Summary Gerontological nursing

CHAPTER 1 The Aging Population 43 CHAPTER OUTLINE Views Of Older Adults Through History Characteristics Of The Older Adult Population Population Growth and Increasing Life Expectancy Marital Status and Living Arrangements Income and Employment Health Insurance Health Status Implications Of An Aging Population Impact of the Baby Boomers Provision of and Payment for Services LEARNING OBJECTIVES After reading this chapter, you should be able to: 1. Explain the different ways in which older adults have been viewed throughout history. 2. Describe characteristics of today’s older population in regard to: life expectancy marital status living arrangements income and employment health status 3. Discuss projected changes in future generations of older people and the implications for health care. TERMS TO KNOW Comorbidity: the simultaneous presence of multiple chronic conditions Compression of morbidity: hypothesis that serious illness and decline can be delayed or postponed so that an extended life expectancy results in more functional, healthy years Life expectancy: the length of time that a person can be predicted to live Life span: the maximum years that a person has the potential to live “Families forget their older relatives … most people become senile in old age … Social Security provides every older person with a decent retirement income … a majority of older people reside in nursing homes … Medicare covers all health care–related costs for older people.” These and other myths continue to be perpetuated about older people. Misinformation about the older population is an injustice not only to this age group but also to persons of all ages who need accurate information to prepare realistically for their own senior years. Gerontological nurses must know the facts about the older population to effectively deliver services and educate the general public. 44 45 VIEWS OF OLDER ADULTS THROUGH HISTORY The members of the current older population in the United States have offered the sacrifice, strength, and spirit that made this country great. They were the proud GIs who served in wars, the brave immigrants who ventured into a new country, the bold entrepreneurs who took risks that created wealth and opportunities for employment, the campus rebels who advocated for the rights of minorities, and the unselfish parents who struggled to give their children a better life. They have earned respect, admiration, and dignity. Today, older adults are viewed with positivism rather than prejudice, knowledge rather than myth, and concern rather than neglect. This positive view was not always the norm, however. Historically, societies have viewed their elder members in a variety of ways. In the time of Confucius, there was a direct correlation between a person’s age and the degree of respect to which he or she was entitled. The early Egyptians dreaded growing old and experimented with a variety of potions and schemes to maintain their youth. Opinions were divided among the early Greeks. Plato promoted older adults as society’s best leaders, whereas Aristotle denied older people any role in governmental matters. In the nations conquered by the Roman Empire, the sick and aged were customarily the first to be killed. And, woven throughout the Bible is God’s concern for the well-being of the family and desire for people to respect elders (Honor your father and your mother … Exodus 20:12). Yet, the honor bestowed on older adults was not sustained. Medieval times gave rise to strong feelings regarding the superiority of youth; these feelings were expressed in uprisings of sons against fathers. Although England developed Poor Laws in the early 17th century that provided care for the destitute and enabled older persons without family resources to have some modest safety net, many of the gains were lost during the Industrial Revolution. No labor laws protected persons of advanced age; those unable to meet the demands of industrial work settings were placed at the mercy of their offspring or forced to beg on the streets for sustenance. The first significant step in improving the lives of older Americans was the passage of the Federal Old Age Insurance Law under the Social Security Act in 1935, which provided some financial security for older persons. The profound “graying” of the population started to be realized in the 1960s, and the United States responded with the formation of the Administration on Aging, enactment of the Older Americans Act, and the introduction of Medicaid and Medicare, all in 1965 (Box 1-1). Box 1-1 Publicly Supported Programs of Benefit to Older Americans 1900 Pension laws passed in some states 1935 Social Security Act 1961 First White House Conference on Aging 1965 Older Americans Act: nutrition, senior employment, and transportation programs Administration on Aging Medicare (Title 18 of Social Security Act) Medicaid (Title 19 of Social Security Act) for poor and disabled of any age 46 1972 Supplemental Security Income (SSI) enacted 1991 Omnibus Budget Reconciliation Act (nursing home reform law) implemented Since that time, American society has demonstrated a profound awakening of interest in older persons as their numbers have grown. A more humanistic attitude toward all members of society has benefited older adults, and improvements in health care and general living conditions ensure that more people have the opportunity to attain old age and live longer, more fruitful years in later adulthood than previous generations (Fig. 1-1). FIGURE 1-1 • It is important for gerontological nurses to be as concerned with adding quality to the lives of older adults as they are with increasing the quantity of years. 47 CHARACTERISTICS OF THE OLDER ADULT POPULATION Older adults are generally defined as individuals aged 65 years and older. At one time, all persons over 65 years of age were grouped together under the category of “old.” Now it is recognized that much diversity exists among different age groups in late life, and older individuals can be further categorized as follows: young-old: 65 to 74 years old: 75 to 84 years oldest-old 85+ The profile, interests, and health care challenges of each of these subsets can be vastly different. For example, a 66-year-old may desire cosmetic surgery to stay competitive in the executive job market; a 74-year-old may have recently remarried and want to do something about her dry vaginal canal; an 82-year-old may be concerned that his arthritic knees are limiting his ability to play a round of golf; and a 101-year-old may be desperate to find a way to correct her impaired vision so that she can enjoy television. In addition to chronological age, or the years a person has lived since birth, functional age is a term used by gerontologists to describe physical, psychological, and social function; this is relevant in that how older adults feel and function may be more indicative of their needs than their chronological age. Perceived age is another term that is used to describe how people estimate a person’s age based on appearance. Studies have shown a correlation between perceived age and health, in addition to how others treated older adults based on perceived age and the resultant health of those older adults (Sutin, Stephan, Carretta, & Terracciano, 2014). How people feel or perceive their own age is described as age identity. Some older adults will view peers of similar age as being older than themselves and be reluctant to join senior groups and other activities because they see the group members as “old people” and different from themselves. Any stereotypes held about older people must be discarded; if anything, greater diversity rather than homogeneity will be evident. Further, generalizations based on age need to be eliminated as behavior, function, and self-image can reveal more about priorities and needs than chronological age alone. COMMUNICATION TIP Not all persons of the same age will be similar in terms of language style, familiarity with current terms, use of technology, education, and life experience. Communication style and method must be based on assessed language competency, style, and preference of the individual. 48 49 Population Growth and Increasing Life Expectancy There was a significant growth in the number of older people for most of the 20th century. Except for the 1990s, the older population grew at a rate faster than that of the total population under age 65. The U.S. Census Bureau projects that a substantial increase in the number of individuals over age 65 will occur between 2010 and 2030 due to the impact of the baby...