Aging Texas Well

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Aging Texas Well
Strengthening Capacity For Our Future
Beth Stalvey, PhD Senior Gerontologist
Texas Department of Aging and Disability Services
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Overview

• Texas Department on Aging and Disability
  Services
• Demographic Trends
• Graying of Baby Boomers
• AGING TEXAS WELL
• Building Community Capacity

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The Aging Population
US Population 60
Texas Population 60

• 2,774,201
• Represents 13 of population

• 45,797,200
• Represents 16 of population

Average Life Expectancy

• 1900 Average Age 46.4
• 2000 Women - Age 79.5 Men - Age 74.1
• 2050 Women - Age 84.9 Men - Age 79.5

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Population Growth in Texas for Selected Age
Groups
Texas State Data Center Population Growth
Scenario 0.5
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The Aging Population 60
Up 113.8 from 1990
Total U.S.
Up 192.2 from 1990
Texas
All facts and figures from the US Census Bureau
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The Aging Population

• The Baby Boomer Wave

• Born 1946-1964
• Currently between the ages of 39-57

The Numbers

U.S.
Texas

• 78,310,361 Boomers
• 28 of the population

• 5,598,649 Boomers
• 28 of the population

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Faster Than General Population

• Projected Population Growth 2001 to 2010 by Age
  Group

Texas State Data Center Population Growth
Scenario 0.5
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• Texas Population 60 Growth
• 1990 - 2010

Texas State Data Center Population Growth
Scenario 0.5
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Texas 60 Population Becoming More Diverse
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Does more life equal better lives? Why would
anyone want to live long and well? What does
aging mean?
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Successful Aging

• Adding life to years (longevity)
• Physical function (lack of disability)
• Coping, adjustment, adaptation, getting
  satisfaction from life (happiness)
• Reaching ones potential and arriving at a level
  of physical, social, psychological well-being
  that is pleasing to self and others

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Aging Texas Well

• Aging Texas Well means that Texans prepare for
  aging in all aspects of life and that state and
  local social infrastructure facilitates aging
  well throughout the life span.

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• Dual Focus
• Individual Preparedness
• Social Infrastructure

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Individual Preparation

• Physical
• Mental
• Social
• Spiritual
• Financial
• Legal

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Physical Health
Achieving and maintaining the best possible
physical health

• Growth in well- elderly.
• 52 of persons over age 65 have two more chronic
  conditions.
• Physical activity improves health across all
  disease categories and all ages.
• 60 of older Texans report participating in
  physical activity in past month

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Nutrition
Achieving and maintaining the best possible
physical health

• Less than one-third of adults 65 years and older
  meet the recommendation for healthy diet.
• Obesity is about to surpass smoking as leading
  cause of death
• 25 of older Texans meet criteria for obesity
• Since 1990, prevalence of obesity has increased
  more than 50 in older adults

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• Individual Tools Activity and nutrition
  materials for all ages, activity levels
• Local community events 5K runs, walk-a-thon
• Mass media campaigns Texercise Tips, radio,
  newspaper, website, other publications
• Worksites State agencies, public, private
• Health care settings Prescription for Exercise
  through provider

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Issues Physical Health
Achieving and maintaining the best possible
physical health

• Growth in evidence-based healthy lifestyles
  programs do not always include older adults
• Care Coordination of multiple chronic
  conditions while traditional disease management
  focuses on one disease
• Medication management has potential to save
  unnecessary costs and improves lives
• Immunization rates among older adults need
  improvement

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Causes of DisabilityUnited States, Canada, and
Western Europe, 2000
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Achieving and maintaining the best possible
mental health
Issues Mental Health

• Mental health is a public health issue
• Stigmas and other social barriers prevent elderly
  from seeking mental health care.
• People over 65 have higher suicide rates than any
  other age group
• Suicide has been linked to depression in 50 of
  cases
• Providers lack training in geriatrics and mental
  health
• Health care coverage for mental health is lower
  than for physical health

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Having a personal belief system that provides
meaning and purpose
Spirituality

• Spirituality facilitates successful aging
• Belief system for coping with adverse
  circumstances
• Meaning in life
• Improved social support system health
• Cross-training is vital
• Clergy and other faith-based members on issues
  associated with older adults
• Social service and other aging staff to
  understand the religious and spiritual needs of
  seniors

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Meeting the need for interaction between
individuals, family and community
Social Engagement

• Socialization and interaction
• Face-to-Face Daily (54) Weekly (35)
• Phone Daily (74) Weekly (21)
• Opportunities exist to engage older Texans in
  social engagement
• Senior Centers, Community Organizations,
  Faith-based, Volunteerism, Employment, Education
• AAA services such as phone reassurance,
  congregate meals

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FinancialAchieving and maintaining an adequate
income by managing monetary resources
Sources of Income of Older Texans
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Achieving and maintaining an adequate income by
managing monetary resources
Financial Preparedness

• Personal savings are at historical low
• Half of retirees do not have employer-sponsored
  pension income
• Assets and savings must be wisely managed
• TANF policy affects grandparent caregivers
• Special programs to protect financial well-being
• Money management services
• Local communities can adopt property tax
  exemptions
• Reverse mortgages

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Planning and managing personal and family life
through advance preparation for major life
decisions
Legal Preparedness

• Statutory tools for legal preparedness are
  available
• Estate planning
• Advance care planning
• Guardianship and Conservatorship
• Protection of legal rights (consumer, legal,
  grandparents, age discrimination)
• Access to legal assistance
• Low cost options are available
• Area Agencies on Aging help with benefits

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Social Infrastructure

• Housing
• Transportation
• Caregiving
• Protections
• Community Supports

• Employment
• Education
• Volunteerism
• Recreation
• Health Long-term Care

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EmploymentWorkforce participation without
age-based biases or barriers
Employment Status by Age Group
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Workforce participation without age-based biases
or barriers
Issues Employment

• Future employment trends indicate increased
  demand for older workers
• TDoA, TWIC and TWC are working together on state
  policy, planning and public awareness issues
• Employers need to take action to retain older
  workers
• Workforce professionals and workforce system
  should provide job training and employment
  services targeted to specific needs of older
  adults

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EducationIntellectual growth and life-long
learning
Educational Attainment of Older Adults by Gender
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Intellectual growth and life-long learning
Issues Education

• Appropriate teaching strategies and curricula for
  older adults
• Distance learning provides new opportunities
• Tuition discount/waiver programs are left to
  discretion of institutions of higher education
• Availability of some resources are limited
• Talking book program has limited staff and
  funding
• Some rural counties dont have libraries
• Only some public libraries in large cities have
  separate departments that are dedicated to senior
  services

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Meaningful unpaid service within a wide range of
civic settings
Volunteerism

• 22 of older adults currently volunteer
• 25 of older are interested in volunteering
  opportunities
• 65 indicated the primary decision to volunteer
• was to help people
• Majority of older adults (35) volunteer 5-10
  hours per month

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Meaningful unpaid service within a wide range of
civic settings
Issues Volunteerism

• Volunteering fosters productivity and increased
  sense of well-being
• Approximately 6.3 non-volunteering Americans
  would volunteer if they had more information
  about opportunities and were asked
• Volunteers prefer challenging work over routine
  tasks
• Volunteers cover gaps in service delivery, but
  require attention, support, and proper management

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Activities of personal interest that provide
enrichment and enjoyment
Recreation

• Participation decreases with age
• Barriers include
• Personal (e.g., programs/activities dont match
  ability levels or interests of a diverse
  population)
• Economic (e.g., high fees associated with
  commercial recreation organizations)
• Information and access (e.g., aware of the
  recreation activities available in their
  communities)
• Time (e.g., hours of operation)

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Personal residences that are affordable,
accessible and integrated
Housing
Housing Status of Older Adults by Age Group
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Personal residences that are affordable,
accessible and integrated
Issues Housing

• Older Texans prefer to live at home but must
  face
• High housing costs including energy costs
• Repair and renovation needs in both low-income
  senior housing and personal residences
• Lack of accessible home features in current and
  future housing
• Lack information on independent living options
• Local policy and planning coordination and
  advocacy by aging stakeholder is vital
• Public Housing Authorities
• For-profit and nonprofit affordable housing
  organizations
• Supportive service providers
• Aging network

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Safe and affordable movement in communities that
are accessible
Transportation

• By 2024,1 in 4 drivers will be over age 65
• Approximately 77 of older Texans report driving
  a vehicle as their primary transportation
• 23 of older Texans do not drive
• 15 fewer doctor visits
• 59 fewer shopping and dining trips
• 65 fewer social, family, religious trips
• Almost 35 of older Texans report being unable to
  get where they needed to go due to transportation
• 21 of older Texans cite the cost as unaffordable

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Safe and affordable movement in communities that
are accessible
Issues Transportation

• Some older drivers can benefit from
• specialized highway designs
• education and skills to accommodate for declining
  skills
• For non-drivers, transportation is key barrier to
  health and human services and maintaining
  independence
• TxDoT is now responsible for coordinating HHS
  transportation services statewide
• A variety of best practices are in development
• Mobility planning at state and local level must
  recognize the needs of older Texans

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Health Care Services Access to preventive, acute
and chronic care services
Source of Health Care Coverage for Older Adults
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Access to preventive, acute and chronic care
services
Issues Health Care Services

• Availability is limited in rural areas and by
  other geographic factors
• Access is limited by lack of resources (e.g.,
  waiting lists) and difficulty navigating system
  (e.g., community-based LTC)
• Affordability affects the insured, uninsured
  (e.g., near elderly) and underinsured (e.g.,
  Medicare limitations)

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Prescription Drug Coverage

• Older adults are 13 of U.S. population but use
  36 of prescription drug use
• Half of respondents to a Texas AARP member survey
  said they have had a problem paying for
  prescription drugs in the last year
• Some seniors report not filling a prescription
  due to costs or skipping doses of their
  medications to make them last longer

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Issues Drug Coverage

• Current drug coverage options are unstable and
  inadequate
• Medicare reform effects are uncertain
• Texas passed, but did not fund a State
  Pharmaceutical Assistance Plans to fill in gaps
• Connection to pharmaceutical discount programs is
  complicated

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Health care professionals with geriatric training
to address the health needs of older Texans
Health Care Workforce

• Older adults are 13 of the population but
  consume 49 of hospital days and 50 of physician
  hours
• Persons with multiple chronic conditions (5) see
  an average of 14 different physicians and make 37
  different office visits per year

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Health care professionals with geriatric training
to address the health needs of older Texans
Issues Health Care Workforce

• Limited supply of providers trained in geriatrics
• 7,600 certified geriatricians in nation fewer
  than 100 in Texas
• Projected need 36,000 by 2030 nationally
• Long-term care is particularly disturbing
• Existing training is limited and not standardized
  across institutions and disciplines
• Geriatric care requires a multi-disciplinary
  approach (e.g., geriatric assessment)

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Health Care Utilization May Rapidly
IncreaseNumber of Physician Contacts Days of
Hospital Care for Persons Age 65
Source Demographic Implications for the
Long-term Care System, Murdock, S.H.
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Long-term Care Utilization May Rapidly
IncreaseProjected Number of LTC Clients age 65,
1996-2030
Source Demographic Implications for the
Long-term Care System, Murdock, S.H.
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Support for family members and other people
providing voluntary care and assistance
Caregiving

• 1 in 4 adults have provided some type of
  caregiving in the past year
• Employee can lose as much as 660,000 in lost
  income, pensions, wages, and Social Security
  throughout their career
• 448,439 children (7.6 of children in state) live
  in grandparent-headed households

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Support for family members and other people
providing voluntary care and assistance
Issues Caregiving

• States are experimenting with innovative
  approaches to caregiver support
• Caregivers need to know about available support
  services
• Grandparents need information and support
• Employees need support in balancing work and
  family

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Personal safety and freedom from abuse, neglect
and exploitation
Protections

• Estimates of elder abuse in the United States
  range from four to 10 percent of individuals over
  age 65
• Only 16 percent were reported to state protective
  and regulatory agencies
• For every reported case of abuse, as many as five
  cases go unreported

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Personal safety and freedom from abuse, neglect
and exploitation
Issues Protections

• The true prevalence of abuse, neglect, and
  exploitation among older Texans is not known
• Ongoing public awareness and education for
  community members, bank employees, health care
  providers and other professionals is critical
• APS referrals are increasing and becoming more
  complex requiring
• Specialized services and community capacity
  building to generate resources at the local level
• Case management involving multidisciplinary
  assessments

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Services and assistance that allow for
independent living
Community Supports

• Access to services is confusing and undergoing
  experimentation and change
• Lack of public awareness of access and Assistance
  resources
• Real choice system grants focusing on navigation
  and aging and disability resource center models
• System reform under 2292 continued
  implementation of TIRN
• Aging of the DD population is aging creating need
  for service delivery systems to work together
• Aging Texas Well capacity building in local
  communities is essential

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Texas Population in 2030

• Poorer, less educated workforce
• Reduced consumer expenditures and household net
  worth
• Increased markets for owned housing, health care
  and personal care
• Reduced demand for traditional educational
  services
• Substantial increase in welfare and human
  services
• Reduced per capita tax revenues
• Increased government costs

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At-Risk Boomers

• 1/5th of population
• Earned less than 30,000/ year
• 18,149 average yearly wage
• 36 had high school diploma
• 16 completed college
• 70 plan to work in retirement years
• 33 fear growing old

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Key Themes

• Aging population is growing and changing
• Aging is Intergenerational Lifespan perspective
• Holistic Approach Aging Texas Well

• Community Capacity Building is Key!

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Texas future depends on Aging Friendly
Communities that provide opportunities and
resources for older Texans to live healthy,
dignified, and independent lives.
ATW Capacity Building

• National Governors Association
• Administration on Aging
• National Association of Area Agencies on Aging
• Southern Governors Association
• Retirement City Initiatives
• Grants to Texas Communities

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Web-Based Assessment
ATW Community Assessment Tool

• Allows communities to evaluate whether they are
  ready for aging population, or whether further
  capacity building is needed.
• A first step for communities interested in
  becoming Aging-Friendly to resources,
  strengths, weaknesses across ATW domains and OAA
  Benchmarks

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Key Steps in Process
ATW Community Assessment Tool

• Understanding Community Assessment
• Why engage in Community Assessment?
• Defining Your Community
• Neighborhood, City, County, Region?
• Forming Community Partnership Team
• Who should be at the table?
• Assessing Your Community
• What question should you ask?
• Planning for the Future
• How can visions and goals be translated into
  Action Steps?

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• What can you do to ensure
• that older Texans in your
• community are Aging Well?

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www.dads.state.tx.us Beth.Stalvey_at_dads.state.tx.us