Seniors will soon outnumber children, but the U.S. isn't ready
The population of the United States is not as young as it used to be, and the year 2035 represents a major demographic turning point.
According to a 2018 U.S. Census Bureau report, in 2035 "there will be 78.0 million people 65 years and older compared to 76.4 million under the age of 18." In other words, the elderly population will outnumber children for the first time in the country's history—a demographic shift that poses a unique set of public health challenges.
Los Angeles County will be especially impacted by the increasing ratio of non-working adults over 65 to working adults. In 2016, there were 5.2 working adults per retired person, but within 20 years, that number is expected to drop to 2.9.
Shinyi Wu, associate professor at the USC Suzanne Dworak-Peck School of Social Work and senior scientist at the USC Edward R. Roybal Institute on Aging, explores the multifaceted challenges that communities will face in the coming years as they work to address the needs of older adults.
Aging U.S. population: meeting mental health needs
When populations age, communities are tasked with supporting both the physical and mental health needs of older adults. California's older adult population alone will increase by 64 percent by 2035 and with it the need for more services. Findings from a 2012 Institute of Medicine report highlight the growing crisis of dementia, substance abuse and mental illness, such as depression among America's older adult population.
The conditions are often stigmatized, resulting in an absence of institutional support for services meant to address them.
"Though the need for mental health services for older adults is increasing, the government does not earmark funds for such services," Wu said.
Coupled with a lack of support and mentorship opportunities for students interested in working with older populations, this has led to a shortage of professionals with the necessary training to treat older patients struggling with these issues—as well as a dearth of crucial social services.
Yet, as the most recent census data indicates, there has never been a more important time for social workers to consider careers working with older adults. As the population of older adults with behavioral and psychological conditions increases, so too will the demand for related services and care.
Addressing diversity in aging U.S. population
The swelling of this demographic is owed, in part, to an influx of immigrants after World War II who now count themselves among baby boomers. The uptick in immigration also accounts for an increase in the ethnic and racial diversity of the aging adult population and their offspring. According to census data, "by 2020, less than half of children in the United States are projected to be non-Hispanic white alone." This trend toward diversity is expected to continue among younger generations as well: Individuals who identify as "two or more races" make up the fastest-growing demographic in America.
Longer life expectancies among foreign-born minorities have also contributed to the growth of the older adult population. Because foreign-born minorities often live longer than their American-born counterparts, they spend more time in the category of "non-working older adult." Asian populations, in particular, tend to live longer than populations of other ethnic backgrounds.
Wu acknowledged the difficulty of accommodating the needs of a diverse population.
"The presence of so many different ethnicities across geographic diasporas, different languages and different cultures creates great challenges for social work," she said.
Current programs often do not account for differences in language and culture, creating a barrier to access for aging people in need. To compound these issues, doctors and social workers are not always trained to recognize medical and mental conditions that are most common among certain groups. For instance, Wu noted that diabetes and high cholesterol are prevalent in Asian and Asian-American communities, but because that disease is often thought to be associated with obesity—which is not as prevalent in those communities—doctors often do not screen for it.
Finding new solutions
Addressing the needs of a large and diverse older adult population will require new and innovative solutions. To start, Wu recommends the integration of high-tech communication tools into caregiving processes. The most obvious benefit of this approach is the convenience factor these tools provide: Older adults with limited mobility may prefer a video conference call with their social worker or health care provider rather than an in-person visit, for example.
Equally important are the potential mental health benefits such tools would offer otherwise isolated older adults: "Teaching older Americans to use technology to communicate can improve cognition as well as feelings of connectedness, which could alleviate symptoms of depression and anxiety," Wu said.
Above all, Wu emphasized that even with increased spending on programs for older adults, prevention of chronic health issues is key. In addition to addressing the needs of the current older adult population, health policymakers and social workers should ask, "How do we ensure that our aging adult population remains healthier—and thus in need of fewer health care services—in the future?
"By avoiding long-term periods of chronic illnesses, morbidity and functional decline, we can reduce health care costs and improve people's quality of life at the same time," Wu said.
She believes that keeping young and middle-aged adults healthy is crucial to lowering health care costs in the long-term. Teaching stress management techniques and supporting a better work-life balance will play a key role in keeping younger populations physically and mentally healthy, so they will need less care as they age.
In summary, as the United States moves toward an older and more diverse population, it is important to develop effective strategies to support the health of aging Americans, thereby lessening the burden of care on families, friends, social workers and caregivers, Wu said.