Social Justice and the Elderly
One of the Last Discrimination
Battles to be Fought!
Ageism in US Culture
• Botox and Viagra sales tripled over past 5
years
• Micro-print on Insulin Syringes & prescription
bottles and information
• Most common concern of elders – cognitive
loss
• Two most common responses by HCPs, family
members, and social networks….
• Productivity is #1 value on the job
Elders are the Primary Consumers of
Health Care Resources
• Elders are 12% of the population BUT they
account for
– 26% of all office visits
– 35% of all hospital stays
– 34% of all prescriptions
– 38% of all emergency response calls
– 90% of all LTC stays
• The % of elders will go from 12% to 20% in the
next 15 years
Number of Elders Using Medicare is on
the Rise
• 2000 – 35% used Medicare as primary
• 2010 – 51% used Medicare as primary
The Number of MD Taking New
Medicare Patients is RAPIDLY
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2008 – 73% MDs took Medicare
2009 – 50% MDs took Medicare
2011 – 35% MDs are taking new Medicare
2011 – MDs are opting out of Medicare
because of the proposed 20% cut possibility
• % worse for primary care MDs
• In NY even the president of the medical
association is not taking new Medicare clients
Specialized Training in Geriatrics is
NOT
• # of PC-MDs
rapidly!
• # of Geriatrics specialists
– Now only 7000 in the US
– Down 20% from 2000
• # Geropsychiatrists
– Now 1 geriatric psychiatrist for 11,000
– 2030 it will be 1:22,000
• <1% Health care professionals receive
specialized geriatric training
Drug Research is Primarily Conducted
on Younger Adults
• There are known changes in body chemistry
with aging
• There are known drug/drug interactions with
increasing age
• There is increased toxicity risks with increasing
age
• There are dosage problems with many meds
with increasing age
Drugs that can affect
cognition
• Anti-arrhythmic agents
• Antibiotics
• Antihistamines decongestants
• Tricyclic
antidepressants
• Anti-hypertensives
• Anti-cholinergic agents
• Anti-convulsants
• Anti-emetics
• Histamine receptor
blockers
• Immunosuppressant
agents
• Muscle relaxants
• Narcotic analgesics
• Sedative hypnotics
• Anti-Parkinsonian
agents
Washington Manual Geriatrics Subspecialty Consults edited by Kyle C. Moylan (pg 15) – published by
Lippencott, Wilkins & Williams , 2003
Pain Management
• Comparing patients with dementia and
without dementia admitted for hip fx repair
– Same number of procedures
– Same types of procedures
– ¼ the pain medications
– 3 times the antipsychotics
Some Stats and Info of Note
• Feeding tubes are still be placed
– 50% (more for African-American, NH residents)
got new tubes
– 17% kept tubes
– Feeding tube placement did not affect outcome
– Having an infection coming in did worsen risk for
death
– Average survival with or without a feeding tube
was 6 months
First Line Treatment for Symptoms of
Discomfort
• For infants and small children?
• For young adults after MVA or sports injury?
• For elders with dementia?
Transportation for Living In the US
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Options
Requirements
Expectations
Alternatives
Housing Options
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Options
Role of personal choice
What happens to ‘sick elders’?
What happens to those with limited funds –
Medicaid?
• What happens to those with dementia?
• What happens to those with limited funds,
health issues and dementia?
Family & Community Awareness
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Birthing classes
‘Parenting classes’
Caregiving classes for families?
Sandwich generation - Boomers
Baby Boomers
What’s Happening?
AND
Who Will Care for the
Boomers?
Who are the Boomers?
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People born between 1946 & 1964
The Post-WWII kids
The Pre-Vietnam War kids
The largest number of babies ever born in US
The first majority ‘town’ generation
76 million strong!!!
How are the BOOMERS now?
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45 – 60 years old
Used to having their own ‘private’ home
Used to working outside the home
Finished or finishing raising their kids
New grandparents
Still have at least one parent alive
Planning to retire & enjoy life
In better health than previous generations
What Happening to Boomers?
• We are the SANDWICH generation
– Supporting ‘late bloomers’ not totally out of the
nest
– Helping with grandchildren – time & care & money
– Still in the role of children for their parents (70-95
years old)
– Caregiving for parents who are beginning to fail
physically, emotionally, and mentally
This group…
• Has a history of more problems with money
management & time management
• Has been more mobile & flexible/less stable in
family & work & living locations
• Spiritually changed – ¼ less connected, ½ as
connected, ¼ more connected to a new group
• Less experience & contact with death – less
talking about it – not ready for it, deny it
What Does This Mean for Us as
Caregivers?
• There are two distinct groups
– Low socio-economic with less education
– Higher socio-economic with higher education
• Both groups are having problems
• Both groups are more challenged than ever
before
• Both groups are feeling the squeeze
Comparing the Two Groups
High Educational Group
Low Educational Group
• Expects care to be delivered
in the person’s home or in a
facility
• Expects to have $$$ help
with care programs or
government sources
• Expects to have options in
where and how care will be
delivered
• Has limited time for
caregiving & managing care
• Expects to care for the
person at home
• Expects there to be
government help
• Expects other family
members to help
• Has more medical
conditions and problems
themselves
• Has limited time for
caregiving & managing care
So What is Happening?
• Options for care tend to be limited AND
frequently do NOT match the majority of
expectations or needs
• The cost is much more than anticipated
• The funding sources are limited
• The care receivers do not have the same point
of view as the caregivers
• Medical, legal, financial, and social systems
are complicated and HARD to negotiate
What is happening to us?
• We are potentially…
– Working THREE jobs – parent, employee, caregiver
• (or FOUR – if the spouse or sibling has problems)
– Physically stressed out – working hard – not well
– Emotionally stressed out – too much to do
– Financially tapped out – demands on both ends
– Mentally drained – always facing problems
– Spiritually concerned – not sure they can keep on
– Socially isolated – don’t have time for friends
For Those in the Sandwich…
• Learn to set limits & live within them
• Take BREAKS – step away
• Get to know what YOU need to…
– Keep going
– Get re-energized
– Get or stay healthy – physically, mentally,
emotionally, cognitively, socially, & spiritually
• THEN START DOING IT!!!!!
Boomers as care receivers…
• They will be cared for by Generation X & Y
• They will expect more than previous
generations in care quality & options
• They will ‘know the system’
• They will want a lot for their money
• They will have trouble having the money they
need
• They will live longer than previous generations
Gen X & Y
Generation X – ‘Slackers’
• Born 1965-79
• 51 million
• Reacted negatively to
Boomers life style & work
behaviors
• Highly individualistic
• Dislike & distrust of formal
structures & rules
• Technologically smart
Generation Y – ‘Echo Boomers’
• Born 1980-2000
• Over 70 million
• Different social norms –’rude’
• Lots of action & attention
• Balance of FUN & work
• Less respect for ‘authority’
• High energy – job changer
• Save for self - future
• Obesity & diabetes on rise
Boomers as care receivers…
• There will be even more variation in what
people can afford and what they will expect
• They will want to have choices in care options
• They want to get their care in their preferred
setting
• They think they will stay healthy &
independent till very near the end of their
lives
OOPS!!!
• There are many more Boomers than Gen Xers
(76 vs 51 million)
• There are not enough resources & services for
the number of Boomers
• The cost of Boomer care is going to be very
high!
• The number of boomers with DEMENTING
illnesses is going to be very high
OOPS!
• Gen X & Y have different caregiving histories
and backgrounds – less experience
• Gen X & Y – more divorces & two income
families – even less time to give care
• Gen X & Y – are more transitory than Boomers
• Gen X– is WORSE with money and savings
than Boomers
• Gen Y – is saving for themselves
What Can We Do to Help
Ourselves?
• Reach Out and Find Out
• Talk about the future
• Get our own house in order
– Legal
– Financial
– Housing
– Physical health
– Mental & cognitive health
– Spiritual health
Financial Opportunities
• Discuss and decide on…
– Financial planning with an elder law expert
– Will & financial PoA
– LTC insurance
– Retirement
– Savings – Pensions – IRAs - Trusts
• Consider need for changes to have what you
want later… what you will need
Legal & Health Care Opportunities
• Talk with your significant others & decide:
– Plan ahead for probable health care needs
– Durable health care PoA
– Advance directives
– What types of care you want in what situations • Curative, restorative, maintenance, palliative
– What locations of care are available – pros & cons
CCRC
ALF
NH
SCALF
RH
Home care
FCH
Others
Housing Opportunities
• Private home with ‘universal design’
• Shared housing – caregiver space AND/OR
mother-in-law apartment
• Retirement/Senior community
• Multi-generational housing
• Apartments or condos
• Complexes with multiple levels of care on site
• Assisted living facilities or family care homes
Physical Health Opportunities
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Exercise
Diet
Chronic disease management
Health promotional activities & habits
Simple message
– Bring your numbers down and
– Bring your activity levels up
Mental – Cognitive Health
Opportunities
• Know what is normal & what is NOT
• Establish baselines for yourself on –
– Cognition
– Emotional well-being
– Stress levels
– Sleep patterns
• Get supported…
– Socialize, sleep enough, de-stress, use resources
Spiritual Opportunities
• Consider your spiritual needs & how to meet
them
• Learn about the latest thinking on later life
achievements and successful aging
• Talk about death & dying - the end of life
• Consider your role in connecting to others
• Find out about palliative care, hospice, sitting
vigil, life review and story telling
• Find a community of faith you can share
First Steps?
• Where are you? - What can you do?
• What should you consider doing?
• Start the conversations… with both sides of
the sandwich…
• What are TOP priorities?
$$$
legal issues
housing options
physical health
mental/cognitive health
spiritual well-being
• Get Started… It won’t happen, if you don’t…
What Can and Should We BE Doing?
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AARP?
Pioneer Network?
Geriatric specialization?
Ageism awareness?
Speak out, Stand up, PARTICIPATE!