03
Aug 02, 2009
More health care providers needed for the elderly
The good news is that Americans in general are living longer—there are eight times as many people over age 65 and 21 times as many over age 85 as there were in 19001—and various surveys indicate that, overall, disability declined in the elderly from 1982 to 1996.2 The bad news is that a potential health care shortage could leave millions of seniors without health care in the coming three decades, just as the number of elderly baby boomers swells.3
Robert F. Schoeni et al. reported their findings on declining disability in The Journals of Gerontology. The findings were based on data from 124,949 participants aged 70 or older in the 1982-1996 National Health Interview Surveys. The researchers pointed out that the prevalence of disability declined over that time. However, gains did not persist over the whole period or accelerate with time. In addition, only “routine care” disability, not more severe disability, decreased. They also point out that gains were among seniors with higher levels of education. They reported that exploring causes for improvements should be a priority in other research into seniors’ disability.2
This does seem an important first step in determining how to ensure optimal health for the growing population of elderly people: the number of people over 65 is projected to almost double in the United States by 2030. At the same time, too few physicians, nurses, nurses’ aides, and home health care workers are being trained; in fact, a recent Institute of Medicine report states there are only about 7,000 physicians specializing in geriatrics in the country. The report recommends tripling the number of health care workers capable of caring for the elderly by 2030—a challenge as the average internist with specialized training in caring for the elderly earns less than the average general internist.3
Home health care workers are also a key group, according to Larimer county residents who participated in a recent survey on aging needs by the Foundation on Aging for Larimer County. Although health professionals’ acceptance of Medicare coverage was seniors’ top concern (cited by 26%), home health care came a close second (25%).
Participate in the discussion about Health Care in Larimer County.
References
1. Smith GP II. Allocating health care resources to the elderly. I. Limitations on elderly access to medical care. Elder Law Review, Annual; 2002 [cited 2009 Jul 27]. Available from: http://findarticles.com/p/articles_6995/is_1/ai_n28132649/
2. Schoeni RF, Freedman VA, Wallace RB. Persistent, consistent, widespread, and robust? Another look at recent trends in old-age disability. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2001;56:S206-18.
3. Zwilich T. Crisis ahead for elderly health care? Seniors could be strapped for health care as demand increases and workforce dwindles, experts warn. Medicare Health Center. WebMD 2008 Apr 14 [cited 2009 Jul 27]. Available from: http://www.webmd.com/medicare/news/20080414/crisis-ahead-for-elderly-health-care
Universal design and more accessible housing for seniors
As the population ages, a lack of accessible housing could become an increasing problem. In a study of accessible housing design published in the journal Housing and Society, researchers Jean Memken and Nichole Earley point out that the growing elderly population means more adaptable, accessible, and safe family housing is needed in all parts of the country. The authors point out that this approach would permit people to age in place, because houses would have features such as accessible entrances and ramps, grab bars and walk-in showers in bathrooms, and a single-level design.1
Unfortunately, in more than 75% of cities examined, less than 1% of accessible single-family housing was available for sale. The shortage existed across the nation, although slightly more (2%) accessible housing was available in the Northeast. The authors suggest evaluating the role that advocacy groups can play in increasing accessible housing options.1
Another research group’s work highlights the importance of universal design and accessibility for seniors’ homes. Frank Oswald and colleagues examined ENABLE-AGE Project home interview data from 1,918 people who were between the ages of 75 and 89 and lived alone in their own homes in Sweden, Germany, the United Kingdom, Hungary, or Latvia. The researchers report in The Gerontologist that these people had a greater sense of well-being and were more independent in their daily activities if they lived in more accessible homes, perceived their homes as useful and meaningful, and did not believe that external influences were responsible for their housing situation. The authors therefore recommend that seniors be consulted to determine their personal preferences for home modification or relocation.2
Similarly, in a cross-sectional study of elderly people reported in The Journals of Gerontology, Gary W. Evans and colleagues found that housing quality is associated with psychological well-being in elderly people living independently in the community. Higher-quality homes led to greater feelings of attachment to home.3
Finally, any options selected to ensure accessible, high-quality housing for seniors must also be affordable. The recent Foundation on Aging for Larimer County Aging Needs Survey revealed that Larimer county seniors’ largest housing concern is affordable services enabling them to continue living at home. Fifty-one percent of those who completed the survey indicated that this was a concern for them.
Participate in the discussion about Housing in Larimer County.
References
1. Memken J, Earley N. Accessible housing availability for the growing U.S. elderly population. Housing and Society 2007;34(1):101-15.
2. Oswald F, Wahl H-W, Schilling O, Nygren C, Fänge A, Sixsmith A, et al. Relationships between housing and healthy aging in very old age. The Gerontologist 2007;47:96-107.
3. Evans GW, Kantrowitz E, Eshelman P. Housing quality and psychological well-being among the elderly population. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2002;57:P381-3.
Elderly people’s risk for poverty and economic vulnerability
Millions of elderly people live below or barely above the poverty line. About 3.4 million of those over age 65 live in poverty (considered to be below an income of $9,669 for one person and $12,186 for a couple in 2006). Meanwhile, 22.4% have a family income below 150% of the poverty line. In an article for the Center for American Progress, Alexandra Cawthorne stresses that seniors’ economic security (or lack of it) will become increasingly important as growing numbers of the 75 million baby boomers enter the senior years.1
Cawthorne adds that the elderly poverty rate would be higher if the measure of poverty were more precise. The burden of rising health care costs with age, for instance, is not taken into consideration in defining poverty. Such costs are worrisome to seniors: in the recent Foundation on Aging for Larimer County Aging Needs Survey, 52% of participants cited health care costs as a concern. This is hardly surprising, as these costs can reduce seniors’ disposable income for other expenses, such as energy and food bills.1 In addition, some groups of elderly people are at greater risk than others: seniors from ethnic minorities represent 70% of the poor economically vulnerable (those with limited incomes that are not low enough for means-tested assistance programs).2 Likewise, women who are 75 or older are three times more likely to be poor than are men of the same age (1.3 million women compared with 416,000 men).1
Finding solutions to assist the poor and economically vulnerable elderly is crucial for a variety of reasons, including evidence of a strong association between illness, death, and income. Studies reveal that people with lower incomes die earlier, have more mental health conditions, more chronic health problems, more functional limitations, and worse health overall. In a National Poverty Center paper, authors Pamela Herd, James House, and Robert F. Schoeni conclude that difficulty meeting needs such as adequate nutrition and a healthy environment, an inability to afford basic requirements such as housing and food, and a lack of health insurance and health care all contribute to worse health in poor people.3
Participate in the discussion about Economic Security in Larimer County.
References
1. Cawthorne A. Elderly poverty: the challenge before us. Center for American Progress; 2008 Jul 30 [cited 2009 Jul 28]. Available from: http://www.americanprogress.org/issues/2008/07/elderly_poverty.html
2. Faruque CJ. The economically vulnerable elderly American. Selfhelp Magazine; 2009 [cited 2009 Jul 28]. Available from: http://www.selfhelpmagazine.com/article/elderly-poor
3. Herd P, House J, Schoeni RF. Income support policies and health among the elderly. Conference on Health Effects of Nonhealth Policies. Washington: National Poverty Center; 2006. National Poverty Center Working Paper Series #06-27.
Ensuring that supportive services meet seniors’ needs
According to a recent Foundation on Aging for Larimer County survey, home care services are an important concern for seniors. In the category of support services, the largest percentage of respondents (29%) stated that home care services were a concern for them.
However, careful, individualized assessment of elderly people’s needs is required before home care services or assistive devices can be provided effectively. Authors William Weissert and colleagues explain in a Journal of Aging and Health article that currently there are several potential problems with home care services, including unclear goals and a lack of information about their effectiveness. The authors recommend clarifying goals and improved selection of clients who can benefit from such care.1
In addition, addressing a shortage of home care workers is necessary, say Clinics in Geriatric Medicine authors Robyn Stone and Robert Newcomer. They recommend the involvement of the private sector, federal government, and state governments in meeting current and future needs for a larger and stronger workforce of paid personal assistant service workers in the community.2
Assistive technology is another area of support for which an elderly person’s specific needs must be assessed appropriately, according to another Clinics in Geriatric Medicine article. Physicians Kenneth Brummel-Smith and Mariana Dangiolo believe effective assessment focuses on a senior’s specific requirements and motivation for using assistive technologies, including personal computers for information and support, devices for activities of daily living and mobility, and tools for managing the home and ensuring personal safety.3
Participate in the discussion about Support Services in Larimer County.
References
1. Weissert W, Chernew M, Hirth R. Titrating versus targeting home care services to frail elderly clients. Journal of Aging and Health 2003;15(1):99-123.
2. Stone R, Newcomer R. Advances and issues in personal care. Clinics in Geriatric Medicine 2009;25(1):35-45.
3. Brummel-Smith K, Dangiolo M. Assistive technologies in the home. Clinics in Geriatric Medicine 2009;25(1):61-77.
