WHAT STARTS HERE CHANGES THE WORLD

Older Texans and Their Families: A Snapshot of Current Issues

Presentation at

Impact Austin Discovery Day

January 5, 2013

Namkee G. Choi, PhD

nchoi@austin.utexas.edu

WHAT STARTS HERE CHANGES THE WORLD

Texas Population in 2011(25.7 million)

84%

5% 11%

Under 60 years 21.8 million 60-64 years 1.2 million65+ years 2.7 million

WHAT STARTS HERE CHANGES THE WORLD

Older Texans (60+ Years)

83%

9% 8%

In 201160-79 years 80-84 years 85+ years

50%50%

In 2020

60-84 years 85+ years

Of 100 largest metro areas in the country, Austin has: 1. Fastest growing number of people aged 55-64 years; and 2. Second fastest growing number of people aged 65+.

WHAT STARTS HERE CHANGES THE WORLD

Demographics of Texans 60+ Years (American Community Survey , 2008)

44% Male; 56% female

Married58%Wid-

owed24%

Div/Sep15%

Never married4%

Marital Status

Anglo64%

Hispanic21%

Black9%

Asian3%

Native American 1% Other

3%

Race/Ethncity

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Demographics/Economic Status

OPL =< 100%12%

OPL 101-150%10%

OPL 151-200%10%

OPL 201+68%

Economic Status

< HS26%

HS/GED27%

Some

col-lege21%

AB de-

gree4%

BA/BS13%

MA/MS8% Doctorate

1%

Level of Education

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Income Sources

73% had no wage/salary income in the

preceding 12 months

8% received Supplemental Security Income

Limited English Proficiency (LEP)

9% not speaking English well or not at all

25% speaking another language at home

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Health Status of Texans 60+ Years (ACS, 2008)

12% self-care activity difficulty

12% cognitive difficulty

18% independent living difficulty

27% ambulatory difficulty

15% hearing difficulty

9% vision difficulty

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Informal Caregivers/Lovegivers in Texas (TX DADS & NFCA)

2.7 million (10.5% of all Texans)

$26 billion worth of care annually: Greater than total

statewide Medicaid spending

39% for spouse; 57% for other family members

Typical caregiver/lovegiver: Age 45-64; female; married and

employed (51%) with children

More than 1/3 provide 40+ hours of care a week.

WHAT STARTS HERE CHANGES THE WORLD

Informal Caregivers in Texas cont.

17% of older Texans (age 60+) are family caregivers (for

older adults and children).

Nationally, 78% of adults living in the community and in

need of long-term care depend on family and friends as

their only source of help.

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Caregiving: Rewarding but Stressful

The unprecedented amount of demands on the family:

o More physical, functional, and cognitive comorbities with longer life span

o Dementia life expectancy: 10-15+ years after the onset

o Physical demands (ADLs/IADLs, lifting, turning, bedding changes)

o Behavioral management issues in dementia caregiving

o Role overload & emotional toll from social isolation, depression, guilt,

loss & grief

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Family Support/Conflict

Caregivers with other family support do better.

Family help may come with a price: Argument over care

provision, cost of care, and institutionalization and other

decision-making

Caregiving can awaken/intensify family relationship issues :

o The altruistic motivation to help can become enmeshed

with unresolved feelings from the past.

o Resentment toward care recipient

o Reawakened sibling rivalries

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Formal Support

Formal (gov’t-paid, subsidized, or privately paid) services help.

Can be problematic: Frequent helper turnover, inadequate level

of helper training, and high cost

15% of older TX caregivers pay someone else to help them care

for their loved ones.

Placement of a loved one in a care facility does not end stress:

o Guilt

o Traveling to visit the loved one

o Learning to interact with staff and monitoring care

o Stress related to financial arrangement

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Stress Process Model of Caregiving (Pearlin et al., 1990)

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Psychosocial Interventions for Caregivers of People with Dementia

Psychoeducation programs (e.g., Antecedent-Behavior-

Consequences [ABCs] in behavioral management)

Communication and skills training

Stress management

Asking for help from extended family and friends

Caregiver support groups

Counseling of caregiver depression, loss and grief

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Effectiveness of Caregiver Programs

Modest but significant benefits on the following

outcomes:

o Delayed nursing home entry

o Caregiver stress/burden

o Caregiver knowledge about dementia, caregiving,

and resources and perceived social support

o Caregiver & patient depression and other

psychological morbidity

WHAT STARTS HERE CHANGES THE WORLD

The Most Important Intervention Element

Involvement of both caregiver and patient in a structured

intervention (e.g., teaching the caregiver problem-solving

skills applicable to the patient, pleasant event planning, &

cognitive stimulation for patient)

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Community Support and Resources National Family Caregiver Support Program (The Older American

Act, Title IIIE)

Community Living Assistance and Support Services (CLASS; TX

DADS)

Private-pay geriatric case management firms

Respite care:

o Home health aides

o Housekeeping services and benefits counseling (CapCOG--

Area Agencies on Aging - AAA)

o Adult day services (AGE)

o Meals on Wheels for both caregiver and the patient

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Community Support and Resources

SAVVY caregiver training (DVD)/support group (Alzheimer’s

Association, AAA)

24-hour hotline, care consultation, and education programs

(Alzheimer’s Association)

Powerful Tools for Caregiving: 6-week caregiver psychoeducation

program (AGE CG Resource Center)

Matter of Balance Fall Prevention (AAA, AGE)

Medication Management Improvement (AAA)

HB 802 created the Lifespan Respite Services Program

SB 271 for informal caregiver assessment and support

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Stakeholder Recommendations (TX DADS)

Increasing public awareness of informal caregiving and resources

Organizing/coordinating more caregiver resources and programs

Identifying and resolving gaps in formal services

Involving stakeholder groups (employers, local community,

medical professions) in addressing gaps in caregiver supports

Addressing the unique needs of ‘kinship’ caregivers raising

grandchildren or other relatives under 18

WHAT STARTS HERE CHANGES THE WORLD

With Attention to…

Care needs of older adults without family support – innovative

solutions for prevention and community building

Cultural and linguistic diversity – training culturally competent care

providers

LGBTQ older adults – Protecting their rights and safe environments

Integration of technology into care delivery for efficiency and cost

saving – older adults are the fastest growing group of Internet users

Geriatric care workforce training and better compensation

WHAT STARTS HERE CHANGES THE WORLD

And Prevention Through Active Aging!“Lifestyle determines almost entirely how

successfully we age.” (Rowe & Kahn, 1998).

Social and productive engagement / volunteering

Exercise body and mind (cognitive stimulation)

Healthy eating

Positive spirituality

WHAT STARTS HERE CHANGES THE WORLD

Questions?