Working with an Aging Population:
Myths and Realities
Patrick Arbore, Ed.D.
Founder and Director, Center for Elderly
Suicide Prevention & Grief Related Services
Institute on Aging, San Francisco, CA
What is Your Aging IQ
National Institute on Aging
Please answer True or False:
• Everyone becomes “senile” sooner or later
• American families have by and large
abandoned their older members
• Depression is a serious problem for older
people
• The numbers of older people keep
growing
Aging IQ
• The vast majority of older people are selfsufficient
• Mental confusion is an inevitable,
incurable consequence of old age
• Intelligence declines with age
• Sexual urges and activity normally cease
around age 55-60
• If a person has been smoking for 30 or 50
years, it does no good to quit
Aging IQ
• Older people should stop exercising and
rest
• As you grow older, you need more
vitamins and minerals to stay healthy
• Only children need to be concerned about
calcium for strong bones and teeth
• Extremes of heat and cold can be
dangerous to old people
Aging IQ
• Many older people are hurt in accidents
that could have been prevented
• More men than women survive to old age
• Death from stroke and heart disease are
declining
• Older people on the average take more
medications than younger people
• Snake oil salesmen are as common today
as they were on the frontier
Aging IQ
• Personality changes with age, just like hair
color and skin texture
• Sight declines with age
Aging Demographics: The Reality
According to the US Census Bureau 2007:
• Total US population – 281,296,639
• Of these, 35.1 million were >65, making up
12.4% of the total population
• About 20.5 million were older women
• 14.4 million were older men
Demographics
• The number of older adults is expected to
double within the next 25 years
• By 2030 about 1 in 5 Americans (72
million people) will be >65
• The age group >85 is now the fastest
growing age population
• 1/3 of older people live alone; 2/3 live with
or near family
Demographics
• Few live in skilled nursing facilities (15% of
those >85
• Control 70% of total net worth in U.S.
• 85+ population with Alzheimer’s Disease
is close to 50% and is growing
• Aging (Baby) Boomers have been turning
65 this year
Denial of Aging
According to Gillick (2006): “When we
believe we will stay young forever, and
when we purchase special vitamins,
herbs, and other youth-enhancing
chemicals to promote longevity, we are
engaging in massive denial
An Elder Speaks
A woman 60 years of age states: “Strange
how these things creep up on you. I really
was surprised and upset when I first
realized it was not the headlights on my
car that were dim but only aging night
vision. Then I remembered other bits of
awareness that forced me to recognize
that I, that 16-year-old inside me, was
experiencing normal changes that go
along with getting old.”
Denial
• Americans spend an extraordinary $6 billion
annually on “anti-aging” remedies
• Aging (baby) boomers and their aging cohort
take pills and dietary supplements that purport to
prevent illness, cure diseases and promote long
life
• There is overwhelming evidence that the
remedies are ineffective at best, harmful at worst
– and a phenomenal waste of money
Covering Up Old Age
• That use of hair color is so pervasive that
it is hard to estimate the amount of money
spent on vanquishing the gray
• The mechanics of hiding age include:
botox, facelifts, and liposuction to name a
few surgical procedures
Anti-Aging Books
• The number of books that are written to
prevent aging far surpass books that
address coping with aging
Reality of Aging
• Very advanced age will be the experience
for many of us
• Life expectancy at age 65 is 19.2 years for
American women and 15.9 years for
American men (Gillick, 2006)
Causes of Death for People >65
National Vital Statistics Report, 2002:
• Heart Disease – 32.4%
• Cancer – 21.7%
• Stroke – 8.0%
• Chronic lower respiratory disease – 5.9%
• Influenza and pneumonia – 3.1%
• Diabetes – 3.0%
• Alzheimer’s disease – 3.0%
• Other – 22.08%
Alzheimer’s Disease
According to the National Alzheimer’s Assoc
(2011):
• Today 5.3 million Americans have AD
• Predicted that as many as 16 million
Americans will have AD by 2050 – there
will be 1 million new cases annually
• 1 in 8 baby boomers will get AD after they
turn 65
• At 85 that risk increases to 1 in 2
Ageism
According to Butler:
“Ageism can be seen as a process of systematic
stereotyping of and discrimination against
people because they are old, just as racism and
sexism accomplish this with skin color and
gender. Old people are categorized as senile,
rigid in thought and manner, old-fashioned in
morality and skills…Ageism allows the younger
generations to see older people as different from
themselves; thus they subtly cease to identify
with their elders as human beings.” p. 12
Traditional Medical Continuum
•
•
•
•
•
•
•
Absence of Disease/Illness
Presence of condition
Seeking treatment
Restricted activity
Major restricted activity
Institutionalization
Illness and death
Implications for the Older Person
Traditional Model
• The expectation is that treatment will be
sought when an individual develops a
condition
• At this point the individual begins the
descent into dependency and
despondency either temporarily or longterm
• The role of the individual is more passive
than active
Implications for those Who Care for
Older People
• A conviction by professional helpers that
older people are individuals with declining
health generates the following response:
Older people are ill and feeble or
potentially so
• To reverse conditions or institute
preventive health measures are useless
for older people
What is the Right Approach to
Medical Care for Older Adults?
• Instead of exploring these questions, we
choose instead to engage in collective
denial of aging
• Prefer to believe that most people can skip
old age altogether – proceed from middle
age to death (60 is the new 40)
• Put out faith in exercise and diet as a
means of assuring a vigorous old age
Preventing Chronic Disease
Through Diet and Exercise
• Many of the problems of older age cannot
be prevented through diet and exercise
• If we assume that diet and exercise
prevents chronic disease, we will fail to
take seriously the need for a radical new
model of medical care – to care for people
with chronic illness
Drugs to Make Us Immortal
• If we put our faith in anti-aging drugs, we
will neglect to fund research into
conditions such as macular degeneration
(the leading cause of visual impairment in
older adults) and osteoarthritis (the
number one medical problem in the elderly
and a major source of pain and immobility)
• These disorders impair the quality of life
for millions of older people
Health and Wellness
According to Pender and colleagues (2002):
Health may be define as “the actualization of
inherent and acquired human potential
through satisfactory relationships with
others, goal-directed behavior and
competent personal care while adjustment
are made as needed to maintain stability
and structural integrity.”
Multiple Dimensions of Health
• Health can be seen as a more expansive
phenomenon with multiple dimensions:
biopsychosocial, spiritual, environmental,
and cultural
• A change in any of those dimensions
affects the health of an individual in a
positive or negative manner
• A behavioral change can lead to
empowerment
Empowerment
• May open many other options for
improving one’s health
• A positive approach to health emphasizes:
strengths, resilience, resources, and
capabilities rather than existing pathology
The Wellness Model
• Well-being
• Self-actualizing
• Growth
• Education
No Discernable Diseases
• Signs of disease
• Symptoms
• Disability
• Premature Death
The Wellness Approach
• This approach suggests that every person
has an optimum level of functioning for
each position on the wellness continuum
to achieve a good and satisfactory
existence
• Even in chronic illness and dying, an
optimum level of wellness and well-being
is attainable for each individual
Achieving Wellness
• Wellness is a balance between one’s
environment, internal and external, and
one’s emotional, spiritual, social, cultural,
and physical processes
Chronic Diseases
• The most prevalent chronic conditions in
people >75 are much more common in
women
• Racial and ethnic differences in health
status continue with the leading causes of
death and disability dramatically higher
among racial and ethnically diverse
populations
Key Strategies for Improving the
Health of Older People
• Healthy Lifestyle Behavior
• Injury prevention
• Diversity of culturally appropriate clinical
preventive services
• Immunization and preventive screenings
• Management techniques for those with
chronic illnesses
Adapted from Generations (2005)
Older Adults and Self-Efficacy
• Self-efficacy implies control and places
one’s wellness in one’s own hands
• Often older people place the responsibility
for their health in the hands of physicians
and nurses
• We need to change older people’s
expectations of physicians, particularly in
the are of health prevention and health
maintenance
Treat People in Accordance with
Geriatric Principles
• Recognize the variety of health statuses
among the elderly
• People with dementia, for example, need
assistance with IADL’s and ADL’s – some
of these individuals are both frail and
experience features of dementia
• People have different pain thresholds, as
well as varying tolerance for discomfort or
uncertainty or disability
Other Changes
• Medicare must be overhauled in order to
meet the needs of those with chronic
illness
• Nursing homes (which house 1.6 million
people) and which will continue to provide
care for the neediest and most disabled
older people have to be transformed from
institutions into homes
References
Butler, R. (1975). Why survive? Being Old in
America. Baltimore: The Johns Hopkins
University Press.
Gillick, M. (2006). The denial of aging:
Perpetual youth, eternal youth and other
dangerous fantasies. London: The
Harvard University Press.
References
Ebersole, P., Hess, P., et al. (2008). Toward
healthy aging (7th ed.). St. Louis: Mosby
Alzheimer’s Association (2011). Generation
alzheimer’s: The defining disease of the
baby boomers.
Yallom, I. (2008). Staring at the sun:
Overcoming the terror of death. San
Francisco: Jossey-Bass