An Aging Society
Like the rest of the country, Santa Clara County is on the cusp of a significant shift in the age demographic. By the year 2020, Santa Clara County’s population of adults over 65 will nearly double, reaching close to 300,000.
Although many of us will be relatively healthy as we age, the prevalence of chronic illness is high among older adults and is likely to increase as we live longer. According to the Centers for Disease Control and Prevention, 88% of those over 65 years of age have at least one chronic health condition. Many of these chronic conditions are directly related to health damaging behaviors.
Common Chronic Diseases and Conditions
The most prevalent chronic diseases among older adults include arthritis, cardiovascular disease, cancer, diabetes, and obesity. In addition, the following primary health conditions affect older adults: depression, cognitive decline, pneumonia and influenza, oral health, and orthopedic/hip fractures.
Consider the following Santa Clara County statistics1:
- In 2002, the age adjusted death rate for cardiovascular disease was 170.6 (per 100,000).
- In 2006, the five most common cancer deaths among men were lung, colorectal, prostate, pancreatic, and Non-Hodgkin’s Lymphoma. The five most common cancer deaths among women are lung, breast, colorectal, pancreatic, and ovary.
- In 2006, 18.2% of adults age 65 and older reported having been told that they have diabetes.
- In 2006, 23.9% of adults age 55-64 reported a Body Mass Index (BMI) at the obese level, and 36.4% reported a BMI at the overweight level. 41% of adults 65 and older reported a BMI at the overweight level.
- In 2006, 77.2% of adults age 65 and older reported visiting a dentist in the last year. Only 45.1% of adults age 65 and older reported having any kind of insurance coverage for routine dental care.
- In 2006, 16.2% of adults age 65 and older reported having one or more days per week when their mental health was not good.
- In 2006, 75% of adults age 65 and older reported having a flu shot in the past 12 months. 69.7% reported ever having a pneumonia shot.
- Falls are the leading cause of injury hospitalization, with an average of 129 deaths and 3,300 hospital discharges/year due to falls. In 2004, the highest number of hospitalizations due to falls occurred among adults age 65 and older.
Research has demonstrated that physical activity is critical to the prevention of chronic diseases, prevention of falls, maintenance of mobility, and promotion of social interaction and emotional and cognitive health. Only a small percentage (16%) of adults across the age continuum engage in the recommended frequency and amount of physical activity, 30 minutes of moderate physical activity 5 or more days a week and 20 minutes of vigorous physical activity 3 or more days a week.
In today’s society older adults are at risk for isolation, loneliness, and depression as their family members move away and they leave the workforce. Additionally, today’s independent older adults prefer to remain in their homes and communities as they age. Their ability to remain in their homes and communities is dependent in part on the availability of resources to support their well-being and opportunities to remain connected. A recent study of Santa Clara County older adult participants in congregate nutrition programs found that the primary reason for participation in the program is socialization. Social interaction and community engagement promotes physical, emotional, and cognitive health and can provide an important outlet for older adults to contribute to their communities.
Transition from Hospital to Home
The transition from hospital to home is often a critical turning point for older adults, potentially precipitating decline in physical and mental health after discharge. As hospital stays have shortened and discharge planning has decreased in many hospitals, patients and their family members may lack the support necessary to prepare them for a successful transition back to home. Once home, service systems and care are often disconnected from the hospital stay and may be fragmented within the community. Older adults who lack the necessary follow-up and support services risk re-hospitalization. Studies have demonstrated that careful discharge planning and post-discharge support services can result in a reduction in readmission.2
Caregiver Capacity and Support
Currently, there is no local, countywide caregiver network, yet the need for and needs of caregivers will continue to grow as our age demographics shift. Most adults (78%) receive long-term care at home and rely exclusively on family and friends for assistance. Caregivers are usually not prepared to provide care in the home after the older adult they are caring for leaves the hospital. They may also not be aware of or know how to use the services available in the community. Santa Clara County and San Benito County, like the rest of California, have too few nurses, certified nurse assistants, and home health workers to adequately support caregivers of seniors for such areas as home health care and respite care.
Informal caregiving, or care provided by family members, friends and neighbors, has a large intergenerational impact, affecting seniors, middle-aged adults, and the children of caregivers. In Santa Clara County, one-fourth of seniors are also caregivers. Caregivers are at high risk for depression, with approximately 11% of full-time professional caregivers reporting a major depressive episode in the past year compared to 7% for all occupations.3 Studies show that 16% of caregivers report a decline in their health after taking on the caregiver role, and about half of caregivers who care for someone with Alzheimer’s disease develop psychological distress. Additionally, lack of training and support is associated with poor health outcomes for both caregivers and recipients. 4 Caregivers have higher rates of chronic conditions than non-caregivers, and caregiving can increase mortality risks. Caregiving has a huge economic impact. According to a recent study by the MetLife Mature Market Institute, the cost to U.S. businesses due to lost productivity of working caregivers is $17.1-$33.6 billion per year. It is critical that caregivers are well trained and supported so that they remain healthy themselves and do not risk economic insecurity due to lost workplace productivity.
1 Santa Clara County Public Health Department, Epidemiology and Data Management, 2005-2006 Behavior Risk Factor Survey Santa Clara County Chartbook; 2004 Adult Health Status Report. http://sccphd.org/portal/
2 Phillips, C., Wright, S., Kern, D., Singa, R., Shepperd, S, Rubin, H. (2004). Comprehensive Discharge Planning with Postdischarge Support for Older Patients with Congestive Heart Failure. Journal of American Medical Association. 291:11; pp 1358-1367.
3 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (October 11, 2007). The NSDUH Report: Depression among Adults Employed Full-Time, by Occupational Category. Rockville, MD.
4 Health Research for Action, UC Berkeley. (February 28, 2007). Report to The Health Trust: Recommendations for Wellness Initiatives. Berkeley, California.