Nursing Staff in Hospitals and Nursing Homes Is It Adequate? (1996) / Chapter Skim
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2 Implications of Population Change
2 Implications of Population Change
Pages 31-41
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These shifts take on added importance and urgency in the context of a rapidly changing health care system, placing intense stress on the system as it tries to hold down expenditures and, at the same time, increase access and maintain quality of health care. Changes in population imply changes in the health care services that will be needed in the years ahead, especially among the elderly population.
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From page 32... ...
The main purpose of this chapter is to provide a general perspective for understanding the implications of these population changes on the demands for health care services in hospitals and nursing homes and the supply of an adequate nursing workforce to provide these services. GROWTH OF THE POPULATION The population of the United States has increased by 12 million people, or 5.1 percent, since the 1990 census.
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2.0 a) Cal 1 .5 1.0 0.0 33 J 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 Decade FIGURE 2.1 Average annual percent change in population 65 years and older, United States, 1900-2040 (middle series projections)
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From page 34... ...
. This rapid growth of the oldest-old population will have a major effect on the health care system in terms of services needed, education, training and experience of health personnel, knowledge of diseases and treatments for the aged, and demands on resources for the services used by this segment of the population.
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FIGURE 2.3 Percent of population 65 years and older by race and Hispanic origin, United States, 1900 and 2050. SOURCE: Bureau of the Census, 1993c.
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Such sociocultural barriers could arise because of differences between receivers and givers of care related to health beliefs and behavior or knowledge about medical services. These differences could make patients reluctant to seek care or comply with prescribed treatments, make care givers insensitive to the needs of patients, and strain relationships between the institutions and their communities.
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The 50- to 65-year age group is often referred to as the "sandwich generation" since they have responsibilities of caring for their children and at the same time of caring for their very old family members. The problem of parent care affects working-age members of the family, especially women who historically have been the informal care givers in the family.
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The risks of chronic conditions and functional impairments increase with age. Most elderly persons report at least one chronic condition such as arthritis, diabetes, hypertension, heart disease, hearing impairments, osteoporosis, and senile dementia.
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The prevalence of these major chronic conditions among the elderly is five times that observed in younger persons. These conditions result in dependence on others for assistance in performing the activities of daily living (ADL,, especially among the older elderly, portending a significant increase in the need for health care and social support services.
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From page 40... ...
The degree of medical instability, impairment, and severity of illness in nursing home residents is increasing (Hing, 1989; Shaughnessy et al., 1990; Kanda and Mezey, 1991; Schultz et al., 1994~. Medical technology, such as the use of intravenous feedings and therapy, suctioning, rehabilitative services, respiratory care, ventilators, oxygen, special prosthetic equipment and devices, formerly used only in the hospital, has been extended to nursing facilities.
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From page 41... ...
Because a person's risk of being institutionalized is unpredictable and the potential economic consequences are devastating, protecting older Americans from the costs of nursing home care is an important and much debated policy issue. The aged population also will be a major force to be contended with in shaping the health care delivery and financing systems that promote high quality of care, and in developing a nursing and other health care workforce that is knowledgeable and sensitive to the special problems and concerns of the diverse elderly population.
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