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HSM330 Lec 5 notes

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Health Services Management
HSM 330
Daolun Chen

Lecture 5 Chapter 2- Aldwin, Carolyn M. & Diane F. Gilmer. 2004. Health, Illness, and Optimal Aging: Biological and Psychosocial Perspectives. Thousand Oaks, California: Sage Publications, Inc. • There has been a dramatic change in population demographics in the last century that continues to provide ongoing challenges for health care providers to provide adequate services to the increasing number of older adults in the world. This issue has become an important consideration in many countries where ethnic diversity and increasing age will impact upon the type of treatment and services required. • The worldwide demographic shift has enabled researchers to appreciate that aging is not strictly genetically determined but is plastic or capable of being influenced by external factors. However, the demographics of morbidity or mortality also provides convincing truth that aging processes also exhibit cumulative affects which can influence the acceleration or deceleration of the aging process. • There are chronic diseases that are more prevalent among different population groups. There are problems in estimating life expectancy by ethnicity as a result of many errors that can occur. Ethnic differences in life expectancy are due to genetic factors but they are also due to health behaviour habits and differential immigration patterns. • Population Aging in the United States • In 1905, children and young people represented a large segment of the population with only a small percentage of individuals of 65 years of age and older. In 1975, this demographic profile had already changed and infants and children were no longer the largest population group. The largest cohort consisted of the Baby Boomers who at that time were between the ages of 10 and 30. The change had also revealed that more people in their 60s and 70s were surviving into their 80s and 90s. • Many more individuals will survive into their 70s and 80s although there will still be relatively few who are 85+. By 2030 the Baby Boomers will have become older in age and it is estimated that 70 million people in the United States alone will be 65 or older at that time. As a result of these shifts in the demographic profile. Its initial shape as one that was pyramidal will become rectangular with distributions that will have changed accordingly. • In 1900, there were only approximately 100,000 people who were over the age of 85 in the United States. This age group currently represents 1.5% of the entire population but its rate of growth has increased by 38% in the 1990s and is expected to quadruple in the first half of this century. In 1980, it is estimated that there were 14,000 centenarians living in the United States. This number has more than tripled in the past 20 years, with 4 out of 5 being women, reflecting the change in gender ratio that occurs with aging. 1 • The probability of reaching 100 years of age improved during the 20 century. In 1879, a person had a 1/400 chance of living to be 100 years old, but as of 1980, there was a 1/87 chance to living to 100. • There are concerns about the economic implications associated with caring for the 85 and older age group of individuals who will likely present with the greatest health and social care needs. There will still be more younger and middle-aged individuals than older people. • Definition: 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: TRD = (a + c)/b Where a = children < 18, b = adults 18-65, and c = adults 65 and older. • There have been some concerns about the growing percentage of older adults that will create a potential crisis in TDRs and will result in overwhelming pressure on working aged adults. An increase in TDRs may also result in competition for services between the old and young. TDRs do not translate directly to dollars spent. Older adults are healthier than before which may lessen the expected burden of health care costs. • In countries such as the United States and Europe there are available resources available to offer assistance for dependant members of their societies. However, this is not necessarily the case in developing nations. • Life Expectancy = average number of years that a person in a particular cohort can expect to live. In 1900 life expectancy was approximately 47 years and in 1999 it was 79 years for a female and 74 years for a male. A child born in 2007 can expect to live at least 30 years longer than one born one century ago. In 1900 the leading causes of death in the United States were: infections diseases (such as Tuberculosis), pneumonia, influenza and gastroenteritis. At that time very few deaths were attributed to heart disease or lung cancer. As well at that time, death was distributed throughout the life span and people of all ages died of Small Pox and tetanus. • Childbirth was associated with high mortality rates and infant mortality rates were also high. At that time, there was difficulty in providing adequate treatment for viral infections. There were often ineffective treatments for bacterial infections and vaccines were unavailable as yet to counteract the spread of viral diseases. The development of public health measures in the last century to control the spread of communicable diseases and the development of vaccinations and treatments offered greater hope. Since the 1930s the primary causes of death th were chronic illnesses rather than infectious diseases. By the end of the 20 century, the leading causes of death among those 65 and older were: cancer, stroke, chronic pulmonary, pneumonia, influenza, with variations that were influenced by ethnicity. 2 • In the past 100 years, age specific life expectancy has also changed. These changes reflect a decrease in infant and maternal mortality rates, improved sanitation practices, better medical care and overall better nutrition. Age specific life expectancy for
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