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1 The Plight of the Dependent Elderly and Their Families
- Johns Hopkins University Press
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13 The past several decades have seen significant improvement in the health of older adults. In the United States and many other parts of the world, people are living longer and with less chronic disability than ever before (WHO 2003; Federal Interagency Forum on Aging Related Statistics 2006). The aging population is burgeoning . While currently the proportion of older persons is 17 percent, by 2050 it is expected to be 26 percent (Weinberger 2007, 17). In the United States in particular, between 2000 and 2050 the population age 65–74 will grow from 18 million to 35 million, the population age 75–85 will grow from 12 million to 26 million, and most dramatically, the population age 85 and above—the fastest growing segment of the population—is expected to quadruple, growing from 4 million to 21 million (U.S. Census Bureau 2008). While there has been considerable debate concerning the nature and extent of future long-term care needs, especially given declining rates of disability in recent decades, the consensus is that they will grow (Institute of Medicine 2008).1 Even though many people over 65 are in good health, the great majority—as many as 80 percent— of older adults contend with at least one chronic disease (hypertension , heart disease, and arthritis, for instance) that calls for care over time (Wolff, Starfield, and Anderson 2002; Pleis and LethbrideCHAPTER ONE The Plight of the Dependent Elderly and Their Families 14 long-term care, globalization, and justice Cejku 2007). Many suffer from two or more (Anderson and Horvath 2002, 2004). Many struggle with “geriatric syndromes” or conditions that tend not to fit into specific disease categories, such as: depression, sensory impairment, incontinence, malnutrition, and osteoporosis (Cigolle, Langa, Kabeto, et al. 2007; Inouye, Studenski, Tinetti, et al. 2007). A significant number are diagnosed with mental health conditions ranging from mild mood disorders to depression to severe cognitive impairment (U.S. Administration on Aging 2001; Johnson and Wiener 2006). An estimated 42 percent of those over 85 have Alzheimer’s disease (Alzheimer’s Association 2007). The elderly are more vulnerable to injury and acute illness as well. There are, not surprisingly, important differences across various demographic categories and subgroups (Institute of Medicine 2008). Marked increases in the age and disability levels of many care recipients are likely to lead to a greater demand for paid care workers given that the care needed may be increasingly complex and require a higher level of skill than many family caregivers , historically the first line of care for the elderly, can provide (U.S. DHHS 2000; Wolff and Kasper 2006; Kramarow, Lubitz, Lentzner, et al. 2007). A Growing Problem According to The Urban Institute’s Retirement Project, even under the most optimistic scenario the size of the older adult population in need of assistance will grow significantly. At best, they argue, by 2040 “the number of older adults using paid home care will increase by three-fourths . . . and the number in nursing homes will increase by two thirds. Over the same period, the number receiving help from their adult children will increase by about one third” (Johnson, Toohey, and Wiener 2007, 3). The aged population will be more diverse than ever before, as well, with declining numbers of whites and increases in the percentage of Blacks, Hispanics and Asians (de Voelker 2010). These changing demographics—attributable to lower mortality and greater control over reproduction— [54.227.136.157] Project MUSE (2024-03-19 14:16 GMT) The Plight of the Dependent Elderly and Their Families 15 give rise to a growing need for long-term care, defined as the “wide array of medical, social, personal, and supportive and specialized housing services needed by individuals who have lost some capacity for self-care because of a chronic illness or disabling condition” (U.S. Special Committee on Aging 2000). Meanwhile, if we look globally, we see that population aging is a worldwide phenomenon, affecting all regions and most countries (Weinberger 2007). As noted above, by 2050, the population aged 60 and above worldwide will have more than tripled from 600 million in 2000 to 2 billion, moving from 17 percent of the population to as much as 26 percent. The oldest old, or those eighty and above, will increase from being just 1.4 percent of the population to 4.3 percent. Projections further suggest that elderly populations in many low- and middle-income countries are growing more rapidly than those in...