Heather M. Young, Ph.D., R.N., F.A.A.N.

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When the Age Wave Hits the ShoreImplications
for Caring for Aging Baby Boomers

• Heather M. Young, Ph.D., R.N., F.A.A.N.
• Professor and Dean
• Associate Vice Chancellor for Nursing
• Betty Irene Moore School of Nursing at UC Davis

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"You are probably going downhill, but it's a
nice, slow ride."
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Social and cultural views of aging

• Media depictions
• Advertising
• Social clock
• Personal and cultural history
• Role expectations for older adults
• Personal expectations

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Common Western Values Youth, Work, Progress,
Independence
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60 is the new 40 80 is the new 60 100 is the new
80
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The Age Wave will hit the shore

• 296 million now 438 million in 2050
• Population over 65 will increase from 12.9 in
  2005 to 20 in 2030
• Population over 85 is the fastest growing
  segment, numbering 31 million in 2050
• Centenarians numbered 37,000 in 1990, 70,000 in
  1999, projected to 834,000 by 2050

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Bronzing (browning of the graying) of America
2000-2030 (Percent increase)
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Societal trends

• More grandparents than grandchildren
• Geographic mobility, changing migratory patterns
• Growing population of rural older adults
• Higher rates of divorce for adults gt 65
• 1.6 men/1.5 women in 1960
• 7 men/8.6 women in 2003
• Fewer children, more adults without children
• More blended families

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Societal trends

• Older adults are more educated 3.4 had a
  bachelors degree in 1950, 17.4 in 2003, gt25 in
  2030
• Have had higher incomes
• Yet gt10 of elders live in poverty
• Significant income disparities for women, people
  of color, those living alone, and rural dwellers

US Census Bureau, 2006
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Income for 65
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Care trends

• Shorter hospital stays
• Higher acuity at discharge
• Greater range of options in care/services
• Preference to be at home
• Increasing consumer direction

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Health-care expenditures

• 2000 - 585 billion on health care, 66 for older
  adults (CMS, 2002)
• 2000 - 120 billion on long term care, 59 by the
  public sector (CBO, 1999)
• Older adults can expect about 90,000 in out of
  pocket health expenditures (Knickman and Snell,
  2002)
• 1997 family care 196 billion, home health
  32 billion, nursing home care 83 billion
  (Arno et al, 1999)
• 25 of expense spent on 5 who die each year
  (Lunney, 2002)

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The post-war silent generation

• Born between 1925 and 1942
• Shaped by depression and war
• Sought job and financial security
• Suburban development/conformity
• Earliest marrying (men at 23, women at 20)
• Strong social clock expected timing
• 94 of women were mothers (3.3 children)

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The boomer generation

• Born between 1946 and 1964
• Biggest age band in history
• Shaped by prosperity, increased individual
  freedom, consumerism, media
• Most educated/highest earners/highest debt
• Geographically dispersed
• More culturally diverse

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The values of a generation

• The Silent Generation
• Scarcity, savings
• Pay as you go
• Socially defined clocks and expectations
• Stay with one job for lifetime
• Expectations for family life
• Private about mental health issues

• Boomers
• Abundance/Debt
• Instant gratification
• Complex families and kin relationships
• Average 5 careers
• Technology addicted
• Fast food, eating out
• Entertainment/leisure
• Pets

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Boomer demographics

• 78.2 million persons, 50.8 female
• 7,918 people turn 60 every day
• 57.8 million will be living in 2030
• gt30 of the population of Alaska, New Hampshire,
  Vermont, Maine, Utah is only state lt 25
• 28.5 hold a bachelors degree, 45 million have
  attended college
• 71 have a living parent
• 63 have at least one adult child

US Census Bureau, 2006
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Sixgenerations

• Dorothy 103
• Margaret 77
• Lucy 57
• Natalie 37
• Hannah 19
• Lili-Mae 1 month

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Boomer financial characteristics

• Median household income 54,170
• Largest homeowner group (80 vs. 69 of the
  general adult population)
• Those over 50 (40 of population) control 75 of
  the assets and are responsible for gt ½ of all
  consumer spending
• 79 have started cut back on
• spending in the last 12 months

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Boomer financial health

• At 50 are on track for a comfortable retirement
• About 25 cannot afford to retire
• Gap between haves and have nots will increase
• Demand on public sources will increase
• 28 of all foreclosures are gt50 yrs old

AARP, 2008
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Boomer financial health

• The leading edge of Boomers (62 year olds, 3
  million) are in the best shape
• Financial assistance 29 provide to a parent,
  19 received from a parent
• 63 have at least one adult child of these, 68
  are providing financial support
• 66 pay for college as a responsibility

Pew Research Center, 2005
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Declining savingsnegative in 2005
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Anti-aging

• 10 billion per year

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Spending on pets
43 billion per year
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Exercise and fitness

• Fitness is a 17.6 billion industry, doubled in
  size in the last 10 years
• 42.7 million health club members in the US in
  29,357 health clubs
• 25 of members are gt55 years old (population
  23)
• Growing industry increase by 22.3 between 2003
  and 2005

International Health, Racquet Sportsclub
Association
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Boomers and technology

• 73 of US adults go on-line (32 of gt 65 yr old)
• 80 seek health info on-line (68 of gt65 yr old)
• Highest use among English-speaking Hispanic
  adults (79), then White adults (76), then Black
  adults (56)
• 93 of households with income gt 75,000
• 93 of college grads vs. 67 of high school grads
• 86 of users with a chronic illness sought health
  info vs. 79 without chronic illness

Pew Foundation, 2006
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Technology 1975 vs. 2005

• E-mail
• CD/CD ROM
• TiVo
• MP3
• Pager
• Cell phone
• Satellite
• Wireless

• 1975
• TV
• Phone
• Radio
• Newspaper
• Mail
• Vinyl records
• 8-track

• 2005
• TV
• Phone
• Radio
• Newspaper
• Mail
• DSL/Cable
• PC
• ipod

Tom Wolzein, Sanford C. Bernstein Co
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Complementary medicine

• 70 percent of Boomers have used some form of
  complementary or alternative medicine
• Most common massage, chiropractic services, body
  treatments
• 10 percent have used medication, hypnosis or
  acupuncture

American Hospital Association, 2007
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Green boomers

• 70 have a sense of responsibility to make the
  world a better place
• 50 buy products that are environmentally safe,
  lowest income most likely to do so

AARP, 2008
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Boomer hopes and dreams

• Live independently
• Maintain health
• Spend time with family
• Travel
• Get in shape
• Pursue interests/hobbies
• Save for retirement
• Reestablish and deepen friendships

AARP, Boomers Turning 60,2006 Money magazine,
2007
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Boomer fears

• Loss of independence (26 percent)
• Moving to a nursing home (13 percent)
• Giving up driving (11 percent)
• Loss of family/friends (11 percent)
• Death (3 percent)

Clarity 2007 Aging in Place Study
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Boomer hopes for housing

• 89 percent want to age in place in their own
  homes
• 53 percent are concerned about ability to do so
• 25 percent plan to move to another area for
  retirement
• Open to using new technologies to enable
  independence

Clarity 2007 Aging in Place Study
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The future of common chronic conditions

• Arthritis/chronic joint syndrome
• Alzheimers disease
• Depression
• Diabetes
• Obesity

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Arthritis/Chronic Joint Syndrome

• Arthritis affects 60 percent of people over 65
• Number of people with arthritis/CJS will double
  from 21.4 to 41.1 million by 2030 (CDC, 2001)
• Over 26 million Boomers (gt50 percent) in 2030
  (Trends in Health and Aging, 2007)
• Increased stress on joints with higher rates of
  obesity
• Stress on joints from physical activity

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Orthopedic Surgery

• Total knee replacements project 673 percent
  increase (to 3.48 million) by 2030
• Total hip replacements 174 percent increase (to
  572,000)
• Increased repair/replacement of artificial joints

American Academy of Orthopaedic Surgeons, 2006
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Alzheimers disease

• In 2007, gt 5 million with Alzheimers disease
• At least 200,000 younger than 65
• Now, someone develops A.D. every 72 seconds, by
  2050 it will be every 33 seconds
• Expect 16 million by 2050
• Current national direct and indirect costs are at
  least 148 billion (Medicaid 21 billion)
• Medicare costs are triple

Alzheimers Association, 2007
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Depression

• Affects 7 million older adults
• By 2020 depression will be the second leading
  cause of disability worldwide
• Higher suicide rates in older adults
• Higher prevalence in nursing home residents

Chapman and Perry, 2008
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Diabetes

• 30 million Americans have diabetes project 46
  million in 2030 (National Diabetes Surveillance
  System, 2007)
• 25 percnet of Boomers in 2030
• Economic impact - 133.5 billion for those born
  between 1931 and 1941 (includes sick days,
  disability, early retirement and premature death)
  (Vijan, Hayward, Langa, 2004)
• 70 percent of diabetes risk attributed to excess
  weight

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Obesity

• Body mass index affecting health and well-being,
  potentially life expectancy
• Obesity affects 300 million people globally
• In US, two-thirds of adults are overweight (130
  million) one-third (61 million) are obese
• 40 percent of US adults are sedentary
• Annual spending for treatment of conditions
  related to overweight/obesity 100 billion/year
  (9 percent of U.S. health expenditures)

Olshansky et al., 2005
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Obesity trends among U.S. adultsBRFSS, 1990,
1998, 2006
(BMI ?30, or about 30 lbs. overweight for 54
person)
1990
1998
2006
No Data lt10 1014
1519 2024 2529
30
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Disability trends

• 26.5 percent in 1982
• 19 percent in 2004
• Declines in need for help with instrumental
  activities of daily living, decline in functional
  impairment
• Racial/ethnic gaps remain constant
• Effects of obesity epidemic
• Future?

Freedman Schoeni, 2006 US Bureau of the
Census, 2006
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Caring for boomers as they age

• The demand
• Who will care
• How will care be designed

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Dependency ratioIt depends

• 9.1 older adults per 100 workers in 1930,
  increased to 20.5 in 2000, projected to be 35.7
  in 2030
• It depends on the criteria
• Dependent older adult (gt65 yrs old)
• Productive member of society (20-64 yrs)

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Projections of Long-term care spending (in
billions of 2000 )
Assumption Projected disability
24.6
22.7
19.3
17.4
15.6
Congressional Budget Office, 1999
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What will be the demand?

• Increased by
• ? older adults
• Sedentary behavior (40)
• Lifestyle smoking, substance abuse
• ? prevalence of chronic diseases, obesity
• ? available family support

• Decreased by
• ? disability
• Improved health, education, income
• ? health promotion
• ? chronic disease management
• Assistive technology

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Boomers aging implications

• Different characteristics than todays older
  adults (demographic, health, economic, social)
• Absolute number AND percentage make a difference
• Different expectations for communication,
  quality, approaches to care
• Alternative models and solutions are required to
  meet needs

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Philosophical underpinnings for care

• Aging vs. independent living models
• Consumer direction
• Olmstead Decision
• New Freedom Initiative
• Community organizing toward interdependence

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Priority areas for solutions

• Health promotion/behavior change
• Chronic disease management self/professional
• Mobility home and community design
• Optimal support and assistance
• Optimizing function/rehab
• Pain management/end of life
• Family care/distance caregiving
• Model systems of care
• Role of technology in health

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Targets for improvement

• Public and community health
• Health care financing and delivery systems
• Family/friend caregivers
• Technology
• Health professional preparation

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Community Opportunities

• Resources of older members of communities long
  retirement, skills/knowledge to share
• Support for families caring for older and
  disabled persons
• Community level planning gaps in services,
  accessibility, opportunities for activity and
  engagement
• Dealing with the demographic makeup of the
  community (e.g., Charlotte County, Florida
  34.7 gt65, Curry County, OR 29.5)

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Livable communities

• Transportation/driving
• Accessible/affordable housing
• Community design
• Civic engagement
• Work/education
• Community supports
• Community partnerships and networks
• Emergency preparedness

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Playgrounds for the future
Health and Community, News.gov.hk
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Universal design

• Access
• Layout
• Height
• Edges
• Color
• Light
• Assistive features
• Safety

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Targets for the health-care system

• Integration across systems of care (acute,
  long-term care, informal)
• Emphasis on transitional care/care coordination
• Financial incentives for managing across systems
• Episodic and chronic management
• Resource allocation
• Consumer preferences advance planning
• Cultural safety and competence

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Targets for community-based long-term care

• Community programs to improve function, decrease
  pain, delay disability, treat depression, manage
  chronic illness, promote health
• Caregiver health, training and support
• Partnerships with groups and organizations
• Palliative/end of life care
• Disability medicine

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Technology

• Cuing, reminding
• Communication with care providers, family
• Remote monitoring/care
• Telehealth
• Medication management organizers, dispensers,
  pumps
• Less invasive surgery
• Electronic medical records
• On-line support and education

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Geriatric health-care workforce

• Certification in geriatrics
• 6,600 geriatricians (need 36,000 by 2030)
• lt 1 of nurses
• 3 of advance practice nurses
• lt .3 of physical therapists
• 720 out of 200,000 pharmacists

2005 White House Conference on Aging Geriatric
Health Care Workforce Issues
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Geriatric training

• lt 3 of current medical students take geriatric
  electives
• 600 physician faculty teaching geriatrics, need
  1,450
• 23 of nursing programs have required geriatrics
  course, 14 have elective
• 58 of 670 baccalaureate nursing programs have no
  full time faculty in geriatrics
• Less than half of 88 schools of pharmacy have
  faculty with geriatric expertise

2005 White House Conference on Aging Geriatric
Health Care Workforce Issues
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Physician shortage (in thousands)
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Projections of supply and requirements for
full-time equivalent R.N.s 2000-2020
800,000 shortage
Shortage
HRSA, BHPr, Projected Supply, Demand and
Shortages of Registered Nurses 2000-2020
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Health professionals

• Gerontological content as a core competency
• Generational distinctions in gerontology
• New ways of working interprofessionally to
  optimize care delivery (acute/chronic disease,
  health promotion, human services, community
  organizing)
• Increase diversity of the health care workforce

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Policy and ethical issues

• Societal responsibilities boundaries of public
  funding, individual and family responsibility
• Recognizing the benefits, burdens, and costs of
  informal caregiving
• Effective and efficient implementation and
  administration of reforms
• Health care rationing
• What outcomes should we value?

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Issues for baby boomers

• Economic security Social Security (??),
  pensions and savings
• Health insurance, access, quality and safety
• Power of the consumer
• Work and retirement
• Community responsibility and action
• Sustainability

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