12.6 The U.S. Elderly

Physical and Mental Health

Perhaps the problem that comes most readily to mind is health, or, to be more precise, poor health. The biological and psychological effects of aging lead to greater physical and mental health problems among the elderly than in younger age groups. These problems are reflected in responses to the General Social Survey question, “Would you say your own health, in general, is excellent, good, fair, or poor?” Figure 12.6 “Age and Self-Reported Health” shows that the elderly are more likely than the nonelderly to report that their health is only fair or poor.

The elderly’s perception of their own health is supported by government estimates of chronic health conditions for older Americans. For every 1,000 people aged 65 or older not living in a nursing home or other institution, 495 have arthritis, 533 have high blood pressure, 309 have heart disease, 405 have hearing loss, 174 have vision problems, and 180 have diabetes (these numbers add up to more than 1,000 as people may have several health conditions) (Federal Interagency Forum on Aging-Related Statistics, 2008). These rates are much higher than those for younger age groups.

The elderly also suffer from dementia, including Alzheimer’s disease, which affects about 1 of every 8 people 65 or older (Alzheimer’s Association, 2009). Another mental health problem is depression, which affects about 14% of people 65 or older. Because of mental or physical disability, 42% of all people 65 or older, or more than 16 million elders, need help with at least one “daily living” activity, such as preparing a meal (Federal Interagency Forum on Aging-Related Statistics, 2008).

Older people visit the doctor and hospital more often than younger people. Partly for this reason, adequate health care for the elderly is of major importance.

Ted Van Pelt – The Coopers – CC BY 2.0.

If the elderly have more health problems, then adequate care for them is of major importance. They visit the doctor and hospital more often than their middle-aged counterparts. Medicare covers about one-half of their health-care costs; this is a substantial amount of coverage but still forces many seniors to pay thousands of dollars annually themselves. Some physicians and other health-care providers do not accept Medicare “assignment,” meaning that the patient must pay an even higher amount. Moreover, Medicare pays little or nothing for long-term care in nursing homes and other institutions and for mental health services. All of these factors mean that older Americans can still face high medical expenses or at least pay high premiums for private health insurance.

In addition, Medicare costs have risen rapidly along with other health-care costs. Medicare expenditures soared from about $37 billion in 1980 to more than $450 billion today (see Figure 12.7 “Medicare Expenditures, 1980–2007”). As the population continues to age and as health-care costs continue to rise, Medicare expenses will continue to rise as well, making it increasingly difficult to find the money to finance Medicare.

Nursing Home Care

While most older Americans live by themselves or with their families, a small minority live in group settings. A growing type of group setting is the continuous care retirement community, a setting of private rooms, apartments, and/or condominiums that offers medical and practical care to those who need it. In some such communities, residents eat their meals together, while in others they cook for themselves. Usually these communities offer above-average recreational facilities and can be very expensive, as some require a lifetime contract or at least monthly fees that can run into the thousands of dollars.

For elders who need high-level medical care or practical support, nursing homes are the primary option. About 16,100 nursing homes exist, and 3.5% of Americans 65 or older (or about 1.3 million individuals) live in them; this figure rises to 14% of people 85 or older (Federal Interagency Forum on Aging-Related Statistics, 2008). About three-fourths of all nursing home residents are women. Almost all residents (94%) receive assistance in bathing and showering, 80% receive help in using the bathroom, and one-third receive help in eating.

As noted earlier, Medicare does not pay for long-term institutional care for most older Americans. Because nursing home care costs at least $70,000 yearly, residents can quickly use up all their assets and then, ironically, become eligible for payments from Medicaid, the federal insurance program for people with low incomes.

Nursing homes are often understaffed to save costs and are also generally not subject to outside inspection. These conditions help contribute to the neglect of nursing home residents.

Sheila – Christian Nursing Home – CC BY-NC-ND 2.0.

If one problem of nursing homes is their expense, another problem is the quality of care they provide. Because their residents are typically in poor physical and/or mental health, their care must be the best possible, as they can do little to help themselves if their care is substandard. As more people enter nursing homes in the years ahead, the quality of nursing home care will become even more important. Yet there is much evidence that nursing home care is often substandard and is replete with neglect and abuse (DeHart, Webb, & Cornman, 2009).

Financial Security and Employment

Earlier we noted that the elderly are less likely than younger age groups to live in poverty and that their financial status is much better than that of previous generations of older people. However, this brief summary of their economic well-being obscures several underlying problems (Crawthorne, 2008; Treas, 1995).

First, recall Chapter 6 “Groups and Organizations”’s discussion of episodic poverty, which refers to the drifting of many people into and out of poverty as their jobs and other circumstances change. Once they become poor, older people are more likely than younger ones to stay poor, as younger people have more job and other opportunities to move out of poverty. Recall also that the official poverty rate obscures the fact that many people live just above it and are “near poor.” This is especially true of the elderly, who, if hit by large medical bills or other expenses, can hardly afford to pay them. In another problem, older women are more likely than older men to live in poverty for at least two reasons: women earn less than men and thus have lower monthly benefits under Social Security than men, and women outlive men and thus use up their savings. Racial and ethnic disparities also exist among the elderly, reflecting poverty disparities in the entire population, as older people of color are much more likely than older whites to live in poverty (U.S. Census Bureau, 2010).

Older women are more likely than older men to live in poverty.

Christian Haugen – Old woman feeding the pigeon – CC BY 2.0.

Two final problems relate to Social Security, which is the largest income source for most elders. If Social Security did not exist, the poverty rate of the elderly would be 44%, or about five times higher than the actual rate (Crawthorne, 2008). Without Social Security, then, nearly half of all people 65 or older would be living in official poverty, and this rate would be even much higher for older women and older persons of color. Unfortunately, many observers think the Social Security system is facing a crisis as the large number of baby boomers now reaches retirement age (Sloan, 2009). Another problem is that, as noted earlier regarding women, monthly benefits are tied to people’s earnings before retirement: the higher the earnings, the higher the monthly benefit. Thus a paradox occurs: people who earn low wages will get lower Social Security benefits after they retire, even though they need higher benefits to make up for their lower earnings. In this manner, the income inequality that exists before retirement continues to exist after it.

This paradox reflects a wider problem involving Social Security. However helpful it might be in aiding older Americans, the aid it provides lags far behind comparable programs in other wealthy Western nations (see the “Learning From Other Societies” box). Social Security payments are low enough that almost one-third of the elderly who receive no other income assistance live in official poverty. For all of these reasons, Social Security is certainly beneficial for many older Americans, but it remains inadequate compared to what other nations provide.

Older people who want to work may have trouble finding employment because of age discrimination and other factors.

Wikimedia Commons – CC BY 2.0.

Older Americans also face problems in employment. Recall that about 16% of seniors remain employed. Other elders are retired or unemployed because several obstacles make it difficult for them to find jobs. First, many workplaces do not permit part-time working arrangements that many seniors favor. Second, the rise in high-tech jobs means that older workers would need to be retrained for many of today’s jobs, and few retraining programs exist. Third, although federal law prohibits age discrimination in employment, it exists anyway, as employers do not think older people are “up to” the job, even though the evidence indicates they are good, productive workers (E. D. Berger, 2009). Finally, earnings above a certain level reduce Social Security benefits before full retirement age (66), leading some older people to avoid working at all or to at least limit their hours. All of these obstacles lead seniors to drop out of the labor force or to remain unemployed (Gallo, Brand, Teng, Leo-Summers, & Byers, 2009).

Bereavement and Social Isolation

“We all need someone we can lean on,” as a famous Rolling Stones song goes, and most older Americans do have adequate social support networks, which, as we saw earlier, are important for their well-being. However, a significant minority of elders live alone and do not see friends and relatives as often as they wish. Bereavement takes a toll, as elders who might have been married for many years suddenly find themselves living alone. Here a gender difference again exists. Because women outlive men and are generally younger than their husbands, they are three times more likely than men (42% compared to 13%) to be widowed and thus much more likely to live alone (see Table 12.3 “Living Arrangements of Noninstitutionalized Older Americans, 2008”).

Many elders have at least one adult child living within driving distance, and such children are an invaluable resource. At the same time, however, some elders have no children, because either they have outlived their children or they never had any. As baby boomers begin reaching their older years, more of them will have no children because they were more likely than previous generations to not marry and/or to not have children if they did marry. Thus baby boomers face not only the prospect of scarcer Social Security funds when they reach retirement age but also a relative lack of children to help them when they enter their “old-old” years (Leland, 2010).

Bereavement is always a difficult experience, but because so many elders lose a spouse, it is a particular problem in their lives (Hansson & Stroebe, 2007). Usually grief follows bereavement. It can last several years and, if it becomes extreme, can involve anxiety, depression, guilt, loneliness, and other problems. Of all of these problems, loneliness is perhaps the most common and the most difficult to overcome.

Elder Abuse

Some seniors fall prey to their own relatives who commit elder abuse against them. Such abuse involves one or more of the following: physical or sexual violence, psychological or emotional abuse, neglect of care, or financial exploitation (Killick & Taylor, 2009). Accurate data are hard to come by since few elders report their abuse, but estimates say that between 2% and 10% of older Americans have suffered at least one form of abuse, amounting to hundreds of thousands of cases annually. Fewer than 10% of these cases come to the attention of the police or other authorities (National Center on Elder Abuse, 2005).

Although we may never know the actual extent of elder abuse, it poses a serious health problem for the elders who are physically, sexually, and/or psychologically abused or neglected, and it may even raise their chances of dying. One study of more than 2,800 elders found that those who were abused or neglected were 3 times more likely than those who were not mistreated to die during the next 13 years. This difference was found even after injury and chronic illness were taken into account (Horn, 1998).

A major reason for elder abuse seems to be stress. The adult children and other relatives who care for elders often find it an exhausting, emotionally trying experience, especially if the person they are helping needs extensive help with daily activities. Faced with this stress, elders’ caregivers can easily snap and take out their frustrations with physical violence, emotional abuse, or neglect of care.