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  • Identify the vulnerabilities of older adults.

  • Review the coverage provided by Medicare and Medicaid.

  • Outline strategies and resources available to assist in caring for vulnerable older adults.


Adults over age 65 (older adults) are among the fastest growing age group in the United States, in part due to the “Baby Boomer” generation (adults born between 1946 and 1964) who started turning 65 in 2011. Between 2000 and 2010, the population aged 65 and over increased at a faster rate (15.1%) than the total US population (9.7%), resulting in 40.3 million adults over age 65, more than in any prior census.1 By 2030, an estimated 70 million people, or 20% of the US population, will be over age 65, with the largest percentage increase among the old-old, those over age 85 years.2

The increasing size of the population of older adults is not unique to the United States. As infectious diseases become better treated, life expectancy, along with chronic disease burden in developing countries, is increasing. By 2050, there will be nearly 1.5 billion adults over age 65 worldwide.3 Regional differences in the pace of aging exist; in sub-Saharan Africa, with 44% of the population under age 15, this pace is slower compared to Japan, China, and Europe where the median age in 2050 is expected to be nearly 50 years (versus 44 years in North America).4,5

Despite these variations, all countries will face the challenge of caring for an aging population. Around the year 2020, it is projected that the number of adults older than 65 years will outnumber children younger than 5 years worldwide.3 The imbalance between the number of young people available to care for the increasing number of older adults is exemplified in China. As a result of the “one child per family” policy instituted in 1980, a single child will be challenged to care for aging parents and grandparents, thus increasing the need for development of other solutions, resources, and even facilities to care for older adults.6

The growing population of older adults presents unique challenges to providers, health-care systems, and caregivers in every country because of the vulnerabilities that often accompany aging. This chapter describes the vulnerabilities of older adults in the United States, although the concepts apply to any country, and discusses strategies to effectively care for this population (Box 23-1).

Box 23-1. Factors Increasing Vulnerability of Older Adults

  • Multiple chronic medical illnesses.

  • Economic insecurity.

  • Mental health issues (e.g., cognitive impairment, depression, and occult substance use).

  • Cultural and educational diversity.

  • Frailty and dependency (including risk of elder abuse).


Mrs. Jones is a 79-year-old African-American woman. She has type 2 diabetes, atrial fibrillation, high blood pressure, glaucoma, and osteoarthritis. Over the past year, ...

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