67% of medical students had some EOL exposure 67% of medical students had some EOL exposure

but only in early stages of terminal illnessbut only in early stages of terminal illness

– 60% had never participated in notifying families of 60% had never participated in notifying families of patient deathpatient death

– pilot hospice option added to community medicine pilot hospice option added to community medicine rotationrotation

• Advanced directives not being followedAdvanced directives not being followed


Alzheimer’s DiseaseAlzheimer’s Disease

• 4 million people affected; 14 million in 4 million people affected; 14 million in 20302030

• Caregivers’ 36 hour dayCaregivers’ 36 hour day

• Pharmacologic tx - cholinesterase Pharmacologic tx - cholinesterase inhibitors for early stages, anti-inhibitors for early stages, anti-psychotics in later stages for behaviorpsychotics in later stages for behavior

• Non-pharmcologic tx for behavior - SCUsNon-pharmcologic tx for behavior - SCUs


Incidence of Alzheimer’s Incidence of Alzheimer’s Disease in East BostonDisease in East Boston

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%

10.0%

65-69 70-74 75-79 80-84 85-89

Hebert et al., JAMA, 1995


Number of Special Care Number of Special Care Units in nursing homesUnits in nursing homes

0

2000

4000

6000

8000

10000

12000

14000

16000

1987 1991 1995


Bioterrorism and Older Bioterrorism and Older PersonsPersons

• Slower to register for assistance, and may not Slower to register for assistance, and may not follow through. follow through.

• May be at higher physical risk in the May be at higher physical risk in the aftermathaftermath

• Are often targeted by fraudulent contractors Are often targeted by fraudulent contractors and “con men”. and “con men”.

• May be susceptible to physical and mental May be susceptible to physical and mental abuse as family stresses increase. abuse as family stresses increase.


Complementary and Complementary and Alternative Medicine Alternative Medicine (CAM)(CAM)

• ““wide range of medical approaches, wide range of medical approaches, therapies, and philosophies that can therapies, and philosophies that can either by used in conjunction with either by used in conjunction with (complementary), or instead of (complementary), or instead of (alternative) more conventional (alternative) more conventional treatments.”treatments.”

(AARP, IB#46)(AARP, IB#46)


CAM TreatmentsCAM Treatments

• AcupunctureAcupuncture

• HomeopathyHomeopathy

• NaturapathyNaturapathy

• Herbal therapiesHerbal therapies

• yogayoga

• Christian ScienceChristian Science

• Nutritional Nutritional supplementssupplements

• Chiropractic servicesChiropractic services

• Massage therapyMassage therapy

• BiofeedbackBiofeedback

• Exercise programsExercise programs

• And So ForthAnd So Forth


CAM Users as a % of CAM Users as a % of group group (AARP 2000)(AARP 2000)

05

1015202530354045

18-24 25-34 35-49 50-64 65+


CAM CAM (AARP, 2000)(AARP, 2000)

• 42% surveyed used CAM in 199742% surveyed used CAM in 1997

• About $1 for every $10 conventional TxAbout $1 for every $10 conventional Tx

• ConditionsConditions– AnxietyAnxiety

– back problemsback problems

– chronic painchronic pain

– urinary tract disordersurinary tract disorders


Issues in CAMIssues in CAM

• Federal ResearchFederal Research

• Medical EducationMedical Education

• CAM use by physiciansCAM use by physicians

• Patient-provider communicationPatient-provider communication

• Insurance coverageInsurance coverage


Ken Dychtwald PredictionsKen Dychtwald Predictions• Elevated life expectanciesElevated life expectancies

• AgesAges

– Middlescence - 40-60Middlescence - 40-60

– Late adulthood - 60-80Late adulthood - 60-80

– Old AgeOld Age - 80-100- 80-100

• Gray PowerGray Power

• Replacement of Social SecurityReplacement of Social Security

• Education, Work, LeisureEducation, Work, Leisure

• Matrix familiesMatrix families


21st century21st century

• Economics Economics – diminished and elusive security, diminished and elusive security,

– competition, competition,

– skills still needed, skills still needed,

– flexible work arrangementsflexible work arrangements

– lifetime of povertylifetime of poverty

• Social support - Multiple scenarios of Social support - Multiple scenarios of reconfigured families and peer support reconfigured families and peer support networksnetworks


21st Century Aging21st Century Aging

• HealthHealth– prevention is key, prevention is key,

– disability disability dependence dependence

– influence of lifestyleinfluence of lifestyle

– influence of lifetime access to health careinfluence of lifetime access to health care


FutureFuture

• It’s the Boomers, not the economyIt’s the Boomers, not the economy

• Diversity - immigrationDiversity - immigration

• The haves have moreThe haves have more

• Dependency ratioDependency ratio

• Compression of morbidityCompression of morbidity

• ““Players” and/or “marginalized”Players” and/or “marginalized”


Public Health Agents of Public Health Agents of Change Change (after Torres-Gil)(after Torres-Gil)

• Understand the social and demographic trends Understand the social and demographic trends affecting an aging societyaffecting an aging society

• Reexamine the underlying principles of the present Reexamine the underlying principles of the present systemsystem

• Consider the influence of longevity and diversity on Consider the influence of longevity and diversity on current systemcurrent system

• Reformulate a social contract between individuals, Reformulate a social contract between individuals, society and governmentsociety and government

• Assisting communities, organizations and older Assisting communities, organizations and older persons to adapt to multiple challengespersons to adapt to multiple challenges


Almost 1/2 of all humans over the age of 65 are alive today.

Klein & Bloom, Successful Aging, 1997

ConclusionConclusion

Aging America: Uncharted Adventures

Documents

Transcript of Aging America: Uncharted Adventures