Aging at the Cutting Edge

1. Aging at the Cutting Edge Sara Honn Qualls, Ph.D. University of Colorado at Colorado Springs

2. We sit at the cusp of an aging revolution – at the cutting edge

3. 1990 1980 1970 1960 1950 1940 1930 The Baby Boom Pattern 4.5 The Boom Years: 1946-1964 The Cutting Edge 4.0 3.5 Birth in Millions 3.0 2.5 2.0 Source: U.S. Census Bureau International Data Base

4. The Aging Revolution has begun % Population over 65

5. 5% to 12.4% Under 5% 12.5% to 20% Above 20% In 2000, A Fairly “Young” World . . . Percent of Population Age 60+ 2000 Source: U.S. Census Bureau

6. 5% to 12.4% Under 5% 12.5% to 20% Above 20% . . . An Aging World by 2025 Percent of Population Age 60+ 2025 Source: U.S. Census Bureau

7. Who is in this aging revolution? • 64% Women • Over 85, 2:1 women:men • Healthier, wealthier, more autonomous • Upcoming Baby Boom cohort - high expectations, high service users • Fastest growing group - old-old (frailest)

8. Diversity is the Rule • Racial and ethnic groups in U.S. anticipate much higher rates of growth than white population. • Growth rates between 1997-2050: • White: 106% • Black: 202% • Native Americans: 269% • Asian: 570% • Hispanic origin: 659%

9. Avoid Disease Successful Aging Maintain cognitive and physical function Engage with life McArthur Foundation study; Rowe & Kahn

10. What happens at the cutting edge of a demographic revolution?

11. Socio-cultural revolutions shift paradigms • the industrial revolution changed • how we work Self-sufficiency -> modern economy • where we live Rural -> urban population centers • how we govern Inherited hierarchy -> democracy

12. Early in revolution • Technologies emerge • Rapidly • In disjointed fashion • Often from backwaters rather than mainstream • Lack of cultural and social support for emerging patterns; clashes occur • Significant social divides • elders and young • Traditional institutions and emerging structures

13. Looking past the cutting edge of the Aging Revolution How will the aging revolution shift paradigms? • Health • Families • Housing • Work

14. Health Care Shifting sands Rising expectations Funding crises Outdated infrastructures

15. 1. Acute -> chronic care with acute episodes • Hospital based -> community based services • Single illness focus -> Holistic wellness • Physician centric care -> Self-management

16. Common Illnesses • Common Chronic Diseases (65+): • Arthritis affects 50% • Hypertension affects 38% • Hearing impairments affect 28% • Heart Disease affects 28% • Mental disorders affect 20% • Common causes of death: • heart disease • cancer • stroke

17. 2. Productive life despite chronic disease/disability • Universal access (vs disabled services) • Universal design • Behavioral health considered key

19. 3. Integrated care within distributed system • Consumer-directed health and wellness information • Virtual health team across agencies and organizations • Inter-professional teams

20. 4. Emphasis on wellness • Chronic disease prevention • Cardio health • Strength training • Depression and cognitive impairment prevention • Functional health Strength, balance, and mobility Cognition and emotion

21. Social Engagement Continues NOT Uncle Joe rocking on the front porch!

22. Women are likely to live alone at some point

23. Older adults have an active social network • Most older adults have 5-10 important people in their network • Average 8.9 • 80% are family • Family is closest person for 90% 3.5 3.5 1.9

24. Families are Involved throughout the lifespan • 80% care provided by family across all generations • Decisions, even in nursing homes • Emotional and practical support • Elders give as much as they receive

25. Families are Changing in Structure

26. Families are providers, advocates and case managers

27. The Family CG Career often covers decades Pre-CG Family Structure Transition to CG Illness Onset Early CG Structure Middle CG Structure CG Period Patient Death Post-CG Structure Late CG Structure

28. Housing and Community

29. The 3rd Age • Active engagement with community and family • Busy life • Onset of physical changes that are manageable

30. Communities for our 3rd Age Convenience, accessibility, aesthetics, affordability, amenities

31. Community life • Engaged, socially connected lifestyle • Planned, intentional • Restorative after death of spouse or retirement • Safety net • Reduced demands • Availability of services

32. Transitions: 3rd –> 4th Age • Stability in meaning and purpose but decline in daily functioning because of • Physical, sensory, and cognitive decline • Slower or limited mobility, energy, cognition • Use of assistance from family, friends, or formal providers to compensate for losses

33. Aging in Place • Apartment meets ideals for setting, social connection, amenities • Stay put to avoid transition • Unable to accomplish move • Unwilling to deal with the stress of moving Regardless, age-related changes WILL occur and need to be accommodated

34. Stability in purpose and meaning but far more limited personal resources Assistance needed The 4th Age

35. Hands on care IADL’s • Transportation • Medication monitoring • Shopping • Appointments • Food preparation • Finances ADL’s Bathing Dressing Toileting Transferring Ambulating

36. The Last Age • Final 18-36 months • Substantial decline • Increasingly frequent acute problems require out-of-home service in hospital, rehabilitation, nursing home • In-home services needed to maintain stability

37. Environmental Interventions • Assistive Technology • Memory Prompts • Communication tools/adaptations • Safety devices that eliminate need for planning and other cognitive skills

38. Environmental Interventions • Limited access • Bank or stock accounts • Driving • Use visual barriers (gates, locks, cloth barriers) • Enhancedaccess • Food grazing option to enhance nutrition • Meaningful task presentation as distractors • Cues for social connection (e.g., light) and activity (e.g., visual and verbal prompts)

39. Community Resources

40. Housing Own Home Own Home with Services Senior Congregate Housing Assisted Living Nursing Home Acute Care

41. Social Services • Meals on Wheels • Respite Care • House repair • Case or Care Management • Transportation • Day Programs

42. Leisure Services • Travel • Shopping • Activity Programs – e.g., day programs, senior orchestras • Educational programs – Elder Hostel • Community Recreation (e.g., Parks/Rec; senior centers) • Physical Exercise (e.g., YMCA, country clubs) • Churches and parachurch organizations • Volunteer organizations (e.g., RSVP) • Civic groups (e.g., Rotary) • Electronic Games…

43. Family Support Services • Illness based organizations (e.g., Alzheimers or Stroke) – education, support, counseling • Caregiver support groups • Home health services • Counselors • Hospital social workers

44. Legal Services • Guardianship • Conservatorship • Advance Directives • Power of Attorney • Durable Health Power of Attorney • Living Will • Estate Planning • Trusts

45. Work Place Revolution Emerging crisis Rising opportunities

46. A Growing Shortage of Workers in the U.S. Expected Labor Force and Labor Force Demand Millions of People Source: Employment Policy Foundation analysis and projections of Census/BLS and BEA data.

47. Percent Growth in U.S. Population by Age: 2000-2010

48. 1970-2010 2010-2050 Growth in the Working-Age Population Worldwide Mexico Brazil India China South Australia Canada US Netherlands Spain France UK Russia Italy Japan Germany Korea Source: Deloitte Research/UN Population Division (http://esa.un.org/unpp/) It’s 2008: Do You Know Where Your Talent Is? Why Acquisition and Retention Strategies Don’t Work, p.6

49. How is CU working on your cutting edge experience?

50. The Aging Initiative A partnership between university and community to create a self-sustaining funding base to enact this vision A forward thinking plan to position this campus in national prominence