WHAT STARTS HERE CHANGES THE WORLD
Older Texans and Their Families: A Snapshot of Current Issues
Presentation at
Impact Austin Discovery Day
January 5, 2013
Namkee G. Choi, PhD
WHAT STARTS HERE CHANGES THE WORLD
Texas Population in 2011(25.7 million)
84%
5% 11%
Under 60 years 21.8 million 60-64 years 1.2 million65+ years 2.7 million
WHAT STARTS HERE CHANGES THE WORLD
Older Texans (60+ Years)
83%
9% 8%
In 201160-79 years 80-84 years 85+ years
50%50%
In 2020
60-84 years 85+ years
Of 100 largest metro areas in the country, Austin has: 1. Fastest growing number of people aged 55-64 years; and 2. Second fastest growing number of people aged 65+.
WHAT STARTS HERE CHANGES THE WORLD
Demographics of Texans 60+ Years (American Community Survey , 2008)
44% Male; 56% female
Married58%Wid-
owed24%
Div/Sep15%
Never married4%
Marital Status
Anglo64%
Hispanic21%
Black9%
Asian3%
Native American 1% Other
3%
Race/Ethncity
WHAT STARTS HERE CHANGES THE WORLD
Demographics/Economic Status
OPL =< 100%12%
OPL 101-150%10%
OPL 151-200%10%
OPL 201+68%
Economic Status
< HS26%
HS/GED27%
Some
col-lege21%
AB de-
gree4%
BA/BS13%
MA/MS8% Doctorate
1%
Level of Education
WHAT STARTS HERE CHANGES THE WORLD
Income Sources
73% had no wage/salary income in the
preceding 12 months
8% received Supplemental Security Income
Limited English Proficiency (LEP)
9% not speaking English well or not at all
25% speaking another language at home
WHAT STARTS HERE CHANGES THE WORLD
Health Status of Texans 60+ Years (ACS, 2008)
12% self-care activity difficulty
12% cognitive difficulty
18% independent living difficulty
27% ambulatory difficulty
15% hearing difficulty
9% vision difficulty
WHAT STARTS HERE CHANGES THE WORLD
Informal Caregivers/Lovegivers in Texas (TX DADS & NFCA)
2.7 million (10.5% of all Texans)
$26 billion worth of care annually: Greater than total
statewide Medicaid spending
39% for spouse; 57% for other family members
Typical caregiver/lovegiver: Age 45-64; female; married and
employed (51%) with children
More than 1/3 provide 40+ hours of care a week.
WHAT STARTS HERE CHANGES THE WORLD
Informal Caregivers in Texas cont.
17% of older Texans (age 60+) are family caregivers (for
older adults and children).
Nationally, 78% of adults living in the community and in
need of long-term care depend on family and friends as
their only source of help.
WHAT STARTS HERE CHANGES THE WORLD
Caregiving: Rewarding but Stressful
The unprecedented amount of demands on the family:
o More physical, functional, and cognitive comorbities with longer life span
o Dementia life expectancy: 10-15+ years after the onset
o Physical demands (ADLs/IADLs, lifting, turning, bedding changes)
o Behavioral management issues in dementia caregiving
o Role overload & emotional toll from social isolation, depression, guilt,
loss & grief
WHAT STARTS HERE CHANGES THE WORLD
Family Support/Conflict
Caregivers with other family support do better.
Family help may come with a price: Argument over care
provision, cost of care, and institutionalization and other
decision-making
Caregiving can awaken/intensify family relationship issues :
o The altruistic motivation to help can become enmeshed
with unresolved feelings from the past.
o Resentment toward care recipient
o Reawakened sibling rivalries
WHAT STARTS HERE CHANGES THE WORLD
Formal Support
Formal (gov’t-paid, subsidized, or privately paid) services help.
Can be problematic: Frequent helper turnover, inadequate level
of helper training, and high cost
15% of older TX caregivers pay someone else to help them care
for their loved ones.
Placement of a loved one in a care facility does not end stress:
o Guilt
o Traveling to visit the loved one
o Learning to interact with staff and monitoring care
o Stress related to financial arrangement
WHAT STARTS HERE CHANGES THE WORLD
Psychosocial Interventions for Caregivers of People with Dementia
Psychoeducation programs (e.g., Antecedent-Behavior-
Consequences [ABCs] in behavioral management)
Communication and skills training
Stress management
Asking for help from extended family and friends
Caregiver support groups
Counseling of caregiver depression, loss and grief
WHAT STARTS HERE CHANGES THE WORLD
Effectiveness of Caregiver Programs
Modest but significant benefits on the following
outcomes:
o Delayed nursing home entry
o Caregiver stress/burden
o Caregiver knowledge about dementia, caregiving,
and resources and perceived social support
o Caregiver & patient depression and other
psychological morbidity
WHAT STARTS HERE CHANGES THE WORLD
The Most Important Intervention Element
Involvement of both caregiver and patient in a structured
intervention (e.g., teaching the caregiver problem-solving
skills applicable to the patient, pleasant event planning, &
cognitive stimulation for patient)
WHAT STARTS HERE CHANGES THE WORLD
Community Support and Resources National Family Caregiver Support Program (The Older American
Act, Title IIIE)
Community Living Assistance and Support Services (CLASS; TX
DADS)
Private-pay geriatric case management firms
Respite care:
o Home health aides
o Housekeeping services and benefits counseling (CapCOG--
Area Agencies on Aging - AAA)
o Adult day services (AGE)
o Meals on Wheels for both caregiver and the patient
WHAT STARTS HERE CHANGES THE WORLD
Community Support and Resources
SAVVY caregiver training (DVD)/support group (Alzheimer’s
Association, AAA)
24-hour hotline, care consultation, and education programs
(Alzheimer’s Association)
Powerful Tools for Caregiving: 6-week caregiver psychoeducation
program (AGE CG Resource Center)
Matter of Balance Fall Prevention (AAA, AGE)
Medication Management Improvement (AAA)
HB 802 created the Lifespan Respite Services Program
SB 271 for informal caregiver assessment and support
WHAT STARTS HERE CHANGES THE WORLD
Stakeholder Recommendations (TX DADS)
Increasing public awareness of informal caregiving and resources
Organizing/coordinating more caregiver resources and programs
Identifying and resolving gaps in formal services
Involving stakeholder groups (employers, local community,
medical professions) in addressing gaps in caregiver supports
Addressing the unique needs of ‘kinship’ caregivers raising
grandchildren or other relatives under 18
WHAT STARTS HERE CHANGES THE WORLD
With Attention to…
Care needs of older adults without family support – innovative
solutions for prevention and community building
Cultural and linguistic diversity – training culturally competent care
providers
LGBTQ older adults – Protecting their rights and safe environments
Integration of technology into care delivery for efficiency and cost
saving – older adults are the fastest growing group of Internet users
Geriatric care workforce training and better compensation
WHAT STARTS HERE CHANGES THE WORLD
And Prevention Through Active Aging!“Lifestyle determines almost entirely how
successfully we age.” (Rowe & Kahn, 1998).
Social and productive engagement / volunteering
Exercise body and mind (cognitive stimulation)
Healthy eating
Positive spirituality