The Aging Populace

156 Presentation THE AGING POPULACE ROBERT N. BUTLER, M.D. Brookdale Professor of Geriatrics and Adult Development, Chairman, Gerald and May Ellen Ritter Department of Geriatrics and Adult Development KATHRYN HYER, MPJ. The Mount Sinai Medical Center New York, N.Y. As a result c^ the 1936 passage of Sodal Security and the 1965 passage of Medicare, there have been considerable improvements in the lot of the elderly, a population conventionally defined as those 65 or older. A1988 census report indicated that if the elderly did not receive government transfer payments (primarily Social Security benefits), the 1986 poverty rate for the elderly would have been 485 percent instead of 12.4 percent1 Medicare, the nation's health insurance entitlement for the elderly, also provides economic security because it protects the elderly against expensive short-term hospitalization and physician's costs. However, the agenda for the economic and health security of older Americans remains incomplete. Medicare was not designed to handle chronic incapacity and the requisite need for long-term careA3 Social Security and Medicare do not even meet basic needs for substantial numbers of people. All Americans, young and old, are confronted with our failure to adopt an effective long-term care policy that provides home, community, and institutional services . As difficult as it is for the majority in America, it is even more difficult for minority Americans. Statistically, whites make up 90 percent of the elderly in America and consequently, most statistics for the elderly pertain to whites. These averages ignore the heterogeneity of the elderly. In part, we tend to view the elderly as a monolith and fail to recognize that, as our title indicates, we are concerned about aging, the process of growing older, as well as the group of people who are in the final stage of life. Aging is a dynamic process which begins from conception—preconception , actually, for the aging of the ova is critical, for example, to the genesis of Journal of Health Care for the Poor and Underserved, Vol. 1, No. 1, Summer 1990 Butler and Hyer 157 Down's Syndrome. Aging is the interaction of physical, social, economic, biological, and psychological phenomena. It occurs individually and by cohort. We must recognize that the experiences of younger blacks, Hispanics, and Native Americans—their access to health care, including preventive care; ability to obtain a good education; exposure to toxic factors; opportunity to work at a well paying job; choices about what to eat and whether to exercise—all of these have lifelong consequences. We need to focus on both the process of aging and the final stage of life. Risk factors To repeat, there is great diversity among the elderly. Married couples have very different economic profiles from those living alone. Young elderly, those 65 to 74 and usually recently retired, generally do not have the same health and economic profile as an 85-year-old widow striving to maintain an independent life in the community. While the poverty rate for elderly couples is only four percent, it is 19 percent for persons living alone and an astounding 73 percent for Black women, aged 85 and older, who live alone.4«5 Almost one-third of all elderly live alone—a risk factor for poverty and poor health (Figure 1). Living alone and being female often means financial vulnerability, longer hospital stays, and a higher probability of institutionalization . It also increases vulnerability to crime, loneliness, and depression. Hispanic elderly are least likely to live alone, and blacks are slightly more FIGURE 1 UVTNG PATTERNS OF ELDERLY PEOPLE Source: Bureau of the Census, 1987. 158_________________Special Problems of Aging FIGURE 2 LTvTNG PATTERNS OF ELDERLY PEOPLE BY RACE OR ETHNICITY Source: Bureau of the Census, 1987. FIGURE 3 PERCENTAGE OF ELDERLY PEOPLE LIVING IN POVERTY, BY LIVING PATTERNS AND RACE Source: Reference 4. likely to live alone than whites (Figure 2). The poverty rate for elderly minorities living alone is shockingly high, with the rate for blacks and Hispanics at least double that of whites (Figure 3). Because females live longer than males, wives are more likely to be left alone than husbands (Figure 4). At age 65, black and white women can expect...