Demographics of an Aging Population

HSc 310 Aging & Health

Today we will discuss the implications of our changing population….changing in that the largest cohort “The Baby-Boom Generation” will soon be making the transition from middle age to old age. How will this shape the our future as potential health care practitioners.

1

Growth of the Older Adult Population 12 10 8 1981 1991

6 4 2 0 Can 65+

Can 75+

HSc 310 Aging & Health

In 1991 older adults (those 65+) represented about 11.6% of the total Canadian population. This was a 2% increase over 10 years. The majority of this population 60% are between the ages of 65-74 years. What will happen over the next 10 years?

2

Percentage of the total population

Canada’s future older population 30 25 20

65+ 75+

15 10 5 0 1996

HSc 310 Aging & Health

2001

2006

2011

2016

2021

2026

2031

Perreault et al. 1990

Looking into the future we will see that this percentage of the older adult population will grow substantially in the first part of this century. Older adults population will grow by 2-4 % every 10 years for the next 20 years. A similar predicted trend will be observed in those who reach 75+ years of age

3

Maximal and Normal Life Span • Maximal documented life span has been reported to be 124 years of age. • However normal life span is considerably less…. In 1990: Canadian Males - 74 years Canadian females 80.7 years In 1960: Males - 60 years Females - 62.1 years HSc 310 Aging & Health

Trivia: Oldest living Canadian “Pierre Joubert” form Charlesbourg Quebec, reached the age of 113 yrs. In 1900 only 40% of the entire population reached the age of 65 years. By 1990 80% of the population would reach 65 years and 50% would reach 79 years of age.

4

Why are we living longer • 1. Decline in child mortality Control of infectious diseases. • 2. Reduction in premature deaths through prevention and early screening programs for diseases such CHD and Cancer. • 3. General increase in life span due enhanced living conditions and advances in medicine. HSc 310 Aging & Health

New medical and surgical techniques, wider availability of comprehensive health care, improved programs of public health and sanitary engineering, the closer control of working conditions,better nutrition, higher standard of living improved knowledge of hygiene.

5

Population in thousands

Projection of Canadian Population by Age and Sex for 2001 1400 1200 1000 800 Females Males

600 400 200 0 0- 4

1014

HSc 310 Aging & Health

2024

3034

4044

5054

6064

7074

8084

90+

Statistics Canada

Baby-Boom - post WWII increased birth rate causing a large increase in the population. Approximately those 35- 54 years of age are included in this cohort. Following them we have the “Echo” cohort which includes yourselves as the offspring of the baby boom generation. The concern is what will happen when the baby boom generation crosses over from middle age to old age? Will we be prepared to support them, what will have to the expenses placed upon health care?

6

Dependency Ratios based of 1991 Census data • Canada working population = 74.4% older population (65+) = 11.6%

• Australia working population = 66.9% older population (65+) = 11.3%

• UK working population = 65% older population (65+) = 15.5%

25

25 20 16

17

15 10 5 0 Canada

Australia

UK

HSc 310 Aging & Health

Dependency ratio: size of the age cohort in relation to the size of the working population (15-64 yrs) older population = population 65+X 100 dependency ratio (older population:working population) With an increasing older population and a declining younger population this ratio will continue to grow in the next millennium.

It will become harder to support the older adult generation. Fewer workers may slow the economy, more money towards social programs. In the next decade your will have to support 2-3 older adults through taxes paid for increased health care, pensions. The UK is already experiencing some of these problems as its baby boom cohort is slightly ahead of ours.

7

Per capita expenditure

Projected social expenditure 320

Based on 1980 = 100

280 240 200 160 120 80 1980

1990

2000

Pensions Family Benefits HSc 310 Aging & Health

2010 Health Education

2020

2030

2040

Unemployment

Statistics Canada.1991

Social expenditures spanning six decades, projections based on constant mortality and migration rates within the population. By 2040 pensions will 38% of the social spending. This will be due to the dramatic increase in the number of older adults by 2010. Health care spending will also increase due to the increased cost of caring for the elderly population.

8

Projected percent social expenditure 1990

2040

1990

40

50

30

40

2040

30

20 20

10

10

0 Ed

u

t ca

0 i

on

a He

lth

Ca

HSc 310 Aging & Health

re Pe

i ns

Un

o

ns

em

pl

o

ym

Fa

m

e

nt

ily

Be

f ne

its

0-14

15-64

65+

Statistics Canada, 1991

Here we see the shift in social program funding in the future as well as who the funding will be for…the second graph shows that the Baby-boom generation will control the majority of the spending habits as they continue to age.

9

0 Chronic Condition

1 Chronic Conditon

Percent distribution of the population

2 Chronic Conditons

100%

80%

35 47

53

45

61 70

60% 25

35 40%

32

31 28

61

20% 30

22

19

20

23 10

0% 60-69

70-79

MALES HSc 310 Aging & Health

80+

60-69

70-79

80+

FEMALES Guralnik et al. 1989

Health resources will be heavily burdened by the older adult population…. Chronic health problems experienced by those 65 yrs and older account for 30% of all health care expenditures for only approximately 12% of the population. This will also place a greater demand upon those working in the health care system - doctors, nurses, hospitals, clinics….

10

Canadian disability rates by age and gender, 1991 80

Disability Rate (%)

70 60 50 40 30 20 10 0 35-64

65-74 Males

HSc 310 Aging & Health

75-84 Females

85+ Total

Statistics Canada, 1991

Disability rates will also increase…including vision, hearing and ambulatory impairments. This place an greater demand upon the rehabilitative medical community which includes the PT’s, OT’s and Kinesiologists.

11

Life Expectancy

Years of active life expectancy and Years of dependent living 20 F M males F females 18 F 16 F 14 M M 12 F M 10 F M 8 M 6 4 2 0 65-69

HSc 310 Aging & Health

70-74 75-79 80-84 Age Groups (years)

85+

Katz et al. 1983

Reducing the years dependent living and the incidence/impact of chronic disease will obviously improve the quality of life for all older adults. This is called the “compression of morbidity”.

12

Future prediction for institutionalization of persons 65+ Institutionalized Population 65+ 460000

360000

260000

160000 1996 2001 2006

HSc 310 Aging & Health

2016

2041

Statistics Canada, 1996

Long-term care services and costs increase exponentially with age…..clearly the benefits to society, not to mention those afflicted would be enormous if the onset of functional limitations could be postponed… However, there does seem to be some positive changes occurring within the health care system...

13

Shift in Care

% use

% of population living in institutional care 20 18 16 14 12 10 8 6 4 2 0

% of the population by age group receiving home 50 care 40 30 20 10 0

1981

HSc 310 Aging & Health

1996

65-69

>85

Statistics Canada, 1999

Encouraging evidence suggests that the rates of disease and disability have begun to decline in those 85+, with recent emphasis shifting from tertiary care toward preventing or delaying the onset of chronic disease, the maintenance of functional well-being may be extended to a time closer to life expectancy. Canada has experienced a decline in institutionalized older adults > 75 years. Increased use of home care services, especially those > 85 years of age. Lack of knowledge by health care providers to deliver effective programs as well as staff in institutional setting to provide effective interventions for this older , sicker and frailer population. Learned dependence by both residents and staff.

14

Total Participants in Programs 1989-99 450 400

403 354

350 300 250 200 150 100 50 0

375

294 248 191

204

126 54

59

21 1989 89-90 90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99

HSc 310 Aging & Health

Older adults are also seeking programs/care that will help maintain and or improve their functional independence. Attending an exercise program for many older adults has become the “magic pill” they needed to make the best of their older adult life. This graph shows the growth of participants in in-house programs at the CAA. Increased participant has been influence by the increased interest in exercise programs as well as a greater variety of exercise programs being offered. Recreational activities - bird watching, gardening, golf

15

“If I’d known I was going to live this long, I’d have taken better care of myself.” Leon Eldred

The end

16