Just as among the non-elderly population in the US, women and minorities experience poverty at higher rates than do white males. Read this fact sheet on poverty poverty among the elderly, put together by the Center for American Progress, an independent nonpartisan policy institute that works to improve the lives of all Americans.
The older population is becoming more racially and ethnically diverse as the overall minority population in the U.S. grows and experiences greater longevity. Racial and ethnic minority populations have increased from 6.3 million in 2003 (17.5% of the older adult population) to 9.5 million in 2013 (21.2% of older adults), and are projected to increase to 21.1 million in 2030 (28.5% of older adults).
Along with general trends in aging for America’s population, the Black or African American population is living longer.
The non-Hispanic African American older population was 4 million in 2014. It is projected to grow to 12 million by 2060. In 2014, African Americans make up 9% of the older population; this is projected to grow to 12% by 2060.
By current US Census estimates, households containing families headed by African Americans age 65 and over reported a median income of $42,805. The comparable figure for all older households was $54,184. The median personal income for older African American men was $23,026 and $14,633 for women. The comparable figures for all older persons were $29,854 for men and $17,366 for women. The poverty rate in 2013 for African Americans age 65 and older was 18.7%, higher than the rate for all older Americans (10.2%).
27% of older African American men and women reported very good/excellent health status. Among older non-Hispanic whites, this figure was 45% for men and 47% for women. Positive health evaluations decline with age. Among African American men ages 65-74, 31% reported very good/excellent health compared with 17% among those aged 85 or older. Among African American women, this rate declined from 30% at ages 65-74 to 20% at age 85 or older.
Most older persons have at least one chronic health condition and many have multiple conditions. Some of the most common conditions among older non-Hispanic African Americans were:
Based on Census data, 34% of older African Americans have both Medicare and supplementary private health insurance, and 11% are covered by both Medicare and Medicaid. In comparison, almost 50% of all older adults had both Medicare and supplementary private health insurance, and 6% were covered by both Medicare and Medicaid. 4% of older non-Hispanic African Americans reported they had no usual source of health care and this figure is consistent with all other older American demographic groups.
State and local agencies who work with aging communities provide services to a total of approximately 11.1 million persons age 60 or older. Consistent with federal and state requirements, considerable emphasis is placed on services to persons with the greatest social and economic need, including members of racial and ethnic minority groups, and especially those who are poor. Among the older persons who received Title III OAA home and community-based registered services, 12% were African American.
Along with general trends for America’s population, the American Indian and Alaskan Native population is living longer.
The non-Hispanic American Indian and Native Alaskan older population was 231,482 in 2014, and is projected to grow to more than 630,000 by 2060. In 2014, American Indian and Native Alaskan persons made up 0.5% of the older population. By 2060, it is projected to be almost 1%.
Almost 50% of older American Indian and Native Alaskans lived in just six states:
23% of older American Indian and Native Alaskan men and 30% of older American Indian and Native Alaskan women reported very good/excellent health. Among older non-Hispanic whites, this figure was 45% for men and 47% for women.
Two frequently occurring conditions among older American Indian and Native Alaskans were diagnosed arthritis (57%) and all types of heart disease (25%). The comparable figures for all older persons were 49% and 31%, respectively.
Among the older persons who received Title III OAA home and community-based registered services, 1.2% were American Indian and Native Alaskan.
Just as with the groups from above, and in accordance with general trends for America’s population, the Asian, Hawaiian, and Pacific Island population is living longer.
The non-Hispanic Asian older population is roughly 1.9 million and is projected to grow to 8.5 million by 2060. Older Asians make up 4% of the older population
More than 60% of older Asians live in just four States:
Households containing families headed by Asians age 65 and over report a median income of $55,335. The comparable figure for all older households was $54,184. The median personal income for older Asian men was $24,093 and $14,602 for older Asian women. The comparable figures for all older persons were $29,854 for men and $17,366 for women. The poverty rate in 2013 for Asians age 65 and over was 16.7% while the rate for all older Americans was 10.2%.
35% of older Asian men and 31% of older Asian women reported very good/excellent health. Among older non-Hispanic whites, this figure was 45% for men and 47% for women. Among Asian men ages 65-74, 41% reported very good/excellent health, compared with 16% among those age 85 or older. Similarly, among Asian women, this rate declined from 39% at ages 65-74 to 13% at age 85 or older.
Some of the most frequently occurring conditions among older Asians are:
31% of older Asians have both Medicare and supplementary private health insurance, and 18% are covered by both Medicare and Medicaid. In comparison, almost 50% of all older adults have both Medicare and supplementary private health insurance, and 6% are covered by both Medicare and Medicaid. In 2011-2013, 4% of older Asians reported they had no usual source of health care, and this figure is consistent with the general population of elders in the US.
Among the older persons who received Title III OAA home and community-based registered services, 3% were Asians.
Along with general trends for America’s population, the Hispanic population in the US is also iving longer.
The Hispanic older population (of any race) is 3.6 million and is projected to grow to 21.5 million by 2060. Hispanics make up 8% of the older population. By 2060, the percentage is projected to be 22%.
Almost 70% (2,312,653) of older Hispanics live in just four states:
Households containing families headed by Hispanics age 65 and over reported a median income in 2013 of $44,228. The comparable figure for all older households was $54,184. The median personal income for older Hispanic men was $15,240 and $11,255 for older Hispanic women. The comparable figures for all older persons were $29,854 for men and $17,366 for women. The poverty rate for Hispanics age 65 and over was 20.4% which is double the rate for all older Americans (10.2%).
3% of older Hispanic men and 27% of older Hispanic women report very good/excellent health. Among older non-Hispanic whites, this figure is 45% for men and 47% for women. Among Hispanic men ages 65-74, 34% report very good/excellent health, compared with 23% among those aged 85 or older. Similarly, among Hispanic women, this rate declined from 31% at ages 65-74 to 19% at age 85 or older.
Most older persons have at least one chronic health condition and many have multiple conditions. Some of the most frequently occurring conditions among older Hispanics are:
23% of older Hispanics have both Medicare and supplementary private health insurance, and 17% are covered by both Medicare and Medicaid. In comparison, almost 50% of all older adults had both Medicare and supplementary private health insurance and 6% were covered by both Medicare and Medicaid. 7% of older Hispanics reported they had no usual source of health care compared with 4% of all older Americans.
Among the older persons who received Title III OAA home and community-based registered services, 8% were Hispanic.
Dunlop, Manheim, Song, and Chang, researchers at the Institute for Health Services Research and Policy Studies at Northwestern University, conducted research which supports and further defines the census information from above. They examined the role of economic access in gender and ethnic/racial disparities in the use of health care services among older adults. They used data from a past study (the Asset of Health Dynamics Among the Oldest Old—AHEAD—Study) to investigate differences in the use of health services by gender and among non-Hispanic White versus minority Hispanic and African American ethnic/racial groups.
The researchers accounted for predisposing factors, health needs, and economic access. When comparing various groups against non-Hispanic White men, their results showed the following:
Although economic access was related to some medical utilization, it had little effect on gender/ethnic disparities for services covered by Medicare. What this research tells us is that Medicare plays a significant role in providing older women and minorities access to medical services, and without it, we would likely see lowered longevity over time for minorities and women in the US.
While we are beginning to have a robust body of research on health care inequities among elderly groups in the US, early studies that addressed disparities in the utilization of health services among older adults had several limitations:
These research problems are beginning to change as more social gerontologists conduct research. However much is not yet known about aging Asian, Native American, Alaskan Native and other less populous minority groups and their health care spending and access habits.
Disengagement theory outlines a process of disengagement from social life that people experience as they age and become elderly. The theory states that, over time, elderly people withdraw, or disengage from, the social roles and relationships that were central to their life in early and middle adulthood. As a functional theory, this framework casts the process of disengagement as necessary and beneficial to society, as it allows the social systems in society to remain stable and ordered.
DISENGAGEMENT THEORY: An ordered process by which the elderly voluntarily withdraws from social life.
Disengagement theory was coined by social scientists Elaine Cumming and William Earle Henry, and presented in the book Growing Old, published in 1961. It is notable for being the first social science theory of aging. However, the book was controversial and because of the controversies, it sparked further development of social science research and theories about the elderly, their social relationships, and their roles in society.
Disengagement theory presents a social-systemic view of the aging process and the evolution of the social lives of elderly. With the theory Cummings and Henry situate aging within the social system, and offer a set of steps that outline how the process of disengagement occurs as one ages, and why this is important and beneficial to a social system on a whole. They based their theory on data from the Kansas City Study of Adult Life, a longitudinal study that tracked several hundred adults from middle to old age, conducted by researchers at the University of Chicago.
Based on this data Cummings and Henry created nine ideas that comprise the theory of disengagement.
Based on these ideas, Cummings and Henry suggested that the elderly are happiest when they accept and willingly go along with the process of disengagement.
As stated above, the theory of disengagement caused controversy as soon as it was published. Some of the most prominent criticisms:
Noted contemporary sociologist Arlie Hochschild asserts that the theory is flawed because it has an "escape clause," wherein those who do not disengage are considered troubled outliers. She also critiqued Cummings and Henry for failing to provide evidence that disengagement is willingly done.
While Cummings stuck to her theoretical position, Henry subsequently disavowed it in later publications, and aligned himself with alternative theories that followed, including activity theory and continuity theory.
Activity theory assumes that there is a positive relationship between a person's life satisfaction and level of activity, which in turn raises how positively an individual views themselves (self-concept) and enhances adjustment in later life. Even though these two theories are not mutually exclusive, activity theory is usually contrasted with disengagement theory.
ACTIVITY THEORY: A set of ideas which support that there are many factors which contribute to successful aging, and also supports that selecting personalized new activities will help with successful aging.
Activity theory is an umbrella phrase for theories which acknowledge human activities as complex, socially situated phenomena. It is a descriptive framework, meaning we don't use it in research in a predictive way (as we would, for example, with the scientific process and testing of a hypothesis).
Activity theories acount for environment, culture, history of the person, motivations, and ease/difficulty of real life activity. One of the advantages of ATs are that they bridge the gap among the individual subject and the social reality in which they reside.
Studies on aging in the early 1970s led to the publication of of work on aging and activity. Sme might call activity theories "common sense" because they simply suggests that as people age, they start to lose the identity they had in work or in family life, and begin to replace the lost roles with new roles that satisfy the gap. Those who continue to participate in activities and interact socially have a higher quality of life and tend to be healthier and live longer, in part because it enhances a sense of self.
Getting out and doing just any old thing, though, might not be as beneficial as doing something a person truly enjoys. Activity theories suggest that doing activities you have no interest in may even have negative consequences. According to scholars who ascible to this theory, continuing enjoyable hobbies and activities throughout all stages of life, from youth to middle age and on to senior stages, may have the greatest benefits in terms of health and happiness.
The biggest single critique of this theory is that is tells us what to do to be happy late in life. in other words, "if you do THIS, you'll be happy." Of course, while you may in fact, be happy by doing things that others suggest, we all know that indiividualistic approaches to any human processes are always the best approaches.
Continuity theory continues to explore the substitution of roles mentioned in activity theory. Under this umbrella, aging persons are advised to substitute new roles for those they have lost. By continuing to adapt and replace activities to the environment of aging, older adults are able to adjust psychologically, socially and behaviorally. These successive replacements and adjustments are the key to life satisfaction according to continuity theories on aging.
CONTINUITY THEORY: a set of ideas which says we set the stage for how we will age when we are young, and that as we grow older, we refine and polish the activities of our younger selves.
Who we are in public, that is to day our social role identities are important parts of what we think of ourselves—our self-concept.
SELF CONCEPT: What we think of ourselves, created by a mix of social roles that we assume in our lives
Our social identities help us to figure out where we fit into a network of all of our of social relationships. These identities reflect our social position. One interesting research project taken on by Moen, Erickson and Dempster-McClain at Cornell University attempts to figure out what impacts our social lives (work, networking, and other pre-retirement roles) may have on us as we begin to age: how will these identities, which have comprised most of our adult lives, impact the aging process and the role(s) we take on later in life?
Individuals move in and out of roles throughout their lives but in late life, these roles tend to diminish in number. As the researchers note, many older adults have less social roles, retirement comes upon them and their children are now adults with their own families.
This can be viewed as a negative change, or as the researchers point out, a positive. Elders are no longer constrained by specific social roles and involvement in the workplace, and they may find that they appreciate the liberty that this brings.
One common transition in later life is a move from independent housing to some type of congregate housing. Increasing numbers of older Americans are choosing to move to continuing care retirement communities (CCRCs). For a substantial entry fee and continuing monthly fees, these facilities offer independent living with a variety of health services and facilities available when needed. A CCRC is designed as a comprehensive facility so residents have a continuum of care available in one place, meaning that as they age, the level of care they need can adjust to their increased demands. Shifts to CCRCs are mostly voluntary but are nonetheless a major transition for older people accustomed to residing in a broader, age-integrated community. Downsizing must occur and often this involves selling the family home. It may also involve moving away from friends and a familiar community. The move from a mixed-age setting to a residence with only older people may affect both social relationships and individual social identities.
As with other research on aging processes, the researchers found that those with a positive outlook, willing to adapt to a new environment and take on new social roles were well suited to these new environments. In other words, well-adjusted seniors don't simply happen—they are the product of a supportive community and family combined with a healthy personal outlook about aging.
Attendance at religious services and the practice of prayer enhance psychological well-being among the elderly. Unfortunately, some elders cannot attend religious services regularly because they have health problems or are no longer able to drive a car. But prayer and other private devotional activities remain significant for many in this demographic. To the extent that religion makes a difference for elders’ well-being, health-care facilities and congregations should do what they can to enable older adults to attend religious services and to otherwise practice their religious faith.
Seniors must face the fact that the longer they live, the more friends and family members may pass away ahead of them. Losing the people they care about can leave seniors feeling abandoned and vulnerable.
Some questions that are prominent in research about religion/spirituality and aging:
We are beginning to have a wealth of data in this area as more interest has been generated amongst researchers. One thing that we know: religiosity does tend to increase as we age. Based on longitudinal data from the General Social Surveys conducted by the National Opinion Research Center, we see a consistent increase in the percentage of Americans reporting to be "very religious" by age:
|RESPONDENTS' REPORTED RELIGIOSITY|
|STRONG||SOMEWHAT||NOT VERY||NO AFFIL.||ROW
Now, before any conclusions are drawn, understand that these results are affected by cohort attitudes and beliefs and periods of measurement. The data are various snapshots in time, capturing different cohorts at various stages of the life-cycle.
Do you believe in life after death? Theorists assume that as societies age there is decreasing belief in and concern with personal immortality, that—like concern about witches and demons—these ideas are "grown out of." We could say that this is due to a number of attitudes, both collective and individualistic:
It makes sense, based on the above, that the death ethos of the United States—one of the most economically advanced and materialistic of nations—should resemble those of other highly developed Western cultures. However in the US, such is not the case. In fact, American death ethos can best be understood in terms of its core goals of salvation before death, control over the death process, and embracement of the hereafter: an immortalist ethos. To doubt the existence of an afterlife is to risk broad public condemnation.
DEATH ETHOS: what we as humans feel, think, do, and judge in relation to the subject of our own deaths, the deaths of those close to us or those we know, and in terms of the ideas we have which are influenced by society and cultural ideals about death and dying.
IMMORTALIST ETHOS: belief in the notion that the soul is immortal.
The Time story from the above edition included the results of a survey (n=1,018 American adults) showing that:
We also have some data that compares the American death ethos with other cultures. In comparing the US to other similarly developed Western nations (such as Great Britain, Ireland, Norway, Italy, Germany, France, and so on) Americans are the least likely to have any doubts about a life after death.
Not surprisingly, the same pattern holds toward beliefs in the existence of heaven and of hell. Americans, for instance, are much more likely to believe in heaven and hell that people in other similar countries. The percentage of the national populations definitely believing in the existence of the devil ranges from a high of 45% in the United to less than 4% in Germany, with a total mean percentage for all nations of 16%.
These findings reflect in part the highly religious character of Americans. Americans are most likely to describe themselves as being either extremely or very religious (26% vs. 12% for the entire sample). In general, this relationship holds regardless of education or age. For instance, whereas there is a negative relationship between education and religiosity (with those in the lowest third educationally being a quarter more likely to be at least somewhat religious than those in the top third) within our total sample, nationally this correlation is weakest in the United States, meaning that among all levels of education, Americans tend to be more religious than their counterparts in other countries.
Americans are also most likely to believe in religious miracles and most likely to report having experienced idionecrophany, or contact with the dead.
IDIONECROPHANY: contact with the dead
40% of Americans claim to have had contact with the dead at least once, roughly twice the percentage of other countries. It should come as no surprise that the After Death Communication Research Foundation is located in the US.
To figure out Americans' belief about what happens after death, we have some generalizable research (more than a decade of data from the National Opinion Research Center's General Social Survey, surveying a total of 16,455 Americans [n=16,455]). These yearly surveys are drawn from a stratified random sample of non-institutionalized American adults who live within the continental United States.
Question: Do you believe there is a life after death?
Over the 17 years covered by the NORC surveys, the proportion of Americans believing in life after death has increased slightly to roughly three in four. NORC also posed the following questions to random samples of Americans:
Question: On a scale of 1-7 where would you place your image of life after death?
So what difference does it make how religious individuals are in old age? Are strongly religious folks happier? Does increasingly religiosity increase the likelihood of being very happy equally for those of varying levels of physical wellness? And does this vary by sex?
PERCENT "VERY HAPPY" BY HEALTH STATUS, SEX, & RELIGIOSITY OF AMERICANS 65 AND OLDER
Older adults often have many major losses within a short period of time. For example, an older adult who loses a partner may suffer other kinds of loss, such as a loss of financial security, a loss of his or her best friend, and lost social contacts. Additional losses to consider may include the losses of independence and physical strength.
When we are trying to help our elders cope with loss, we may think they seem to overreact to a minor loss. But, what may seem minor to us may bring memories and feelings about a previous greater loss. You can help elders who are grieving by considering the following:
Being familiar with how loss impacts elders can only benefit you as you begin working with this community. Knowing the basic of the stages of grief will help you to recognize what stage of the process an elder is in:
In 1969 Elisabeth Kübler-Ross described five stages of grief in her book "On Death And Dying." These stages represent the normal range of feelings people experience when dealing with change in their own lives or in the workplace. While this work is not without criticism (we will touch on this at the end of this lesson), these stages have become the most common approach to identifying where a person might be with the process of grieving. The five stages of grief Kübler-Ross wrote about are: Denial, Anger, Bargaining, Depression and Acceptance.
When Kübler-Ross wrote about these stages she explained that these are normal reactions we have to tragic news. In fact, she called them defense mechanisms or coping mechanisms that we need to move through in order to manage change.
We don't move through the stages one at a time, in a neat, linear, step by step manner. That would be far too easy! What happens is that we occupy different stages at different times and can even move back to stages we have been in before. Kübler-Ross said the stages can last for different periods of time and will replace each other or exist side by side at times.
Ideally it would be good to think that we will reach the phase of 'Acceptance' while managing change but some people get stuck in the stages and find it difficult or impossible to move on.
Let's look at how people react in each of the five stages.
"I can't believe it…this can't be happening… not again!"
Denial is usually a temporary defense that gives us time to absorb news of change before moving on to other stages. It is the initial stage of numbness and shock. We don't want to believe that the change is happening. If we can pretend that the change is not happening, if we keep it at a distance, then maybe it will all go away. This is a bit like an ostrich burying its head in the sand.
"Why me? It's not fair!... NO! I can't accept this!"
When we realize that the change is real and will affect us our denial usually turns to anger. Now we get angry and look to blame someone or something else for making this happen to us. What's interesting is that our anger can be directed in many different directions. People get angry with the boss, themselves, or even God. In tough economic times it's often the economy that is blamed, or perhaps the fault of the government. You might find you are more irritable towards colleagues or family. You'll notice others finding fault with the smallest things.
"Just let me live to see my children graduate… I'll do anything if you give me more time… Just a few more years? Please?!”
This is a natural reaction of those who are dying. It's an attempt to postpone what is inevitable. We often see the same sort of behavior happening when people are facing change. We start bargaining in order to put off the change or find a way out of the situation. Most of these bargains are secret deals with God, others, or life, where we say "if I promise to do this, then you make the change not happen to me." In a work situation someone might work harder and put in lots of overtime to prove themselves invaluable in order to avoid retrenchment.
"I'm so sad, why bother with anything… what's the point of trying?"
When we realize that bargaining is not going to work the reality of the change sets in. At this point we become aware of the losses associated with the change and what we have to leave behind. This has the potential to move people towards a sad state, feeling down and depressed with low energy.
The depression stage is often noticeable in other ways in the workplace. People dealing with change at work may reach a point of feeling unmotivated and uncertain about their future. In the workplace or with school there could be an increase in absenteeism.
"It's going to be OK… I can't fight it; I should prepare for it."
As people realize that fighting the change is not going to make it go away they move into a stage of acceptance. It is not a happy space, but rather a resigned attitude towards the change, and a sense that they must get on with it. For the first time people start considering their options. It's a bit like a train heading into a tunnel. "I don't know what's in there, I have to keep going on this track, I'm scared but have no option, I hope there's light at the end..."
This can be a creative space as it forces people to explore and look for new possibilities. People often learn lots about themselves, and it's always good to acknowledge the bravery that acceptance takes.
The stages of change are typically represented in the form of a change curve diagram. The change curve diagram is valuable as it:
However, the change curve diagram portrays a linear process of change. It's easy to assume that the process of change begins with 'Shock' or 'Denial' and ends with 'Acceptance' after moving through each phase. But remember that Kübler-Ross emphasized that we move around between the stages. You may feel acceptance but while getting coffee at work you hear news that throws you back into anger or denial. Moving between the stages is normal! The only time for concern is becoming stuck in one of the stages. 'Anger' and 'Depression' are two of the stages where people can get stuck. If someone you know is facing death, pay attention to what is happening in that person’s life and help them to move on. If you are stuck in one of these stages, consider speaking to someone or meeting with a professional.
Although she does not include hope as one of the five stages in this model, Kübler-Ross adds that hope is an important thread running through all the stages. This hope is the belief that there will be a positive end to the change and that there is some meaning that will eventually be learned from the experience; this is an important indicator of our ability to successfully navigate change. Even in the most difficult circumstances there is an opportunity for growth and learning, and there will be an end to the change.
In therapeutic practice, most people are relieved to identify the stage they are currently in as well as recognizing what they have previously felt. People identify with the stages from past experiences of change that might have been of a personal nature. It's also a huge relief to know that these reactions and feelings are normal and are not signs of weakness or that they are falling apart. The Kübler-Ross model is very useful to identify and understand how other people are dealing with change. People immediately get a better sense of their reactions and why people they know are behaving in a particular way.
Not everyone agrees that this model is useful. Its main critics say the five stages are too simplistic and don't adequately describe the wide range of emotions people experience during change. The model is also criticized for making assumptions about broad applicability. Critics say it's unlikely that people all over the world experience the same reactions and emotions.
To be fair, the preface to "On Death and Dying" notes this and mentions that these are generalized reactions and people may wish to give them different names according to their experience. However, for those who need a basic model or who are beginning in practice, this model is easy to use and easy to understand. People are able to apply it in their lives and tell others about it as well.
“Live, so you do not have to look back and say: 'God, how I have wasted my life.'”
--Elisabeth Kübler-Ross, M.D. (1926-2004).
As students of gerontology, issues that you may need to consider when working with patients or clients may not always be obvious. Some may be difficult to consider, but discussing how a person's race, ethnicity, and/or gender may be contributing not only to their sense of physical well-being, but also to their emotional health, can be of great benefit. Likewise, discussions about religion and spirituality can be immensely helpful to you, for example, when attempting to relocate an elderly person into a care facility, or when attempting to find appropriate community services to help a senior staying at home.
Acknowledging a person's grief is also paramount to being able to help them. While it likely won't be your role to counsel (we leave that to trained clinicians), simply allowing a person to discuss and express their grief is an important role that you can fill. Remember that often, seniors (especially those with mobility issues) don't have anyone to talk to on a daily basis—your willingness to simply listen can be of great benefit to them, and will also help you feel good about the social roles you are filling in your profession and personally.