Expert Answer:Demographic Patterns of the Aging Population Paper

  

Solved by verified expert:Describe the changing demographic patterns of the aging population. How do these patterns vary by age, gender, race, and ethnicity? How will the demographic changes in the population in the next decade influence the type and delivery of community resources available to older adults?
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CHAPTER
Page 15
2
DEMOGRAPHY
OF AGING
Copyright © 2003. SAGE Publications. All rights reserved.
T
he 20th century witnessed a dramatic change in population
demographics. At its beginning, most countries had pyramid-shaped
population profiles, with children and young people greatly out­
numbering those who were older. By the century’s end, however, the pyra­
mid shape had changed as the percentage of the population who were
children decreased and the number of middle-aged and older persons
increased. Although most people are aware that the United States and
Europe have experienced an increase in the number of older adults, espe­
cially those over the age of 85, what is less well-known is that this is true of
most nations. The increase in the number of older citizens is creating prob­
lems for developing countries that do not have adequate resources or the
economic stability to support a large older adult population. In the United
States, ethnic diversity in the older population is growing. No longer primar­
ily European Americans, this group now includes substantial numbers of
Asian, Latino, and African Americans. The greater number, ethnic diversity,
and increasing age of the population will complicate treatment and service
delivery in the areas of health and social care, as well as affecting transportation,
business, education, and even recreation.
This chapter examines the dynamics of the population growth in the
United States, focusing particularly on the increase in numbers of older
Aldwin, C. M., & Gilmer, D. F. (2003). Health, illness, and optimal aging : Biological and psychosocial perspectives. Retrieved from http://ebookcentral.proquest.com
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DEMOGRAPHIC, THEORETICAL, AND METHODOLOGICAL ISSUES
adults, with an overview of how life expectancy has changed in the past 100
years. We will address, briefly, how increasing numbers of older people may
affect the economy of the country. We also report the geographic distribution
of older people. Particular attention is given to those who live in rural areas,
because a large percentage of older adults live in nonmetropolitan areas.
Next, we look at population changes in other parts of the world (including
Europe, Africa, South America, and Asia). A focus of this discussion is the
morbidity and mortality rates of these countries and the difficulties of
providing resources for their aging populations.
The last part of the chapter addresses demographic factors as they relate
to the rate of aging; more specifically, how do gender, marital status, ethni­
city, and socioeconomic status affect the mortality and/or morbidity of an indi­
vidual? Each subsection covers the demographics of a particular population
and the specific risk involved in being a member of that group.
The worldwide demographic shift highlights the fact that aging is not
strictly genetically determined but is plastic, or susceptible to influence.
Nonetheless, the demographics of morbidity and mortality also demonstrate
the opposing principle—that aging processes also exhibit cumulative effects,
which can manifest either as aging acceleration or deceleration. How differ­
ences in gender, marital status, ethnicity, and socioeconomic status affect life
expectancy will be reviewed with this dialectic in mind.
Copyright © 2003. SAGE Publications. All rights reserved.
● AGING IN THE WORLD
In this section, we focus primarily on aging trends in the United States, but
we provide an international overview as well.
Population Aging in the United States
Changing demographic profiles. In 1905, children and young people made
up the largest segment of the population, with only a small percentage of
people 65 years of age and older (see Figure 2.1a). This created a pyramidshaped profile, with a broad base of infants and children and relatively few
older adults. Pyramid-shaped population profiles result from high fertility
rates and high mortality rates.
By 1975, the demographic profile of the country had changed (see
Figure 2.1b). Infants and children were no longer the largest population
groups. Instead, the largest cohort consisted of the baby boomers, who were
then between the ages of 10 and 30. There was also a slight widening at the
Aldwin, C. M., & Gilmer, D. F. (2003). Health, illness, and optimal aging : Biological and psychosocial perspectives. Retrieved from http://ebookcentral.proquest.com
Created from umuc on 2019-03-23 09:38:54.
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Demography of Aging

Copyright © 2003. SAGE Publications. All rights reserved.
top of the pyramid as more people in their 60s and 70s survived into their 80s
and 90s. On the other hand, the indentation in the middle of the 1975 pyra­
mid characterized those between the ages of 35 and 45, the result of the low
birthrate during the Depression.
The smaller Depression cohort has resulted in an interesting occurrence.
For the first time in over a century, the growth rate of the older population in
the 2000 census did not exceed that of the rest of the population. Although the
total population increased by 13.2%, the population of older adults increased
by just 12%. Furthermore, the proportion of those 65 and older in the total
population dropped from 12.6% in 1990 to 12.4% in 2000 (Hetzel & Smith,
2001). This will change as the baby boomers begin to turn 65 in the year 2011.
Figure 2.1c depicts the remarkable changes that are expected to occur by
the year 2010. The bottom two thirds of the pyramid will have squared off con­
siderably by that time. There will be comparable numbers of children and young
and middle-aged adults. Many more will survive into their 70s and 80s, although
there will be relatively few who are 85 and older, compared with the rest of the
population. By 2030, the baby boomers will have swelled the ranks of older
people, becoming the grandparent boomers (see Figure 2.1d). It is projected
that as many as 70 million people in the United States will be 65 or older by 2030
(Administration on Aging [AOA], 2002). The demographic profile continues to
change from a pyramid shape to one that is rectangular. Atchley (2000) argues
that countries with rectangular population distributions tend to be more pros­
perous and more politically stable than those with the classic pyramid shape.
85+ in the United States. About 100,000 people were over the age of 85 in
the United States in 1900. This number has grown rapidly since that time.
Although this age group represents a small proportion of the total popula­
tion, currently 1.5%, it is the fastest growing segment of the older population.
In fact, it increased by 38% in the 1990s, from 3.1 million in 1990 to 4.2 mil­
lion in 2000 (Hetzel & Smith, 2001). Remarkably, this number is expected to
quadruple in the first half of this century, nearing a projected 18.9 million by
the year 2050 (Hobbs & Damon, 1996).
Accurately counting the number of centenarians in this country (or any
other) is not easy, as exaggeration of reported age is common in older people
who are proud of their ability to survive into later years (Medvedev, 1974). It
is estimated, however, that about 14,000 centenarians lived in the United
States in 1980 (Hobbs & Damon, 1996). This more than tripled in the past 20
years; the 2000 census reported 50,454 centenarians. Four out of five were
women, reflecting the change in gender ratio with age. South Dakota had the
highest proportion of centenarians in its population—1 of every 3,056
people (Hetzel & Smith, 2001). The chances of becoming a centenarian
Aldwin, C. M., & Gilmer, D. F. (2003). Health, illness, and optimal aging : Biological and psychosocial perspectives. Retrieved from http://ebookcentral.proquest.com
Created from umuc on 2019-03-23 09:38:54.
17
Aldwin, C. M., & Gilmer, D. F. (2003). Health, illness, and optimal aging : Biological and psychosocial perspectives. Retrieved from http://ebookcentral.proquest.com
Created from umuc on 2019-03-23 09:38:54.
18
12
10
8
12
10
8
6
0
0
2
Population in millions
2
4
6
8
10
12
0
0
2
Population in millions
2
4
6
8
Female
10
12
14
14
Baby Boom
Projected Population by Age and
Sex: 2010
4
95+
85-89
85-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
Age
Population by Age and Sex: 1905
4
Female
12
10
8
12
10
8
Figure 2.1d
14
Male
Figure 2.1b
14
6
6
Male
0
0
2
Population in millions
2
4
6
8
Female
10
12
0
0
2
Population in millions
2
4
6
8
Female
10
12
Baby Boom
Projected Population by Age and
Sex: 2030
4
Age
90+
85-89
85-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
14
14
Baby Boom
Population by Age and Sex: 1975
4
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
Age
SOURCE: Hobbs, B., & Damon, B. L. (1996). 64+ in the United States (Current population reports: Special studies, P23-190).
Washington, DC: Government Printing Office.
Figure 2.1c
14
Male
6
75+
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
Age
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Figure 2.1a
14
Male
Copyright © 2003. SAGE Publications. All rights reserved.
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Demography of Aging

greatly improved during the 20th century. A person born in 1879 had a 1 in
400 chance of living to be 100 years old, but a person born in 1980 has a 1 in
87 chance of living to 100 (Hobbs & Damon, 1996).
Although it is true that the older population is healthier than ever before,
there is concern about the economic stress that growing numbers of older
adults may place on the country. More than any other age group, those 85
and older have the greatest health and social care needs, and an increase in
their numbers may have a major impact on the resources of the nation.
Age dependency ratios. The sheer number of older adults will present daunt­
ing challenges for subsequent generations, but there still will be more
younger and middle-aged than older people. Therefore, the working units of
the population will outnumber those who are dependent on them.
Furthermore, in many cases, older adults are beneficial to the economic
health of the country rather than a burden.
A total dependency ratio (TDR) compares the number of economically
nonproductive citizens (below age 18 and age 65 and older) with the number
of working-aged adults. Although not entirely accurate (some individuals
make considerable money in early or late life and some working-aged adults
are disabled, unemployed, or taking time out to raise children), the age
dependency ratio is a rough estimate of the number of people who need to
be supported by workers. The equation is simple:
Copyright © 2003. SAGE Publications. All rights reserved.
TDR = (a + c)/b
where a = children < 18, b = adults 18 to 65, and c = adults 65 and older. A serious concern is that the growing percentage of older adults in the population will create a crisis in TDRs and place an overwhelming burden on working-aged adults. Furthermore, an increase in TDRs may result in com­ petition for services between the old and the young. TDRs do not translate directly to dollars spent, however. The amount that children and elders cost working family members and society depends on such factors as the level of services provided and the savings, pensions, investments and other types of benefits that older adults can draw on. Older adults are healthier than ever before, which may lessen the expected burden of health care costs. Although there has been a considerable downturn in economic stability recently, with the uncertainty of the stock market and failure of some retirement funding, older people are still less likely to live in poverty than in the past (more on this later in the chapter). In poor families in the United States, Social Security payments to grandparents are often the most stable source of income for the family as a whole. Countries that have economic surpluses, such as the Aldwin, C. M., & Gilmer, D. F. (2003). Health, illness, and optimal aging : Biological and psychosocial perspectives. Retrieved from http://ebookcentral.proquest.com Created from umuc on 2019-03-23 09:38:54. 19 02-Aldwin.qxd 20 6/21/03 2:37 PM ● Page 20 DEMOGRAPHIC, THEORETICAL, AND METHODOLOGICAL ISSUES Copyright © 2003. SAGE Publications. All rights reserved. United States and Europe, are able to provide sufficient resources for the dependent members of their societies. Developing nations, however, may experience much more strain, as will be explained later in this chapter. Life expectancy. As mentioned in Chapter 1, life expectancy is the average number of years a person in a particular cohort can expect to live. There has been a remarkable change in the life expectancy of people living in the United States. A child born today can expect to live at least 30 years longer than one born a century ago. Although life expectancy in 1900 was about 47 years (Hobbs & Damon, 1996), a female born in 1999 can expect to live 79 years and a male, almost 74 years (Anderson & DeTurk, 2002). In 1900, the leading causes of death in the United States were infectious diseases such as tuberculosis, pneumonia, influenza, and gastroenteritis (Sahyoun, Lentzner, Hoyert, & Robinson, 2001). Very few deaths were caused by heart disease, and death from lung cancer was extremely rare. Death was distributed throughout the life span; people of all ages died of smallpox and tetanus, childbirth was associated with high mortality rates, and infant mortality was quite high (about 16%, compared with less than 2% today). Treatment for bacterial infections was rudimentary and often ineffective, and vaccines against viruses had not yet been developed. The discovery of how infectious diseases spread occurred in the late 19th and early 20th centuries, leading to the development of public health measures to control the spread of communicable diseases and the research and development of vaccines and drugs (Green & Ottonson, 1994). Since the 1930s, the primary causes of death have shifted away from infectious diseases to ones that are more chronic in nature. By the latter part of the 20th century, the five leading causes of death among those 65 years and older were heart disease, cancer, stroke, chronic obstructive pulmonary disease, and pneumonia and influenza, with slight variations depending on ethnicity (Sahyoun et al., 2001). Age-specific life expectancy has also changed dramatically in the past 100
years, however. The conditions that have fostered this extension of life include
a decrease in infant and maternal mortality rates, improved sanitation practices,
better nutrition, and improved medical care. For example, in 1900, a 65-year-old
would be expected to live less than 13 more years. In contrast, a person who
was 65 years of age in 1999 could expect to live another 17.7 years (Anderson &
DeTurk, 2002). As might be anticipated, age-specific life expectancy has changed
less for the old-old over the course of the last century. In 1900, the life
expectancy of an 85-year-old was about 4 years (Hobbs & Damon, 1996), and it
had increased to only 6.3 years in 1999 (Anderson & DeTurk, 2002).
A French woman, Jeanne Calment, was possibly the longest-lived person
in the world. At her death in 1997, she had reached the age of 122 years and
Aldwin, C. M., & Gilmer, D. F. (2003). Health, illness, and optimal aging : Biological and psychosocial perspectives. Retrieved from http://ebookcentral.proquest.com
Created from umuc on 2019-03-23 09:38:54.
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Demography of Aging

5 months (Noveck, 1997). Although there have been reports of people living
beyond this time, when records are examined, these cases of longevity are not
validated. For example, Medvedev (1974) visited and studied centenarians in
Georgia in the former USSR, where there appeared to be a large number of the
oldest-old. He found that ages were often exaggerated. Many had taken on the
birth dates of siblings who died as infants but shared the same name. Of great
interest was that, when he returned a couple of years later, people had often
increased their stated ages by 5 or 10 years. Thus, an individual who claimed to
be 125 was found to be only 104. This reflected the fact that centenarians were
valued in the USSR; often, parades were held in their honor.
Longevity comes at a cost. Chronic diseases such as arthritis, diabetes,
osteoporosis, hypertension, arteriosclerosis, and multiple neurological disor­
ders have replaced the acute diseases of years ago. In general, chronic dis­
eases are not curable, and the main goal of treatment is management of the
illness to decrease its rate of progression and therefore limit disability.
Thus, this dramatic increase in life expectancy has evoked two major con­
troversies. Fries and Crapo (1981) first argued for a phenomenon they termed
the “compression of morbidity.” Fries (1989) noted that survival tables showed
an increased squaring of the curve, with larger numbers of people surviving until
late life. Demographic trends suggested that the onset of major chronic dis­
abling illnesses had been delayed. He proposed a fairly rosy scenario, that
people would remain healthy longer, until a few months before their maximum
life span (about 85) and would then die after a relatively short period of
disability. Others, however, have argued that the increase in number of persons
surviving until very late life translates into an extension of morbidity, with
people living longer with disabilities (Roos, Havens, & Black, 1993). Still others
have maintained that periods of active life expectancy exceed disability
(Doblhammer & Kytir, 2001; Manton & Land, 2000).
It is likely that individual differences exist in the compression or exten­
sion of morbidity. For example, people with poor behavior habits (cigarette
smoking, inactivity, and obesity) have higher levels of disability in late life and
extended declines before death, whereas those with healthier lifestyles show
little disability and only short periods of disability before death (Hubert,
Bloch, Oehlert, & Fries, 2002). Centenarians may enjoy a compression of
morbidity, but those who die in their 80s may not (Perls, 1997).
The second controversy, over whether there is a maximum life span in
humans, has not been resolved. Clearly, the maximum life span is not 85;
Jeanne Calment was a witness to that. Is it 122? Or not really fixed? Vaupel and
his colleagues (1998; Oeppen & Vaupel, 2002) have argued that the dramatic
increase in old age survival presages an increase in the maximum life span.
The average life expectancy in the world has more than doubled in the past
two centuries. Before 1950, most of that increase was due to a decrease in
Aldwin, C. M., & Gilmer, D. F. (2003). Health, illness, and optimal aging : Biological and psychosocial perspectives. Retrieved from http://ebookcentral.proquest.com
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DEMOGRAPHIC, THEORETICAL, AND METHODOLOGICAL ISSUES
Copyright © 2003. SAGE Publications. All rights reserved.
infant mortality, but in the past half century, it is because of greater survival
in late life. Current projections are that the average life expectancy for women
will be in the 90s by 2040.
Vaupel and his colleagues argue that the maximum life span reflects statis­
tical forces rather than simply genetic ones. For example, suppose that the force
of mortality in late life is .5—that is, half of the individuals 90 years old will die
in the next year. When there are only a few ind …
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