DEVELOPMENTAL PERSPECTIVES

ON OLDER ADULTS
 NUMBER OF OLDER ADULTS WILL
INCREASE SUBSTANTIALLY OVER THE
NEXT 20 YEARS

Number of additional older adults, age 65+ (thousands)

Change in older adults, age 65+ (Thousands)

85 91
71 67
55 47
- - - - -
1950s 60s 70s 80s 90s 00s 10s 20s 30s 40s 2050s
Sources: U.S. Census Bureau and Minnesota State Demographic Center
 NUMBER OF OLDER ADULTS WILL
INCREASE SUBSTANTIALLY OVER THE
NEXT 20 YEARS

Change in older adults, age 65+ (Thousands)

335
285

85 91 97
55 71 67 66 56
47

1950s 60s 70s 80s 90s 00s 10s 20s 30s 40s 2050s

Sources: U.S. Census Bureau and Minnesota State Demographic Center

 WHY ARE CHANGES SO MARKED NOW?
Population by age and sex
Minnesota, 2010
85+
80 to 84
75 to 79
70 to 74
65 to 69 65 years
60 to 64
55 to 59
50 to 54
45 to 49
40 to 44
35 to 39
30 to 34
25 to 29
20 to 24
15 to 19
10 to 14
5 to 9
Under 5
300000 200000 100000 0 100000 200000 300000

Male Female
Source: U.S. Census Bureau
 FOR THE FIRST TIME IN MN HISTORY:
MORE 65+ THAN SCHOOL-AGE BY 2020
1,800,000
1,600,000
1,400,000
1,200,000
1,000,000
800,000 18-24
65+
600,000
5-17
400,000
200,000
0
1950

1960

1970

1980

1990

2000

2010

2020

2030

2040

2050

2060
U.S. Census Bureau & Minnesota State Demographic Center
 INCREASINGLY OUR DEMOGRAPHICS WILL
CHANGE THE DEMAND FOR SERVICES

General Fund
Expenditures Within Health &
FY 2012-2013 Human Services
All other
areas • Medical Assistance Expenditures:
19% 25% of GF spending (8.5 billion)
K-12
Higher Educati • Medical Assistance Expenditures
Educati on
on for the Elderly and Disabled: 16%
42% of GF spending (5.5 billion)
7%
Health • MA expenditures include basic
& care, long-term care waivers and
Human
long-term institutional care
Service
s
31%

Sources: Minnesota Management and Budget, February 2013. House Research, Long-
Term Care Services for the Elderly, November 2012
 FROM 2008: IF STATE HEALTH CARE COSTS
CONTINUE THEIR CURRENT TREND, STATE
A n n u a l A v e G r o w th 2 0 0 8 -2 0 3 3

SPENDING ON OTHER SERVICES CAN’T GROW

9% 8.5%
8%
7%
6%
5%
3.9%
4%
3%
2%
1% 0.2%
0%
Revenue Health Care Education & All
Other

General Fund Spending Outlook, presentation to the Budget Trends Commission,

August 2008, Dybdal, Reitan and Broat
 4 PHASES OF ADULTHOOD

Middle Older

Young Late
 ONE OR MANY PHASES IN OLDER
ADULTHOOD?

• Integrity vs despair
• Later maturity
• Old Age:
• Ego Differentiation vs. Work-Role Preoccupation
• Body Transcendence vs. Body Preoccupation
• Ego Transcendence vs. Ego Preoccupation
• Late adulthood and late, late adulthood
• Young old, old-old, and very old
 FISCHER’S THEORY OF LATE AND
OLDER ADULTHOOD

2nd Period: Early 4th Period: Later

Transition Transition

1st Period:
3rd Period: Revised 5th Period : Final
Continuity with
lifestyle period
middle age
 FIRST PERIOD: CONTINUITY WITH
MIDDLE AGE

• Retirement or continued employment/homecare

• Few new activities are learned
• For many, some professional work carries through
• More time available
• Significant concerns: $, health, others’ health, staying
active, years left
• Interests and activities pursued from middle age
 SECOND PERIOD: EARLY TRANSITION

• Events that initiate transition:

death of spouse, onset of
illness, need to relocate
• Other elements: decreased
income, increased income,
perceived changes in marriage,
social relationships, concern for
spouse
 SECOND PERIOD: EARLY TRANSITION
• Events that initiate transition: death
of spouse, onset of illness, need to
relocate
• Other elements: decreased income,
increased income, perceived changes
in marriage, social relationships,
concern for spouse
• Results from an accumulation of
losses, e.g., deaths and caregiving
• Relocation and loneliness:
seeking activities that are social
• Some transitions result from
decisions: work or other activities
 5 TASKS NECESSARY FOR ADAPTING
TO LATE ADULTHOOD

• Recognition of aging and definition of instrumental limitations

• Redefinition of physical and social life space
• Substitution of alternate sources of need satisfaction
• Reassessment of criteria for evaluation of the self
• Reintegration of values and life goals

Transition ends middle age lifestyle and

introduces them to older adulthood
 THIRD PERIOD: REVISED LIFESTYLE

• Adaptation
• Affiliation w/ older adult age
group as means of socialization
• Activity changes match the
revised lifestyle
• Revised goals and activities are
very individual
• Adaption can be positive
 THIRD PERIOD: REVISED LIFESTYLE

• Adaptation • A sense of finitude continued

• Affiliation w/ older adult age as did fear of dependency
group as means of socialization • “Retirement careers” – service
• Activity changes match the • Relatively stable
revised lifestyle
• Revised goals and activities are
very individual
• Adaption can be positive
 FOURTH PERIOD: LATER TRANSITION

• Common events: loss of health and mobility

• Inability to care for oneself – disabilities, illnesses,
accidents
• Moving to a care facility – loss of spouse, relocation of
family, loss of caregiver
• Transition: adapt, set new goals, find activities consistent
with needs and capabilities
 FIFTH PERIOD: FINAL PERIOD

• Limited mobility requiring levels of care – reexamine

lifestyle, new activities
• A time of growth: learning new things, free from worry
• A time of resignation: loss, finitude, speak of mortality,
loneliness
 FISCHER’S THEORY OF LATE AND
OLDER ADULTHOOD

2nd Period: Early 4th Period: Later

Transition Transition

1st Period:
3rd Period: Revised 5th Period : Final
Continuity with
lifestyle period
middle age
 70% OF ADULTS OVER 65 WILL NEED
LONG-TERM CARE

Family and Informal

Caregivers Home Health Care
• 52 million or 1 in 5 households • 80% of older adults
• 43 million – dementia care • 9-11 hours a day on average
 LONG-TERM CARE

Assisted Living Facilities Nursing Homes

• 750,000 residents • 4.2% of total population
• Typical resident: 87-year old female • Over 95 years of age, 50%
who needs 2-3 ADLs
• 7-to-1 female to male
 MEMORY CARE

• 1/9 Americans has Alzheimer’s • 68% of nursing home residents

disease have cognitive impairment
• 1/3 over the age of 85 • 52% of assisted living facilities
provide dedicated memory
care