HPRB3700 - test 3 chapter 9

transportation for OA

-2012, almost 36 million 65+ licensed to drive Enables independence - housing, medical, financial, and social services are useful only to those that can access them -Unavailability of it has made some services offer it: churches, community services, and local area agencies on aging

income statistics of OA

-2015, Social Security benefit for a retired worker was $1335 (90% of 65+ receive SS benefits) -Of these beneficiaries: 53% married, 74% unmarried receive 50% of their income from SS -22% married and 47% unmarried depend on SS for 90% of their income -Average of $16,020 per year before Medicare deductions

+/- of caregiving

-: face many health problems including elevated levels of depression and anxiety, higher use of psychoactive meds, poorer physical health, compromised immune function, and increased risk of early death, less personal freedom and privacy, economically impacted +: fulfillment and giving back, extending personal network, sense of purpose

nutrition in OA

-Accelerate many age-related decrements and increase the likelihood of several chronic illnesses later on in life -Both obesity and malnutrition can pose challenges with the older adult population in the US

cognitive tasks

-Assistance that involves scheduling appointments, monitoring health conditions, reminding elders of the need to take medications, an in general as backup memory

why look at dependency ratios?

-Changes in dependency ratios provide indirect broad indication of periods when we can expect particular age distribution of the country to affect the need for distinct types of social services, housing, and consumer products (good way to know how to allocate resources) -Example: high youth (focus on education), high old (caregiving and flexible employment)

tasks of daily living

-Eating, bathing, dressing, toileting, walking, getting in and out of bed in a chair, and getting outside

expressive tasks

-Emotional support, socializing and inclusion in social gathering, and trying to prevent feelings of isolation and loneliness

assisted living

-For people who need a wide range of help in medication management, bathing, dressing, and meals - do not require same care as in a nursing home -Can vary greatly from high-rise buildings, to multi-building campuses, to mansion-style homes

health care for OA

-Health problems increase with age, meaning increased healthcare services (major issue for all segments of society) -Heaviest users of healthcare services 920% have 10+ visits to a doc a year) -Spend twice as much per person and are in hospital for short-stays more than any other group of people (37% of 35 million) -Higher usage rates for professional dental care, vision aids, and medical equipment/supplies -Public funds are used to pay for healthcare of older adults

5 types of services of Older Americans Act Amendment of 2000

-Information to caregivers about available services -Assistance to caregivers in gaining access to the services -Individual counseling, organization or support groups, and caregiver training -Respite care -Supplemental services, on a limited basis (Some companies provide services to those that take care of older adults that offers them flexibility, stress reduction, and other services)

living arrangements of OA

-Linked to income, health status, and availability of caregivers -Expected to increase due to desire to live independently among baby boomers and improved economic status -Older women are more likely to live alone than older men -2014 - 57% lived with a spouse, 28% lived alone (non-institutionalized older adults) -Only 3.4% of older population is in nursing homes - with older women having higher usage rates than older men

Why do marital status show more women being unmarried than men in the older adult population?

-Men have shorter life expectancies (76.1 compared to 81.2 for women) -Men tend to marry women younger than themselves -Men who lose a spouse through death or divorce are more likely to remarry than women

education of OA

-Older adults have completed fewer year of formal education than their younger counterparts - education level has increased drastically in recent decades -1970 - only 28% of older adults had completed high school, but in 2014 - 84% had -2014 - ¼ of older adults had a bachelor's degree or higher Educational attainment differs by race and ethnic origin with more whites having completed high school than any of the minority groups Baby boomers are the most educated cohort in the history of the US and will only increase

paying for a nursing home

-Paying for these services is a major concern - semi-private rooms are $6235 per month and more for a private room -Payment is dependent on type of care needed, type of insurance coverage, and financial status -Options for paying include: private, long-term care insurance, Medicare, and Medicaid -Medicare only covers staying in a nursing home for a limited period of time and only is qualified following a hospital stay -If an individual has a long-term care insurance policy, nursing home stays are generally covered as part of the policy

why are income needs reduced among older adults that are retired?

-Retirees do not need to purchase job-related items such as special clothing or tools, pay union dues, or join professional associations -No longer need to commute every day, buy as many meals away from home, or spend money on business travel -Children are grown and now independent -Home mortgage has often been retired -Taxes are usually lower because income is lower -Many community services are offered at reduced prices for older adults -but what increase their expenses is healthcare and home maintenance

housing for OA

-Symbol of independence, link to people, and place for family gatherings -Changing residence can negatively affect an older adult, but is often best

caregiving in the future

-The need for personal care is projected to increase, and costs are expensive -Long-term care insurance policies - sufficient income protection against the depletion of assets

10 myths about aging

1. After age 65 life goes steadily downhill - 85 is the new definition of old age, and 65 defining old age is arbitrary 2. Old people are all alike - they have more differences amongst each other than another other segment of population 3. Old people are lonely and ignored by their families - least likely to be lonely - usually in contact with loved ones even if they live alone 4. Old age used to be better - didn't used to live this long but no way it would have been better than today 5. Old people are senile - cognitive impairment is result of disease and are not a guaranteed part of older adulthood 6. Old people have the good life - loss of loved ones, loss of health, and loss of value in society still affect older adults 7. Most old people are sickly - most do have at least one chronic health problem but majority are active 8. Old people no longer have any sexual interest or ability - most have active and satisfying sex lives 9. Most old people end up in nursing homes - only 3-4% live in nursing homes, only 1% 65-74 reside in a place, 19% of old old (85+) live in nursing home 10. Older people are unproductive - more like to be retired but are very productively engaged at home and in community (all-time high for professional employment)

ideal transportation solutions 4 components

1. Fare reductions or discounts for all public transportation, including that of interstate level 2. Subsidies to ensure adequate scheduling and routing of present public transportation 3. Subsidized taxi fares for the disabled and infirm 4. Funds for senior centers to purchase and equip vehicles to transport seniors properly, especially in rural areas

top 5 causes of death for elders

1. Heart disease - responsible for ¼ of the deaths -Overall age-adjusted mortality rate has fallen - due to declining heart disease and stroke rates 2. Malignant neoplasms (cancer)- stayed about the same rates 3. Chronic lower respiratory disease (CLRD) 4. Cerebrovascular disease (stroke) 5. Alzheimer's -Responsible for almost 2/3 of the total deaths in older adults

6 instrumental needs of OA

1. Income 2. Housing 3. Personal Care 4. Health Care 5. Transportation 6. Community Facilities and Services

4 different levels with which older adults may need assistance

1. Instrumental Tasks 2. Expressive Tasks 3. Cognitive Tasks 4. Tasks of Daily Living

5 possible forced future alternative for medicaid

1. Raising taxes to pay for the care 2. Reallocating tax dollars from other programs to pay for health care 3. Cutting back on coverage presently offered 4. Offering care to only those who truly cannot afford it otherwise (AKA means testing) 5. Completely revamping the present system under which the care is funded

3 different of OA pertaining to transportation

1. Those who can use present forms of transportation (whether their own or public) 2. Those who could use public transportation if the barriers of cost and access (no service available) were removed 3. Those who need special services beyond what is available through public transportation

1 in 5 men and 1 in 3 women are unable to perform these 5 activities:

1. Walking 2-3 blocks 2. Writing 3. Stooping or kneeling 4. Reaching up overhead 5. Lifting something as heavy s 10 lbs. -Women are more likely to have these limitations -Can be either chronic conditions or impairments

8 physical limitations

1. Walking a ¼ of a mile 2. Walking up 10 steps without resting 3. Standing or being on their feet for about 2 hours 4. Sitting for about 2 hours 5. Stooping, bending, or kneeling 6. Reaching over their head 7. Using their fingers to grasp or handle small objects 8. Lifting or carrying something as heavy as 10 pounds

7 demographic variables affecting OA

1. marital status 2. living arrangements 3. racial and ethnic composition 4. geographic distribution 5. economic status 6. education 7. housing

older adults statistics: 1950 vs. 2010

1950, 8% of the population (12 million) were age 65 in 2010, 13.1% of the population (40.1 million) were 65

meal service

1972 amendments outlined a national nutritional program and provided funds for meal services -home-delivered though congregate-meal programs -Can be delivered to central locations, sometimes hospitals, schools, senior centers and are delivered by volunteers -Strictly regulated by guidelines to ensure meals meet certain requirements -Cost of meals varies by site and client income level - older adults may pay full price, pay a portion of the cost, or make a voluntary contribution

obesity in OA

2010, 38% of those age 65 were obese compared to 22% two decades earlier, only 26% are in healthy weight range

geographic distribution of OA

2013, lived in 13 states predominantly: California (4.8 million), Florida (3.6 million), Texas (3 million), NY (2.8 million), Pennsylvania (2.1), Ohio, Illinois, Michigan, NC, NJ, GA, VA, and AZ with well over 1 million -Mostly live in metropolitan areas (85%)

assisted living services

3 meals a day Housekeeping Transportation 24-hour security Exercise and wellness programs Personal laundry Social and Rec activities Staff help Assistance with eating, bathroom, dressing, walking Access to health and medical services (physical therapy/hospice) Emergency services Medication management Care for cognitive impairments

marital status of OA

3/4 of older men are married, under half of women are married, over 1/3 of women are widowed -2014: 14% of older adults were divorced

National Elder Abuse Incidence Study

551,000 older adults (60+) had experienced abuse (emotional, physical, psychological), neglect, or self-neglect in a domestic setting Also revealed: -Female elders are abused at higher rates than men -Elders 80+ are abused at rates 2-3x higher than the rest of the elderly population -90% of all elderly abuse and neglect incidents where a perpetrator is identified, the perp is a family member, and 2/3 are adult-children or spouses -Victims are usually depressed, frail, and confused

young old

65-74

middle old

75-84

health behaviors of OA

76% of older adults in the US rate their health as excellent, very good, or good

old old

85+ -make up the fastest growing segment of the older adult population

poverty rates among OA

9.5% of older population lives in poverty (recently income has improved) -Unmarried women and minorities have the highest poverty rates, married the lowest

memory impairments

Alzheimer's is the leading cause of memory loss in older adults

3rd leading cause of death among OA

Chronic Lower Respiratory Diseases

what has forced OA to move to less-desirable areas?

Cost of utilities, insurance, real estate taxes, repair, and maintenance

mistreatment of OA

Elder Abuse Prevention Laws and Adult Protection Services help fight against OA abuse

nursing home / skilled nursing facility

Generally the last housing option for individuals who can no longer live on their own and need 24-hour care or supervision -Provide short and long-term care -Medical monitoring and treatment is also available, daily living

racial and ethnic composition of OA

Growing larger and more diverse - 2013, predominantly white -78.8% White, 8.6% Black, 7.5% Hispanic, 3.9% Asian, and less than 1% for Pacific Islanders, American Indians, and Alaska Natives

homemaker service

House cleaning, laundry, meal prep

instrumental tasks

Housekeeping, transportation, maintenance on the car or yard, and assistance with business affairs

vaccinations and OA

Immune systems tend to weaken over time which increases the risk of infectious diseases - older adults need vaccines for pneumonia and influenza -In 2014-2015 flu season - 66.7% of those over 65 received a flu vaccine and only about 60% have had the pneumococcal vaccine in their lifetime

cigarette smoking in OA

Just over 9% of older adults are cigarette smokers -Decreased due to decreasing number of male smokers

physical activity in OA

Least physically active of any age group - loss of physical fitness due to the aging process, suffer from chronic conditions -Should focus on muscle strengthening and aerobic conditioning, also balance training due to increased risk of falls (11% meet physical activity guidelines)

life expectancy trends of AP

Life expectancy has also continued to increase 1900 - 47.3 years, 2007 - 77.9 -Men and Black people live less than women and white people in general

independent Living

Live in own home, apartment, or condo Independent living apartments, retirement communities, or senior housing

housing of OA

Majority of older Americans live in adequate, affordable housing -26.8 million households headed by older persons in 2013, 81% owners, 19% renters -Tend to be older, of lower value, and in greater need of repairs -65% of older adults, housing represents an asset because they have no mortgage or rental payments, or they can sell their home for a profit - but for others with low incomes, housing becomes a burden

future trends for the aging population of US

Populations are going to continue to age -By 2030, 1 in 5 people will be 65 or older and the age group 18 and younger will decrease to around 22%

Interventions provided by APS

Receiving reports of adult abuse, exploitation, or neglect Investigating these reports Case planning Case monitoring Evaluation -Also may provide or arrange for provision of medical, social, economic, legal, housing, law enforcement, or other protective, emergency or supportive services

major sources of income for OA

Social Security (86%) Income from assets (51%) Private pensions (27%) Government employee pensions (14%) Earnings (28%) Social Security, pensions (government employee pensions, private pensions, or annuities), earnings from jobs, income from assets (savings accounts, stocks, bonds, real estate), and other miscellaneous sources (public assistance for poor older adults)

chore and home maintenance service

Yard work, cleaning gutters/windows, installing screens and storm windows, making minor plumbing and electrical repairs, maintaining furnaces and air conditioners, and helping to adapt a home to nay impairments older adults might have -i.e. provisions for wheelchairs and installing ramps or special railings to assist older adults to more from one area to another

Meals on Wheels

a community-supported nutrition program in which prepared meals are delivered to individuals in their homes, usually by volunteers (delivered 5 days per week to homebound people)

dependency ratio

a comparison between those individuals whom society considers economically unproductive (nonworking) to the productive (working) -Typically this is defined by age; productive: 19-64, unproductive: 0-19 & 65+

homebound

a person unable to leave home for normal activities

labor-force ratio

a ratio of total number of individuals who are not working to the number of those who are -Lightens burden from DR because it shows that baby boomers are tending to work longer

fertility rates

an expression of the number of births per 1,000 women of childbearing age (15-44) in the population during a specific time period -At their highest in the beginning of the 20th century -Baby boomers: 1946-1964 birth years (76 million babies born during this time)

major needs of housing for OA

appropriateness accessibility adequacy affordability -Requirements can change more rapidly than consumption as household composition, decreasing mobility, and/or increasing morbidity change -The single biggest need: the need for modifications due to physical limitations -Handrails, chairlifts, live-in help

medicaid

approved also in 1965, helps to cover the health care costs of poor older adults, primarily for nursing home care (continuing care), home health care, and prescription drugs -2012, 8 million older adults were covered by it

what is the biggest problem OA face?

availability of affordable housing -the ones in most need are often frail and disabled, have low incomes, and live in rural areas

Congregate Meal Programs

community-sponsored nutrition programs that provide meals at a central site such as a senior center (usually around noon) -Funded by federal and state monies and also provide social interaction and the opportunity to connect with other social services

adult day care

daytime care provided to older adults who are unable to be left alone (modeled after child day care) -Therapy, counseling, health education, etc. too -Can also be specifically designed for those who have cognitive impairments like Alzheimer's, are veterans, or are blind

mortality rates

death per 100,000 - had had an impact on aging population -1900 - 1720 per 100,000, Now - 810

impairments

deficits in the functioning of one's sense organs or limitations in one's mobility or range of motion -Far more prevalent in older adults

functional limitations

difficulty in performing personal care and home management tasks

national highway traffic safety administration

driver safety/transportation issues

medicare

enacted in 1965 - provides almost universal health insurance coverage for older adults -coverage is biased towards hospital care, while chronic health care needs such as hearing aids, eyeglasses, and most long-term services are not covered -2015, program had 55 million enrollees and expenditures just over $597 billion

Older Americans Act Amendment of 2000

established the National Family Caregiver Support Program, which has been administered by the Administration on Aging (AoA) of the US Dept. of Health and Human Services - provides grants to states based on the percentage of the population age 70+ -Funding is used to support services that assist families and informal caregivers to keep loved ones at home for as long as possible

senior center

facilities where older adults can congregate for fellowship, meals, education, and recreation -11,000 in the US and usually built with local tax dollars (uncommon in rural areas) -Some serve as central locations for offering a variety of services such as legal assistance, income counseling, income tax return assistance, program referrals, employment services, and other appropriate services and information

Older Americans Act of 1965 (OAA)

federal legislation to improve the lives of older adults -Created national nutrition programs, state and area agencies on aging, and other programs -State and area agencies on aging added in 1973, inform, guide, and link older persons to available, appropriate, and acceptable services to meet their needs -Provide flexibility to develop plans that allow for local variations - planning and service areas

Adult Protection Services

first line of defense to report elder abuse; they ensure the safety and well-being of elders and adults with disabilities who are in danger of being mistreated or neglected, are unable to take care of themselves or protect themselves from harm, and have no one to assist them

most common chronic conditions in OA

hypertension, arthritis, heart disease, cancer, and diabetes

2 factors with the greatest effect on transportation needs of older adults are

income and health status -maintaining a car is difficult to do too or need a modified car to adapt to their new limitation

Instrumental Activities of Daily Living (IADL's)

more complex tasks such as handling personal finances, preparing meals, shopping, doing house work, traveling, using phone, and taking meds

economic status of OA

o 1970, about 25% of elders lived in poverty, 2013 - 9.5% and 5.6% near-poor -Social Security constituted 90% or more of the income received by 36% of beneficiaries (22% married, 47% nonmarried) -Economically more vulnerable to circumstances beyond their control (1/4 of older adult income comes from work earnings) - loss of a spouse, deteriorating health and self-sufficiency, changes in Social Security, Medicare, and Medicaid legislation, and inflation

physical limitations

older adults having difficulty performing any of these eight physical activities

Independent Transportation Network

older adults who agree to stop driving turn in their cars, and the value is booked into an account from which they can draw to receive rides - started by a mom who had a son hit by an elderly driver

old

once they reach 65

visitor service

one individual taking time to visit with another who is unable to leave his or her residence (voluntary and serves both homebound and institutionalized people)

care provider

one who helps identify the health care needs of an individual and also personally performs the caregiving service

care manager

one who helps identify the health care needs of an individual but does not actually provide the health care services

informal caregiver

one who provides unpaid assistance to one who has some physical, mental, emotional, or financial need limiting his or her independence

service package

pick several services as a combo and pay for them as if they were single services

continuing care retirement community (CCRC)

planned communities for older adults that guarantee lifelong residence and healthcare -Residents move to different levels of services based on their needs (levels: individual home, assisted living facility, nursing home) -Paid for through long-term contracts/leases, large entry fees, and monthly fees -Additional services = extra fees (financially too expensive for many OA)

respite care

planned short-term care, usually for the purpose of relieving a full-time informal caregiver -Can provide full care, including sleeping quarters, meals, bathing, social activity, and medication monitoring - frequented by informal caregivers that gives primary caregivers time to take vacations/be relieved for some time

retirement community

residential communities that have been specifically developed for individuals in their retirement years or of a certain age -Require little or no assistance with daily activity - but services provided are social activity, transportation, laundry, meals, and housekeeping

types of impairments

sensory, physical, memory, oral health/absence of teeth

home health care

services provided in the patient's place of residence; an alternative to institutional care - medical treatment, physical therapy, and homemaker services often allow patients to be cared for at lower costs than a nursing home or hospital and in familiar place, their home -Run by health departments, hospitals, or private companies -Can provide full range of services such as preventive, primary, rehabilitative, and therapeutic services - provided by nurses, home health aides, and personal care workers -Some expenditures are paid for by Medicare but significant portions could have to be paid out of pocket, other means could be long-term care insurance policies, Medicaid, or reimbursement by a supplemental insurance policy such as Medigap

dietary concerns

sodium intake, reduced caloric needs, increased vegetable consumption, and increased water consumption

chronic conditions

systematic health problems that persist longer than 3 months, such as hypertension, arthritis, heart disease, diabetes, and emphysema -Most have at least one and ¾ have two/ these conditions can or cannot be life-threatening -Number of chronic conditions increases with age - and can result in impairments such as loss of sight, from diabetes -95% of health care cost comes for older adults comes from chronic disease

Activities of Daily Living (ADL's)

tasks such as eating, bathing, walking, toileting, getting in/out of bed or chair, and getting outside

why can dependency ratios be misleading?

teenagers sometimes participate in labor force and homemakers do not if they are unemployed or disabled and DR does not account for it

fact about widowed women

tend to have more social support, but generally suffer from a lowered financial status upon being widowed

median age

the age at which half of the population is older and half of the population is younger 92010: it was 37.3 2035: 39)

total dependency ratio

the dependency ratio that includes both young and old -Calculated by adding number of youth + old, then dividing that by the number of people 20-64 years old x 100 -1900 - 70.5 (lowest), 2010 - 67, 2040 - 85

ageism

the result of ignorance, misconceptions, and half-truths about aging and older adults

true or false: Glasses, hearing aids, and regular dental care are not covered under Medicare

true

demography of aging

typically defined as a study of those who are 65 and older and of the variables that bring about change in their lives

sensory impairments

vision, hearing postural balance, or loss of feeling in feet -Increase with age, 5.3 million older adults have vision loss -25% aged 65-74 have significant hearing loss, and 50% of 75+ do too -1/3 of the people who could benefit from hearing aids over 70 have ever used them -1 in 3 older adults falls each year, and 1 in 5 falls causes serious injury - 95% of hip fractures are caused by falls

old-age dependency ratio

when only the old are compared

youth dependency ratio

when only the youth are compared

US Department of Housing and Urban Development (HUD)

works to provide safe, decent, affordable housing for older adults and other groups