Aging Arizona

Growing old is a subject many people prefer not to discuss, but it’s a reality that no one can escape. Where you grow old might make all the difference.

John Stuart Hall is project director and principal investigator of “The Coming of Age” project. He says that a huge, fundamental change in the age structure of populations in Arizona and the United States is taking place right now. He suggests that the change will have enormous, cascading consequences.

“The change in the age structure of our population will remake our society and severely strain public and private capacity in the first half of the 21st century,” says Hall, a professor in the School of Public Affairs at Arizona State University.

“The Coming of Age” report was published in May 2002. It was the result of a 16-month research effort and was prepared in partnership with St. Luke’s Health Initiatives. The report takes a broad look at demographic trends, economic issues, the future of Medicare and Social Security, health care infrastructure, and the expectations and concerns of an aging baby boomer population.

A group of scholars from ASU, the University of Arizona, other universities, and consulting firms made up the research team. Team members conducted interviews and other research on demographics, economics, public policy, aging, and health.

A statewide random sample of 501 Arizonans participated in the study’s telephone survey. The participants were ages 40 to 59. Interviewers asked questions about current or near-term family caregiving; options for Social Security and Medicare; and overall outlooks on aging and the future.

Hall says the project results prove that the healthy aging perspective deserves reinforcement for two reasons. First, baby boomers already enjoy better health than earlier generations, and many already report acting to safeguard their health. Second, healthy aging offers the opportunity to create the brightest future for elders and for Arizona.

“If individuals make smart choices and communities support them, tremendous personal and public costs may be avoided,” he says. “It’s important that everyone be informed about this change in aging.”

Age to reconstruct society
It is estimated that Arizona’s 60-plus population will triple in size from approximately 875,000 today to almost 3 million people by 2050.

Patricia Gober initiated the demographic portion of the study. The ASU geography professor says this growth trend is going on right now.

“What’s different today is that the next group of elders, specifically the baby boomers, is bigger than any other group before it,” Gober says. “The older population is living longer and healthier lives. Numbers show how big this issue really is. The demand for healthcare will be big and there will not be enough resources for everyone.”

Gober is an early baby boomer. She is raising a teenage daughter and managing her mother’s well-being. She says that baby boomers have half as many children to depend on in old age as today’s seniors.

“In many cultures, children are the primary caregivers for the elderly and for families,” she says. “The elderly coming of age today will have less number of children caring for them. Arizona’s communities are not ready for a new wave of elders.”

Advances in technology have contributed to successful aging. As a result, today’s elders have a low risk of disease, high mental and physical functionality, and enjoy a much more active lifestyle. Gober says that continued retirement migration also plays a big part in the projected growth of Arizona’s elderly population.

Researchers found that many Arizona elderly are migrants from outside the state. Almost half (47.6 percent) of the state’s retirement-age residents moved here after they turned 55 years of age. These newcomers are on average younger, wealthier, more highly educated, and the most independent of all retirees. As a result, their presence is felt economically and socially through increased demand for consumer goods, protective services, and housing.

The effects of this demographic shift will be profound for health care services. But Gober says the effects also will be seen in education and training, patterns of advocacy, and the behavior of families and communities around elder care.

“Some people may think their situation is isolated,” she says. “It’s not. The coming of age is a societal situation. We can all see ourselves in this report. Knowing that, I believe a huge challenge waits on the horizon.”

Can Arizona escape aging?
In 2000, the 60-plus crowd accounted for 17 percent of the state’s population. Hall says that Arizona should expect to see that number increase to 24 percent in 2020 and 26 percent in 2050.

The number of Arizonans over 65 years of age will be roughly comparable to the number of children under 17 in less than 30 years. Fewer Arizona workers will pay taxes to support the young and the old.

“No one can escape the aging process,” Hall says. “As age-related needs for care increase, capacity to care may be at risk. Our research shows a trend that fewer workers will support more elders and youngsters. It’s scary when you look closely at the future convergence of these twin trends.”

In 1999, the U.S. Census Bureau reported that whites dominated Arizona’s 60-plus population. They totaled 85 percent. Hall says that tomorrow’s aged Arizonans will exhibit similarities and differences when compared with those of today.

“Women will continue to dominate the ranks of the 65-plus population,” Hall says. “Tomorrow’s elders will be more diverse in heritage, health needs, and outlooks.”

Nationally, the number of Hispanic elders grew 67 percent between 1990 and 2000. That compared to 9 percent growth among the non-Hispanic, white elderly.

Thinking about The Coming of Age
Researchers did a statewide survey of Arizonans ages 40 to 59 years old for “The Coming of Age” project. Only 18 percent said they thought the aging of the population was a serious problem for the state. But three of every four persons interviewed said that it presented them some “personal anxiety.”

Nancy Welch is a consultant with the Insight Group. She coordinated focus groups for the project. She found that many of the people in the focus groups had very little concern about growing old.

“What stuck out most during the discussions was that people hadn’t really thought about the issue,” she says. “Even if they had cared for one elderly person they never thought about it for themselves – and they should.”

One of the mixed messages that have contributed to the lack of attention on aging, Welch says, is the “If you don’t feel old, you don’t think about it very much” attitude.

“The definition of ‘old’ changes all the time,” she says. “The media have done a good job of portraying elders as vital and healthier. Everyone sees this portrayal as positive. However, we can’t forget that there will be a need for resources once this population becomes less active and more dependant on assistance, be it through family or health care.”

Welch says that many of today’s family structures include an elder family member residing in the home of one of his or her children.

“Care is a family matter, especially among the Hispanic culture,” she says. “More people are caring for children and caring for elders at the same time. This will continue to be a big concern for many members of the community.”

Another mixed message causing little concern among some baby boomers is retirement. Among those who expected to move upon retirement, planned retirement communities are not a favored destination in this survey—by a wide margin. Fully two-thirds of these movers said that they expected to live in a rural area, rather than an urban environment.

Welch says this may not be the best move.

“People have this romantic idea that living and retiring in a rural area is ideal,” she says. “Truth of the matter is that moving out in the middle of nowhere can create other obstacles such as lack of doctors, living resources, and community support. If an elder receives medical care in a rural area, chances are they will have to pay extra for the amount of service they can receive for less in an urban area.”

The complexity of aging
Most Americans and Arizonans believe that everyone, including elders, should have access to high-quality, low-cost health care. In addition, people want health services when, where, and how they want them. Roger Hughes is executive director of St. Luke’s Health Initiatives. Unfortunately, he says, instant health care gratification is at odds with reality.

“It’s the steamroller effect,” Hughes says. “People are getting older and healthcare providers and policy makers are scrambling to keep up, which is why people need to prepare.”

Hughes, who is turning 60, says thinking about growing old is not as easy as picking a nursing home or place to retire.

“There have been advances in technology, but you still have to wonder if there will be enough resources to provide health care in the future,” he says. “I’m still somewhat active and healthy, but you better believe I’m thinking about this more and more.”

Homes for the elderly and continuing care retirement communities employ approximately 8,474 Arizonans statewide. Services for the elderly and disabled persons employ another 3,220 people. Hughes says health care workers are in short supply and will be in greater demand in the future.

“There is already fewer numbers of young people and healthcare workers responsible for a large number of elder people,” he says. “What will happen once the number of elders triples? The costs of employing these people will go up; the cost of services will go up; and the struggle to find someone to pay for all of this will hit us hard.”

Hughes says doing nothing inevitably will damage the quality of life in Arizona, which is another reason why he suggests preparing for the coming of age.

“It starts now,” he says. “For some, it starts when they see their parents getting old. Siblings begin asking ‘Who will take care of them?’ and ‘Where will they live?’ It’s probably wise to know those answers sooner rather than later.” —Manny Romero