The Age Factor: Recent Trends, Current Challenges & Future Directions

1. The Age Factor: Recent Trends, Current Challenges & Future Directions Maria C. Hernandez-Peck, PhD Center for Studies in Aging Eastern Washington University

2. As We Enter the 21st Century • An aging population of 35 million in 2000 • 1 in every 8, or 12.4% an older American • 5,574 individuals reaching age 65 each day • Those reaching age 65 have an average life expectancy of an additional 17.9 years

3. Categories of Older People • Young old (65 to 74) 18.4 million • Middle Old (75 to 84) 12.4 million • Old-Old (85+) 4.2 million, the fastest growing group • Centenarians (100+) 50,545

4. Some Current Statistics • Older women outnumbering older men 20.6 million to 14.4 million • 143 women for every 100 men at age 65+; this ration increases from 117 for the 65 to 69 age group, & to 245 for the 85+ • Almost 400,00 grandparents age 65+ having primary responsibility for their grandchildren who live with them • One Baby Boomer turning 50 every 7.5 seconds

5. Projections for 2030 • The older population will more than double to 70 million • The 85+ population will increase from 4.2 million in 2000 to 8.9 million • Members of minority groups will represent 25% of the older population, up from 16% in 2000

6. The Older Foreign Born • Accounted for 3.1 million of persons 65+ • 1/3 from Europe; 31% from Latin America; 22% from Asia, and 8% from other parts of the world • Anticipated future foreign born elders will be from Latin America or Asia • 2/3 of all foreign born elders have been in the U. S. over 30 years

7. In Spokane County • 60+ accounted for 66,242 in 2000 • 65+ estimate for 2005 is at 72,332 • 80+ accounted for 14,840 in 2000 • 80+ estimate for 2005 is 26,699

8. Projected Numbers for 2030 • 60+ will account for 120,826 • 75+ will account for 33,903

9. Elders Accessing Services • 13 to 15% of frail elders access services funded through the Aging and Long Term Care of Eastern Washington • The typical client is 75+, female and living alone

10. The Challenge Ahead for Our Community • How to utilize the gifts of those persons reaching the later years in better health with a desire to continue to contribute to community enhancement and well-being, through either paid employment or volunteer opportunities • How to maintain a safety-net to protect the most frail and vulnerable

11. Four Major Areas of Concern • Maintaining and Enhancing Economic Security of Older Persons • Promoting Physical and Mental Well-being (Healthy Aging) • Creating Elder Friendly Communities • Avoiding the Caregiving Crunch

12. Maintaining & Enhancing Economic Security • Rethinking the need and timing of Social Security Reform • Unhinging old age from the obsolete marker of 65 and index entitlements to rising longevity • Let people chose to retire when they are ready and when they can afford to , instead of holding everyone to uniform standards • Smash the silver ceiling and make it easier for people to pursue meaningful employment in maturity

13. Maintaining & Enhancing Economic Security • Replace the “linear” life paradigm with a new “cyclic” one that takes maturity into account as a time of new life pursuits and passions • Create job sharing opportunities for older persons needing and wanting to return to work

14. Promoting Healthy Aging • Involves both physical and emotional well being • Increase in health promotion and disease prevention programs • Increasing availability of service providers knowledgeable about issues and challenges confronting elderly today

15. Facts About Mental Health in the Later Years • The majority of older Americans cope constructively with the physical limitations, cognitive changes, and various losses, such as bereavement, that frequently are associated with late life • On the other hand, a substantial proportion of the population age 55 and older, almost 20% of this age group, experience specific mental disorders that are not part of “normal” aging

16. Severely Impairing Conditions If Unrecognized or Untreated • Depression • Alzheimer’s Disease • Alcohol and Drug Abuse and Misuse • Anxiety • Late-life Schizophrenia

17. Substance Abuse Issues • As many as half of all people with serious mental illnesses develop alcohol or other drug abuse problems at some point in their lives • 15% of older men and 12% of older women treated in primary care clinics regularly drink in excess of limits recommended by the National Institute on Alcohol Abuse and Alcoholism • An estimated 17% of older adults misuse and abuse alcohol and medications

18. Suicide and Depression • Older people have the highest rate of suicide in the U.S. population • Suicide rates increase with age, with older white men having a rate of suicide up to six times that of the general population • Depression is neither well recognized nor treated in primary care settings, where most older adults seek and receive health care

19. Difficulties in Assessment • Detection of mental disorders in older adults is further complicated by high co-morbidity with other medical disorders • The symptoms of somatic disorders may mimic or mask psychopathology, making diagnosis more taxing • Older individuals are more likely to report somatic symptoms than psychological ones, leading to further under identification of mental disorders

20. Difficulties in Assessment • More than half, or 51% of older individuals who have committed suicide have seen their primary care physician within one month of the suicide (Caine, et. al. 1996) • Almost half had psychiatric symptoms. However, symptoms were recognized in less than one third • Treatment was offered in less than 1/4 of the cases • Treatment rendered was considered adequate in on 2% of the cases

21. The Role of Primary Health Care Providers • Primary care providers carry much of the burden for diagnosis of mental disorders in older adults • However, the rates at which they recognize and properly identify disorders often are low • With respect to depression, a significant number of depressed adults are neither diagnosed nor treated in primary care

22. The Role of Primary Health Care Providers • One study of primary care physicians, only 55% of internists felt confident in diagnosing depression, and even fewer (35% of the total) felt confident in prescribing antidepressants to older persons • Researchers estimate that an unmet need for mental health services may be experienced by up to 63% of older adults aged 65 years and older with a mental disorder

23. Current Challenges • Transitioning to a Medicaid only system in providing Mental Health Services • The fact that older persons in greatest need of mental health services will not self-refer . • Inadequate ways of identifying older persons in need mental health services

24. Current Challenges • Inability of primary health care providers in identifying depression in older persons • Inadequate reimbursement for psychiatric and/or mental health services and its impact in community based systems • Downsizing of geriatric beds in State Mental Hospitals and relocating those patients to community based settings • Definition of medically needy as those with an income of $582 per month

25. Some Potential Solutions • Achieving Mental Health Parity • Increasing the income level for medically needy from $582 to $771 per month • Increasing State funding for mental health services to non-Medicaid eligible older persons • Integrating aging and mental health services at the community level

26. Some Potential Solutions • Implementing ways of identifying frail elders at risk (e.g., Gatekeeper Program) • Educating primary health care providers on how to identify depression and other mental disabling conditions in older persons

27. Additional Potential Solutions • Providing Extended Community Services to older persons who have been discharged from State Mental Hospitals • Increasing health promotion and disease prevention efforts in mental health services to older persons (e.g., depression screening programs)

28. Additional Potential Solutions • Co-locating mental health service providers in primary care physicians’ offices • Postponing premature hospitalization by funding counseling and other support services to caregivers of Alzheimer's patients

29. Developing an Elder Friendly Community • Creating communities that enable elder choice and involvement with ready access to necessary services in all living arrangements , whether at home, supported living or in long term care facilities • Affordable housing options for the elderly within new developments and as we attempt to rebuild our downtown area • Transportation systems that take into consideration elder needs

30. Elder Friendly Communities • Learning and Productivity centers within local institutions of higher learning for those wanting a second career or further learning • Courses for high school students on what it means to have an older relative • Supermarkets that adjust to an aging population • Aggregation of services for convenience purposes • Technology enabling services • Integrated home services

31. Challenges of Family Caregiving • 1 in every 4 households in caregiving, half of them with no outside help • 25% of all workers provide elder care, with most of them being employed full time • Most have to rearrange their work schedule --Take unpaid leave -- Decrease working hours

32. Value & Cost of Informal of Caregiving • The value of informal caregiving is estimated at $196 billion per year • Informal caregiving exceeds nursing home and home care expenses by $81 billion a year • Caregiving costs US businesses $114 billion annually • Caregivers lose up to $659,139 in earned income over a lifetime

33. Avoiding the Caregiving Crunch • Finance long-term care through private insurance and reverse mortgages • Establish new eldercare-oriented employee benefits • Expand and integrate community based long-term care services (i.e., respite, adult day services, special transportation services, case management, caregiver support groups, etc.)

34. Alzheimer’s Disease • 8 to 15% of people over age 65 have Alzheimer’s disease • The prevalence of dementia (most of which is accounted for by Alzheimer’s disease) nearly doubles with every 5 years of age after 60. • Studies also reveal age-related increases in Alzheimer’s disease with the 85+ accounting for 48% of those with Alzheimer’s disease

35. The Cost • An estimated 4 million individuals diagnosed with Alzheimer’s disease • The estimated cost of Alzheimer’s disease to Medicare and Medicaid totaled $50 billion in 2000 and is projected to be $72 billion in 2010.

36. In Conclusion • Thus, while people are living healthier into old age and doing so on a mass scale, there remain many difficulties, both psychic and physical, that eventually come with growing old. Many are living long enough to suffer age-related diseases like Alzheimer’s and Parkinson’s -- diseases that involve long term care decline and thus the need for long term care.

37. In Conclusion • And, precisely because many individuals have taken advantage of modern freedom’s opportunities for education, careers and geographic mobility, many elderly will live in greater isolation from loved ones, separated from children and grandchildren who have settled elsewhere or whose lives are defined primarily by work and school.

38. In Conclusion • Smaller and less stable families will likely compound these problems, as the burdens of caregiving fall on one or two adult children, who in many cases are called upon to care for parents who did not always cared well for them. • Many among the growing population of childless elderly will have no relatives at all to look after them.

39. The Question Remains • Can a society that values self-reliance, personal freedom, and careerism reconcile itself to the realities of dependence, diminished autonomy, and responsibility for others? • How we care for the dependent elderly will test whether modern life has not only made things better for us but also made us better human beings, more willing to accept the obligations to care and more able to cope with the burdens of caregiving.