By Susan Blumenthal, M.D., M.P.A. and Emma Lape
The baby boom generation is revolutionizing American culture, leaving its mark on every product, service, and institution it touches in the 21 century. As baby boomers grow older, society is transforming as a result with services related to aging including health care, retirement planning, housing, and community life. Consider this: 8,000 baby boomers turn 65 every day. [1] In 2013, adults over 65 constituted 14 percent of the population in the United States and will account for an estimated 20 percent by 2050. [2] There are already 55,000 Americans over age 100, and by 2050 the number of centenarians will reach 600,000 -- roughly the population of the entire state of Vermont! [3] What's more, the baby boom generation is more racially and ethnically diverse than any previous generation. By 2050, 20 percent of seniors will be Hispanic, 12 percent black, and 9 percent Asian. Women are a majority of seniors, accounting for 57 percent of the U.S. population today and a projected 55 percent of Americans over age 65 by 2050. [4]
Currently, one of the greatest unmet needs of seniors is the ability to age in place. Today, 93 percent of Americans over 65 live independently in the community, while only 3 percent reside in assisted living facilities and 4 percent in nursing homes. Moreover, studies show that the vast majority of older adults want to age in place. Aging in place can be understood as:
"The ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level." [5]
The concept is a simple one: Increasingly, older adults want to stay in their own homes, neighborhoods, and towns even if this necessitates specialized services to maintain their independence. But "aging in place" will require a shift in the way our society thinks about the role of communities and the way services are delivered to individuals. When an older adult loses the ability to perform certain tasks for herself due to illness or disability, but wants to remain in her home, strong community support systems can permit her to do so. All sectors of society will need to play a role in providing older adults with a broad range of community-based assistance to meet their needs including 1) affordable and accessible housing, 2) convenient transportation, 3) work, education, and volunteer opportunities, 4) access to health and support services, 5) participation in civic and cultural activities, and 6) intergenerational connections. When communities rise to effectively address these challenges, they become more livable and welcoming for people of all ages, across the life cycle.
Achieving communities that support aging in place will require working together across the public and private sectors, and engaging experts in urban planning, architecture, health care, transportation, agricultural policies and social services. Communities must ensure that people of all ages can meet their basic needs, but the concept of aging in place demands much more than survival; it also calls for vibrant, engaging communities that recognize the needs of seniors and their contributions:
"Aging in place supports the notion that older persons should be able to maintain a desirable lifestyle by participating in their communities, remaining independent as their health allows, having access to educational, cultural, and recreational facilities, feeling safe, and living in an intergenerational environment." [6]
Some experts believe that the last component is the key. A number of sociologists and other researchers now say that American society suffers from a dearth of intergenerational interaction. In other words, society has become too segregated by age. People travel through life in cohorts based on birth year -- from schools to the workforce to retirement homes. One study found that between 1990 and 2010, young and older Americans were living apart in communities to the same degree as whites and Hispanics [7]. Although the percentage of multigenerational households has risen during the past several decades -- from 12 percent in 1980 to 16 percent in 2010 -- it remains lower than it was in 1940, when 25 percent of households had more than two generations under the same roof. [8] The recent economic recession brought a sharper increase in multigenerational households, from 3.7 percent in 2000 to 4.4 percent in 2010. [9] But even this is telling: The decision for children to share a house with parents and grandparents is made out of economic necessity, not preference.
Age segregation creates divides in society, contributing to ageism and depriving everyone of opportunities for intergenerational learning. But communities can encourage intergenerational interactions to everyone's benefit. Young people can facilitate seniors' ability to age in place, while older adults can enrich the lives of the young and share their knowledge and skills.
Intergenerational living is just one element of a new vision for aging in America. As Robert Browning once wrote, "Grow old along with me! The best is yet to be." Growing older in America must involve an emphasis on healthy aging, not just more years of life with illness or disability. Rather than accepting social isolation for older adults as a matter of course, a focus is needed on building intergenerational communities in which everyone benefits from interactions with other age groups.
Communities should help older adults achieve and maintain wellness: Healthy, nutritious foods must be made accessible and affordable for seniors, as well as opportunities for exercise and outdoor recreation. Additionally, information technology and social media can be harnessed as powerful tools for improving connectivity and quality of life for seniors connecting them to friends and families as well as information across town, across the country and our world.
However, none of these benefits will be realized unless we work together across all sectors of society to build healthy communities that meet the needs of citizens, regardless of age. A framework of action is urgently needed to prepare our communities for an increasingly aging population. Currently, opposing forces are at work; resources to support older adults are shrinking even as the demands of this population group grow. The current boom of older adults is no surprise, and in fact the public health community has been developing initiatives related to aging for decades. Many innovative solutions to promote aging in place exist, but work remains to be done on "scaling up" and spreading these strategies in communities nationwide.
Pilot programs have demonstrated several effective ways of helping older adults age in place, as exemplified by a diverse group of projects supported by the Community Innovations for Aging in Place (CIAIP) initiative. CIAIP, funded from 2009-2012 by the United States Administration on Aging, supported organizations across the country to test and evaluate strategies to facilitate aging in place. The 15 organizations funded by CIAIP took different paths based on the varied characteristics of their communities and older adult populations. The programs were grouped into five general categories:
- Broad-based community development and planning (e.g. planning and construction of an intergenerational village)
- Service provision in settings where older adults live (e.g. chronic disease self- management in a senior living center)
- Building bridges across organizational silos (e.g. integration of medical and social services to prevent re-hospitalizations)
- Mobilizing human capital through volunteering and advocacy (e.g. using the Time Bank model to facilitate neighbors helping neighbors)
- Outreach to overlooked or disenfranchised subgroups (e.g. services to support LGBT older adults)
These innovative approaches are components of a nationwide shift from hospital-based to community-based health care. Chronic disease is responsible for most of the burden of disease in our communities, affecting half of all adults in the United States -- about 117 million people. Furthermore, 1 in 4 adults lives with multiple chronic conditions. The sickest 10 percent of patients account for 60 percent of health care costs in America. That's why the promotion of healthy aging and the implementation of chronic disease management by focusing on community-based prevention strategies are so important. Studies show that social support is linked to positive outcomes in physical health, with beneficial effects on the cardiovascular, immune and endocrine systems [10]. Thus, improving social support systems in communities can have a significant effect on population health.
Furthermore, the Affordable Care Act of 2010 ignited a prevention revolution, providing financial incentives for preventive care, wellness, and chronic disease management in neighborhoods across the country. To implement this transformation, innovative community-based approaches that result in must involve local governance, mobilize all sectors of society with diverse stakeholders, be well funded, scaled up and spread to meet these goals and to chart a course towards health for all Americans. And this should also have another benefit: decreasing the costs of health care as it moves from expensive hospital based medical interventions to more responsive, accountable community based care.
For all these reasons, designing environments for seniors to age in place is an important part of the benefits communities can provide for individuals in the 21 century. And everyone -- across all generations -- will benefit from this emphasis on promoting better health across the life cycle.
References:
[1] Grunewald, Will. "How Baby Boomers Are Changing Retirement Living." The Washingtonian 13 Mar. 2014.
[2] Vincent, Grayson K., and Victoria A. Velkoff. "The Next Four Decades: The Older Population in the United States: 2010 to 2050." census.gov. United States Census Bureau, May 2010.
[3] "Profile America Facts for Features: Older Americans Month: May 2011." United States Census Bureau. United States Census Bureau, 23 Mar. 2011.
Kincel, Brian. "The Centenarian Population: 2007-2011." census.gov. United States Census Bureau, Apr. 2014.
[4] Vincent, Grayson K., and Victoria A. Velkoff. "The Next Four Decades: The Older Population in the United States: 2010 to 2050." census.gov. United States Census Bureau, May 2010.
[5] Oberlink, Mia. "Community Innovations for Aging in Place (CIAIP) Final Report." CIAIP. Administration on Aging, Apr. 2014.
[6] Oberlink, Mia. "Community Innovations for Aging in Place (CIAIP) Final Report." CIAIP. Administration on Aging, Apr. 2014.
[7] Neyfakh, Leon. "What 'age segregation' does to America." The Boston Globe 31 Aug. 2014.
[8] Taylor, Paul, Jeffrey Passel, Richard Fry, Richard Morin, and Wendy Wang. "The Return of the Multi-Generational Family Household." Pew Social Trends. Pew Research Center, 18 Mar. 2010.
[9] Lofquist, Daphne. "Multigenerational Households." census.gov. United States Census Bureau, Aug. 2013.
[10] Uchino, Bert N., John T. Cacioppo, and Janice K. Kiecolt-Glaser. "The Relationship Between Social Support and Physiological Processes: A Review With Emphasis on Underlying Mechanisms and Implications for Health." Psychological Bulletin119.3 (1996): 488-531.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of The Huffington Post. She is a Senior Fellow in Health Policy at the New America Foundation and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. She is also Senior Policy and Medical Adviser at amfAR, The Foundation for AIDS Research. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the federal government in the Administrations of four U.S. presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House advisor on health. Prior to these positions, Dr. Blumenthal was Chief of the Behavioral Medicine and Basic Prevention Research Branch, Head of the Suicide Research Unit, and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. She has chaired numerous national and global commissions and conferences and is the author of many scientific publications. Dr. Blumenthal has often served as a medical expert in the news and most recently was featured on the Emotions of Aging episode of the PBS television series, Feeling Grand. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the 2009 Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Beene Foundation. She is the recipient of the Rosalind Franklin Centennial Life in Discovery Award.
Emma Lape is a junior at Dartmouth College, pursuing a degree in classics and biology. She is a Health Policy Intern at the New America Foundation in Washington, D.C.