The growth in the number and proportion of older adults in the United States is unprecedented in the nation's history. By 2050, it is anticipated that Americans aged 65 or older will number nearly 89 million people, or more than double the number of older adults in the United States in 2010.
The rapid aging of the U.S. population is being driven by two realities: Americans are living longer lives than in previous decades and, given the post-World War II baby boom, there are proportionately more older adults than in previous generations. Many Americans are now living into their 70s, 80s, and beyond. The leading edge of the baby boomers reached age 65 in 2011, launching an unparalleled phenomenon in the United States. Since January 1, 2011, and each and every day for the next 20 years, roughly 10,000 Americans will celebrate their 65th birthdays. In 2030, when the last baby boomer turns 65, the demographic landscape of the nation will have changed significantly. One of every five Americans—about 72 million people—will be an older adult.
The aging of the nation's population has wide-ranging implications for virtually every facet of American society. At each point in the lifespan of baby boomers, the United States has felt and been changed by the impact of their numbers and needs—from booming sales in commercial baby food during the late 1940s, to the construction of thousands of new schools during the 1950s, to the housing construction boom of the 1970s and 1980s. The significant proportion of Americans represented by the baby boomers continues to exert its influence. In large measure, this influence will have its most profound effects on the nation's public health, social services, and healthcare systems. Public health plays a key role in advocating for those in need, linking individuals and communities to available services, and promoting healthy aging because of its effects on personal, societal, cultural, economic, and environmental factors. The public health sector is ideally positioned to meet the growing needs and demands of a rapidly aging nation.
Leading Causes of Death
During the twentieth century, effective public health strategies and advances in medical treatment contributed to a dramatic increase in average life expectancy in the United States. The 30-year gain in life expectancy within the span of a century had never before been achieved. Many of the diseases—including tuberculosis, diarrhea and enteritis, and syphilis—are no longer the threats they once were. Although they may still present significant health challenges in the United States, these diseases are no longer the leading killers of American adults. However, other diseases have continued to be leading causes of death every year since 1900. By 1910, heart disease became the leading cause of death every year except 1918–1920, when the influenza epidemic took its disastrous toll. Since 1938, cancer has held the second position every year. Heart disease and cancer pose their greatest risks as people age, as do other chronic diseases and conditions, such as stroke, chronic lower respiratory diseases, Alzheimer disease, and diabetes. Influenza and pneumonia also continue to contribute to deaths among older adults, despite the availability of effective vaccines.
The burden of chronic diseases encompasses a much broader spectrum of negative health consequences than death alone. People living with one or more chronic diseases often experience diminished quality of life, generally reflected by a long period of decline and disability associated with their disease.
The nation's expenditures for healthcare, already the highest among developed countries, are expected to rise considerably as chronic diseases affect growing numbers of older adults. Today, more than two-thirds of all healthcare costs are for treating chronic illnesses. Among healthcare costs for older Americans, 95 percent are for chronic diseases. The cost of providing healthcare for one person aged 65 or older is three to five times higher than the cost for someone younger than 65.
By 2030, healthcare spending will increase by 25 percent, largely because the population will be older. This estimate does not take into account inflation and the higher costs of new technologies. Medicare spending is projected to increase from $555 billion in 2011 to $903 billion in 2020.
Death and decline associated with the leading chronic diseases are often preventable or can be delayed. Multiple opportunities exist to promote and preserve the health of older adults. The challenge is to more broadly apply what is already known about reducing the risk of chronic disease. Death is unavoidable, but the prevalence of chronic illnesses and the decline and disability commonly associated with them can be reduced.
If a meaningful decline in chronic diseases among older adults is to occur, adults at younger ages, as well as the nation's children and adolescents, need to pursue health-promoting behaviors and get recommended preventive services. Communities can play a pivotal role in achieving this goal by making healthy choices easier and making changes to policies, systems, and environments that help Americans of all ages take charge of their health.
More than a quarter of all Americans and two of three older Americans have multiple chronic conditions, and treatment for this population accounts for 66 percent of the country's healthcare budget. The nation's healthcare system is largely designed to treat one disease or condition at a time, but many Americans have more than one, and often several, chronic conditions. For example, just 9.3 percent of adults with diabetes have only diabetes. Other common conditions include arthritis, asthma, chronic respiratory disease, heart disease, and high blood pressure.
People with chronic diseases may also have other health problems, such as substance use or addiction disorders, mental illness, dementia or other cognitive impairments, and developmental disabilities. The varied nature of these conditions leads to the need for multiple healthcare specialists, a variety of treatment regimens, and prescription medications that may not be compatible. People with multiple chronic conditions face an increased risk of conflicting medical advice, adverse drug effects, unnecessary and duplicative tests, and avoidable hospitalizations, all of which can further endanger their health. Figure 3.1 shows the rates of multiple chronic conditions among Medicare fee-for-service beneficiaries.
To address these risks, the U.S. Department of Health and Human Services (HHS) developed a strategic framework to improve health outcomes for people with multiple chronic conditions. Federal agencies and key partners will use this framework to improve and coordinate care for people with multiple chronic conditions, make the best use of effective self-care strategies, and support research to fill knowledge gaps.
As more and more Americans reach the age of 65, society is increasingly challenged to help them grow older with dignity and comfort. Meeting these challenges is critical to ensuring that baby boomers can look forward to their later years. Three key areas that public health professionals are beginning to address among older adults are binge drinking, emergency preparedness, and health literacy. These areas have long been the target of healthcare and aging services professionals.
However, older adults who binge drank reported engaging in this behavior more frequently than their younger counterparts—an average of five to six times a month. They also reported consuming an average of about six drinks when they did, thereby increasing their risk of developing many health and social problems.
Centers for Disease Control and Prevention (CDC) is assessing the public health effect of excessive drinking, including binge drinking. They are also working with states and communities to translate strategies for preventing excessive alcohol consumption recommended in The Guide to Community Preventive Services (Community Guide) into public health practice. These recommendations include increasing the price of alcohol, regulating the number and concentration of alcohol retailers in a community, holding alcohol retailers liable for harms resulting from illegal sales to underage or intoxicated persons, maintaining government controls of alcohol sales (avoiding privatization), using electronic screening and brief intervention for excessive alcohol use, and limiting the days and hours when alcohol is sold.
CDC is also helping to increase screening and counseling for excessive alcohol use in clinical settings, as recommended for adults by the U.S. Preventive Services Task Force (USPSTF). Taken together, these prevention measures can help reduce excessive alcohol use and the many health and social harms related to it. They can also help the United States meet the Healthy People 2020 leading health indicator of reducing binge drinking among all U.S. adults.
Some older adults may have difficulty keeping themselves safe and healthy during an emergency or natural disaster. Conditions such as impaired mobility, multiple chronic health conditions, or difficulty with memory may cause some older adults to need extra help planning for and dealing with situations such as hurricanes or floods. Emergencies and disasters can also disrupt the help that many older adults rely on for independent living, such as help from friends, family, and home-based medical care.
Why Does Health Literacy Matter?
Every day, people confront situations that involve life-changing decisions about their health. These decisions are made in places such as grocery and drug stores, workplaces, playgrounds, doctors' offices, clinics and hospitals, and around the kitchen table. Obtaining, communicating, processing, and understanding health information and services are essential steps in making appropriate health decisions. However, research indicates that today's health information is presented in ways that are not usable by most adults. Limited health literacy occurs when people cannot find and use the health information and services they need.
What Is Health Literacy?
Health literacy was defined by Healthy People 2010 as, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Healthy People 2020 is tracking health literacy improvement, which is defined as how many healthcare providers make sure their instructions are easy for patients to understand.
How Can We Improve Health Literacy?
Recent federal policy initiatives have brought health literacy to a tipping point. The skills of individual patients are not the only important part of health literacy. This concept includes what health systems and professionals do to make health information and services understandable for everyone, regardless of their literacy skills. We can build our own health literacy skills and help others—such as community members, health professionals, and anyone who communicates about health—build their skills. Every organization involved in health information and services needs its own health literacy plan to improve its organizational practices.
This chapter contains text excerpted from the following sources: Text beginning with the heading “U.S. Population Is Aging” is excerpted from “The State of Aging and Health in America 2013,” Centers for Disease Control and Prevention (CDC), May 31, 2016; Text under the heading “Emerging Issues in the Health of Older Adults” is excerpted from “Older Adults,” Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services (HHS), August 23, 2017.