Retooling for the Aging of
the U.S. Population
Mary Altpeter, PhD, MSW, MPA
Institute on Aging,
University of North Carolina at Chapel Hill
NC-HAN, Member campus of the
CDC-Healthy Aging Research Network (HAN)
NACDD, March 9, 2010
Presentation Overview
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Making the case for health and well-being for
older adults
The health status and future of Boomers
What’s happening in health promotion and
aging
Retooling challenges we face
Resources to help
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The CDC-Healthy Aging Research Network (HAN)
NCOA, N4A, NASUA
2
A question to consider…
Given the demographics, health needs and
trends of our growing older population, what
retooling might your state and local public
health departments need to consider now to
be ready for tomorrow?
3
Multiple aspects of older adult
health and well-being
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Population trends
Marital status, (living arrangements)
(Education), health literacy, internet use
Wealth
Workforce participation
Volunteerism
Caregiving
4
5
70 million
35 million
21 million
3 million
4.2 million
Living to 100
6
Number of Centenarians in the U.S.
17 % of all seniors
601,000
447,000
324,000
10% of all seniors
72,000
2000
96,548
2008
214,000
131,000
2010
2020
2030
2040
2050
Source of data: US Census Bureau, Current Populations Reports, P23-199RV, July 1999
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Indicator 3 – Marital Status
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9
10
SPECIAL FEATURE – Health Literacy
11
Computer and Internet Use in the
United States: 2003
in thousands
20,000
computer use
15,000
internet
access
10,000
5,000
0
15-24 25-34 35-44 45-54 55-64
Source: US Census Bureau, 2005
65+
Age
12
Past and Projected Number of Workers
Over Age 55, 1970-2025
40,000
31,851
35,000
33,346
30,000
25,000
20,000
15,000
14,505
15,039
15,026
1970
1980
1990
18,437
10,000
5,000
0
2000
2015
2025
Source: US Census Burea, 2008; GAO Report to the Ranking Minority Member, Subcommittee on EmployerEmployee Relations, Committee on Education and the Workforce, House of Representatives, Nov. 2001
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Change in Median Net Worth of 65+
Households: 1984 - 2005
1984
2005
Average – $109,900
Average – $196,000
Whites – $125,000
Whites – $226,900 81%
Blacks – $28,200
Blacks – $37,800
Source: Older Americans 2008, Key Indicators of Well-Being
79%
34%
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Poverty Rate by Age, U.S. (2007)
25
Percent
20
<18 years
15
19 - 64 years
10
65+ years
5
0
Age group
Source: Statehealthfacts.org, retrieved 4/15/09
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Factors in the Decision to Work in Retirement (%)
Pre-retirees who plan
to work in retirement
Working
Retirees
Desire to stay mentally active
87
68
Desire to stay physically active
85
61
Desire to remain productive or useful
77
73
Need health benefits
66
20
Desire to help other people
59
44
Desire to be around people
58
47
Need the money
54
51
Desire to learn new things
50
37
Desire to pursue a dream
32
20
Source: S. Kathi Brown, "Staying Ahead of the Curve 2003: The AARP Working in Retirement Study,"
Washington, DC: AARP, 2003 *Respondents could choose as many factors as apply to them
16
Older Adults as Volunteers
Age 55-64
Age 65+
% who
volunteer
28.1
23.5
Tot. #
volunteers
9.456 million
8.749 million
Median
annual hours
per
volunteer
58
96
Source: U.S. Bureau of Labor Statistics, Volunteering in the United States, 2008
17
Grandchildren in Grandparents’ Homes Where
Grandparents are the Householders
3,000,000
2,500,000
2,000,000
No parent present
1,500,000
One or more parents
present
1,000,000
500,000
0
1970
1980
1990
2008
Source: US Census Bureau, Current Population Survey, March and Annual Socieconomic Supplements, 2008 and earlier.
http://www.census.gov/population/socdemo/hh-fam/ch7.xls
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Value and Cost of
Informal Caregiving

12.8 million Americans need care
 7.3 million are 65 and older

The value of informal caregiving is estimated at $196
billion per year

Informal caregiving exceeds nursing home and home
care expenses by $81 billion

Caregiving costs U.S. businesses $11.4 billion annually

Caregivers lose up to $659,139 over a lifetime
Geriatric Social Work Initiative, San Jose State University, College of Social Work
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20
Chronic diseases account for 75% of the
$1.4 trillion we spend on health care
1980
21
$245 billion
an average of $1,066 per person
2001
$1.4 trillion
an average of $5,039 per person
2011
$2.8 trillion
an average of $9,216 per person
Mensah: www.nga.org/Files/ppt/0412academyMensah.ppt#21
Heffler et al. Health Affairs, March/April 2002.
Boomers will be living longer:
% people age 65 who will live to age 90
45
42%
40
35
Four-fold increase
28%
Percent
30
25%
25
20
14%
15
10
7%
5
0
1940
1940
Source of data: US Census Bureau
1960
1960
1980
1980
Decade
2000
2000
2050
2050
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Boomers are relatively wealthier but are also
worried about future health care costs
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Wealthy - possess ¾ of nation’s financial
assets + estimated $1trillion in annual
disposable income
Yet, 44% those 55-59 fearful of not having
sufficient resources to live beyond age 85
“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
Boomers provide a substantial
amount of caregiving
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>70% have at least one
living parent
25 million live with an aging
parent
13 million provide parental
caregiving
“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
What’s the health picture for
Boomers?
By 2030
 More than 6 of every 10 will be managing more than
one chronic condition
 14 million (1 out of 4) will be living with diabetes
 >21 million (1 out of 3) will be considered obese
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Their health care will cost Medicare 34% more than others
26 million (1 out of 2) will have arthritis

Knee replacement surgeries will increase 800% by 2030
“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
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What’s the health care picture for
Boomers?
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Cause significant shift in health care:

By 2020, Boomers will make 40% of all physician office
visits
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By 2030 hospital admissions among Boomers will increase
more than 100%, totaling half of all admissions in the US
“When I’m 64: How Boomers Will Change Health Care ”, American Hospital Association, May 2007
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NCOA Survey Key Findings
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Americans 44 and older with chronic conditions are diverse
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One in four has delayed health care due to cost
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Most rely on health care system for help, but it’s not working well
for many
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Many are not getting help and support they need
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Cost, confidence, lack of knowledge are barriers to managing
conditions
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Learning how to change behaviors in realistic ways and getting
tips and advice from others would be most helpful
Source: Re-forming Healthcare: Americans Speak Out About Chronic Conditions & the Pursuit
of Healthier Lives, NCOA, March 2009
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Types of support NCOA survey respondents
identified:
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71% - Learn how to exercise or eat better in a way
that is realistic and works with your limitations
68% - Get practical tips and advice from other
people who have health problems similar to yours
59% - Set goals and work together with other people
who are trying to improve their health
58% - Learn how to manage work, family and other
responsibilities and still take care of your health
Source: Re-forming Healthcare: Americans Speak Out About Chronic Conditions & the
Pursuit of Healthier Lives, NCOA, March 2009
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Threats to Health Among Seniors
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73% age 65 - 74 report no regular physical activity
81% age 75+ report no regular physical activity
61% - unhealthy weight
~35% - fall each year
20% - clinically significant depression; age group
at highest risk for suicide
32% - no flu shot in past 12 months
35% - never had pneumococcal vaccine
20% - prescribed “unsuitable” medications
Also at greatest risk for fire-related injuries, and
traumatic brain injury (age 75+)
Sources: State of Aging and Health, 2007; www.cdc.gov/nchs; www.cdc.gov/ncipc/olderadults.htm
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The prevention imperative
Only 30% of
physical aging is
attributable to
genetic heritage!
Prevention – it’s for EVERYONE!
Slide from Becky Hunter, UNC CAH
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Rowe and Kahn Model
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“Healthy Aging”
Managing
Chronic
Conditions
“and injury and
promoting health”
“optimizing”
Source: Marshall, V.M. & Altpeter, M. (2005). Cultivating social work leadership in
health promotion and aging: Strategies for active aging interventions. Health & Social
Work, 30(2), 135-144.
PRC-HAN Definition of Healthy Aging
Healthy aging is the development and maintenance of
optimal physical, mental and social well-being and
function in older adults.
It is most likely to be achieved by

individuals who live in
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physical environments and communities that are safe and
support the adoption and maintenance of attitudes and
behaviors known to promote health and well-being;
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the effective use of health services to prevent or minimize
the impact of acute and chronic disease on function
CDC-funded PRC Healthy Aging Research Network
http://depts.washington.edu/harn/
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Health promotion and disease prevention does
work for older adults
Longer life
 Reduced disability
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Improved mental health
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Later onset
Fewer years of disability prior to death
Fewer falls
Positive effect on depressive symptoms,
social connectedness
Delays in loss of cognitive function
Lower health care costs
www.healthyagingprograms.org/content.asp?sectionid=85&ElementID=304
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Some common approaches used in
health promotion and aging
 Socio-ecological
theory
 Chronic Care Model
 RE-AIM Framework
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Chronic Care Model
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Selfmanagement
support
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Community
resources
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Organization of
health care
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Interdisciplinary
teams
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Decision support
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Clinical
information
systems
RE-AIM framework
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Analyze epidemiological data to
target health issues and
populations
Develop common core of
practical process and outcome
measures
Build partnerships across
multiple sectors
Implement evidence-based
health promotion programs with
fidelity
Maintain individual-level benefits
and sustain ongoing
programming
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The Social-Ecological Perspective
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The health and well-being of older adults will
be improved only if we work from a broad
perspective.
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Comprehensive planning and partnerships at
all levels are required.
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Changes at the individual level will come with
improvements at the organizational,
community and policy levels.
Adapted: Prevention: Why Does It Matter? PowerPoint presentation by Nancy Whitelaw,
March 2007, available at: www.healthyagingprograms.org
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www.healthyagingprograms.org
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A short list of evidence-based health promotion
programs for older adults
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Chronic Disease Self-management
Program
Matter of Balance
Fit and Strong
AF Exercise Program
AF Aquatics Program
Arthritis Self-Help Program
Fit and Strong
Diabetes Self-Management
Healthy IDEAS
PEARLS
Enhance Wellness/Enhance
Fitness
Active Living Every Day
Active Options
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What the data tell us
• Older adult population is the fastest growing sector of
the overall population and older adults are becoming
more racially and ethnically diverse.

Increased demand for tailored programming for reaching
oldest old and minority elders
• Race, class and gender compound aging effects,
resulting in higher risks for health, poverty and other
social problems.
• Income, education and health literacy is an issue for a
significant portion of the boomer and older adult
populations
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What the data tell us (continued)
• The majority of older adults report good health and many
are able to work and contribute to family and society
• Cost related to health care are growing out of control
• Exponentially higher expenditures for health care and services
• “Costs” to caregivers is staggering
•
direct out-of-pocket expenses, economic insecurity caused by
changes in work patterns, and health effects
• Unprecedented demand by older adults and boomers for
• caregiving and other support services
• long term care solutions
• health promotion/disease prevention, falls prevention and chronic
care programs
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Challenges in Retooling for Health Promotion
and Disease Prevention for Older Adults
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Science not shared – growing body of evidence of
interventions that can positively impact health, disability
and quality of life

Much work to be done in expanding the evidence base in
health promotion/disease prevention and chronic disease
self-management for diverse older populations

Fragmented systems and services across aging, public
health, medical care, and mental health Untapped assets
of 29,000 organizations currently reaching 7-10 million
older adults
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Lack of common conceptual “language”
Lack of integrated service planning across the “lifecourse”
Adapted: Prevention: Why Does It Matter? PowerPoint presentation by Nancy Whitelaw,
March 2007, available at: www.healthyagingprograms.org
43
Challenges in Re-tooling (cont’d)

Untapped creative approaches to reaching older adults,
e.g., through worksites, libraries, grandparent groups and
intergenerational programming
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Under-developed health information technology to help
older adults and boomers manage their conditions and
participate in health promotion, falls prevention and
chronic disease self-management programming

Under-developed mechanisms to tap into and train
boomer and older adult populations as valuable
resources in delivering health promotion programs
44
Key messages for “retooling”
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It’s never too late to start
and it’s always too early
to quit
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But, it’s also never too
early to start - life course
perspective
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Think “immediate” – those
currently 65+
Think “intermediate” – those
35-64
Think “long-range” – children
Adapted from: Robert Butler, “Maintaining Healthy Lifestyles,” International Longevity
Center, 2000 and “Reimagining America: AARP’s Blueprint for the Future”, 2005
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Some Resources to Help…
National level partnerships for health
promotion advocacy: A growing list…
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Centers for Disease Control and Prevention
Administration on Aging
Centers for Medicare and Medicaid Services
Agency for Healthcare Research and Quality
Environmental Protection Agency
Robert Wood Johnson Foundation
Archstone Foundation
John A. Hartford Foundation
Atlantic Philanthropies
National Council on Aging
American Society on Aging
National Association of State Units on Aging
National Association of Area Agencies on Aging
National Association of Chronic Disease Directors
“Disease-specific” Associations
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Sites of the CDC PRC-Healthy Aging Research
Network (HAN)
University of
Washington
University of
Colorado
University of
Illinois at
Chicago
University of
Pittsburgh
University of
California at
Berkeley
West Virginia
University
University of
North Carolina
University of
South Carolina
Texas A&M
University
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Activities of the PRC-HAN
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Better understand the determinants of healthy
aging in older adults
Identify interventions that
promote healthy aging.
Assist in the translation of
such research into
sustainable communitybased programs
throughout the nation.
Examples of PRC-HAN Resources
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Conference Series (Physical Activity, Depression,
Environmental and Policy Factor)
Written materials such as conference monograph
and RE-AIM issue brief
On-line modules for Provider Training
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www.prc-han.org
Getting to the Modules: The NCOA
Center for Healthy Aging website
www.healthyagingprograms.org
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Content Overview
http://www.healthyagingprograms.org/captivate/mainmenu.htm
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A question to consider…
Given the demographics, health needs and
trends of our growing older population, what
retooling might your state and local public
health departments need to consider now to
be ready for tomorrow?
59
Thank You!
Mary Altpeter
UNC Institute on Aging
Mary_Altpeter@unc.edu
60