Chapter 1
The Aging Population
Terms to Know
Comorbidity: the simultaneous presence of multiple
chronic conditions
Compression of mortality: 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
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Introduction
Myths of aging
Misinformation as an injustice
Role of the gerontological nurse:
o Know the facts
o Educate the public
o Care for the older adult
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Views of Older Adults Through History
Current older population offered sacrifice, strength,
and spirit making the country great
Older adults currently viewed with
o Positivism versus prejudice
o Knowledge versus myth
o Concern versus neglect
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Views of Aging by Societies
Confucius: correlation of age and respect
Chinese: attaining old age was an accomplishment
Egyptians: dreaded growing old
Greeks: struggles between the old and the young
Ancient Romans: limited respect for elders
The Bible: well-being of family; desire to respect
elders
Medieval times: rise of superiority of youth
Industrial revolution: persons of advanced age left
unprotected
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Historical Changes for Older Adults
1900: Pension laws passed in some states
1935: Social Security Act
1961: First White House Conference on Aging
1965: Older Americans Act
o Administration on Aging
o Medicare and Medicaid
1972: Supplemental Security Income (SSI)
1991: Omnibus Budget Reconciliation Act (OBRA)
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Question #1
Is the following statement true or false?
The first significant step in improving the lives of older
adults during the 20th century was the introduction of
Medicare and Medicaid.
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Answer to Question #1
False
Rationale: The first significant step in improving the
lives of older adults was the passage of the Federal
Old Age Insurance Law under the Social Security Act
in 1935. Medicare and Medicaid were introduced in
1965.
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Characteristics of the Older Adult
Population #1
Young-old: 60 to 74 years
Middle-old: 75 to 84 years
Oldest-old: 85+
Profile, interests, and health care challenges vary
with each group.
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Characteristics of the Older Adult
Population #2
Chronological age
o Years lived since birth
Functional age
o Physical, psychological, and social function
Perceived age
o How others estimate age based on appearance
Age identity
o How people feel or perceive their own age
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Population Growth and Increasing Life
Expectancy
 Persons 65+ years currently represent more than 16% of the
U.S. population.
 By 2030, older adults will grow to 20% of the population.
 Life expectancy has increased:
o 1930: 59.7 years
o 1965: 70.2 years
o Present: 78.7 years
 Population over 85 years expected to double by 2040.
 Maximum life span currently believed to be 122 years for
humans.
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Factors Influencing Increased Life
Expectancy
Advancements in disease control and health
technology
Lower infant and child mortality rates
Improved sanitation
Better living conditions
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Life Expectancy: Race and Gender
In 2017, by Race, Sex, and Hispanic Origin
Race
Male
Female
White
76.4
81.2
Black
71.9
78.5
Hispanic (any race)
79.1
84.3
Gap widening between white people and black
people
o Nurses should be concerned with health and societal
issues.
Gap narrowing between males and females
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Compression of Morbidity
Hypothesis advanced by James Fries
Suggests if onset of serious illness and decline
would be delayed, or compressed, into few years
prior to death, people could live a long life and
enjoy a healthy, functional state for most of their
lives
More years of life means little if they consist of
discomfort, disability, and poor quality of life
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Marital Status and Living Arrangements
Half of women over 65 are widowed.
The majority of men are married.
Most older adults live with spouse or other family
member.
Twice the number of women than men live alone in
later life.
The potential for living alone increases with age of
both men and women.
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Income
Percentage of older adults living below the poverty
level has declined.
Most depend on Social Security for more than half of
their income.
High prevalence of home ownership by older adults.
o “Asset rich and cash poor”
Women and minority groups have less income than
white men.
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Employment and the Older Adult
Population
Percentage of older workers in labor force declining
Men leaving workforce at earlier age
Number of middle-age women employed increasing
Baby boomers desire to continue to work at the age
of retirement
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Question #2
“Asset rich and cash poor” relates to which of the
following statements regarding older adults?
A. Net worth of older adults is half the national
average of middle-age adults.
B. Homes are paid for, but there is not enough
money available for monthly expenses.
C. The majority of older adults live below the
poverty level.
D. Financial problems in the older adult population
are due to level of debt.
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Answer to Question #2
B. Homes are paid for, but there is not enough money
available for monthly expenses.
Rationale: Median net worth of older households is
nearly twice the national average because of the high
prevalence of home ownership, but many older adults
are “asset rich and cash poor”—they live in a house
that has appreciated in value over the years, but they
barely have sufficient monthly income to meet basic
expenses.
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Health Insurance
Medicare: health insurance program
o Part A: hospital and other services
o Part B: medical visit services and other services
o Part C: Medicare Advantage Plans
o Part D: drug plan
Medicaid: state and federally funded
Affordable Care Act: expanded Medicaid
Long-term care insurance
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Health Status
 Chronic illnesses are major problems.
 Most older adults have at least one chronic illness or comorbidity
 Chronic conditions limit ADLs and IADLs: major source of disability.
 Leading chronic conditions:
1. Hypertension
2. High cholesterol
3. Arthritis
4. Ischemic heart disease
5. Diabetes
6. Chronic kidney disease
7. Heart failure
8. Depression
9. Alzheimer’s disease and dementia
10. Chronic obstructive pulmonary
disease
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Leading Causes of Death
 Diseases of the heart
 Malignant neoplasms
 Chronic lower respiratory diseases
 Cerebrovascular disease
 Alzheimer’s disease
 Diabetes mellitus
 Accidents (unintentional injury)
 Influenza and pneumonia
 Nephritis, nephrotic syndrome, and nephrosis
 Parkinson’s disease
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Implications of an Aging Population
Increasing need for gerontological nurses.
Health and social agencies must anticipate future
needs.
Government payment of services in jeopardy in age
of budget cuts.
Baby boomers are the next wave of older adults.
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Baby Boomers
Individuals born between 1946 and 1964
January 1, 2011, beginning of baby boomers turning
65
Diverse group
Better educated
Enamored with “high-tech” products
Inventors of “fitness movement”
Informed consumers
Will demand changes in long-term care
Blended families
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Provision of and Payment for Services
Higher rates of hospitalization, surgery, and
physician visits
o Paid by federal dollars, most often
Less than 5% of older adults live in a nursing home,
assisted living, or other institutions
Approximately 1 in 4 older adults will spend time in
nursing home
Most Medicaid budget spent on long-term care
Long-term care payment
Role of the gerontological nurse
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Gerontological Nurses
Need to be advocates in ensuring that costcontainment efforts do not jeopardize the welfare of
older adults
Actively involved in discussions and decisions
Assume leadership in developing cost-effective
methods of care delivery
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Question #3
Is the following statement true or false?
Chronic disorders most prevalent in the older adult
population are ones that can have a significant impact
on independence and the quality of life.
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Answer to Question #3
True
Rationale: Chronic illness is a major problem for the
older population and results in limitations in ADLs,
IADLs, and quality of life.
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