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. Why is American growing older?2. Should we care?3. Nation’s health promotion goals4. Public health approach to aging
1. Why is American growing older?
Population versus individual aging
Fertility changes past centuryAnnual live births per 1,000 women aged 15-44 years
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
2008
Total fertilityNumber 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, 2010www.pewsocialtrends.org/2010/06/25/childlessness-up-among-all-women-down-among-women-with-advanced-degrees/
= Fewer babies
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
Life expectancy at age 65
Source: http://www.agingstats.gov
50% increase in last century
Life expectancy at age 65
Source: http://www.agingstats.gov
Racial disadvantage continues into old age
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
0
20
40
60
80
100
120
140
160
180
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
mill
ions
<18 65-84 age 85+
Source: U.S. Bureau of the Census, p25-1130 & historical statistics
2040=81.2 million
2010=40.2 million elderly
Minority elderly population, 2000-2010
Numbers triple 30 years
0
5
10
15
20
25
30
2000 2010 2020 2030 2040 2050
mill
ions
American IndianAsian/Pac IslanderLatinoAfrican American
Source: U.S. Bureau of the Census, p25-1130 & historical statistics
2000=5.6 million
2030=17.6 million
Percent 65+, 1950 to 2050
Source: World Population Prospects: The 2008 Revision, http://esa.un.org/unpp
2000
Baby boom
Growing Diversity of Elderly in California, % nonLatino white
Source: California Department of Finance, January 2013http://www.dof.ca.gov/research/demographic/reports/projections/P-2/
Growing Diversity of Elderly in California
Source: California Department of Finance, January 2013http://www.dof.ca.gov/research/demographic/reports/projections/P-2/
2. Should we care?
2012 Elections
http://elections.nytimes.com/2012/results/president/exit-ll
Obama
Romney
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.
AustraliaUK
France
Spain
Germany
Japan
ItalyCanada
Sources: Older Americans 2008 andhttp://www.who.int/whosis/whostat/EN_WHS09_Table7.pdf
Leading causes of death falling Persons Age 75-84, U.S.
SOURCE: NCHS, http://www.cdc.gov/nchs/datawh/statab/unpubd/natality/natab2003.htmAnd Health US 2008.
Disease patterns of the elderlyU.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/gen29-2/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
Source: U.S. Census, 2011 American Community Survey* nonLatino # may be of any race
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 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 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
Monthly Expenses
Los Angeles City Humboldt County
Owner w/o Mortgage
Renter, One Bedroom
Owner w/o Mortgage
Renter, One Bedroom
Housing $496 $1,137 $358 $688Food 258 258 253 253Transportation 239 239 239 239Health Care=Good 182 182 403 403Miscellaneous 237 237 251 251Elder Index Per Month $1,422 $2,053 $1,504 $1,833
Elder Index Per Year $17,062 $24,640 $18,049 $22,001Note: Numbers may not add up to total due to rounding.
Conclusions
1. The U.S is becoming older as a nation2. Demography is not destiny with
improving health and changing medical practice
3. Healthy aging goes beyond adding years to life and focuses on adding life to years – involves increased attention to chronic and nonfatal conditions
4. 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