11 13 2014 Migratory stream movement of older people to the sun belt 96 don t move when they retire destination 0 places with a warm climate and reasonably priced retirement housing Assisted Living Facilities most 65 74 live on their own in homes apts ALF 1 85 and higher are likely to need help 7 of ALF and 19 in NHs most significant trend growing can meet better needs than nhs Most ALFs provide meals personal care limited medical assistance intermediate care between home nursing home they age in place don t have to move housekeeping utilities social activities transportation and security Continuum care retirement communities CCRS life care concept Provides a continuum of housing arrangements living to assisted living Up front fee to reduce expenses pros needs met if require intensive medical care o less isolated cons overwhelmed with houseworl o decreased ability to move around neighborhood Compression of morbidity thesis 2 premises 1 Human life span is fixed and infinite health care improvements and prevention will be disabled into the last few years of the life span HW demand will decrease and illness disability as well Con old people will spend more of that time ill disabled and HC costs will rise and resources may be strained Effect of exercise on health preventative medicine Second most important lifestyle change after smoking More fit keep weight under control Less headaches and joint probs Netter LT and ST memory Predictor of morbidity Effect of Alcohol cirrhosis of the liver 14 week Cancerns hypertension Occasional wine lower mortality Moderate consumption protects against heart disease stroke Smoking life expectancy 7 10 years less Heart attack cancer smoke All linked to smoking Associated with disability COPD chronic obstructive pulmonary disease Emphysema and chron bronchitis Difficulty breathing and loss of energy Obesity trends increased in past 40 years 60s 24 for women and 10 for men 2009 increased 30 Theory of cumulative disadvantage relationship between education health and aging Those who begin life with a lot of resources continue to have these opportunities to accumulate more of them while the opp Fall further behind Gap in health and status should increase with age Which racial ethnic groups have the best health Whites Asian Worst African americans Hispanics Native Americans More prone to develop serious illness Social factores are poor health lifestyles Explained by cum Disad Hispanics are less likely to have ubsyrabce Health maintenance organizations HMOs control costs to the public managed care Main improve efficiency of health care services and control costs Health insurance plans run by financial officers Physicians are members and services are monitored by administrators to achieve efficiency and control costs People must choose among doctors Must be administered to show that financial savings not compromising health Retiree HI by employers trend emploers have come to see reiree health insurance as a liability and many have been reducing eliminating it altogether Policies have become increasingly expensive The number of retired workers has increased The federal govt requires firms to report all costs and liabilities associated with retirees health plans trends in labor force participation among older men and women Men increase in labor fp among older men 1990s o From 21 in 90s to 30 in 2010 o The most important trend is the increase in labor force participation LFP among older men o Change is even more dramatic in men in late 60s Women 1995 and 90s increase age 45 64 o GS steady and increased dramatically in 94 o 50 60 64 now o factors dramatic force participation in married women and with children increase in education choosing to delay retirement Hoe does LF participation vary over the life course by race and ethnicity In every age group blacks and Hispanics have the highest level or unemployment than for whites Highest for black men until 54 then exceeded by Hispanic men Black women have the highest employment rates until age 44 then exceeded by Hispanic women Hispanic women have the lowest labor force participation What did the Age Discrimination in Employment Act do ADEA banned discrimination agains workers 40 65 and forbade employers to fire demote reduce the salaries of older workers without food cause Hoes do caregiving responsibilities for the frail elderly differ by gender Women are typically the primary caregivers of ill and disabled fam members Daughters who provide care for their aging parents do not give up their other obligations they give up their free time Caregiving reflects a gendered division of labor Men have been socialized to be the breadwinners Women are seen as natural caregivers Daughters more likely to provide hands on personal care such as feeding dressing breathing or cleaning up after a bowel accident Sons are more likely to arrange transportation and social services and provide help with household repairs yard work and managing finances What is caregiver stress Burden is a psych cost Refers to the management of the tasks stress refers to the strain felt by the caregiver Stress depends on coping skills 88 had helpers who provided hands on care physical exhaustion poorer immune responses and deterioration of their own health status longterm care giving also increases depressive symptoms among caregivers that these symptoms persisted for years What are some of the causes of patient abuse in nursing homes Amount of nurses Non profit vs for profit nursing homes Not for profit facilities deliver a higher quality care Staff turnover affects the quality of care High turnover low quality of care Overworked nurses and staff turnover is an impediment in care What are board and care homes Residential care homes Defined contribution plan Pension plan A savings plan with some tax advantages Employer contributes a given percentage of a worker s annual earnings to a pension account or the worker makes direct contributions The longer workers make contributions to their dc funds the more money they will have to live on in retirement Defined benefit plan Pension plan Pays a specified amount when a worker reaches a given age There is no advantage in continuing to work beyond retirement age because a worker s pension does not increase in additional years Impose stiff financial penalties on workers who do not retire on time What are instrumental activities of daily living IADLs Functional status refers to the degree of difficulty in