Overview

Complex Care Needs of Older Adults

Growing Older Adult Population

The surge in the older adult population in the United States is a well-known trend. Adults in the Baby Boom generation are beginning to reach retirement age, and advancements in medical care, along with a greater focus on healthy living, are extending lives. Between 1990 and 2006 life expectancy for the total population went from 75 to 78 years. In fact, many older adults live well into their 80s and 90s. By the year 2030, 71 million adults—20 percent of the total population—will be 65 or older, and 7 million will be age 85 and older, a number projected to jump to 19 million by 2050.¹ Women remain the majority of adults age 65 and older, especially among those 85 and older, a trend that will most likely continue.

In addition to the rapid growth in the older population as a whole, there also is increased diversity among this group. Older adults who are African-American, Latino, Asian, or Native American currently account for 19 percent of all adults over age 65. By 2030, older adults of color will form 33 percent of the older adult population.²,³ The number of lesbian, gay, bisexual, or transgender older adults is currently estimated to be one to three million; this will grow to two to six million by 2030.⁴

“The current and future realities of the demographic shift epitomize the need for geriatric-trained social workers,” says James Lubben, DSW, MPH, The Louise McMahon Ahearn University Chair in Social Work and the Director of the Institute on Aging at Boston College.

Older Adults have Complex Health, Economic, and Social Needs

Older adults today tend to be healthier and more active than previous generations. Yet older adults are a diverse group. While some are healthy and active, others have chronic or serious acute illnesses or functional difficulties. Even healthy and active older adults have periodic health issues.

In addition, some older adults have sufficient resources, while others struggle financially. Some have strong support networks of family and friends living nearby, while others are more isolated. Few people completely escape the physical effects of aging that usually necessitate more trips to the doctor and increasing use of all types of health care services.

Older adults use more health care services than any other age group. Over 80 percent of adults 65 and older have at least one chronic health condition, such as heart disease, diabetes, cancer, or arthritis, and one-half have two or more chronic conditions.⁵,⁶ People over age 85 are more likely to have chronic illnesses that affect their daily activities and require health care, long-term care, and other support services. The incidence of Alzheimer’s disease and other forms of dementia increases with age.

Older adults, especially those with multiple chronic health conditions, often take several prescription drugs and are likely to see numerous physicians and other health care providers in different specialties. Older adults often experience hearing and vision impairments and may have difficulty walking.

Physical problems aren’t the only consequence of aging. Some older adults suffer with depression, other mental health issues, or addictions, and some become homebound or isolated. According to the National Institute of Mental Health, between one and five percent of older adults living in their homes suffer with major depression, as do 13.5 percent of those who require home health care and 11.5 percent of older hospitalized patients. An estimated 5 million adults over age 65 have symptoms of depression that put them at risk for developing major depression.⁷

Even older adults who don’t experience serious medical or psychological problems must cope with issues involved in the transitions of older age. These people may benefit from retirement counseling, grief or mental health counseling, or long-term care planning.

Socioeconomic Factors Impact Aging

For many older adults the physical effects of aging are compounded by other factors. “Gender, race, ethnicity, social class, and sexual orientation intersect in ways to create subpopulations of older adults who face more challenges in their lives than others,” says Nancy R. Hooyman, PhD, MSW, who holds the Nancy R. Hooyman Endowed Professorship in Gerontology and is Dean Emeritus, School of Social Work, University of Washington, Seattle. For example, women and elders of color, along with the oldest members of the population face the highest rates of chronic illnesses such as diabetes, hypertension, stroke, and heart disease.

Regardless of their gender, race, or financial situation, as people age, they often require increasing assistance with day-to-day living, including negotiating the complex health care system. Traditionally, family members step in to help out. However, some older adults don’t have a support network of family and friends. Even for those who do have help from family members, navigating the fragmented, poorly coordinated health care and social systems can be daunting and time-consuming. Most people lack the comprehensive knowledge to understand the multiple medical, psychological, social, and financial needs of their older parent or loved one. And few older adults and their family members are aware of all the services available to them and how they interconnect.

While Social Security and Medicare have been tremendously effective in reducing the proportion of older adults technically in poverty (now just over 10 percent), older adults are disproportionately on limited incomes, with 40 percent either poor or nearly poor (as compared to 32 percent of the population in general). Some segments of the older adult population, such as people of color and women, are particularly vulnerable.

In general, women receive lower Social Security payments than men, due in part to lower wages and the likelihood of spending several years out of the labor force to be caregivers. Twice as many women as men age 65 and older are poor. Nearly three times as many older African-Americans and more than twice as many Latino elders are poor compared to their Caucasian counterparts. Poverty typically translates into disparities in access to health care. It can also lead to poor nutrition, which can adversely affect health.

People with fixed and limited incomes are often eligible for public programs, such as Medicaid, Food Stamps, and others, as well as assistance from nonprofit organizations. However, the dizzying array of services along with their often complex application requirements can lead to underuse unless professionals such as social workers with expertise in understanding these programs are available to assist.

1. Bureau of the Census, Current Population Reports, P23-178RV (May1993) and P25-1104 (Nov 1993).
2. Administration on Aging. (2008). A profile of older Americans: 2008. Washington, DC: U.S. Department of Health and Human Services.
3. U.S. Census Bureau. (2006). Population Division, interimstatistics. Population projections by age: 2005. http://www.census.gov/population/projections/52PyrmdUS1.pdf
4. Blank, T.O. (2006). Gay and lesbian aging: Research and future directions. Educational Gerontology, 32, 241-243.
5. MedPAC (Medicare Payment Advisory Commission). Report to the Congress: Increasing the Value of Medicare. Washington, DC: MedPAC. 2006.
6. Wolf J.L., Starfield B., & Anderson G. Prevalence, expenditures,and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine. 2002. Vo. 162, Number 20, pp. 2269-2276.
7. Hybels C.F. & Blazer D.G. Epidemiology of late-life mental disorders. Clinics in Geriatric Medicine, 19(Nov. 2003):663-696.

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