Are We Prepared to Help Older Adults Age in Place?
Authors: Matthew Dietrich, Karen Frederickson Comer
Most older adults want to remain within their homes and communities as they age. This research brief examines data trends in Central Indiana and Indiana that relate to potential challenges and opportunities for older adults who want to age in place and continue to contribute to their communities.
Key findings include:
- Over the last decade in Central Indiana, the number of older adults with conditions that will require some form of care from others has grown
- While the count of older adults with a disability has dropped for the White population, it has increased for the Black and Hispanic older adult population
- In general, prevalence of depression and obesity has increased across all older adult age groups in Central Indiana, while diabetes prevalence has remained the same
- The number of younger adults in Central Indiana with disabilities also is growing
- Both the physician and nurse workforces in Indiana have been relatively stagnant or declining in fields related to geriatrics
- The share of older adults who reported feeling burdened by caregiving in Central Indiana dropped from 2017 to 2021
Older adults are among the fastest growing demographic group both nationally and in Central Indiana. This trend means that in the coming years there will be more older adults in the population than ever before. This raises the question: “What are the anticipated needs of our growing older adult population, and will our communities have adequate health care and support services available to allow older adults to successfully age in place?”
This report focuses on the first part of that question. Specifically, it dives into the characteristics of the older adult population that are related to the ability to age in place and then assesses current resources available to help adults age in place. As the available data permits, this report quantifies the Central Indiana older adult population1 by several important breakdowns, such as race, gender, and age groups.
Understanding how to support aging in place is important. According to national surveys, most individuals want to stay within their communities as they grow older, stay connected to local relationships built up over the years, and maintain freedom and autonomy in daily living. However, depending both on individual health and the resources available within a community, aging in place may not be feasible for all within Central Indiana. We exam this important topic within Central Indiana, with an initial focus on characteristics and potential needs of older adults who want to age in place.
What are the characteristics of the older adult population who will need help if to age in place?
Many older adults (defined hereafter as age 55+) are still quite active and healthy, both physically and mentally. However, with age comes increased risk factors for several types of physical and mental ailments that may make aging in place challenging, and often requiring some form of help or assistance.
Variables most likely to be associated with greater need of healthcare services at an older age
For older adults on Medicare and/or Medicaid, common beneficiaries include those with diabetes, depression, or obesity. All three conditions are associated with a greater likelihood of needing assistance to age in place—from at-home care to healthcare facility access. While varying slightly by county, diabetes prevalence for all age groups has remained steady over the last decade, with a recent uptick in the oldest-old (age 85+) population. However, both depression and obesity have increased on average for older adults throughout Central Indiana, with obesity rates steadily increasing not only in the oldest-old (age 85+) and middle-old (age 65-84), populations, but those age 64 and younger as well. For example, in Marion County, the obesity rate for Medicare and Medicaid beneficiaries has tripled for adults age 65+ in the last decade. With an increasing number of older adults experiencing obesity each year comes an increasing number of older adults with increased risk factors for other ailments that can lead to increased mortality and morbidity, such as cardiovascular disease and severe illness from COVID-19.
The nuance of older adult health outcomes between counties is also important to point out as this may reflect geographic disparities. For example, Hamilton County has noticeably lower diabetes prevalence for older adults than other counties such as Marion and Shelby Counties. This may be related to a variety of factors, such as greater availability of medical resources and services in some areas over others, or upstream societal factors influencing diabetes health outcomes in some areas more than others (as Type I and Type II diabetes are grouped together here).
Important health trends in older adults related to aging in place
Changes in the health of the older adult population in Central Indiana and beyond have important implications for the type of care and facilities needed to help older adults age in place. One important trend worth elaborating on is the increasing rates of obesity among older adults. As noted earlier, while this leads to greater risk factors for other diseases and health complications within older adults, it also adds additional needs and requirements for caregivers. For example, caregivers may require special equipment to move obese older adults as needed for hygiene, nutrition, and health care. Also, larger beds can be required. This trend of a greater proportion of older adults who are obese is also likely to continue based on even higher rates of Medicaid and/or Medicare beneficiaries who are age 64 and under that are obese. This trend is not limited to Central Indiana. A national study found an increase in prevalence of obesity among long-stay nursing home residents from 2005-2015.
How many older adults in Central Indiana are likely to need help?
With a growing older adult population in Central Indiana, it is expected that there will be more older adults who will need some form of assistance to age in place. Variance in need among different subpopulations of older adults is also expected. For example, while the overall number of older adults with a disability has been steady for the last 4-5 years, the number of White older adults with a disability has dropped and the numbers of Hispanic and of Black older adults with a disability have both increased. This may be due to a diversifying older adult population. Similar trends can be seen in older adults with a self-care disability, although the associated uncertainty in values for Hispanics is greater.
Who is available to help older adults who want to remain in the community (age in place)?
As detailed in the SoAR chapter on caregiving, many individuals who help older adults age in place are informal caregivers—friends and family who provide essential services without pay to assist others. Importantly, most older adults are caregivers themselves, with four out of five older adults in Central Indiana reporting that they assist a friend, family, or neighbor. It is estimated that in Indiana, there are approximately 790,000 family caregivers worth an economic value of $10.8 million dollars for their unpaid services. However, available data on the actual number of caregivers in Central Indiana and the trend over time is difficult to come by, for most caregiving services are informal and not accurately documented through any databases.
Deep Dive: Caregiving
Caregiving impact on older adults
Caregiving, while rewarding, can be a trying and difficult experience for many depending on the circumstance, length of time, and level of involvement needed. For example, during the height of the COVID-19 pandemic, caregivers reported a much higher rate of adverse mental health conditions relative to non-caregivers. A stark statistic is that nearly 40 percent of caregivers had passive suicidal ideation within the last month, and 32 percent had serious suicidal ideation within the past month. The rate of serious suicidal ideation was eight times more than non-caregivers during this time.
However, the COVID-19 pandemic may have had other effects on caregivers as well due to measures such as social distancing and limited visitations. From 2017 to 2021, the Community Assessment Survey for Older Adults (CASOA) found that in general, the share of older adult caregivers felt less burdened by caregiving. This could be related to a variety of factors, such as social distancing limiting the ability and time of some to provide care in certain settings, or more flexible work options (remote work) that took stress and burden off caregiving and allowed caregivers to spend more time with the person they were caring for. Regardless of the reasoning behind these trends, there are still many older adult caregivers and caregivers in general who experience feelings of being burdened, stress, or anxiety. Thus, it is also imperative that there is appropriate support to help caregivers when needed, which will be discussed further in the second edition of this research brief that will focus on service gaps for the older adult population.
Alle forsøg på at få ændret den nuværende tyske lægemiddellov, som kun tillader apoteker at sælge håndkøbsmedicin, har været forgæves. Apoteket er helligt Lees meer bij i Tyskland. Og det samme gælder for farmaceutfaget. For at få et eksamensbevis og en licens skal du studere i fire år, derefter et år mere med praktik og statslige eksamener.
What is the likelihood of unmet need?
An important component of a rising older adult population and more adults wanting to age in place is whether there are enough people to help older adults age in place. While difficult to assess with absolute certainty the likelihood of unmet need, there are several workforce trends pointing towards unmet need in the future for Central Indiana older adults.
One example of a workforce trend indicating potential unmet need is the registered nurse population in Indiana. While this workforce previously had been increasing, it stagnated from 2019 to 2021, possibly due to the COVID-19 pandemic. However, the older adult population in both Indiana and Central Indiana has continued to sharply increase during this time. Another way to look at this is through the ratio of registered nurses in Indiana relative to the older adult populations in Indiana and Central Indiana. This ratio has decreased from 2013 to 2021 for both Indiana and Central Indiana. While there isn’t information in the literature about an “ideal ratio” for older adults specifically, the national median population/RN ratio is around 96:14 and in general, the greater number of nurses per capita was associated with better population level health outcomes.
Most older adults want to stay within their communities and age in place. There are several trends within the aging adult population in Central Indiana that point to increased need for healthcare and social services to best support aging in place. The second part in our series on aging in place in Central Indiana will elucidate more on the availability of specific services, potential service gaps for the older adult population, possible social disparities in access to these services, and what can be done moving forward to address these needs.
- When referring to Central Indiana within this report, we generally mean the 8-county region of: Boone, Hamilton, Hendricks, Marion, Hancock, Morgan, Johnson, and Shelby counties. However, when using Public Use Microdata Sample (PUMS) from the Census Bureau for data and charts, Central Indiana entails adding Putnam and Brown counties due to data aggregation limitations.
- Self-care difficulty was derived from whether respondents of the American Community Survey (ACS) stated that they had “difficulty dressing or bathing.” Difficulty with these activities are two of six specific Activities of Daily Living (ADLs) often used by health care providers to assess patients’ self-care needs.
- Primarily older adults, from three programs–Medicaid Waivers, the Community and Home Options to Institutional Care for the Elderly and Disabled (CHOICE) Program, and Title III, Older Americans Act (OAA).
- Based on county-level data on 1,929,414 RNs in 33 states in 2012.