Efforts to improve the health and well-being of Americans over the next 5 years will be shaped by important changes in demographics. Our Nation is growing older and becoming more racially and ethnically diverse.
More Americans are living longer, and the proportion of the Nation’s population that is age 65 or older is growing rapidly. A baby born in 2006 can expect to live to age 78. This age expectancy represents a gain of more than 10 years since 1965, when the Older Americans Act of 1965 (Public Law 89-73) first authorized Medicare and Medicaid. From 1950 to 2006, the total resident population of the United States doubled from 150 million to more than 300 million. During this same period, the population 65 years of age and over grew twice as rapidly, increasing from 12 to 36 million. According to projections from the U.S. Census Bureau, after the first Baby Boomers turn 65 in 2011, the number of older people will substantially increase. In 2030, the older population is anticipated to be twice as large as in 2000, and will represent nearly 20 percent of the total U.S. population.xxxiii
The aging of the population has important implications for health care, public health, and human service systems. As the older fraction of the population increases, more services will be required for the treatment and management of chronic and acute health conditions and disabilities. The average 75 year old has three chronic conditions and uses five different prescription drugs.xxxiv Today’s health care workforce lacks much of the training required to provide appropriate care to today’s older adults and is thus unprepared for the projected increase in the number of older Americans over the next 20 years. Equally important, the health care workforce is older than in the past.
Across the country, long-term care providers are facing a shortage of qualified and committed direct care workers—those certified nursing assistants, home health aides, and personal care workers who provide hands-on care to millions of older adults and individuals with disabilities. Over the next 10 years, the country will need an estimated 874,000 additional direct care workers to meet growing demand. At the same time, the supply of workers traditionally relied upon to fill these positions—middle-aged women— will fall by about half by 2030.xxxv
Older Americans also have behavioral health and human service needs. Some older adults experience late onset of mental and addictive illnesses; others have experienced them throughout their lives. Older adults may experience depression and anxiety as they face physical decline, death of family members and other loved ones, and increased limitations in normal daily activities. In lieu of seeking treatment, some older adults—as with other populations—may “self-medicate” with alcohol. Further, older adults may misuse prescription or over-the-counter medications, often inadvertently.
The science of aging indicates that chronic disease and disability are not inevitable. As a result, health promotion and disease prevention activities and programs are an increasing priority for older adults, their families, and the health care system.
Diversity has long been a characteristic of the Nation’s population, but the racial and ethnic composition has changed over time. In recent decades, the percent of the population that is of Hispanic or Asian origin has more than doubled. In 2000, 19 percent of the population identified themselves as Black or African-American, Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or of more than one race; 12.6 percent of the total U.S. population identified themselves as of Hispanic origin. The U.S. Census Bureau projects that by 2010, 20.7 percent of the total U.S. population will identify themselves as Black or African-American, Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or of more than one race; and 15.5 percent will identify themselves as of Hispanic origin.xxxvi
The U.S. Census Bureau also reports that nearly one in five people, or 47 million U.S. residents age 5 and older, spoke a language other than English at home in 2000—an increase of 15 million people since 1990. According to the report, Spanish speakers increased from 17.3 million in 1990 to 28.1 million in 2000, a 62 percent rise. Only
55 percent of the people who speak a language other than English at home report they speak English “very well.”xxxvii
These changes in the racial and ethnic composition of the population have important consequences for the Nation’s health because many of the measures of disease and disability differ significantly by race and ethnicity. These shifts in the racial and ethnic makeup of the United States require health professionals and organizations to achieve cultural competence and to ensure that they utilize appropriate and tailored approaches in working with these population groups.