Aging

Question 1

Describe current and projected trends in aging in the United States

Answer 1

• Since the baby boom population hit 65 years the shift in age accelerated - shifted from pyramid to rectangle like shape
• Due to longer life expectancy
• Decline in birth rate
• Greater racial/ethnic diversity
• Prevalence of chronic illness among the elderly has been increasing

Question 2

Compare and contrast trends in aging versus trends in the under 18 population in the United States

Answer 2

Aging - projected to continue to grow rapidly

Under 18 - Will stay steady

Number of elderly will exceed number of people under 18.

Question 3

Explain why, from a public health perspective, trends in aging adults matters

Answer 3

• Social Security, Medicare, and Medicaid are paid for by taxes on working adults. But # of working adults is steady while # elderly is increasing.
• Healthcare spending increases faster than GDP –> current financial support for healthcare programs isn’t sustainable

Question 4

Describe the concept “compression of morbidity”, and explain why this is the best-case scenario from a public health perspective (compared to life extension; solely shifting morbidity, etc.)

Answer 4

• Compression of mortality –> people live longer, but very few live beyond 100 (most deaths occurring in the elderly)
• Compression of morbidity –> Increase in life expectancy accompanied by an increase in average age of onset of morbidity. People spend less time being sick before dying. Desirable outcome.
• US has experiences compression of morbidity over the past few years, it will have a positive effect in the future of medicare and medicaid.

Question 5

Define Social Security, Medicare, and Medicaid, and rank the relative expenditures of each program

Answer 5

SS - oldest program. Social insurance. Federal, medical, hospital and prescription drug insurance for those over 65. Current workers pay for those retried or disabled in taxes. There is a tax for SS. Recently increased retirement age to 67.

Medicare - 1965 (Great society programs) - care for 65+ and disabled. Pay as you go (current workers pay for those retried or disabled). There is a tax for medicare.

Medicaid - federal + states program. Pays for nursing home care for poor and old people. No special tax for medicaid. Funded from general tax. Also pay as you go.

Most expensive:
1) SS
2) Medicare
3) Medicaid

Question 6

Explain the “perfect storm” that will lead to ongoing solvency concerns for Medicare and Social Security

Answer 6

• High and rising cost of care
• Aging population
• Increasing elderly-dependency ratio is increasing (fewer active working paying the taxes)

Question 7

What is the difference between individual and population aging?

Answer 7

A population ages when the age structure shifts to older ages.

Question 8

What is the dependency ratio for children vs elderly?

Answer 8

Children - number of kids/ number of working adults (18-64) *100

Elderly - number of elderly (over 65)/number of working adults * 100

Question 9

How does immigration help lessen the burden brought by a growing dependency ratio?

Answer 9

• The US birthrate is decreasing
• Immigrants are usually working-age and healthy
• More immigrants help pay for the taxes needed to support the aging population

Question 10

What is morbidity?

Answer 10

The condition of suffering from a disease or medical condition.

Question 11

What are possible medicare solutions?

Answer 11

• Increase age of eligibility
• Increase premiums and co-pay for high income people
• Decrease benefits
• Negotiate drug prices
• Increase payroll taxes
• Many of these are unpopular with politicians (have high voting range)

Question 12

What are some solutions for social security?

Answer 12

• Recent increase in age for retirement
• Percentage of high-income recipients subject to tax (means test recipient of benefits)
• Increasing tax rate (16% increase, smaller than increase for medicare)

Question 13

What are the general possible solutions for medicare, medicaid and social Security

Answer 13

• Increase taxes
• Decrease eligibility
• Decrease level of benefits
• Some combination of these 3

Question 14

How have trends in poverty among the elderly changed?

Answer 14

• Has been low in recent decades
• Lower when compared to other age groups
• Decline started in 1965 due to SS (created in 1935, but must have contributed to SS by paying taxes to qualify)
• Medicare and Medicaid were created and started working in 1965

Question 15

What are the patterns of work in the elderly?

Answer 15

• The proportion of working women has increased since WW2 (18-64yrs)
• Proportion of men working has decreased since WW2 (18-64yrs)
• Elderly - lower than in the 1940s, but slow increase in the past few years

Question 16

What are the main income sources for the elderly? And what explains the differences among different income levels?

Answer 16

1) Social Security (especially for lower-income people) –> successful at reducing poverty among the elderly
2) Upper 2 quintiles –> have a good amount coming from earnings (work)
- Higher income workers –> jobs that don’t involve significant physical effort

Question 17

How would increasing retirement age affect lower-income elders?

Answer 17

• Reducing benefits –> improves long-term fiscal status of SS program
• Workers in the lower-income are less likely to reach the retirement age (might die before) –> if they do reach it, they are expected to have a reduced life expectancy

Question 18

How has decreasing smoking, as a health promotion strategy, affected elderly people?

Answer 18

Successes - PH success
- Larger # of seniors
- Healthier people on average (compression of morbidity)
- Greater survival to 65
- Longer survival post 65

Challenges
- More medicare beneficiaries (especially 85+) –> increased cost
-Increase costs in nursing homes (paid by Medicaid)
- Increased SS costs

Question 19

Describe the case study of the Czech Republic regarding tobacco.

Answer 19

• Philip Morris did a study in which they found that using tobacco products would kill more people prematurely, which would save the government money