Who Are the Elderly?

Based on 2010 statistics from the U.S. Census Bureay, more than half of the older American population are 65–74 years of age, and about 57 percent are female, reflecting males’ shorter life spans. About 80 percent of the elderly are non-Latino whites, compared to about 66 percent in the population as a whole; 8.6 percent are African American, compared to about 13 percent of the population; and 7.0 percent are Latino, compared to 15 percent of the population. Also “in 2018, there were 52 million people age 65 and older, according to the Census Bureau’s Vintage Population Estimates. Their share of the population grew as well, from 12.4 percent in 2000 to 16.0 percent in 2018.”^[1]

The percentage of elders living in poverty is 9.0, compared to 15.1 percent of the entire population. Although most elders have fixed incomes, the fact that their family size is usually one or two means that they are less likely than younger people to live in poverty. In fact, today’s elderly are financially much better off than their grandparents were, thanks to Social Security, Medicare (the federal health insurance program for older Americans), pensions, and their own assets. We will revisit the health and financial security of elders a little later.

In terms of education, about 22 percent of the elderly are college graduates, compared to about 29 percent of the population as a whole. This difference reflects the fact that few people went to college when today’s elderly were in their late teens and early twenties. However, it is still true that today’s elders are better educated than any previous generation of elders. Future generations of the elderly will be even better educated than those now.

While most elders are retired and no longer in the labor force, about 16 percent do continue to work (see Table:  Demographic Composition of the Elderly, 2010). These seniors tend to be in good health and to find their jobs psychologically satisfying. Compared to younger workers, they miss fewer days of work for health or other reasons and are less likely to quit their jobs for other opportunities (Sears, 2009).

Although many older Americans do not fit the negative image with which they are portrayed, it is still true that they face special problems because of their age and life circumstances and because of ageism.  Some of these problems are discussed below.

Physical and Mental Health

Perhaps the problem that comes most readily to mind is health. It is true that many older people remain in good health and are fully able to function mentally and physically (Rowe et al., 2010). Still, the biological and psychological effects of aging do lead to greater physical and mental health problems among the elderly than in younger age groups, as we briefly discussed earlier. These problems are reflected in responses to the General Social Survey (GSS) question, “Would you say your own health, in general, is excellent, good, fair, or poor?” Figure 1 below, “Age and Self-Reported Health” shows that the elderly are more likely than the non-elderly to report that their health is only fair or poor.

The elderly’s perception of their own health is supported by government estimates of chronic health conditions for older Americans. Of all people aged 65 or older not living in a nursing home or other institution, almost 50 percent have arthritis, 56 percent have high blood pressure, 32 percent have heart disease, 35 percent have hearing loss, 18 percent have vision problems, and 19 percent have diabetes (these numbers add up to more than 100 percent as people may have several health conditions) (Federal Interagency Forum on Aging-Related Statistics, 2010). These rates are much higher than those for younger age groups.

The elderly also suffer from dementia, including Alzheimer’s disease, which affects almost 13 percent of people 65 or older (Alzheimer’s Association, 2009). Another mental health problem is depression, which affects almost 15 percent of people 65 or older. Because of mental or physical disability, about two-thirds of all people 65 or older need help with at least one “daily living” activity, such as preparing a meal (Federal Interagency Forum on Aging-Related Statistics, 2010).

If the elderly have more health problems, then adequate care for them is of major importance. They visit the doctor and hospital more often than their middle-aged counterparts. Medicare covers about one-half of their health-care costs; this is a substantial amount of coverage but still forces many seniors to pay thousands of dollars annually themselves. Some physicians and other health-care providers do not accept Medicare, meaning that the patient must pay an even higher amount. Moreover, Medicare pays little or nothing for long-term care in nursing homes and other institutions and for mental health services. All these factors mean that older Americans can still face high medical expenses or at least pay high premiums for private health insurance.

In addition, Medicare costs have risen rapidly along with other health-care costs. Medicare expenditures soared from about $37 billion in 1980 to more than $500 billion today (see Figure 6.2 “Medicare Expenditures, 1980–2010”). As the population continues to age and as health-care costs continue to rise, Medicare expenses will continue to rise as well, making it increasingly difficult to find the money to finance Medicare.

Nursing Home Care

While most older Americans live by themselves or with their families, a small minority live in group settings. A growing type of group setting is the continuous care retirement community, a setting of private rooms, apartments, and/or condominiums that offers medical and practical care to those who need it. In some such communities, residents eat their meals together, while in others they cook for themselves. Usually these communities offer above-average recreational facilities and can be very expensive, as some require a lifetime contract or at least monthly fees that can run into the thousands of dollars.

For elders who need high-level medical care or practical support, nursing homes are the primary option. About 16,100 nursing homes exist, and 3.9 percent of Americans 65 or older live in them (Federal Interagency Forum on Aging-Related Statistics, 2010). About three-fourths of all nursing home residents are women. Almost all residents receive assistance in bathing and showering, 80 percent receive help in using the bathroom, and one-third receive help in eating.

As noted earlier, Medicare does not pay for long-term institutional care for most older Americans. Because nursing home care costs at least $70,000 yearly, residents can quickly use up all their assets and then, ironically, become eligible for payments from Medicaid, the federal insurance program for people with low incomes.

If one problem of nursing homes is their expense, another problem is the quality of care they provide. Because their residents are typically in poor physical and/or mental health, their care must be the best possible, as they can do little to help themselves if their care is substandard. As more people enter nursing homes in the years ahead, the quality of nursing home care will become even more important. Yet there is much evidence that nursing home care is often substandard (DeHart, Webb, & Cornman, 2009). Nursing homes are often understaffed to save costs and are also generally not subject to outside inspection. These conditions help contribute to any substandard treatment of nursing home residents.

Financial Security and Employment

Earlier we noted that the elderly are less likely than younger age groups to live in poverty and that their financial status is much better than that of previous generations of older people. One reason for this is Social Security: If Social Security did not exist, the poverty rate of the elderly would be 45 percent, or five times higher than the actual rate (Kerby, 2012). Without Social Security, then, nearly half of all people 65 or older would be living in official poverty, and this rate would be even much higher for older women and older persons of color. However, this brief summary of their economic well-being obscures some underlying problems (Carr, 2010; Crawthorne, 2008). Once they become poor, older people are more likely than younger ones to stay poor, as younger people have more job and other opportunities to move out of poverty. And the official poverty rate obscures the fact that many people live just above it and are “near poor.” This is especially true of the elderly who, if hit by large medical bills or other expenses, often cannot afford to pay them.

Second, the extent of older Americans’ poverty varies by socio-demographic factors and is much worse for some groups than for others (Carr, 2010). Older women, for example, are more likely than older men to live in poverty for at least two reasons. Because women earn less than men and are more likely to take time off from work during their careers, they have lower monthly Social Security benefits than men and smaller pensions from their employers. As well, women outlive men and thus use up their savings. Racial and ethnic disparities also exist among the elderly, reflecting poverty disparities in the entire population, as older people of color are much more likely than older whites to live in poverty (Carr, 2010). Among women 65 and older, 9 percent of whites live in poverty, compared to 27 percent of African Americans, 12 percent of Asians, and 21 percent of Hispanics.

This paradox reflects a wider problem involving Social Security. However helpful it might be in aiding older Americans, the aid it provides lags far behind comparable programs in other wealthy Western nations (see “Lessons from Other Societies” below). Social Security payments are low enough that almost one-third of the elderly who receive no other income assistance live in official poverty. For all these reasons, Social Security is certainly beneficial for many older Americans, but it remains inadequate compared to what other nations provide.

Bereavement and Social Isolation

“We all need someone we can lean on,” as a famous Rolling Stones song goes. Most older Americans do have adequate social support networks, which are important for their well-being. However, a significant minority of elders live alone and do not see friends and relatives as often as they wish. Bereavement takes a toll, as elders who might have been married for many years suddenly find themselves living alone. Here a gender difference again exists.

Because women outlive men and are generally younger than their husbands, they are three times more likely than men (42 percent compared to 13 percent) to be widowed and thus much more likely to live alone (see Table 3: Living Arrangements of Noninstitutionalized Older Americans, 2010).

Many elders have at least one adult child living relatively nearby, and such children are an invaluable resource. At the same time, however, some elders have no children, because either they have outlived their children or they never had any. As baby boomers begin reaching their older years, more of them will have no children because they were more likely than previous generations to not marry and/or to not have children if they did marry. Baby boomers thus face a relative lack of children to help them when they enter their “old-old” years (Leland, 2010).

Bereavement is always a difficult experience, but because so many elders lose a spouse, it is a particular problem in their lives. The grief that usually follows bereavement can last several years and, if it becomes extreme, can involve anxiety, depression, guilt, loneliness, and other problems. Of all these problems, loneliness is perhaps the most common and the most difficult to overcome.

For an interesting comparison of the U.S. with selected other countries’ quality of life for aging populations, read the article “Multidimensional Comparison of Countries’ Adaptation to Societal Aging” in the Proceedings of the National Academy of Sciences journal (PNAS). Note: read for general concepts and look at the variety of charts and graphs that support these concepts.  Don’t worry if you don’t have background for some of the statistical information or the Materials & Methods section – you should find the concepts and comparisons interesting.