The Implications of an Aging Population

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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
• swallace_at_ucla.edu

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Todays talk

1. Why is American growing older?
2. Should we care?
3. Nations health promotion goals
4. Public health approach to aging

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1. Why is American growing older?
Population versus individual aging
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Fertility changes past centuryAnnual 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
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Total fertilityNumber expected lifetime births
per woman
SOURCE NCHS, http//www.cdc.gov/nchs/births.htm
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Percent women 40-45 w/o kids
SOURCE Pew Research Center, 2010 www.pewsocialtre
nds.org/2010/06/25/childlessness-up-among-all-wome
n-down-among-women-with-advanced-degrees/
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Fewer babies
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Concentration of death in old ageIn 1900, 41
live to old age, in 2006 83 do
http//www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09
.pdf
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Life expectancy at age 65
50 increase in last century
Source http//www.agingstats.gov
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Life expectancy at age 65
Racial disadvantage continues into old age
Source http//www.agingstats.gov
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Why is America aging?

• Declining birth rates fewer kids
• Declining mortality rates more elderly

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Population, Number Kids Elders, 1900 - 2050

• Number of elderly will double in 30 years

204081.2 million
201040.2 million elderly
Source U.S. Bureau of the Census, p25-1130
historical statistics
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Minority elderly population, 2000-2010

• Numbers triple 30 years

203017.6 million
20005.6 million
Source U.S. Bureau of the Census, p25-1130
historical statistics
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Percent 65, 1950 to 2050
Baby boom
2000
Source World Population Prospects The 2008
Revision, http//esa.un.org/unpp
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Growing Diversity of Elderly in California,
nonLatino white
Source California Department of Finance, January
2013 http//www.dof.ca.gov/research/demographic/re
ports/projections/P-2/
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Growing Diversity of Elderly in California
Source California Department of Finance, January
2013 http//www.dof.ca.gov/research/demographic/re
ports/projections/P-2/
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2. Should we care?
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2012 Elections
Romney
Obama
http//elections.nytimes.com/2012/results/presiden
t/exit-polls
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Total Dependency Ratio0-18 65up /
(19-64)100
Sources U.S. Census, P25-1130 (1996)
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Labor Force Participation Rates
Source Fullerton, Monthly Labor Review, Dec 1999
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Percent GDP spending on health vs. population
age 65, 2006
U.S.
Germany
France
Canada
Italy
Australia
UK
Spain
Japan
Sources Older Americans 2008 and http//www.who.i
nt/whosis/whostat/EN_WHS09_Table7.pdf
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Leading causes of death falling Persons Age
75-84, U.S.
SOURCE NCHS, http//www.cdc.gov/nchs/datawh/stata
b/unpubd/natality/natab2003.htm And Health US
2008.
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Disease patterns of the elderlyU.S. 2010-11
Source http//www.agingstats.gov
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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
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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
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Help With Daily Activities, Community Residents
W/2 ADLs, By Age
Source Kaye H S et al. Health Affairs
20102911-21
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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

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3. Nations 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

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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. 292(2005)
  http//www.generationsjournal.org/generations/gen2
  9-2/article_thepublichealth.cfm

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Multiple falls by age, California
Source 2010-11 California Health Interview Survey
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Food insecurity by income, age 65 California
Source 2010-11 California Health Interview Survey
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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)

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Geriatric Issues - Summary

• Several challenges to healthy aging are common
  among the oldest and poorest elders
• Healthy aging is more than avoiding disease

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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

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Types of prevention

• Primary prevent problem from happening, e.g.
  immunizations

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Types of prevention

• Primary
• Secondary detect problem early and treat before
  serious harm results, e.g. blood pressure or
  breast cancer screening

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Types of prevention

• Primary
• Secondary
• Tertiary after a health problem has happened,
  maximize independence quality of life, e.g.
  rehab, in-home supportive services

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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

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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

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Poor and near poor, Age 65 Over, California 2010
nonLatino may be of any race
Source U.S. Census, 2011 American Community
Survey
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Distribution of household expenditures, 2010
Source 2012 AgingStats.gov
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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 geo-graphic 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 nations economy and society ....
  (National Research Council, 1995, page 1)

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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

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Elder Standard Index 2011, Single older adult ,
LA City Humboldt County
Monthly Expenses Los Angeles City Los Angeles City Humboldt County Humboldt County
Monthly Expenses Owner w/o Mortgage Renter, One Bedroom Owner w/o Mortgage Renter, One Bedroom
Housing 496 1,137 358 688
Food 258 258 253 253
Transportation 239 239 239 239
Health CareGood 182 182 403 403
Miscellaneous 237 237 251 251
Elder Index Per Month 1,422 2,053 1,504 1,833
Elder Index Per Year 17,062 24,640 18,049 22,001
Note Numbers may not add up to total due to
rounding.
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Conclusions

• 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

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Thank you
www.healthpolicy.ucla.edu