Aging Population and Health Issues

Aging, Health, and Long-Term Care

• The population aged 65 and older will significantly increase by 2030.
• More services will be needed for treating chronic and acute health conditions, and disabilities.
• Medicare beneficiaries with multiple chronic conditions, especially frail elders with functional/cognitive impairments, need care coordination.
• Baby boomers turning 65 in 2011 led to a substantial increase in older adults.
• By 2034, older adults are projected to outnumber children under 18.
• By 2060, nearly one in four Americans will be at least 65 years of age.
• Overall aging of the population is due to increased life expectancy and decreasing fertility.
• The "old-old" (85 and older) population segment has been the fastest-growing segment in recent years.
• The percentage of those aged 65+ is projected to grow more slowly after 2030.
• In 2050, the non-white population is projected to be 53% compared to 21% in 2014.

Common Health Problems in an Aging Population

• Chronic diseases last a year or longer and require ongoing medical attention, limiting daily living activities.
• Common chronic diseases in the elderly include arthritis, stroke, diabetes, chronic lower respiratory diseases, dementia, and Alzheimer's disease.
• Individuals with chronic diseases may have pre-existing health problems such as alcoholism, substance abuse, mental illness, or developmental disabilities.

Basic and Complex Activities of Daily Living

• Loss of functional ability with aging, including limitations in vision, hearing, mobility, communication, cognition, and self-care.
• Loss of ability to perform complex tasks, organizational skills, and instrumental activities of daily living (IADLs).
• Managing money, shopping, preparing meals, and taking medications are examples of IADLs.
• Basic activities of daily living (ADLs) include skills needed to care for oneself, such as eating, bathing, dressing, personal hygiene, and mobility.
• Chronic disease and loss of ability to complete ADLs/IADLs lead to the need for long-term care services and support.
• In 2016, a survey showed that 69% of those aged 85+ had at least one disability, compared to 9% of those under 65.
• Stroke and dementia are the most debilitating conditions; Alzheimer's is the leading cause of dementia.
• Dementia is a decline in cognitive function affecting memory, language, and problem-solving skills.

Medicare for Older Adults

• Medicare benefits primarily apply to treatment of patients with acute illnesses requiring hospitalization and short-term skilled nursing care.
• Medicare covers rehabilitation centers, nursing homes, and home healthcare.
• Medicare is divided into four parts: Parts A, B, C, and D.
• Deductibles and copayments are part of the program.

Medicaid for Older Adults

• Medicaid covers a broad range of services not covered by Medicare.
• Medicaid acts as supplemental insurance for the elderly and disabled.
• Medicaid pays Medicare premiums and covers prescription drugs.
• The Medicaid program is the primary payer for long-term services and supports (LTSS).
• Medicaid spousal impoverishment provisions protect resources for community-living spouses.

Long-Term Services and Supports (LTSS)

• Long-term health care is needed when individuals of any age are unable to perform basic ADLs due to physical or mental impairment.
• Preadmission Screening and Resident Review (PASRR) is a process for evaluating those needing long-term care services.
• Supports include intermediate care facilities for people with intellectual disability (ICF/ID).
• LTSS also includes inpatient psychiatric services for individuals under 21, and services for older adults in institutions for mental illness, including Nursing facilities (NF) and skilled nursing facilities (SNF).

Community Long-Term Care Services

• These services are privately funded and regulated by federal and/or state governments, in addition to standards for nursing homes.
• Examples of these services include: Adult day care, Residential care communities, Home health agencies, and Hospice.

National Study of Long-Term Care Providers

• The National Center for Health Statistics (NCHS) conducted a 2016 study on long-term care services in the U.S.
• The study found that there are 65,000 providers serving 8.3 million people annually.

Long-Term Care Providers in the United States, 2016

• The table shows a breakdown of long-term care providers in the US in 2016.

Nonmedical Care Facilities

• Residential care and assisted-living facilities support individuals with basic living needs.
• Services may include meals, housekeeping, medication management, or assistance with activities of daily living (ADLs) as needed, including transportation.
• They may be part of retirement communities, nursing homes, senior housing, or stand-alone facilities.

Home Health Agencies

• Provide part-time nursing and/or medical care in patients' homes.
• Services may include physical, speech, occupational therapy, or social services, as well as medical supplies (e.g., wheelchairs, walkers).

Hospice

• Hospice care manages pain, symptoms, and provides emotional, psychological, and spiritual support for patients and families in the final stages of life.
• Services may include medications, medical supplies, and equipment.

Adult Day Care Services

• Provides supplementation for home care, or alternatives to residential care facilities.
• Supplemented supervision for individuals with cognitive decline, like dementia, or assistance with ADLs.
• Includes therapeutic treatment, social/recreational activities, meals, and some medical services, including transportation.

Program of All-Inclusive Care for the Elderly (PACE)

• Programs encourage states to provide a comprehensive array of Medicare and Medicaid benefits through a single delivery system for dual eligible enrollees.
• This improves care coordination and administrative efficiency.
• PACE provides preventive, primary, acute, and long-term care for older individuals with chronic care needs.

The Aging Network

• This is a system of federal, state, and local entities supporting older adults.
• The network includes the U.S. Administration on Aging (AOA), state aging units, Area Agencies on Aging (AAAs), Title VI Native American aging programs, and senior centers.
• Senior centers deliver about 60% of services.

Demographic Trends and Projections

• Measures of disease and disability differ significantly by race and ethnicity in the U.S.
• The percentage of Caucasians is expected to decrease while other racial groups will increase.
• Health professionals/organizations must achieve cultural competence to serve all population groups effectively.

Health Literacy

• Limited health literacy affects individuals across ages, races, incomes, and educational levels.
• Impacts are more significant in lower socioeconomic and minority populations.
• Those with low English proficiency and older adults are highly affected.
• Health literacy encompasses understanding medical instructions, appointment schedules, and complex healthcare systems.
• Limited health literacy is also associated with worse health outcomes.

Personnel Needs

• Healthcare practitioners routinely serve older adults in the future.
• These individuals are crucial to the care process.
• Health professionals need training and education in geriatrics, broader understanding of health problems including ethnicity, race, and economic groups, including recent immigrants.
• Future health education and interprofessional education (IPE) is critical.
• Training for health professionals needs to address health literacy to help older individuals manage their well-being.