J James Cotter PhD VCUs Department of Gerontology School of Allied Health Professions Knowledge Needed for Hiking Lay of the land Equipment How to stay fit and safe Route selection Essential Gear ID: 935659
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Slide1
Hiking the Retirement Journey
J. James Cotter, PhD
VCU’s Department of Gerontology
School of Allied Health Professions
Slide2Knowledge Needed for Hiking
Lay of the land
Equipment
How to stay fit and safe
Route selection
Slide3Essential Gear
Maps – health care
Social Security card
An address book
Good food and Water
Sunglasses and Sunscreen
Layered clothing / comfortable walking shoes
Special First Aid Kit
Camera and binoculars
Compass and Flashlight
A language book
Slide4Trends in an Aging Society
More personal responsibility
Increasing lifespan
Limited government programs
Growing diversity
Redefining aging
Changing technology
Slide5Issues you will confront
The financing of retirement and medical care
Changes in the organization and delivery of health care services.
Especially long-term care
including informal caregiving
The need for health promotion
Diverse clients and diverse workforce
Slide6Challenges in Caring for an Aging Population
Transitions of health and care settings
Importance of self-management
Importance of lifestyle
Interaction between physical and social
Effects of deconditioning
Slide7Growth of 65+ Population in Virginia
thousands
Slide8Map 1: Aging and the new aging
40 - Age discrimination
50 - AARP discounts
60 - Older Americans Act
65-67 - Medicare and Social Security
75 - frailty marker
85 - the old-old
Slide9Changing view of “old”
Traditional groupings
Young-old = 65-75
Old = 75-85
Oldest-Old = 85+
Dychtwald’s Middlescence
Middlescence - 40-60
Late adulthood - 60-80
Old Age - 80-100
Raise retirement age
Age 70?
Age 75?
Slide10Generations
Slide11Redefining Aging
84% of all Americans say they would be happy to live to be 90
What defines old age?
Decline in physical ability - 41%
Decline in mental functioning - 32%
Reaching a specific age - 14%
National Council on Aging survey, 2001
Slide12Life Expectancy
National Vital Statistics Report, Vol. 47, No. 28, December 13, 1999
National Research Council, 1988
Slide13Number of Centenarians
Jeanne Calment, died in 1997 at the age of 122.
A 65 year old must live 57 more years to catch her record.
Slide14Changing structure of society
Traditional aging pyramid
New aging pyramid
Slide15How long have YOU got? More than you thought.
http://www.livingto100.com
The average life expectancy for men is 80 years, for a women - 85.
Slide16Gear: A language book:Ethnic Diversity and the Aged
http://www.prb.org/Content/NavigationMenu/PRB/AboutPRB/Reports_on_America/ReportonAmericaTwoCenturies.pdf
Slide17A New Diversity
Age
Ethnicity/Race
Gender
Physical abilities
Sexual orientation
Family structure/ Marital status
Religious beliefs
Education
Income/Wealth
Work/ Employment
Based on Griggs, 1995
Slide18Gerontographics Life-stage Model
Healthy Indulgers (18%)
Healthy Hermits (36%)
Ailing Outgoers (29%)
Frail Recluses (17%)
Moschis,
American Demographics,
1996
Slide19From acute to chronic
“in 1995 for the first time more people died of chronic disease than from acute disease.”
Val Halmandaris, National Association of Home Care
Slide20% aged reporting ADL limitation
Adapted from Admin. on Aging, 1997
Slide2114th Annual
International Congress
On Anti-Aging Medicine
April 7-9, 2006
Orlando, Florida
,
The
American Academy of Anti-Aging Medicine
… Anti-aging medicine, which promises the baby boomers
a 100 year plus youth filled life
span, is the
hottest topic in health care
with recent in-depth features on the future of medicine appearing in Time and U.S. News and World Report.
http://www.worldhealth.net/
Anti-Aging Medicine
Slide22Baby Boomers: Then and Now
Then: Watching John Glenn's historic flight with your parents.
Now : Watching John Glenn's historic flight with your kids
Then: The Grateful Dead
Now : Dr. Kevorkian
Then: Getting out to a new, hip joint
Now : Getting a new hip joint
Slide23EquipmentGear: Your Social Security card
Social Security
Pension or 401(k)
Assets – your house and savings
Medicare
Private health insurance or Medigap
Health Care Providers
Maybe Medicaid later
Slide24How many legs on that three-legged stool? You may need 6.
Assets
Pensions
Social Security
Public Benefits
Medical Coverage
Employment
Slide25Increase personal savings rate from ZERO
Median credit card debt $1900
(
http://moneycentral.msn.com/content/Banking/creditcardsmarts/P74808.asp
)
Savings rate is: a – .05%
Negative .05% !
Pensions to 401(k)s
Rising costs from increased personal responsibility in medical care
Avoid a Poverty Stricken Old Age
Slide26To Privatize or Not to Privatize?
Will NOT solve the shortfall in Social Security – makes it worse.
Rate of return in the stock market is higher but is inconsistent
Philosophical: Should government be in the retirement business?
Amount of money invested (7.5%) will not be returned in equivalent benefits
Social Security is supportive of women and low income earners
Life insurance, disability insurance, retirement
Slide27Labor Force Participation Rates(adapted from Atchley & Barusch, 2004)
%
Slide28Financing Health Care for Older Persons
Medicare
‘Medigap’ Policies
HMOs
Prescription Drugs
Medicaid
Long-term care
Long-term care Insurance
Medical Savings Accounts
Slide29Home
Apartment Complex
Retirement Center
Assisted Living
Nursing Home
Hospital
Hospice
Meals on Wheels
Outpatient Health
Care
Case Mgmt
Home Health Care
Map:
Health Care
Transitions
Slide30LTC Continuum - HCBS
Home and Community-based Services
Adult Day Care
Home health Care
Homemaker/Personal Care
Social Support Services
Home-delivered meals
Transportation
Slide31Continuum of Care
Institutional
Residential / Medical
Nursing Facilities
Sub-acute Care
Inpatient Hospice
Residential / Assisted
Board and Care
Assisted Living
CCRCs
Slide32Paying for Nursing Homes, 2000 (%s)
Source: Shi & Singh, 2005.
Slide33Medicare: We’ve Got You Covered – well 50% anyway
Medicare pays 56% of its beneficiaries total health care expenditures
$1,180 / yr on average in out-of-pocket costs -- Kaiser Family Foundation
Extra
amount needed in retirement if no employer health insurance - $200,000 (WSJ, March 7, 2006)
Slide34The Elderly Poor Spend a Greater Portion of Their Income on Health
The Elderly Poor Spend a Greater
Portion of Their Income on Health
%
Slide35How much LTC insurance will I need? There’s the rub.
Predicting lifelong disability
What if its never needed?
Lifetime risk at 65=39%, at 85=49%
Predicting future long-term care system
What if services developed are not covered?
Predicting future long-term care costs
What will be the cost of a nursing home in 2032? - $190,000/year
Slide36The 2030 Problem:
Aging shocks:
Uncovered cost of Rx
Uncovered cost of medical care
High cost of private insurance for medical care
High and uncovered costs of LTC
Caring for Aging Baby Boomers
Knickman, J.R. & Snell, E.K. (2002).
HSR: Health Service Research
,
37:4
.
Slide37Staying Fit and Safe
Maintaining your health
Prevention is key
Gear: walking shoes
Your health is your lifestyle
Diet, including water, and exercise
Specific issues
Gear: Sunscreen and Sunglasses
Gear: Special first aid kit
Slide38Healthier Older Population
Fries (1984), Compression of morbidity
Palmore (1986), relative health of elderly has improved
Rogers (1990), living longer and healthier
Manton (1995), significant decreases in prevalence of 16 medical conditions
Cassel (2000), declining or postponing disease
Slide39Food Preparation
Nutrition knowledge
What foods to eat
How to prepare foods
Alcohol
Slide40The new Food Pyramid: MyPyramid.gov
Slide41Essential Gear 2: A Buddy
Slide42Changing Family Structure
Source: US Census, 2000
Slide43Older People of the 21st Century
Diversity: “plan for multiple groups of senior citizens” Characteristics
smaller families
suburbs
women in the work force
social movements
Silverstone, Gerontologist, 1996
Slide4421st century (cont’d)
Economics
diminished and elusive security,
competition,
skills still needed,
flexible work arrangements
lifetime of poverty
Social support -
Multiple scenarios of reconfigured families and peer support networks
Slide4521st Century Aging
Health
prevention is key,
disability
dependence
influence of lifestyle
influence of lifetime access to health care
Slide46Route Selection
New vocation – avocation – activities
Changing role
Grandparent, caregiver, companion
Gear – Camera and binoculars
Enjoy the journey; scope out the path ahead
Slide47Train Wreck 5: Elder Wasteland
What does a person do with 25-45 years of retirement?
What will you do?
Slide48Stay up with technology:The two most important devices for 21
st
century living
Slide49Ten Tips For Healthy Aging
Eat a balanced diet.
Exercise regularly.
Get regular check-ups.
Don't smoke. It's never too late to quit.
Practice safety habits at home to prevent falls and fractures.
From the National Institute on Aging
Slide50Ten Tips For Healthy Aging
Always wear your seatbelt when traveling.
Avoid overexposure to the sun and the cold.
If you drink, moderation is the key. And when you drink, let someone else drive.
Keep personal and financial records in order to simplify budgeting and investing. Plan long-term housing and financial needs.
Keep a positive attitude toward life. Do things that make you happy.