healthier lifestyle, increased income and wealth, and greater emotional and instrumental support (Schwartz, 2008). The presence of a spouse is considered a strong measure of support in old age and, alternatively, the absence of a spouse is a strong risk factor for nursing home admission (Scommegna, 2013). In the United States, older men are more likely to be married than older women. More than three-quarters (74%) of men age 65 to 74 are married, whereas slightly more than one-half (58%) of all women are married. In contrast, widowhood is much more common among older women. Women age 65 and older are three times as likely as men of the same age to be widowed; 34% of women are widowed compared with 12% of men in this age group. In 2015, only 18% of women age 85 were married (Federal Interagency Forum on Aging-Related Statistics, 2017). The living arrangements of the older population (Figure 4) are important because they are linked to income, health status, and the availability of caregivers. There is a misconception that the majority of older adults reside in nursing homes; in reality, less than 3.1% of adults age 65 and older actually live in an institutional setting (AoA, 2017). The likelihood of living in a skilled nursing facility (SNF) does rise with age, with 13.2% of SNF residents being 85 or older. Approximately 28% of community-dwelling older adults lived alone in 2017 (AoA, 2017). In 2014, older men were more likely to live with a spouse (72%) compared with older women (46%). In contrast, older women were twice as likely as older men to live alone (35% and 19%, respectively), which is at least partly a consequence of women’s longevity (AoA, 2014). A growing portion of older adults live in households with their grandchildren or in parent- maintained households in which grandchildren are present. In 2017, 1 million adults over the age of 60 were responsible for the basic needs of one or more grandchildren under the age of 18 living with them (AoA, 2017). Figure 4: Living Arrangements of Adults Age 65 and Older (2014) Note. From “A Profile of Older Americans: 2014,” by the Administration on Aging, 2014. Retrieved from http://www.aoa.acl.gov/Aging_Statistics/ Profile/2014/docs/2014-Profile.pdf; and “Current Population Survey Annual Social and Economic Supplement,” by the U.S. Census Bureau (2014). Retrieved from https://www.census.gov/hhes/www/poverty/publications/pubs- cps.html. While family composition may represent an additional burden for adults over the age of 65, it may also represent an important health asset. One-third of people age 70 and older with physical limitations receive regular help with activities of daily living (ADLs) such as dressing and bathing and with instrumental ADLs (IADLs) such as shopping and transportation from their adult children (National Institute on Aging [NIA], 2015). Although older adults receiving support from their adult children are less likely to use nursing home care (NIA, 2015), family support is dependent on the number and availability of members to provide care. Black and Hispanic older adults are those most likely to receive help from their children (American Psychological Association, 2015).
Although gender is not directly related to health, there are profound age-related differences between genders. Older women report more chronic illnesses, higher depressive symptoms, and more functional limitations than men of the same age (Federal Interagency Forum on Aging-Related Statistics, 2016). Because women are likely to live longer than men, older women are more likely to live alone, experience higher rates of widowhood, and experience greater degrees of poverty (AoA, 2014). According to the National Healthcare Disparities Report, women comprise the majority of persons needing long-term care; three-quarters of all nursing home residents and two-thirds of all home care consumers are female (Agency for Healthcare Research and Quality [AHRQ], 2012). As a function of increased longevity, women are also at greater risk of developing Alzheimer disease (Federal Interagency Forum on Aging-Related Statistics, 2017). On the other hand, men have a greater number of health disparities than women and suffer higher levels of heart disease, cancer, diabetes, and emphysema. As the population of older adults grows, it will also grow more diverse because of demographic changes in the U.S. population as a whole. Minorities currently comprise 20% of the 65-and- older population; their numbers will grow to nearly 40% by 2050. According to the U.S. Census Bureau (2014), the percentage of “Non-Hispanic White-Alone” older adults in the United States is expected to decline in the coming decades (Figure 3). National trends suggest that the older Hispanic population will grow the fastest, from nearly 3 million in 2010 to 22 million in 2060, and will be larger than the older Black population (Federal Interagency Forum on Aging-Related Statistics, 2017). Figure 3: Percentage of U.S. Non-Hispanic White-Alone Older Adults, 2012-2050
Note. From “An Aging Nation: The Older Population in the United States,” by J. M. Ortman, V. A. Velkoff, and H. Hogan, 2014. Retrieved from https://www.census.gov/prod/2014pubs/p25-1140.pdf. Historically, older adults who are members of minority groups have had disproportionately higher rates of chronic conditions. It has been postulated that a lifetime of educational, employment, and social discrimination adversely affects the health of minorities, manifested as physical and mental health problems as people age. Research has identified many health disparities among racial and ethnic groups (AHRQ, 2014). Older Hispanic and Black Americans have been reported to be in worse health and with higher degrees of impairment than older Caucasian adults (Scommegna, 2013). Recent surveys of older adults demonstrate higher prevalence of diabetes in Hispanic and non-Hispanic Black older adults, but higher incidence of heart disease and cancer in non-Hispanic White older adults (Federal Interagency Forum on Aging-Related Statistics, 2017). Marital status is associated with social and economic well-being in aging. Marriage provides several vital benefits, such as a Defining health and function The healthcare needs of older adults are often diverse, complex, and comprehensive. Chronic conditions alone pose numerous complexities in health management, but the cumulative impact of health conditions extends far beyond traditional medical
care. With older adults, the management of health conditions is inextricably linked to multiple factors affecting or being affected by the individual, the environment, and specific activities of daily life. Consider the following scenario:
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