Download Aging Tsunami Speaker Notes - 5.01 MB

Speaker Notes to Accompany
Preparing for the Aging Tsunami
Sharon K. Ostwald, PhD, RN, FGSA, FAHA
Professor & Isla Carroll Turner Chair of Gerontological Nursing
The University of Texas Health Science Center at Houston
Houston, Texas, USA
2012
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We ARE an aging society! The world’s older population grew by an average of 870,000
people each month during 2008. By 2020, the world population aged 60 and older is
expected to reach ONE BILLION.
Although industrialized countries are further along in the aging of their populations,
developing countries are already experiencing a fast transition to lower fertility levels
and longer life spans. Latin American countries will soon have much older populations
who will put a higher demand on resources, including health care resources. Geriatric
professionals must now prepare for the aging tsunami that is sure to come so that they
will not be engulfed by the demands it will bring.
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The purposes of my presentation today are
1) To identify trends that will challenge geriatric nurses now and in the future and
2) To suggest some important areas of focus for geriatric nurses.
The world’s population is aging.
The growth in the older population has generally been associated with developed
countries, such as the United States of America and Europe as shown on the map.
Europe still has the highest proportion of people over the age of 65. In Europe, 1 out of
every 4 people will be over the age of 65 by 2040 and 1 out of every 7 people will be
over the age of 75 years. For years Sweden, Germany and Italy have had the highest
percents of older people in the world.
Percent Population 65 and Over, 2008
(presentation slide #3)
Of the 25 countries in the world with the highest proportion of older people, 24 are in
Europe. Japan, however, now has the highest percent of older people of any country in
the world – 21.6% of the Japanese are over the age of 65.
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The World’s 25 Oldest Countries, 2008
(presentation slide #5)
In many parts of the world the growth of older people is steady and they are living long
and healthy lives. However, the exploding older population will produce challenges for
many parts of the world.
Projections for the aging population suggest that every month for the next 10 years, 1.9
million people over the age of 65 will be added to the world’s population. As shown on
the map by 2040 people over the age of 65 will comprise more than 11% of the
population in most of the countries in the world.
Percent Population 65 and Over, 2040
2012
(presentation slide #6)
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Adults over 65 will outnumber children under age 5.
Declining fertility rates and improved health and longevity have generated rising
numbers and proportions of older people in most of the world. For the first time in the
history of the world, people aged 65 and over will soon outnumber children under age 5
Young Children and Older People as a Percentage of Global Population
1950 – 2050 (presentation slide #8)
Fewer children means fewer workers employed to support older people who retire.
There will also be fewer family caregivers available to care for the growing numbers of
frail elderly. A commonly used indicator of societal support is a dependency ratio, the
ratio between youth and/or older people and working-aged people. The older
dependency ratio (ODR) is defined as the number of people aged 65 and over per 100
people aged 20 to 64. Older dependency ratios are shown here. Higher dependency
ratios mean more people over 65 compared with those under 65. Latin America is
relatively low, but the ratio is estimated to increase over the next 30 years.
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Older Dependency Ratio for World Regions: 2000, 2020, & 2040 (presentation slide #10)
The health care system will be challenged to provide more care at less cost and more
alternatives for care of older people who do not have families available to provide long
term care. This situation presents immense challenges for geriatric nurses. We need to
be sure that nurses are receiving special education about the physiology of aging,
pharmacology and how medications affect older people in different ways than younger
people, the atypical symptoms of disease often seen in older people, the complexities of
caring for older people who often have several chronic illnesses simultaneously, and the
socioeconomic and environmental factors that may challenge an older person’s ability
to return home and to care for themselves. Family and friends need to be taught how
to care for the special needs of frail elders.
Older populations will increase more rapidly in developing
countries than in developed countries.
The process of population aging is primarily determined by two factors – birth rates and
death rates. Originally most countries have a large number of children below the age of
15 and a small percent of people over the age of 65 so that the age structure looks like a
pyramid. Most developing countries have experienced a lower birth rate in recent
years, similar to what occurred earlier in Europe and North America. As fertility rates
drop, the number of children decreases. At the same time adults are living to be older.
This causes a change in the shape of the population pyramid. By 2050 the population
pyramid for developing countries will look very much like the those currently in the USA
and Europe. As this process accelerates, age structures within countries will change.
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Eventually, older people become an ever-larger proportion of each nation’s total
population.
Population in Developed and Developing Countries by Age and Sex- 1960, 2000 & 2040
(presentation slide #11-13)
The percent of increase in the developed countries is not expected to change nearly as
much as in the developing countries.
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Percent Increase in Population Aged 65 and Older 2008 to 2040
(presentation slide #17)
Japan, 30%
United Kingdom,
66%
United States, 107%
China, 209%
India, 274%
Singapore, 316%
Many of the countries in Latin America are expected to see large increases in the
population over 65 between 2008 and 2040. In Japan, for instance, the elderly
population is expected to increase by only 30%, while in Chile it is projected to increase
by 160%.
Furthermore, developing countries will have less time to prepare for the aging changes
in the population. While the US has had 69 years to prepare for the doubling of the
aging population, Chile will only have 27 years to prepare.
The Speed of Population Aging in Selected Countries
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(presentation slide #18)
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Life expectancy is increasing.
Most countries show a steady increase in longevity over time. Life expectancy is a
probability estimate of how long individuals can expect to live, given the environmental
and disease conditions currently in existence. Life expectancy varies by country, but
generally continues to rise with only a few exceptions (like Russia). It has surpassed 80
years in at least 7 countries. Japanese have the longest life expectancy from birth with
an average of 82 years.
While genetics may influence how long older people live, it is the behaviors and
exposures that occur over a lifetime that interact with biology and psychology that
determine whether people reach old age with good or poor health. In all European
countries (as well as the USA and Canada) the life expectancy for both males and
females age 75-84 is increasing. In all Latin American countries, life expectancy has now
pasted 70 years of age.
Life Expectancy at Birth for Selected Countries by Region: 2008
(presentation slide #21)
Costa Rica
77.4
Chile
77.2
Argentina
76.5
Uruguay
76.1
Mexico
75.8
Jamaica
73.0
Brazil
72.5
Colombia
72.5
Peru
70.4
Developing Countries
Developed Countries
Guatemala
70.0
United States
78.1
Some personal characteristics have been found to be associated with life expectancy
and health, regardless of culture. In most countries women have a longer life
expectancy than men. The ratio of women to men in the age group over 85 is 2:1.
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Female Advantage in Life Expectancy at Birth for Selected Countries: 2008
(presentation slide #23)
A difference in sex-ratio to mortality throughout the world has been contributed to
lifestyle and environment, rather than genetics. Men have traditionally practiced more
risky behaviors (i.e., driving without seatbelts), been exposed to more occupational
hazards (i.e., pesticides), and maintained a more unhealthy lifestyle (i.e., smoking and
alcohol consumption).
Highest Life Expectancy at Birth 1840 – 2000
2012
(presentation slide #24)
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It is currently estimated that about one-third of the years lived after age 65 are lived in a
state of dependency (WHO, 2002a). For instance at age 65 the average woman has
approximately 20 years of life left. It is estimated that 13.3 of those years will be spent
in good health and 6.7 years will be spent being dependent on others. The estimates for
65 year old men are similar, except that their life expectancy after age 65 is 17.1years
with 5.6 years estimated to be spent needing assistance from others (Administration on
Aging, 2007).
The number of the oldest old is rising.
The absolute number of elderly is increasing; the percent of elderly in global populations
is increasing, and the average life expectancy at birth and at age 65 is increasing. In
addition, the number of oldest old is also increasing. Demographers usually talk about
the young-old (65-74), the old-old (75-84) and the oldest-old (> 85). Among the over 65
age group, the oldest individuals are the fastest growing group. As can be seen the
people over the age of 80 in China made up over 17% of all of the people over age 80 in
the world. The US contributes 11.7% and Latin American countries together contribute
7.3%
Global Distribution of People Aged 80 and over (Percent of Worldwide Total) 2008
(presentation slide #26)
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Since as people get older, they are likely to require more health care resources, there is
particular interest in the increase in the oldest-old. The fastest growing group of adults
over the age of 65 is among the oldest-oldest-old, those over the age of 100 who we call
‘centenarians’. The world population of centenarians is projected to increase 746%
between 2005 and 2040. By 2040 the population over 100 is projected to reach 1.2
million.
Percent Change in the World’s Population 2005 – 2040
(presentation slide #27)
Disparities exist between urban and rural people aged 65 and
older.
The health status of older people may not only be related to what country they live in,
but also whether they live in rural or urban areas. In general older people are usually
concentrated in rural areas, but no clear world-wide pattern exists. Health care services
are usually grouped in large metropolitan areas so older people living in larger cities
may have more access to health and social care, and therefore live longer, healthier
lives.
Chronic diseases are becoming an increasing burden.
Fewer numbers of children and better treatment of infectious diseases, results in aging
populations. This causes a shift in deaths to chronic diseases. The survival curve for
most countries looks like this one from the US
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Survival Curve for U.S. White Females: 1901 and 2003
(presentation slide #28)
This trend is also seen in Latin American countries where the trend is toward more
deaths in older populations groups. The proportion of deaths occurring over the age of
65 for American countries is shown here.
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Proportion of All Deaths Occurring at Age 65 or Over in 29 Countries/Areas: Circa 2001
(presentation slide #29)
Age makes older adults more prone to the development of chronic diseases like heart
disease, cancer, strokes, and diabetes. It is well-accepted that health in older adults
results from lifelong interactions between an individual’s genetic make-up and the social
and physical environments in which they live. Over 75% of the deaths in the developed
world are due to chronic diseases and most of these deaths occur after the age of 65.
This graph demonstrates the increase in chronic diseases as a cause of death as people
age.
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Major Causes of Death in the European Union by Age 2001
(presentation slide #31)
Within the next two decades, the World Health Organization expects a shift in the
burden of disease to shift from infectious or communicable diseases to chronic or noncommunicable diseases in all developing countries. They predict that by 2030 the
burden of chronic or non-communicable diseases will exceed 50% in developing
countries and the burden of communicable disease will drop to 32%.
The Increasing Burden of Chronic Non-communicable Diseases on Low and Middle
Income Countries (presentation slide #32)
Research during the last 20 years has suggested that poor health in adults is related to
early childhood risks, especially malnutrition during pregnancy and early childhood. In
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Latin America, early malnutrition has been correlated with diabetes in adulthood. In
addition, childhood infections may have long term effects on adult mortality.
In addition, failure to thrive in children may be related to poorer physical, cognitive, and
emotional functioning in later years. In Puerto Rico, the probability of being disabled
among people growing up in poor conditions was 60% higher than among people with
better childhood socioeconomic levels. In cities the probability was 22% higher.
Probability of Being Disabled at Ages 60 and Over Conditional on Early Childhood
Health Conditions Latin American/Caribbean Cities* & in Puerto Rico: Circa 2001
(presentation slide #33)
Poor Health Conditions
37.0
33.0
26.0
Cities*
22.5
Puerto Rice
*Cities include Bridgetown, Barbados; Buenos Aires, Argentina; Havana, Cuba; Mexico City, Mexico;
Montevideo, Uruguay; Santiago, Chile; & Sao Paulo, Brazil
Geriatric nurses have an important role in promoting health and preventing disease
among older adults. While some believe that older adults may be too old to change
their lifestyles, regular exercise, a healthy diet, avoiding tobacco, using alcohol in
moderation, and correctly using medications can increase an older person’s health and
improve their quality of life. An individual’s risk for disease can be altered, even in old
age. A major focus of geriatric nurses is to develop interventions that help older people
to promote their health, prevent disease, and manage chronic illnesses to prevent
excess disability. Attention to health promotion and disease prevention programs can
lead to a delay in the age that people develop a chronic disease. This postponement in
the onset of disease will result in fewer premature deaths, less time with disability and a
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smaller proportion of total life spent with disease and disability. Personal health
practices and the strength of the social network significantly impact the development of
disability.
The prevalence of disability increases with age.
Studies in different countries have consistently shown that dependence in activities of
daily living (ADL) and instrumental activities of daily living (IADL) increases with age,
beginning at about age 75 and is higher in women and people with low incomes. An
important focus for geriatric nurses is to maintain independence in ADL and IADL and
prevent disability in older adults. If chronic diseases can be controlled early, excess
disability can be reduced and quality of life improved
Maintaining Functional Capacity Over the Life Course
(presentation slide #34)
Fortunately, the prevalence of disability has been declining among older people in
countries like the USA. If this trend continues, as can be seen here, and holds for other
countries, as well, the number of older adults living with disability will decrease
significantly over time. This is particularly important in controlling costs related to the
aging tsunami.
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Chronic Disability Decline in the United States 1982 to 2005
(presentation slide #35)
Higher educational levels have long been associated with good health, healthy lifestyles,
and functional independence. Countries with high levels of educational attainment
have higher life expectancies and a higher quality of life in old age. Reactions to risk
factors may partially be a function of educational level. People with higher educational
backgrounds are more likely to adopt healthy lifestyle behaviors (WHO, 1999).
Social, physical and economic environments affect healthy aging.
Overall health can be influenced by multiple factors that are outside of the individual’s
control – the social, physical, and economic environments within which they live.
Poverty is a powerful determinant of health which controls where older adults live, what
they eat, and where they shop. Poverty increases older adults’ risks for chronic and
infectious diseases, decreases their access to medical care, and ultimately decreases
their physical and mental health, their independence, and their life-expectancy. Lack of
income can contribute to poor nutrition and homelessness, which in turn can contribute
to greater poverty and ill health. Countries throughout the world are trying to
determine how to pay the pensions and health care costs of a rapidly increasing older
population. In many countries, there is a trend for older adults to remain employed
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until older ages. This trend can be seen in the labor force participation for men and
women in many Latin American countries.
Labor Force Participation Rate for Males Aged 55 to 64 in Six Latin American Countries
(presentation slide #39)
Labor Force Participation Rate for Females Aged 55 to 64 in Six Latin American Countries
(presentation slide #40)
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Lack of social support, poor social conditions, housing, isolation, poverty, and poor
education increase the likelihood of poor health by increasing the risk for disability,
dependence on others, and death (WHO, 1999). Older adults who are most vulnerable
to poor health are those with less education, lower incomes, and poor social support.
The availability of social security income after retirement is important in helping to
maintain higher function in older ages. Social security coverage for 13 Latin American
countries can be seen here.
Social Security Coverage in 13 Latin American Countries: Circa 2002 (presentation slide #41)
(Percentage of employed population paying contributions)
In addition to income, social support is important in helping the elderly to maintain
good health and function. Availability of social support appears to be decreasing in
many countries of the world. As can be seen in this graph of living arrangement of older
adults in Japan, cultural changes are changing the family support available to older
adults.
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Living Arrangements for People Aged 65 and Older in Japan (presentation slide #45)
In developing countries, the aging of the population places a “double burden of disease”
on health care systems that are also trying to manage epidemics of infectious diseases
and malnutrition among their populations, while caring for people with chronic diseases
(WHO, 2008). To be effective, health care professionals must develop systems of care
that provide comprehensive, coordinated primary care that is easily accessible to older
adults.
Geriatric professionals have a crucial role in the care of older adults.
Health promotion and disease prevention activities are important to prolong active
aging and to increase the quality of life of older adults. The international perspective of
active aging implies maintaining autonomy, independence, and intergenerational
solidarity, as a part of health promotion and disease prevention (WHO, 2002).
Throughout the world, regardless of gender, ethnicity or socioeconomic status, the
major causes of death and disability in populations above the age of 60 are chronic
diseases. While some have questioned the importance of expending resources on
promoting health and preventing disease in older people, many reasons exist to support
health promotion and disease prevention activities among older adults. These include:
1) prevention of premature death,
2) delay of the onset of chronic diseases,
3) postponement of disability related to chronic diseases,
4) higher quality of life,
5) greater participation in the life of the family and community in paid and
unpaid roles, and
6) reduction in medical care costs, especially hospitalization and nursing home
costs.
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Because the risks of disease and disability are higher in older people, even small
increases in health can make big differences in active life expectancy and the cost of
medical care.
Geriatric professionals need to be prepared by education and experience to take a
leadership role in meeting the challenges of an aging population.
What are the implications for geriatric professionals?
Geriatric professionals can have a very crucial role in helping the rapidly increasing
number of people aged 65 and older to age with health and dignity. They need to be
prepared to:
1. Screen older adults for common problems like high blood pressure, high
cholesterol and diabetes – before they become seriously ill.
2. Develop hospital and community health promotion programs to reduce risk
factors for chronic disease with a focus on diet, tobacco, exercise, alcohol, and
accident prevention.
3. Treat chronic disease early to prevent excess disability - chronic pulmonary
disease, cardiovascular disease
4. Educate older people to manage their own chronic diseases – diabetes
5. Assist older people to maintain their dignity and be involved in decisions that
affect their lives.
6. Encourage intergenerational interaction between younger and older people
7. Educate family and friends to provide care to frail older people
8. Start outreach programs that address poverty and income inequities, low
literacy levels, and social isolation that increase illness and interfere with
treatment.
9. Advocate for elimination of environmental hazards – unsafe housing, poor air
and water quality, lack of transportation crime and abuse.
10. Provide public education to decrease discrimination against older adults with
mental or physical disabilities
We have described a number of global aging trends that warn us of an aging tsunami
that is to come within the next two decades.
1. Rapid aging of the world’s population, especially in developing countries
2. Imbalance of people over 65 and under 15
3. Increasing life expectancy with a rapid increase in numbers over 80
4. Geographical inequities between urban and rural dwelling older people
5. Increasing prevalence of chronic diseases with a burden of disability
6. Social, physical, and economic environments affect healthy aging.
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The changing global population pyramid illustrates these aging trends.
Global Population Pyramid in 2002 & 2025
(presentation slide #52)
The world is undergoing a rapid change – a tsunami wave is coming. The rapid
population shift has created a “double burden of disease” in many countries who are
simultaneously dealing with epidemics of infectious and chronic illnesses. Two
directions hold promise for improving the lives of older adults in the 21 st century – 1)
health promotion, disease prevention, and chronic disease management for every
person throughout their lifespan, and 2) institution of public policies that guarantee a
safe and healthy environment in which to age. As the population of the world lives
longer, the quest is also to live better. Geriatric professionals can and WILL make a
difference in the lives of older adults.
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References
Centers for Disease Control and Prevention (CDC) & The Merck Company Foundation. (2007). The State of Aging and
Health in America 2007. Whitehouse Station, NJ: The Merck Company Foundation. Retrieved December 27, 2008
from http://www.cdc.gov/aging/pdf/saha_2007.pdf
Kinsella, K., Wan, H, U.S. Census Bureau, International Population Reports P95/09-1. An Aging World: 2008. U.S.
Government Printing Office, Washington, DC, 2009. Retrieved on July 15, 2009 at
http://www.census.gov/prod/2009pubs/p95-09-1.pdf
United States Department of Health and Human Services (USDHHS). (2000). Healthy People 2010: Understanding and
Improving Health. Retrieved December 27, 2008 from http://www.healthypeople.gov/
World Health Organization (WHO). Toward a Policy for Health and Aging: Fact Sheet. Retrieved August 28, 2009 from
http://www.who.int/ageing/publications/alc_fs_ageing_policy.pdf
World Health Organization. (1998). Growing Older and Staying Well: Ageing and Physical Activity in Everyday Life.
Geneva, Switzerland: World Health Organization Press. Retrieved August 25, 2009 from
http://whqlibdoc.who.int/hq/1998/WHO_HPR_AHE_98.1.pdf
World Health Organization. (1999). Ageing: Exploring the Myths. Geneva, Switzerland: World Health Organization
Press. Retrieved December 26, 2008 from http://whqlibdoc.who.int/hq/1999/WHO_HSC_AHE_99.1.pdf
World Health Organization. (2002). Active aging: A policy framework. Presented at the Second United Nations World
Assembly on Aging, Madrid, Spain. Geneva, Switzerland: World Health Organization Press. Retrieved June 10, 2009
from http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf
World Health Organization. (2004). Towards Age Friendly Primary Health Care. Geneva, Switzerland: World Health
Organization Press. Retrieved December 28, 2008 from http://whqlibdoc.who.int/publications/2004/9241592184.pdf
World Health Organization. (2008). The Global Burden of Disease: 2004 Update. Geneva, Switzerland: World Health
Organization Press. Retrieved December 28, 2008 from
http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf
Photographs used for the cover slide are allowed by the MorgueFile free photo agreement and the Royalty
Free usage agreement at Stock.xchng. They appear on the cover slide in this order:
Wallyir at morguefile.com/archive/display/221205
Mokra at www.sxc.hu/photo/572286
Clarita at morguefile.com/archive/display/33743
The Training Excellence in Aging Studies (TEXAS) program promotes geriatric training from
medical school through the practicing physician level. This project is funded by the Donald W.
Reynolds Foundation to the division of Geriatrics and Palliative Medicine within the department
of Internal Medicine at The University of Texas Health Science Center at Houston (UTHealth).
TEXAS would also like to recognize the following for contributions:
Houston Geriatric Education Center
Harris County Hospital District
Memorial Hermann Foundation
The TEXAS Advisory Board
Othello "Bud" and Newlyn Hare
UTHealth Medical School Office of the Dean
UTHealth Medical School Office of Educational Programs
UTHealth School of Nursing
UTHealth Consortium on Aging
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