Chapter 1

The Aging Population

Contemporary View of the Elderly
• Positivism rather than prejudice.
• Intelligence rather than myth.
• Concern rather than neglect.
Positive Views of Aged Throughout
History
• Age of Confucius: direct correlation between age and
degree of respect.
• Taoism: viewed old age as the epitome of life.
• Ancient Chinese: believed attaining old age was a
wonderful accomplishment deserving great honor.
Negative Views of Aged Throughout
History
• Early Egyptians: dreaded growing old; experimented
with potions to maintain youth.
• Greeks: myths portray many struggles between old and
young.
• Aristotle: denied elderly any role in government.
• Ancient Romans: had limited respect for elders; killed
them first in conquered nations.
Defining the Lives of Older Americans
• 1914: Dr. I. L. Nascher (the father of geriatrics), wrote
the first geriatric textbook.
• 1935: passage of the Federal Old Age Insurance Law
under the Social Security Act.
• 1965: formation of the Administration on Aging,
enactment of Older Americans Act, introduction of
Medicaid and Medicare.
Growth of the Older Population
• Persons over 65 years represent more than 12% of the
population in the United States.
– Over 34 million persons exceed 65 years.
• Life expectancy
– 1930: 59.7 years.
– 1965: 70.2 years.
– Present: 77.1 years.
Factors Influencing Increased Life
Expectancy
• Advancements in disease control and health technology.
• Greater numbers of people surviving period of infancy
and other dangers throughout life span.
• Improved sanitation and living conditions.
Unique Subsets of Elderly
• Young-Old: 65 to 75 years.
• Old: 75 to 85 years.
• Old-Old: 85 to 100 years.
• Elite Old: over 100 years.
Geographic Breakdown of Older
Populations
• Greatest numbers of older populations:
– California, New York, Florida, Pennsylvania, and
Texas
• Percentage of a state’s population older than 65 years of
age:
– Florida takes the lead, followed by Rhode Island,
West Virginia, Iowa, and Arkansas.
Geographic Breakdown of Older
Populations (cont.)
• States with the most dramatic increases in the
percentage of elderly residents:
– Nevada, Alaska, Hawaii, and Arizona
• States with the lowest percentage of total population
over age 65 years:
– Alaska, Utah, and Georgia
Race and Gender Differences
• Late 1980s to Present: wider gap in life expectancy
between white and black people.
– Black life expectancy declined due to homicides and
HIV/AIDS.
• 20th Century: ratio of men to women steadily declined
to fewer than 7 men to women.
– Trend is changing; ratio of men to women is
increasing.
Income Analysis of Older Populations
• Less than 15% of older people fall below poverty level.
• The elderly still possess financial problems:
– Social Security makes up more than half of their
income.
– Many older adults are “asset rich and cash poor.”
• Women and minority groups are poorer than white men.
Education of the Older Population
• Trend toward a more educated senior citizen group in the
U.S.
– Increase in the number of persons completing high
school since the 1940s.
• Older people with advanced degrees are more prevalent
than in the past.
– These adults have higher incomes.
Health Status of Older Populations
• Fewer acute illnesses.
– Lower death rate from these problems.
– Usually require longer periods of recovery and
present more complications.
Health Status of Older Populations (cont.)
• Chronic illness is a major problem.
– Most have at least one chronic disease; many have
several.
– Causes activity limitations for personal care in 49%
of all older individuals.
– 27% have difficulty with home management
activities.
Use of Resources by Older Populations
• Higher rates of hospitalization, surgery, and physician
visits exist.
– Care is more likely to be paid by federal dollars than
private insurers or the elderly themselves.
• Less than 5% of the older population is institutionalized
at any given time.
Use of Resources by Older Populations
(cont.)
• One in four older adults will spend some time in a
nursing home.
– Most private-pay residents spend their assets in 1
year and need government support.
– Most of the Medicaid budget is spent on long-term
care.
– Gerontological nurses need to advocate to insure
that cost-containment efforts do not jeopardize care.
Impact of the Baby Boomers
• Most have children, but low birth rate means fewer
biologic children to assist them in old age.
• They are the best-educated generation ever.
• Their income tends to be higher than other groups.
• Their leisure time is scarcer than other adults; they are
more likely to feel stressed.
• They exercise more frequently than other adults.
Predictions for Baby Boomer Healthcare
• They will have a highly active role in their health care.
• Their ability to access information will keep them
informed.
• They will not be satisfied with the conditions of today’s
nursing homes.
• Their blended families may need special assistance with
caregiving demands.
Economic Impact of Growing Elderly
Population
• An increasing demand for the provision of and payment
for services to this group.
• Questions about the ongoing ability of the government to
provide a wide range of services for older adults.
• Concern that the elderly are using a disproportionate
amount of tax dollars and that limits should be set.
Role of Gerontologic Nurses in Protecting
the Older Population
• Active involvement in decisions pertaining to the
rationing of services.
• Assumption of leadership in developing cost-effective
methods of care delivery that do not compromise the
quality of services to older adults.