Maximizing the Aging Opportunity

1
Maximizing the Aging Opportunity

• Larry Polivka, Ph.D.
• Nutrition Workshop
• Palmyra, Wisconsin
• October 4, 2007

2
Demographic Overview

• The age 65 population will increase from 35
  million to 75 million plus by 2040
• The 85 population is growing the fastest
• The age 65 population will become increasingly
  diverse as the Hispanic, African-American, and
  Asian populations reach 25-30 of those 65 by
  2040.

3
Economic Status

• The economic status of future retirees (baby
  boomers) is not likely to differ much from
  current retirees, with two exceptions
• The most affluent 5 to 10 is likely to be
  substantially better off
• And the least affluent 25-50, however, may not
  be as well off, depending on health care costs
• Poverty rates could increase significantly,
  however, if out-of-pocket health care costs
  continue to grow faster than the CPI

4
Economic Status (contd)

• Financial well-being is strongly related to the
  health of both partners
• In the original Health Retirement Survey, average
  household net worth was 31,000 when both
  partners were in poor health but more than
  400,000 when they were in excellent health
• The poverty rate among older women is twice as
  high as for men (14 and 7)
• The economic status of future retirees in the
  middle (between the bottom and top 25 of the
  income and wealth continuum) could be threatened
  by increasing out-of-pocket health care costs
• (30-40 of income by 2030 and 45-50 for those
  with low incomes without Medicaid protection)

5
Economic Status (contd)

• According to the National Retirement Risk Index
  (NRRI), the percentage of retirees who fail to
  achieve 80 of their last wage in retirement
  income will increase from 25 today to over 40
  by 2025 because of
• Increasing health care costs
• Low interest rates
• Low Social Security payments
• Declining defined benefit and pension plans

6
Economic Status Ensuring Security

• The economic security of future retirees will
  depend on
• Maintaining and strengthening Medicare and Social
  Security, which now provides about 41 of
  retirement income (over 50 for 60 of all
  retirees)
• Improved defined contributions pension plans
  (higher savings)
• Moderating health care cost increases
• Improving retiree health status

7
Health Status and Health Care Costs

• Positive Trends
• The health and functional status and longevity of
  the 65 population has improved (increased)
  substantially over the last 40 years
• Older Americans are in reasonably good health
  overall, but there are striking differences by
  age, race, and ethnicity

8
Health Status and Health Care Costs (contd)

• Positive Trends (contd)
• These trends are largely a result of
• Increased educational attainment
• Improved health behaviors
• Nutrition
• Medicare and Medicaid (1966) enhanced access to
  more high quality and affordable health care
  services

9
Health Status and Health Care Costs (contd)

• Positive Trends (contd)
• Older people use alternative medicines and
  supplements to a surprising degree
• Among HRS respondents in the year 2000, more than
  half say they had used some kind of dietary or
  herbal supplement
• Nearly half had seen a chiropractor, and 20 had
  used massage therapy

10
Health Status and Health Care Costs (contd)

• Less Positive Trends
• All health care trends, however, are not positive
• Obesity and diabetes rates have increased
  substantially in 30 years and could push up
  impairment rates among baby boomers in the future

11
Health Status and Health Care Costs (contd)

• Less Positive Trends (contd)
• Rates of dementia
• Serious depression
• White Americans ages 55 to 64 are less healthy
  than their British counterparts, despite higher
  overall incomes and higher levels of health care
  spending.

12
Health Status and Health Care Costs (contd)

• Less Positive Trends (contd)
• Medicare is not well-designed to support high
  quality chronic care, prevention and wellness
  servicesacute care focus, even in managed care
• Insufficient geriatric focus among physicians,
  nurses, allied health services and health care
  organizations generally

13
Health Status and Health Care Costs (contd)

• Less Positive Trends (contd)
• LTC is still dominated by nursing home care, but
  this is slowly changing (assisted living and
  in-home care)
• LTC needs will increase by 50-100 over the next
  40 years and will become a serious threat to the
  economic security and psychological well-being
  of many in the 75 population.

14
Health Status and Health Care Costs (contd)

• Health care is expensive for the nation as a
  whole, not just Medicare but what greater use do
  we have for our increased productivity gains
• Health care does need, however, to be made more
  efficient (less waste) and more effective (proven
  services)
• better, more integrated information systems
• pay for performance
• more standardized, scientifically based care to
  reduce wide regional variances and cost
  differences

15
Prevention and Wellness

• Exercise and Nutrition
• As of 2006, only about 20 of those age 65
  exercise an average of 30 minutes a day32
  percent report no physical exercise in the
  previous month
• Only 30 of those 65 report eating five or more
  servings of fruit and vegetables daily

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Prevention and Wellness (contd)

• Obesity
• Over 20 of those 65 are obese. Over 30 of
  baby boomers are obese, which is almost twice the
  percentage a generation ago another 30-35 are
  overweight (BMI of 25)
• This is a major reason the rate of diabetes has
  grown so rapidly since the 1970s
• Obesity is also associated with higher rates of
  other chronic diseases, including cancer, heart
  disease, and stroke

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Prevention and Wellness (contd)

• Nutrition
• Supplementation with multinutrients
  (multi-vitamins) can enhance immune function of
  the elderly
• The risk for fracture could be reduced 12 with
  calcium and vitamin D supplements
• The recommended dietary allowance set by the
  National Academy of Sciences for calcium in
  people over 50 is 1,200 milligrams400 IU of
  vitamin D and 600 for those 71 and older

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Prevention and Wellness (contd)

• Nutrition (contd)
• In a recent analysis of more than 18 studies
  involving nearly 60,000 people, those who took
  vitamin D supplements had a 7 reduction in
  mortality from all causes compared with those who
  didnt take the vitamin.
• No negative results from taking vitamin D, as
  long as doses were keep between 300 to 2,000
  international units (IU) per day

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Prevention and Wellness (contd)

• Nutrition (contd)
• Emerging research points to a role for vitamin D
  in cancer prevention and treatment, particularly
  against breast, colon, prostate and lung tumors
• Vitamin D may also help prevent Type 2 diabetes
• With age, the skins ability to produce vitamin D
  drops significantlyadults 65 or older make only
  25 of the vitamin D produced by those ages 20-30

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Prevention and Wellness (contd)

• Nutrition (contd)
• Just 3.5 ounces of either salmon or mackerel
  provides 90 of the daily value for vitamin D
• Other foods naturally rich in vitamin D include
  sardines, tuna, eggs, and liver
• Fortified foods include milk, margarine, and some
  breakfast cereals
• Supplemental zinc and vitamins E,C,A, and
  beta-carotene may also improve immune function

21
Prevention and Wellness (contd)

• Vaccinations, Screenings and Falls
• Only about 65 of those 65 have received flu and
  pneumonia vaccines. The CDC goal is 90
• Mammogram, colorectal and cholesterol screening,
  however, are provided at rates well above the CDC
  goals
• Hip fracture hospitalizations are still well
  above CDC goals, especially for women at 1,113
  per 100,000 women age 65, indicating the need
  for more exercise and nutritional interventions

22
Prevention and Wellness (contd)

• Weight Loss Nutrition
• Numerous studies show that weight loss in older
  persons is associated with poor outcomes
• A meta-analysis by the Cochrane collaboration
  found that caloric supplements decrease mortality
  and length of hospitalization
• The GAIN (Geriatric Anorexia Nutrition) registry
  found that nursing home residents who gained
  weight had a significantly lower mortality than
  those who continued to lose weight

23
Prevention and Wellness (contd)

• Weight Loss Nutrition (contd)
• The most common cause of weight loss in older
  persons is depression
• Other causes include inadequate feeding
  assistance, isolation, pain, poor environment,
  medications, and a variety of medical conditions
• In many patients, weight loss can be reversed
  with the use of antidepressants with orexigenic
  properties such as mirtazapine

24
Prevention and Wellness (contd)

• Weight Loss Social Isolation
• Nearly 85 of widowed subjects report a weight
  change during the two years following their
  spouses death, as compared with 30 of married
  subjects
• The widowed group was more likely to report an
  average weight loss of 7.6 pounds

25
Prevention and Wellness (contd)

• Weight Loss Physical Problems
• Some older people may overly restrict foods
  important to good health because of chewing
  difficulties and gastrointestinal disturbances,
  such as constipation, diarrhea and heartburn
• Adverse reactions from medications can cause
  older people to avoid certain foods
• Other medical problems, such as arthritis, stroke
  or Alzheimers disease, can interfere with good
  nutrition

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Conclusions

• The crucial implications of health status and
  health costs for the economic well-being of
  current and future elderly
• The pivotal role of prevention and wellness in
  healthy aging
• The need to make good nutrition and regular
  exercise a higher priority in public policy and
  among health care providers

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Conclusions (contd)

• The U.S. could benefit enormously from the huge
  growth in the older population over the next
  30-40 years
• if the proper steps are taken to create cultures
  and organizational infrastructures, including
  physical and mental health care systems that are
  conducive to greater participation of older
  people in all dimensions of community life