Public Health Priorities for an Aging Society

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1 Public Health Priorities for an Aging Society Steven P. Wallace, Ph.D. Professor, UCLA School of Public Health Associate Director, UCLA Center for Health Policy Research Chair, Gerontological Health Section, APHA

2 Part 1 Demographics of Aging & the Growth of the Elderly Population Photo from Aging Magazine, AoA

3 Population, Number by Age Number of elderly will double in next 30 years age < =69.4 million =34.7 million elderly < age 8> Source: 0 U.S. 0 Bureau 0 of the 0 Census, 0 p & 1 historical 1 statistics

4 Decline in fertility & increased age of motherhood Fertility rate & mother s age of first birth Births/1000 women age Mean age of first birth SOURCE: NCHS,

5 Concentration of Death in Old Age In 1900, 41% live to old age, in % do Source: United States Life Tables, NCHS 2004.

6 Voting Rates by Age, U.S Do you need to be worried about the elderly vote? % registered % voted 58.9% 66.8% 71.8% 75.6% 60.1% 78.6% 77.3% 65.1% 60.0% 53.4% 43.0% 44.8% 31.8% 19.3% SOURCE: Voting & Registration of the Election of November July U.S. Census Bureau

7 Voting by Age & Race, CA 2004 & % of electorate in each group Statewide vote = Kerry 55%, Bush 44% 84% Kerry Bush 61% 38% 54% 44% 52% 47% 57% 42% 68% 31% 64% 35% 52% 47% 14% (29%) 65+ (12%) ages (20%) (39%) black (7%) latino (14%) asian (9%) white (65%) Source: LA Times, November 4, 2004, p. B9

8 Minority Elderly Population Number minority elderly will triple - Latinos largest group in American Indian Latino 2000=5.6 million total Asian/Pac Islander African American 2030=17.6 million total African American Latino Asian/Pac Islander American Indian Source: U.S. Bureau of the Census, p

9 Characteristics of California Elderly Socioeconomic Status, Persons Age 65 and over 24.8% 28.6% 20.5% 16.9% 8.1% 3.2% Living Alone In Nursing home Ltd English Proficient On Medi-Cal SOURCE: UCLA Center for Health Policy Research, Health of Older Californians, Poor Poor+Near Poor

10 Characteristics of California Elderly Health Risks, Persons Age 65 and over 53.5% 37.2% 16.6% 8.0% Smokes Obese (BMI>=30) Sedentary SOURCE: UCLA Center for Health Policy Research, Health of Older Californians, 2003.; Data from Califormia Health Interview Survey, 2001 Hypertension

11 Characteristics of California Elderly Health Conditions, Persons Age 65 and over 23.7% 17.3% 14.8% 10.3% Heart disease Cancer, not skin Diabetes SOURCE: UCLA Center for Health Policy Research, Health of Older Californians, 2003.; Data from Califormia Health Interview Survey, 2001 Asthma

12 Leading Causes of Death Persons Age 75-84, U.S male 1950 male 1999 female 1950 female 1999 Rates per 100,000 population Heart disease CBV Cancer COPD UCLA Center for Health Policy Research Source: Health U.S., 2002, NCHS, tables 37-39

13 Characteristics of California Elderly Nonfatal Health Conditions, Persons Age 65 and over 50.0% 23.4% 11.5% Arthritis Functional limits (stairs) SOURCE: UCLA Center for Health Policy Research, Health of Older Californians, 2003.; Data from Califormia Health Interview Survey, 2001 Mental Health Impairs Activities

14 Nonfatal hospitalized injuries, California Age 65+ /100k Age 0-64 /100k suicide falls auto-passenger poison

15 Characteristics of California Elderly Health Services Use, Persons Age 65 and over 32.8% 32.0% 23.7% 21.8% 12.4% No Flu Shot 1 yr No Mammogram 3 yrs Delay in Care No Dental Visit 1 yr ER Visit 1 yr SOURCE: UCLA Center for Health Policy Research, Health of Older Californians, 2003.; Data from Califormia Health Interview Survey, 2001

16 Part 2 Why Public Health?

17 What is Public Health? Fostering the conditions under which people can be healthy Prevention focus Population focus Health vs. Disease Focus

18 Healthy People 2010 National Health Promotion & Disease Prevention Goals Increase the span of healthy life Reduce health disparities

19 National Public Health Week 2005 Empowering Americans to Live Stronger, Longer Defend from illness & injury immunizations, follow medication advice, prevent accidents, diet/exercise/tobacco Detect Cancer, diabetes, glaucoma, hearing loss Direct (Manage, reverse illness effects) Follow treatment regimen, get help paying for drugs Health Department action HRA-e

20 Part 4 What Can the Public Health & Aging Networks Do?

21 Intervention Levels Primary, Secondary & Tertiary Prevention Society - policy Institutions Individuals

22 Geriatric Issues Foster the conditions under which people can be healthy Healthy Aging Urinary incontinence Falls Polypharmacy, Depression, Oral health Support for informal caregivers Healthy Death

23 Very Important for meaningful life 88% 86% Persons age 65 and over 67% 38% 32% Family & Friends Health Spiritual Life Community New Learning Source: NCOA, American Perceptions of Aging in the 21st century

24 Promoting Social Ties Fosters an engagement with life Individual Promote lifelong learning, new interests Facilitate communications among family Organizational Be responsive to both age segregated and intergenerational programming Social Assure sufficient resources Value full range of seniors contributions, not just those that mimic paid jobs

25 Geriatric Issues Foster the conditions under which people can be healthy Healthy Aging Urinary incontinence Falls Polypharmacy, Depression, Oral health Support for informal caregivers Healthy Death

26 Urinary Incontinence, US, 1999 Lost urine beyond respondent s control past year 48.2% 32.6% 33.9% 24.7% 18.4% 11.3% Men Source: 1999 Medicare Current Beneficiary Survey Women

27 Untreated urinary incontinence heightens the risk of Stigma, embarrassment social isolation, depression, infection loss of sleep with daytime somnolence deconditioning, falls and associated fractures, nursing home admission out of pocket costs for continence supplies increased landfill demand

28 Environmental Impact Impact of incontinence supplies on landfill SB204 (Perata) findings: It is estimated that personal care products represent somewhere between 1-1/2 and 3 percent of the materials disposed of in landfills in California. This means that personal care products are among the largest single product disposed of in landfills. According to the EPA, nearly 20 billion disposable personal care products containing 5 million tons of untreated human waste are disposed of in landfills each year.

29 UI Interventions Individual level Treat symptioms Burgio K, Locher J, et al. Behavioral vs. drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA 1998; 280(23): Organizational level Increase awareness & skills in medical care Societal level Destigmatize condition Start advocacy groups like AHA, ALA, Alz Assoc Include cost of diaper disposal in product

30 Geriatric Issues Foster the conditions under which people can be healthy Healthy Aging Urinary incontinence Falls Polypharmacy, Depression, Oral health Support for informal caregivers Healthy Death

31 Falls and the Elderly In 1998, more than 9,600 persons 65+ in the U.S. died from fall-related injuries, the #1 cause of injury death among the elderly. Hip fractures are among the most serious fall-related injuries. Half of older adults who fracture a hip never regain full functioning. Approximately 300,000 older adults suffer fall-related hip fractures each year. Over 1200 older adults each year go to the hospital because of falls injuries in Fresno.

32 Non-injury Falls 30% of elderly fall each year, half of them more than once falls and associated fear of falling frequently also lead to reduced activity & social isolation and, consequently, impaired function

33 Preventing falls Correct problems at multiple levels... Individual level Medical conditions - stroke, vision/hearing loss Deconditioning, gait/balance problems Organizational level Medications (psychotropics) / polypharmacy Provide appropriate assistive devices Social-community level Environment - poor lighting, uneven floors Promote community-level advocacy Rizzo J, Baker D, McAvay G, Tinetti M. The cost-effectiveness of a multifactorial targeted prevention program for falls among community elderly persons. Medical Care 1996; 34(9):

34 Geriatric Issues Foster the conditions under which people can be healthy Healthy Aging Urinary incontinence Falls Polypharmacy, Depression, Oral health Support for informal caregivers Healthy Death

35 Age and ADL Difficulty 55.5% 41.9% 35.7% 24.5% 22.7% 27.5% 30.1% 16.9% &up male female

36 Who Helps Disabled Elderly at Home Includes primary and secondary caregivers Professional 30% Spouse 24% Sibling 2% Other 3% Daughter 20% Son 6% Other female 10% Other male 4% Source: 1994 National Caregiver Survey (AARP Report)

37 Support for Caregivers 1993 Family & Caregiver Leave Act Six weeks unpaid leave 2000 National Family Caregiver Support Program $125 million Information to caregivers about available services; Assistance to caregivers in gaining access to services; Individual counseling, organization of support groups, and caregiver training to assist caregivers in making decisions & solving problems relating to caregiving roles; Respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities; and Supplemental services, on a limited basis, to complement the care provided by caregivers.

38 Community Based LTC barriers Immigrants Highest 35% 30% 25% US Born NonLatino whites US Born Mexican Americans Mexican American Immigrants 20% 15% 10% 5% 0 Didn't know existed Costs Didn't want welfare No help to call Staff not speak Spanish

39 Geriatric Issues Foster the conditions under which people can be healthy Healthy Aging Urinary incontinence Falls Polypharmacy, Depression, Oral health Support for informal caregivers Healthy Death

40 Healthy aging includes a healthy death Minimal pain Following directions of elderly and/or family In comfortable setting

41 National Public Health Week 2005 Empowering Americans to Live Stronger, Longer Defend from illness & injury immunizations, follow medication advice, prevent accidents, diet/exercise/tobacco Detect Cancer, diabetes, glaucoma, hearing loss Direct (Manage, reverse illness effects) Follow treatment regimen, get help paying for drugs Health Department action HRA-e

42 Conclusions The older population is growing rapidly Public Health and Gerontology need to work together to address health needs of older persons Traditional target conditions Older adult specific issues We can add life to years-not just years to life Primary, secondary & tertiary prevention At the individual, organizational, and societal levels

43 A Few Resources Health of Older Californians: County Data Book AskCHIS - query system, at county level Improving the Care of Older Adults with Common Geriatric Conditions (AAHP Foundation, Washington, DC, Feb. 2002) Aging States Project APHA Gerontological Health Section

Health Policy Research Brief

Health Policy Research Brief May 2010 Older Californians At Risk for Avoidable Falls Steven P. Wallace, Nadereh Pourat, Eva Durazo and Rosana Leos More than a half million older Californians (565,000)