Aging in Place
Judith L. Warren, Ph.D.
Professor and Gerontology Specialist
Texas Cooperative Extension
Texas A&M University System
September 2003
Demographics of Aging in America
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Increasing numbers of older adults
Migration to sunbelt
Out-migration of youth in rural areas
Aging in place
Gender and income
Increasing Hispanic population
Household configuration
Education
Health and healthcare access
Core Issues in an Aging Rural Society
• Economic Development/Human Capital
– Work and Volunteer Issues
– Careers in an Aging Society
• Independent Living
– Housing and Services
– Chronic Health Conditions
• Elder Care
– Formal and Informal
– Family Caregiving
Percent of Population by Age Group:
2003 – 2050
80
70
60
0-54
55-64
65-74
75-84
85+
50
40
30
20
10
0
2003
2020
2050
Source: U.S. Census Population Projections
Greatest Growth in Old-Old
85+ Age group increased 38% between
1990/2000
95+ Age group increased 34.7%
Centenarians (100+)
• 1990 - 37,306
• 2000 – 50,454
• Greatest # live in New York and California
• Greatest % live in South Dakota and Iowa
States With Highest
Proportion of 65+ (2000)
Florida
17.6%
South Dakota
14.7%
North Dakota
14.3%
Pennsylvania
15.6%
Rhode Island
14.5%
Arkansas
14%
West Virginia
15.3%
Maine
14.4%
Iowa
14%
Baby Boomers are all
in the same state
“the state of denial”
Age 65+ Males per 100 Females
• Ratio declines with each
age group
• Increase in male to
female ratio since 1990
65+
65-74 • Are men getting
healthier?
75-84
85+
• Are women at increased
health risk?
90
80
70
60
50
40
30
20
10
0
1990
2000
Poverty Levels: 1959 & 1998
35
30
25
20
65+
Under 18
15
10
5
0
1959
1998
Sources of Income & Net Worth
• Main source continues to be Social
Security and Pensions
• Between 1984 and 1999, the median
net worth for 65+ head of households
increased by 69%; for 45-64 – it
declined by 23%
• 1999 Median for White - $181,000;
for African Americans - $13,000
Labor Force Participation
90
80
70
60
55-61
62-64
70+
50
40
30
20
10
0
1963
1999
• Decline in
participation rates
• Most decline
occurred prior to
1980
• Today, 8-10 boomers
expect to work part
or full time
• Under $30,000
income -1/5th of
boomers are at risk
Percent of U.S. Population by
Race & Hispanic Origin
80
70
60
50
Caucasian
African Amer.
Hispanic
Other
40
30
20
10
0
2003
2020
2050
Percent of Population Over 65
by Race & Hispanic Origin
90
80
70
60
Caucasian
African Amer.
Hispanic
Asian/Pacif. Is.
Am. Indian/Alask.
50
40
30
20
10
0
2000
2050
Marital Status of 65+ (1998)
9
8
7
6
5
4
3
2
1
0
65-74
75-84
85+
Male, never Female,
married
never
married
Male,
Divorced
Female,
Divorced
Living Arrangements For 65+
80
70
60
Live with spouse
50
Live with other
relative
Live with non-relative
40
30
20
Live alone
10
0
Men
Women
White
Other
Women Women
Household Type & Expenditure
• In 2000, 25.8% householders lived alone;
9.2% of these householders were over 65.
• 21% of all household units were over 65
years of age: 10.9% 65-74; 7.8% 75-84; and
85+ 2.3%.
• Housing burden varies by income with the
bottom 1/5th of the median household
income spending 36% and the top 1/5th
spending 26% of their income on housing.
Educational Attainment of 65+
(1998)
80
70
60
50
Non-Hispanic White
Non-Hispanic Black
Hispanic
Asian/Pacific Isl.
40
30
20
10
0
High School
Bachelor's Degree
Chronic Health Issues of Older Adults
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Arthritis
Diabetes
Hypertension
Chronic Sinusitis
Vision
Osteoporosis
Hearing
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Varicose Veins
Heart Disease
Deformity/Other
Emphysema
Dementia
34% are affected by
more than 1
condition
Chronic Diseases, Complications
and Disability Will Increase
• Today, obesity affects 20-30% of 4th graders;
50% of 9th & 10th graders
• 2010: 50% of 20-30 year olds will have
diabetes
• 2020: 50% of 30-40 year olds will have
complications and disability
• 2020: 50% loss in workforce; 50% depend
on Medicare/Medicaid/disability income
Functional Limitations in 85+
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Walking
Getting outside
Bathing
Transferring
Dressing
Using toilet
35%
45%
30%
22%
17%
14%
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Eating
Preparing Meals
Managing $$
Using the phone
Light housework
4%
28%
26%
21%
31%
Percentage of Total Out-of-pocket
Expenditures Allocated to Health Care in
Households Headed by Persons 65+
16
14
Income Level
12
Lowest Fifth
Second Fifth
Third Fifth
Fourth Fifth
Highest Fifth
10
8
6
4
2
0
1987
1994
1998
Source: Consumer Expenditure Survey, Non-Institutionalized Elderly,
Chartbook 2000, U. S. Census
Percent of Elderly in Nursing Homes
25
20
All 65+
65-74
75-84
85+
15
10
5
0
1990
2000
Caregiver Profile
• Est. 45-52 million individual caregivers
• 10-25% of population provides care
• Women represent 74% of primary
caregivers
• Spouses provide 36% of care;
daughters 29% and sons, 8%
• Average caregiver 63 years old
• 69% live with care recipient
Grandparent Caregiving
• 11% of grandparents care for
grandchildren for at least 6 months
• At least 55% of children in relative care
live with a grandparent
• 77% are female grandparents
• 62% are non-Hispanic white
• Factors increasing chance for raising
grandchildren: poverty level; being
African-American; and divorce, drug
abuse or incarceration of child’s mother
The Two America’s of
Retirement Security
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More Secure
Steady employment
Married, dual income
Employer pension
401(k) plan
Health insurance
Home equity
Long-term investments
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Less Secure
Intermittent
employment
Divorced or single
No pension
No 401K
No health insurance
Rent
No long-term
investments or savings
for emergencies
Core Issues in an Aging Rural Society
• Economic Development/Human Capital
– Work and Volunteer Issues
– Careers in an Aging Society
• Independent Living
– Housing and Services
– Chronic Health Conditions
• Elder Care
– Formal and Informal
– Family Caregiving
Economic Development
& Human Capital
• Rural mainstays: schools, nursing homes,
hospitals, small businesses
• Long-term care jobs at poverty or near-poverty
level; 92% turnover in Nurse Aides; Frontline
caregivers increasingly non-English speaking
• Aging workforce:
– 22% eligible to retire in 2005
– Greater proportion of health care professionals are
55+ than other occupations
– Increased need for geriatric training
Work & Financial Security
• Leading economic indicator of family
hardship not unemployment but no
health insurance
• 2/3 of working poor have no health
insurance
• Personal savings remain low compared
to other developed countries
Independent Living
• Housing
• Services
1997 Title III Service Use
• Lower usage rates in rural vs. urban
areas
• Rural, non-Hispanic Black elders
participate at disproportionately higher
rates than other 60+ users
• Non-white Hispanic elders participate at
disproportionately lower rates than
other 60+ users
Independent Living
• Prevent Chronic Disease
• Managing Chronic Disease
Elder Care
• Formal and Informal Care
• Family Care
Summary
• We are an Aging Society-undeniably
• Economic disparity between population
segments continues to grow affecting health
and quality of life outcomes
• Disparity between rural and urban areas
continues with high percentages of elders in
rural areas and a declining economic base
• Rural areas have opportunities to focus on
health and care solutions
• Public policies are needed which reward
disease prevention and foster smaller scale
eldercare solutions