The Implications of an Aging Population

The Implications of an Aging
Population
Steven P. Wallace, Ph.D.
Professor, UCLA School of Public Health
Assoc. Dir., UCLA Center for Health Policy Research
[email protected]
Today’s talk
1.
2.
3.
4.
Why is American growing older?
Should we care?
Nation’s health promotion goals
Public health approach to aging
1. Why is American growing older?
Population versus individual aging
Fertility changes past century
Annual live births per 1,000 women aged 15-44 years
2008
SOURCE: NCHS, http://www.cdc.gov/nchs/data/statab/natfinal2001.annvol1_01.pdf &
http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf & Health U.S., 2011
Total fertility
Number expected lifetime births per woman
SOURCE: NCHS, http://www.cdc.gov/nchs/births.htm
Percent women 40-45 w/o kids
SOURCE: Pew Research Center, 2010
www.pewsocialtrends.org/2010/06/25/childlessness-up-among-all-women-down-among-women-with-advanced-degrees/
= Fewer babies
Concentration of death in old age
In 1900, 41% live to old age, in 2006 83% do
http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf
Life expectancy at age 65
50% increase in last century
Source: http://www.agingstats.gov
Life expectancy at age 65
Racial disadvantage continues into old age
Source: http://www.agingstats.gov
Why is America aging?
• Declining birth rates = fewer kids
• Declining mortality rates = more elderly
Population, Number Kids & Elders,
1900 - 2050
Number of elderly will double in 30 years
180
2040=81.2 million
160
140
<18
65-84
age 85+
millions
120
2010=40.2 million elderly
100
80
60
40
20
0
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
Source: U.S. Bureau of the Census, p25-1130 & historical statistics
2000
2010
2020
2030
2040
2050
Minority elderly population,
2000-2010
Numbers triple 30 years
30
25
20
millions
2030=17.6 million
American Indian
Asian/Pac Islander
Latino
African American
15
10
2000=5.6 million
5
0
2000
2010
2020
2030
Source: U.S. Bureau of the Census, p25-1130 & historical statistics
2040
2050
Percent 65+, 1950 to 2050
Baby boom
2000
Source: World Population Prospects: The 2008 Revision, http://esa.un.org/unpp
Growing Diversity of Elderly in
California, % nonLatino white
Source: California Department of Finance, January 2013
http://www.dof.ca.gov/research/demographic/reports/projections/P-2/
Growing Diversity of Elderly
in California
Source: California Department of Finance, January 2013
http://www.dof.ca.gov/research/demographic/reports/projections/P-2/
2. Should we care?
2012 Elections
Romney
Obama
http://elections.nytimes.com/2012/results/president/exitll
Total Dependency Ratio
[0-18 + 65&up / (19-64)]*100
Sources: U.S. Census, P25-1130 (1996)
Labor Force Participation Rates
Source: Fullerton, Monthly Labor Review, Dec 1999
Percent GDP spending on health vs.
% population age 65+, 2006
U.S.
Germany
Canada
France
Italy
Australia
UK
Sources: Older Americans 2008 and
http://www.who.int/whosis/whostat/EN_WHS09_Table7.pdf
Spain
Japan
Leading causes of death falling
Persons Age 75-84, U.S.
SOURCE: NCHS, http://www.cdc.gov/nchs/datawh/statab/unpubd/natality/natab2003.htm
And Health US 2008.
Disease patterns of the elderly
U.S. 2010-11
Source: http://www.agingstats.gov
Disability at age 65+ is decreasing
• Age-adjusted
disability rates falling:
35% in 1992 to 29%
in 2009
• ADLs: getting out of
bed/chair, walking,
bathing, dressing,
eating, using the toilet
Source: www.agingstats.gov
Fair/poor self-assessed health at
ages 65 -75 decreasing
• Fair & poor (versus
excellent, very good,
& good) self
assessed health
declining, i.e. good
health improving!
Source: NCHS, Health U.S. 2008, http://www.cdc.gov/nchs/hus.htm
Help With Daily Activities, Community
Residents W/2+ ADLs, By Age
Source: Kaye H S et al. Health Affairs 2010;29:11-21
Demography is not destiny
• Proportion of the elderly population does not
necessarily determine health care spending
• Higher rates of illness & disability, but…
• Continued health improvements can counter
increased needs caused by growing population
• Public health approaches are the most
promising to improve health outcomes of the
elderly
3. Nation’s health promotion goals
#1-Attain high-quality,
longer lives free of
preventable disease,
disability, injury, and
premature death
• Focus on the quality
of the years, not just
their quantity
Beyond disease: Geriatric health
• Chronic conditions:
Falls, Disability,
Urinary incontinence,
Oral Health
• Environment: Food
insecurity, Social
support, Polypharmacy,
Healthy communities
See Wallace, Steven P. “The Public Health
Perspective on Aging.” Generations. 29:2(2005)
http://www.generationsjournal.org/generations/gen292/article_thepublichealth.cfm
Multiple falls by age,
California
Source: 2010-11 California Health Interview Survey
Food insecurity by income, age
65+ California
Source: 2010-11 California Health Interview Survey
Disability – Long term care
• Does Medicare cover
prolonged nursing
home care? (35%
correct)
• Does Medicare cover
in-home personal
care aid for chronic
conditions? (21%
correct)
Geriatric Issues - Summary
• Several challenges to
healthy aging are
common among the
oldest and poorest
elders
• Healthy aging is
more than avoiding
disease
4. Public health approach
• Definition of Public Health = Assuring
the conditions under which people can be
healthy
(Institute of Medicine, Committee for the Study of the Future of Public Health. The
future of public health. Washington, DC: National Academy Press, 1988)
• Population / community / system focus
• Interest in prevention vs. cure
• Emphasis on health vs. disease
Types of prevention
• Primary – prevent
problem from
happening, e.g.
immunizations
Types of prevention
• Primary
• Secondary – detect
problem early and
treat before serious
harm results, e.g.
blood pressure or
breast cancer
screening
Types of prevention
• Primary
• Secondary
• Tertiary – after a
health problem has
happened, maximize
independence &
quality of life, e.g.
rehab, in-home
supportive services
Falls - a public health approach
• Primary – Promote physical activity, reduce
polypharmacy, universal housing design (for
all older adults)
• Secondary - Strength training, environmental
modifications (for at-risk older adults)
• Tertiary – Counseling to decrease fear of
falling, improve primary care ID/treatment of
falls, social support interventions
Poverty – a cross cutting risk
• Primary – Assure a living wage with adequate
health care and pension
• Secondary – Maintain the communal risk
feature & disability benefits of Social Security
• Tertiary – Provide public assistance (SSI) at
the Elder Economic Security Standard level
Poor and near poor, Age 65 & Over,
California 2010
* nonLatino # may be of any race
Source: U.S. Census, 2011 American Community Survey
Distribution of household
expenditures, 2010
Source: 2012 AgingStats.gov
The Problem: Federal Poverty
Guideline
The current measure needs to be
revised: it no longer provides an
accurate picture of the differences
in the extent of economic poverty
among population groups or geographic areas of the country, nor an
accurate picture of trends over time.
The current measure has remained
virtually unchanged over the past
30 years. Yet during that time, there
have been marked changes in the
nation’s economy and society ....
(National Research Council, 1995,
page 1)
Elder Economic Security
Standard (EESS)
• Adjusted for local (county) costs of living
versus national average
• Takes actual costs of basic necessities for older
households
• Includes housing, food, transportation, health
care, and other costs
Elder Standard Index 2011, Single
older adult , LA City & Humboldt County
Los Angeles City
Monthly Expenses
Housing
Owner w/o
Mortgage
Humboldt County
Renter, One
Bedroom
Owner w/o
Mortgage
Renter,
One Bedroom
$496
$1,137
$358
$688
Food
258
258
253
253
Transportation
239
239
239
239
Health Care=Good
182
182
403
403
Miscellaneous
237
237
251
251
$1,422
$2,053
$1,504
$1,833
Elder Index Per Month
Elder Index Per Year
$17,062
Note: Numbers may not add up to total due to rounding.
$24,640
$18,049
$22,001
Conclusions
1.
2.
3.
4.
The U.S is becoming older as a nation
Demography is not destiny with
improving health and changing medical
practice
Healthy aging goes beyond adding
years to life and focuses on adding life
to years – involves increased attention
to chronic and nonfatal conditions
Public health approaches to prevention
using multilevel interventions are
possible to reduce challenges to healthy
aging… including using a more realistic
assessment of “poverty”
Thank you
www.healthpolicy.ucla.edu