Seniors and Boomers: Living Longer, Living Healthier ... - Waterpik

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Disclosure Statement: • The content for this self-study course was developed and written by Water Pik, Inc. employee Carol A. Jahn, RDH, MS. • This course was designed, developed, and produced by Water Pik, Inc. • Water Pik, Inc. manufactures and distributes products addressed in this course. Course Objective: To provide the dental team with research and information to understand and recognize the overall health needs and expectations of baby boomers and senior citizens and provide them with quality care and patient service. Learning Outcomes: • Understand the societal and social impact of aging. • Identify the chronic diseases, conditions, and disabilities affecting those over age 50. • Discuss how chronic disease and disability may impact oral health. • Recognize how physical limitations affect daily self-care and make appropriate recommendations. INTRODUCTION Every eight seconds, someone in US turns 50. People over the age of 65 exceed 35 million. By 2050, that number is expected to be 89 million. Influenced by the US baby boom that occurred between 1946 and 1964 followed by lower fertility rates especially in Europe, for the first time, globally, those over age 65 will soon outnumber those under the age of 5. 1 In the United States, data from the 2010 census indicate that the senior demographic is increasing faster than younger populations, making one out of every nine Americans “old” (over age 65). 1 This larger aging population is leaving its mark on a culture that has long emphasized youth. So-called boomers are better educated and healthier than previous generations. They will likely spend 20–25% of their lives in retirement, and many will continue to desire an active and intellectually stimulating lifestyle. 1 The good news is that this is a likely and reasonable expectation. Findings demonstrate that levels of mortality and other indicators of health that used to exist at age 70 now occur at age 80; and those that used to prevail at age 80 appear at age 90. 2 So, not only are people living longer, but people are living longer in better health. BOOMING NUMBERS OF SENIORS: IMPACT ON SOCIETY The concept of retirement will likely be different for boomers. Many expect to continue working past age 65; at least half indicate they expect to work part-time following retirement. 1 They will likely have more discretionary income. Few will be in nursing homes; more will choose active retirement communities. Non-Hispanic whites make up more than 80% of the older population; by 2030 the number is expected to decrease to 72%. 3 Another dimension of the aging population is the number of people living to ages 90 and beyond. The older population is now subcategorized into three demographics; “young-old” (65–74), “old” (74–85), and the fastest-growing segment referred to by some as the “oldest old” or the “super elderly” (85+). 15 Centenarians, or those age 100 and above, now number more than 55,000, and this number is increasing daily. About 80% are women. 3 Data now indicate that many of the oldest old have health profiles that are similar to those 7–8 years younger, allowing them to avoid disability and lead healthy, independent lives. 5 Data indicate that many of the oldest old have health profiles that are similar to those 7–8 years younger allowing them to avoid disability Work Life Better health, higher levels of education, economic changes, knowledge work versus physical labor, availability of health insurance, increased prevalence of retirement savings plans (401K) versus pensions, and eligibility for social security benefits mean that more older individuals are choosing to stay in the work force longer. 3,6 Between 2003 and 2010, the fastest-growing labor force group was comprised of people ages 55 to 64. By the year 2020, when all baby boomers will be 55 years old or older, the percentage of workers age 55 and up is projected to be over 20%, an anticipated 8% increase from 2000. The enjoyment of working and the feeling of usefulness are the most common reasons for staying employed. 3 Not only are older workers choosing to transition into retirement rather than cease working completely, employers are encouraging older workers to stay in the workforce by offering flexible hours, fewer days, or even working a part-year schedule. 6 More older individuals than younger choose self-employment or alternative employment including independent contracting, on-call work, temporary help, or contractual agreements. 3 Senior citizens who stay in the workforce are twice as likely as their non-working counterparts to report that they are in very good to excellent health. In fact, those who retire at an early age—between 50 and 58—are the most likely group to report poor health as the primary reason for retirement. Older workers also report higher levels of education and greater prosperity. 3 Home Life and lead healthy, independent lives. 5 About 80% of people over the age of 65 own their own homes. Most do not move, preferring to grow old near children/ grandchildren. The percentage of older people living in a nursing home has been declining since 1990. In 2000, only 4.5% of those age 65 and older lived in this type of facility. Both improved health and increasing options for long-term care play a role in 2
an older person’s decision to live independently. Assisted living, which allows people to have more privacy and independence yet provides some personal and nursing services as needed, is increasingly popular as are residential care facilities. Residential facilities have various levels of care in close proximity allowing people to move between arrangements as needed. 3 With increasing age, living in a nursing home becomes more likely; currently, about 18% of those over 85 years reside in one. The majority (41.7%) of seniors living in a nursing home are women over age 85. Male nursing home residents are generally younger, possibly because they have higher rates of serious and/ or permanent injuries at a younger age. 3 CHRONIC CONDITIONS: MEDICALLY COMPLEX AND COMPROMISED As people live longer, the prevalence of disease, especially chronic disease including heart disease, chronic obstructive pulmonary disease (COPD), diabetes, and arthritis, increases. 4 Improved screenings leading to earlier detection, coupled with more effective treatments, have decreased suffering, disability, and mortality. 2,5 This is evidenced by the fact that the US mortality rate continues to decline as life expectancy (now 78.7) increases. More people are living to age 65, and those who do have more years remaining than people did a century ago. 3 The top four leading causes of death in older individuals are heart disease, cancer, stroke, and COPD. 3 Heart disease and cancer account for nearly half of all deaths. Diabetes and Alzheimer’s disease also are responsible for a significant number of deaths in seniors. In 2007, Alzheimer’s disease and diabetes switched places, with Alzheimer’s disease now the sixth leading cause of death and diabetes the seventh. 7 Heart Disease and Stroke Cardiovascular disease (CVD) is responsible for more deaths in the United States than any other cause; it claims more lives each year than cancer, lower respiratory diseases, and accidents combined. It is the leading cause of death in both men and women, accounting for one in every three deaths and approximately one death every 39 seconds. Thirty-three percent of CVD deaths occur before age 75. Men are more likely to suffer a heart attack before age 75, while women are more likely to suffer a stroke. The average number of life years lost due to a heart attack is 16.6. If all CVD were eliminated, life expectancy would rise by seven years. 8 Ninety percent of both male and female coronary heart disease (CHD) patients are exposed to at least one of the following risk factors: hypertension, high cholesterol, cigarettes, or diabetes. With regard to stroke, hypertension and cigarette smoking are the strongest risk factors. Prevention of these risk factors in youth is thought to be a key to “successful aging.” 8 High blood pressure (HBP), or hypertension, affects one in three adults, with an estimated 8% of people who have it undiagnosed. Until age 45, more men than women have HBP; between 45 and 64, the percentages are similar. After 64, more women than men have HBP; in adults over 65, 75% of women and 65% of men have HBP. The prevalence of hypertension in blacks is the highest in the world at 41.4%. Blacks tend to develop it earlier in life and have higher readings. Consequently, their risk of a first stroke is twice that of whites. 8 Approximately 50.2% of adults have been told they have high cholesterol (at or above 200 mg/dL). Only about one-third of treated patients meet their LDL cholesterol goals. For patients with a history of CHD, only 20% are at their LDL goal. About 8% of those with high cholesterol are undiagnosed; women are more likely to be undiagnosed than men. 8 Smoking is a power predictor of cardiac arrest. Smoking results in greater risk of early death—about 13.2 years earlier for men and 14.5 years earlier for women. Smokers are also more likely to experience a heart attack sooner than a nonsmoker—nine years sooner for men and 13 years sooner for women. 9 Nonsmokers exposed to secondhand smoke at home or work increase their risk of heart disease by 25%–30%. Even brief exposure to secondhand smoke can cause blood platelets to become sticky, the lining of blood vessels to be damaged, and coronary flow to decrease. 8 Older adults are less likely to smoke than those younger. Approximately 9.3% of men and 8.6% of women over age 65 smoke. In this demographic, more men (54.7%) than women (29.6%) identified themselves as former smokers. Heart disease death rates in people with diabetes are 2–4 times higher than in those without diabetes. About 68% of people with diabetes die of some form of heart disease and about 16% of stroke. 10 The presence of diabetes at age 50 has been shown to confer the highest lifetime risk for cardiovascular disease of any single risk factor. 11 Other data show that for people with diabetes who are normal weight, the lifetime risk of CVD is 54.8% for women and 78.6% for men. In comparison, the lifetime risk increases for those who are obese by 78.8% for women and 86.9% for men. 8 Diabetes and Obesity Diabetes affects 26.9% of people (10.9 million) ages 65 and older. Another 50% of seniors have pre-diabetes, a condition in which the fasting blood glucose is higher than normal, but not high enough to be considered diabetes. Pre-diabetes increases the risk of developing type 2 diabetes, heart disease, and stroke. Fifty-five percent of cases of diabetes are diagnosed between the ages of 45 and 64. Another 20% are diagnosed at 65 or older. 10 The risk of death for people with diabetes is twice that of people of a similar age without diabetes. 10 A person with diabetes who suffers a heart attack has a significantly higher mortality rate at 30 days and one year post-event than those who have a heart attack and do not have diabetes. 12 It has also been shown that up to 22% of people 50–75 with type 2 diabetes may have asymptomatic coronary artery disease. 13 In addition to heart disease, both type 1 and type 2 diabetes can lead to other serious complications. Diabetes is the leading cause of new cases of blindness. In those over age 40, 28.5% have retinopathy. Diabetes is also the leading cause of kidney failure, 3
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Seniors and Boomers: Living Longer, Living Healthier ... - Waterpik

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