Social Justice and the Elderly

One of the Last Discrimination Battles to be Fought!

Ageism in US Culture

• Botox and Viagra sales tripled over past 5 years• Micro-print on Insulin Syringes & prescription

bottles and information• Most common concern of elders – cognitive

loss• Two most common responses by HCPs, family

members, and social networks….• Productivity is #1 value on the job

Elders are the Primary Consumers of Health Care Resources

• Elders are 12% of the population BUT they account for – 26% of all office visits– 35% of all hospital stays– 34% of all prescriptions– 38% of all emergency response calls– 90% of all LTC stays

• The % of elders will go from 12% to 20% in the next 15 years

Number of Elders Using Medicare is on the Rise

• 2000 – 35% used Medicare as primary • 2010 – 51% used Medicare as primary

The Number of MD Taking New Medicare Patients is RAPIDLY

• 2008 – 73% MDs took Medicare• 2009 – 50% MDs took Medicare• 2011 – 35% MDs are taking new Medicare• 2011 – MDs are opting out of Medicare

because of the proposed 20% cut possibility• % worse for primary care MDs• In NY even the president of the medical

association is not taking new Medicare clients

Specialized Training in Geriatrics is NOT

• # of PC-MDs rapidly!• # of Geriatrics specialists– Now only 7000 in the US– Down 20% from 2000

• # Geropsychiatrists – Now 1 geriatric psychiatrist for 11,000 – 2030 it will be 1:22,000

• <1% Health care professionals receive specialized geriatric training

Drug Research is Primarily Conducted on Younger Adults

• There are known changes in body chemistry with aging

• There are known drug/drug interactions with increasing age

• There is increased toxicity risks with increasing age

• There are dosage problems with many meds with increasing age

Drugs that can affect cognition

• Anti-arrhythmic agents

• Antibiotics• Antihistamines -

decongestants• Tricyclic

antidepressants• Anti-hypertensives• Anti-cholinergic

agents• Anti-convulsants• Anti-emetics

• Histamine receptor blockers

• Immunosuppressant agents

• Muscle relaxants• Narcotic analgesics• Sedative hypnotics• Anti-Parkinsonian

agents

Washington Manual Geriatrics Subspecialty Consults edited by Kyle C. Moylan (pg 15) – published by Lippencott, Wilkins & Williams , 2003

Pain Management

• Comparing patients with dementia and without dementia admitted for hip fx repair– Same number of procedures– Same types of procedures– ¼ the pain medications– 3 times the antipsychotics

Some Stats and Info of Note

• Feeding tubes are still be placed– 50% (more for African-American, NH residents)

got new tubes– 17% kept tubes– Feeding tube placement did not affect outcome– Having an infection coming in did worsen risk for

death– Average survival with or without a feeding tube

was 6 months

First Line Treatment for Symptoms of Discomfort

• For infants and small children?• For young adults after MVA or sports injury?• For elders with dementia?

Transportation for Living In the US

• Options• Requirements• Expectations• Alternatives

Housing Options

• Options• Role of personal choice• What happens to ‘sick elders’?• What happens to those with limited funds –

Medicaid?• What happens to those with dementia?• What happens to those with limited funds,

health issues and dementia?

Family & Community Awareness

• Birthing classes• ‘Parenting classes’• Caregiving classes for families?• Sandwich generation - Boomers

Baby Boomers What’s Happening?

AND Who Will Care for the

Boomers?

Who are the Boomers?

• People born between 1946 & 1964• The Post-WWII kids• The Pre-Vietnam War kids• The largest number of babies ever born in US • The first majority ‘town’ generation

76 million strong!!!

How are the BOOMERS now?

• 45 – 60 years old • Used to having their own ‘private’ home• Used to working outside the home• Finished or finishing raising their kids• New grandparents• Still have at least one parent alive• Planning to retire & enjoy life• In better health than previous generations

What Happening to Boomers?

• We are the SANDWICH generation– Supporting ‘late bloomers’ not totally out of the

nest– Helping with grandchildren – time & care & money

– Still in the role of children for their parents (70-95 years old)

– Caregiving for parents who are beginning to fail physically, emotionally, and mentally

This group…

• Has a history of more problems with money management & time management

• Has been more mobile & flexible/less stable in family & work & living locations

• Spiritually changed – ¼ less connected, ½ as connected, ¼ more connected to a new group

• Less experience & contact with death – less talking about it – not ready for it, deny it

What Does This Mean for Us as Caregivers?

• There are two distinct groups– Low socio-economic with less education – Higher socio-economic with higher education

• Both groups are having problems• Both groups are more challenged than ever

before• Both groups are feeling the squeeze

Comparing the Two GroupsHigh Educational Group

• Expects care to be delivered in the person’s home or in a facility

• Expects to have $$$ help with care programs or government sources

• Expects to have options in where and how care will be delivered

• Has limited time for caregiving & managing care

Low Educational Group

• Expects to care for the person at home

• Expects there to be government help

• Expects other family members to help

• Has more medical conditions and problems themselves

• Has limited time for caregiving & managing care

So What is Happening?• Options for care tend to be limited AND

frequently do NOT match the majority of expectations or needs

• The cost is much more than anticipated• The funding sources are limited• The care receivers do not have the same point

of view as the caregivers• Medical, legal, financial, and social systems

are complicated and HARD to negotiate

What is happening to us?

• We are potentially… – Working THREE jobs – parent, employee, caregiver• (or FOUR – if the spouse or sibling has problems)

– Physically stressed out – working hard – not well– Emotionally stressed out – too much to do– Financially tapped out – demands on both ends– Mentally drained – always facing problems– Spiritually concerned – not sure they can keep on– Socially isolated – don’t have time for friends

For Those in the Sandwich…

• Learn to set limits & live within them• Take BREAKS – step away• Get to know what YOU need to…– Keep going– Get re-energized– Get or stay healthy – physically, mentally,

emotionally, cognitively, socially, & spiritually• THEN START DOING IT!!!!!

Boomers as care receivers…

• They will be cared for by Generation X & Y• They will expect more than previous

generations in care quality & options• They will ‘know the system’• They will want a lot for their money• They will have trouble having the money they

need• They will live longer than previous generations

Gen X & Y

Generation X – ‘Slackers’• Born 1965-79• 51 million• Reacted negatively to

Boomers life style & work behaviors

• Highly individualistic• Dislike & distrust of formal

structures & rules• Technologically smart

Generation Y – ‘Echo Boomers’• Born 1980-2000• Over 70 million• Different social norms –’rude’• Lots of action & attention• Balance of FUN & work• Less respect for ‘authority’• High energy – job changer• Save for self - future• Obesity & diabetes on rise

Boomers as care receivers…

• There will be even more variation in what people can afford and what they will expect

• They will want to have choices in care options• They want to get their care in their preferred

setting• They think they will stay healthy &

independent till very near the end of their lives

OOPS!!!

• There are many more Boomers than Gen Xers (76 vs 51 million)

• There are not enough resources & services for the number of Boomers

• The cost of Boomer care is going to be very high!

• The number of boomers with DEMENTING illnesses is going to be very high

OOPS!

• Gen X & Y have different caregiving histories and backgrounds – less experience

• Gen X & Y – more divorces & two income families – even less time to give care

• Gen X & Y – are more transitory than Boomers• Gen X– is WORSE with money and savings

than Boomers• Gen Y – is saving for themselves

What Can We Do to Help Ourselves?

• Reach Out and Find Out• Talk about the future • Get our own house in order– Legal– Financial– Housing– Physical health– Mental & cognitive health– Spiritual health

Financial Opportunities

• Discuss and decide on…– Financial planning with an elder law expert– Will & financial PoA– LTC insurance– Retirement – Savings – Pensions – IRAs - Trusts

• Consider need for changes to have what you want later… what you will need

Legal & Health Care Opportunities

• Talk with your significant others & decide:– Plan ahead for probable health care needs– Durable health care PoA– Advance directives– What types of care you want in what situations -• Curative, restorative, maintenance, palliative

– What locations of care are available – pros & cons CCRC NH RH FCHALF SCALF Home care Others

Housing Opportunities

• Private home with ‘universal design’• Shared housing – caregiver space AND/OR

mother-in-law apartment• Retirement/Senior community• Multi-generational housing• Apartments or condos• Complexes with multiple levels of care on site• Assisted living facilities or family care homes

Physical Health Opportunities

• Exercise• Diet• Chronic disease management• Health promotional activities & habits• Simple message – Bring your numbers down and – Bring your activity levels up

Mental – Cognitive Health Opportunities

• Know what is normal & what is NOT• Establish baselines for yourself on –– Cognition– Emotional well-being– Stress levels– Sleep patterns

• Get supported…– Socialize, sleep enough, de-stress, use resources

Spiritual Opportunities

• Consider your spiritual needs & how to meet them

• Learn about the latest thinking on later life achievements and successful aging

• Talk about death & dying - the end of life• Consider your role in connecting to others• Find out about palliative care, hospice, sitting

vigil, life review and story telling• Find a community of faith you can share

First Steps?• Where are you? - What can you do?• What should you consider doing?• Start the conversations… with both sides of

the sandwich…• What are TOP priorities?

$$$ legal issues housing optionsphysical health mental/cognitive healthspiritual well-being

• Get Started… It won’t happen, if you don’t…

What Can and Should We BE Doing?

• AARP?• Pioneer Network?• Geriatric specialization?• Ageism awareness?• Speak out, Stand up, PARTICIPATE!