Heading Along The 21st Century

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By the time you reach old age, the 21st century will be well along. Technology will have have made major advances that will make common place

what is science fiction today. Our daily lives may be vastly different than they are right now. Life will undoubtly be more complicated

You will probably have experienced lots of things in the long walk of life: marriage, children, career changes, relocation, personal

developmen, physical and cognitive changes, and so on. You will know what adult development is like.

For now though we must be content with gazing into a crystal ball. We know many things about adult development and aging to guide us, but

there are many unknowns, too. Throughout life we have encountered predictions about the future and how older people may fare. Some of

these predictions are positive; for example it is likely that more people will live to advance ages. Other forecasts are not so rosy; as

more many people live to an old age, there will be more need, for long term care. These predicyion represent our best guess about how life

can be like in 40 years and so, based on what we know and what is likely to happen if we continue the way we are going.

 

The purpose here in these writing, is to pull together several crucial issues facing gerontologists as we grow through the 21-st century.

This survey will not be exhaustive; rather we will focus on two things; points that have been singled out for special concern and areas where special

where major advances may have a dramatic impact in our own development.

 

Three issues have been identified as trouble spots for the future. The first is the need for better research, a problem that underlies

all the others. Second we will examine the growing crisis in health care and health policy. Third, we will consider the need for creating

productive roles for the elderly. Other issues concern areas of ongoing research that have the potential to revolutionize our own development

course. Chief among these is the research on biological and physiological aspects of aging. Also important are discoveries that are being

made in the cognitive domain that challenge age old stereotypes of aging.

 

Identifying issues of concern

 

Throughout this book we have seen that adult development and aging are complex processses that we are far from understanding.Because the

number of older people is rising and because we need more and better information, three issues need to be adressed in the near future

if we are to optimize our own development into this century. These are better research, health care, and productive roles.

 

The need for better research

 

We have considered various methods for conducting research on adult development and aging. Recall that of the major methods(cross

sectional, longitudinal, time-lang, and sequnetial), longitudinal and sequent designs are the ones that tell us what we really want to

know; whether a particular process or behaviour changes over time. Cross-sectional research identifies only differencies that are

related to age; they may reflect true age changes or merely cohort differences. But the vast majority of research we have considered

is cross sectional.Longitudinal and sequential work is confined mainly to topics in cognitive and personality development.Where does

this leave us?

The problem we are faced with is the possibility that much of what we know about adult development and aging may not reflect true age changes.

Rather it may largely reflect cohort differences that are, in turn, a reflection of the changes that have occurred in society

over this century. This may mean that differences in intellectual skills needed by each suceeding generation to survive and adapt

in daily life.

 

Cross sectional research will never solve the problem, since age and cohort are always confonded. Longitudinal research addresses the issues

of age change, but it is severely limited because the results may not generalise across cohorts. Sequential research appears to be our best, and only

way out. We must have reliable data on whether the differencies we observe between age groups are something innate in humans or whether they are

due more to historical experiential factors.

But improved research does not only mean using a different more sophisticated design. It also means cutting across disciplines and incorporating

finding from one field to interpret data from another. A good example is the need for a blend between biological-physiological research

and behavioral research. The search for the genetic link in Alzheimer's disease, for instance may also yield the key to why cognitive processes

fail. Cognitive and neurological scientists working together will make substantially more progress than either group working alone.Likewise

there may be a connection between changing levels of neurotransmitters and aspects of personality , mainly studied through psychopathology.

 

The point is that we need better research not only to understand more about adult development and aging but also to know how better

to commit resources for the future. As we will see, the most serious problem facing the United States concerning the elderly is health

care; the lack of data collected over time from multiple cohorts seriously impairs our ability to plan for the future. Getting better

information also mean changing our research priorities from a system that rewards quantity, which promotes more cross-sectional research, to one

that rewards high quality which would promote more longitudinal and sequential research. Perhaps changing our priorities should be the place to start;

otherwise, the future will arrive and we will not still have a data base.

 

The Crisis in health care

 

No problem in the United States will be more pressing in the coming years than the need for health care for older adults. The number of

elderly will increase dramatically over the nect 30 to 40 years, most rapidly in the over 80 ages group. By the year 2000 the over 80 group

constitute the largest single federal entitlement group, receiving neraly $83 billion in benefits. Health care costs for adults over age 65 will soar as the

expanses for chronic and debilitating disease moment.Long-term care is already in crisis;beds are in short supply, and the cost of the average

nursing home is beyond the means of many. Information is also scarce and the statistical tools for analyzing it ar often inadequate. The growing concern over

health care for the elderly prompted the national research council(NRC) to study the situation and make several recommandations concerning

future health care policy. These recommandations adress several areas of special concern as well as general issues.

 

The NRC identifies the financing of medical care for the elderly as the most important health policy issue facing the UNited States in the

1990s. The cost of care, who will pay for it, and how it will be financed are issues that must be addressed. The changes in medicare

and medicaid during the 1980s and the growing realistaion that private insurance will need to become more heavily involved had a

significant impact on how health care is financed. We noted that many public and private insurance programs do not adequately cover the cost

of quality long-term care. The trend toward increased reliance on individuals to either have their own health coverage or pay for care themselves

has profound implications for people facing chronic debilitating conditions such as Alzheimer's disease. The NRC points to a lack of

adequate data on the cost burden of such care, and it plays high priority in obtaining them.

 

How health care is delivered is a second issue facing American society. The deminishing number of physicians in rural areas and in some

specialities, the closing of inner-city hospitals and lack of transportation to health care centers present significant problems to older

adults, especially minority groups and the frail. The growth of four-profit care and business oriented approaches to health care, not

recognising age differencies in recovery time in illness, and increased competition also create barriers to quality health care for the elderly.

 

The NRC identifies the need for and cost of long-term care as major factors in the overall financing picture. Moreover, many of the issues

cited earlier apply to long-term care facilities.Many nursing homes do not take medicaid patients, for example, forcing many elderly

poor to settle for lower quality care aor no care. We have no consistent programm of data collection to determine how many poeple are likely to need

long-term care in teh future. Surveys also need to include facilities over than nursing homes, such as chronic disease hospitals, mental health

facilities, rehabilitation centers, group homes, half way houses, and residential facilities.

 

A smart investiment strategy according to the NRC would be to spent health care dollars on health promotion and disease prevention. These

approach will emphasize keeping oneself in good health in order to avoid the more expensive treatment programs. Generally speaking,

paying for check-ups and needed treatment early in the disease process is markedly less expensive than waiting until the disease has

spread. Important intervention goals include promotion healthy activities and lifestyle among older adults. Whether the federal government

should finance prevention and promotion is an important policy decision.

 

Monitoring health care systems to ensure that people get the best care for their money and that care quality meets high standarts are

also important. Simply solving the financing problem is only half the battle. The health care industry must be held accountable for its

actions.

 

Carrying out the NRCs recommandations will be expensive. By its own estimate, data collection alone may cost $15 billion to $20 billion

or more.Such a high price make ones wonder whether the benefits will justify the expanse. The answer is a resounding yes.We have too little

information now to adress the coming crisis in health care adequately. Policy makers need reliable data on which to base decisions about

where to allocate federal dollars on order to do the most good for the most people. Not collecting adequate information and not making

appropriate policy decisions would be far mor expensive, both in terms of dollars and in the quality of life of older people.. Our

goals should be to enable the elderly to stay healthy and functionality independent as long as posssible, to provide access to quality

health care of whatever type is appropriate and to provide care in the last restrictive and most cost-effetcive environment. The issue

facing us is whether we are willing to assume the cost burden. If not the alternatives are not pleasant to think about.

 

Productive Roles for older adults

 

One of the key issues facing adults is the lack of formal social rules. Adults currently relinquish many of the major roles of

adulthood by the time they reach old age. We have noted that older cohort experience major declines in societal significance

as a result of these role looses. One of the most important of these rilinquished roles is work. As more people enter retirement

over the coming decades, the issue of how to keep older adults connected with society will become more critical. In effort to draw up

guidelines for addressing the need to develop productive roles for older adults the Comittee on Aging Society of the Institute of the

Medicine and the National Research Council explored unpaid productive roles as one alternative. Unpaid productive roles are ones in which individuals

make a significant contribution to society but are not given wages. The difference between paid and unpaid productive roles is sometimes

arbitrary, and the work is often similar.

 

Voluntarism has a long, distinguished tradition in the United States. From boy scout troop leaders to friendly vistors in hospitals and nursing homes,

millions of people donate their time freely each year. The CAS argues that we should look to older adults as a major force of volunteers in social

health services. It proposes that a systematic effort at providing unpaid productive roles for older adults would accomplish two things. First it would

increase the availability of some social and health services that could be provided by nonprofessionals. For example existing programs, such as the Foster

Grandparents could be enhanced, and new programs such as home visitation for the frail elderly could be started in many communities. Second unpaid products

would give older people a formal way to maintain self esteem and identity after retirement without having to be employed. Unpaid productive roles would enable them

to retain societal significance by using their accumulated years of experience and expertise.

 

An important issue not directly addressed by the CAS is that volunteers often end up in clerical or social tasks, with little opportunity to have a direct

say in the operation of the program. This is not an optimal situation, of course, since volunteers often come into the program with years of

experience. This is especially true for older adults, who may view volunteer positions as low status roles that do not take advantage of their experienve.

The CAS gives most attention to the prospect of older volunteers(providing, of course, that the status and menial nature of volunteer work are addressed).

It points out that declining federal and state support of social service programs through the 1980s has led to a serious shortage of people to provide

these such needed services.

 

The growing number of older people could be a resource in easing the impact of personnel cuts that have been made as a result of fewer dollars. Estimates

are that between 35% abd 40% of older adults already perform some sort of volunteer work, and projections are that this figure will increase. Thus the

potential pool is relatively large.

 

 

If a considered effort is to be made to provide older adults with formalized roles through unpaid product activities, several impediments to

participation need to be addressed. older people are often not actively recruited by organizations or are not encouraged to remain. Individuals are often

expected to cover expenses such as transportation, with little hope for tax deductions to help defray such costs. Unions are often reluctant to accept volunteers

viewing them as a way to displace paid employees. Some older adults themselves view voluntarism as a form of exploitation, feeling tha volunteers considered

second class citizens in organizations. The lack of adequate transportation for elderly people who do not drive means that people who might otherwise

volunteer will not do so because thay cannot get there.

 

How can we eliminate this barriers?First of all we need to explicitly recognize that older adults have a welath of experience and expertise that should not be

allowed to go to waste. Kneiffer notes that this expertise of the elderly has been systematically and increasingly thrown away since the 1940s. We need to begin

to draw on older adults as experts in much the same way as members of some nonindustrialized societies do. Second, we need to make possitive appeals to older

adults to become volunteers and share their knowledge. Third, there need to be incentives for volunteers, including increased recognition. Fourth we need improved supervision,

development, and management of volunteers programs.Providing services takes coordination of both goverment and business. Carefull planning needs to be done

and programs have to be monitoredto ensure that they provide optimal service. Finally the impediments outlined

earlier need to be removed. Most important transportation to and from the volunteer site should be provided to those who want to participate. Well-planned

and well-managed volunteer programs could becomeextremely cost effective, both in terms of the servicesthey provide and the benefits to the volunteers. Social and

health services that are currently unavailable could be provided at a fraction at the cost of identical programs using only a paid stuff. Volunteers benefit by feeling more useful

in society and regaining aspects of identity lost after retirement.

 

Volunteer programs are not a panacea, however. The CAS notes that volunteers programs should never be used as a way to cut corners or to eliminate qualified

proffesionals. Such programns should be viewed as a way to supplement existing services, not as a replacement for them. Used appropriately, however voluntarism

could be an effective way to reconnect older adults to society.

 

What about you? How do you predict the future during this century, in a health, elderly point of view??

[sheepdog 10]

I love the idea of encouraging and even seaking out the older people in our communities for volunteer work, and in some instances even some paid consultant or guidences fees paid to them for their expertise and vast knowledge. They can be a vast "databse" if you will for much information. At one of the places I lived on for a few years I had a 90 year old man for a neighbor. I got in the habit of checking on him pretty frequently, and we became good friends. His children lived near by, and they did check on him, but they never took him anywhere or actually did anything with him. I kind of felt bad that he was stuck home all the time. He was quite physically fit, and could get around pretty well for his age. I took him fishing a few times, and to town several times. He was really sharp. I learned a ton of stuff about gardening and how to do things from him. Remember, this man lived back when everybody still road horses to town! It was a great experience for me and I highly advice everyone to develope a healthy respect for the elderly and seek out their guidence. Another benefit of the volunteer work, it is actually benificial to the elderly person. Everybody has to have a reason to get out of bed in the morning. Having something to look forward to and really, to live for is very important no matter what your age, but it is even a bigger benefit when you are older, and things start weighing you down, like all those aches and pains that come along with old age. But as human age increases and we start living longer, most likely what is going to happen is the government will simply raise the retirement age. If you can't start drawing social security until you are 70, that is 5 to 8 more years that you will have to pay in to the government from your wages, and 5 to 8 more years they will not have to start paying you back all that money they took from your paycheck to start with.