GPSAP:

Chapter 5: Sociodemographics

Lisa Boyle, MD, MS

Norman Afzal, MD

1.By the year 2040 the U.S. population age 65 and older will:

  1. Decrease
  2. Double
  3. Quadruple
  4. Remain the same
  5. Triple

Rationale: In the year 2011, 41.1 million or every one in eight American was age 65 and older (representing about 13.3 % of the U.S. population). The population of Americans age 65 and older is projected to increase to 79.7 million by the year 2040 (representing about 21% of the population). The fastest growing segment of the older population is the “oldest old” who are 85 years and older, projected to triple from 5.7 million in 2011 to almost 14.1 million in 2040.

The recommended response is b.

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Blazer DG, Hybels CF, Hays JC. Demography and epidemiology of psychiatric disorders in late life. In: Blazer DG, Steffens DC, eds. The American Psychiatry Publishing Textbook of Geriatric Psychiatry. 4th Ed. Washington, DC: American Psychiatric Publishing, Inc., 2009.

A Profile of Older Americans: 2012, Administration on Aging Administration for Community Living, U.S. Department of Health and Human Services, 2011. Available at: Accessed January 13, 2014.

2.Which older racial ethnic group in the United States is projected to experience the most rapid growth by 2050?

  1. American Indian
  2. Asian
  3. Black
  4. Hispanic
  5. People who report 2 or more races

Rationale: Projections of the growth of the older adult population in the U.S. are that all racial and ethnic groups will increase, with the largest growth in the older Hispanic population (under 3 million in 2010, compared with 17.5 million by 2050). In 2010, approximately 80 percent of the US older adult population were non-Hispanic Whites, compared with 9% Blacks, 7% Hispanics (of any race), and 3% Asians. In 2050, the percentage of non-Hispanic Whites is projected to decrease to 58%, with corresponding increases in other racial ethnic groups: 20% Hispanic, 12% Black, and 9% Asian. By 2050, it is projected that the older Hispanic population will be larger than the older Black population, representing the largest racial ethnic minority in the U.S.

The recommended response is d.

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Federal Interagency Forum on Aging-Related Statistics. Older Americans 2012: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington DC: US Government Printing Office. June 2012. Accessed January 13, 2014.

3. Which of the following statements about living arrangements of older adult Americans is most accurate?

  1. Older Asian, Black and Hispanic women have similar rates of living with relatives other than a spouse.
  2. Older Black men have lower rates of living alone compared with other racial ethnic populations.
  3. Older Hispanic men have lower rates of living with relatives other than a spouse compared with non-Hispanic White men.
  4. Older non-Hispanic White women have higher rates of living with relatives other than a spouse compared with older Black women.
  5. Older women have higher rates of living with a spouse compared with older men.

Rationale: In 2010 in the U.S., the rates of older Asian, Black and Hispanic women who live with relatives other than a spouse were not statistically different (33-36%) and higher than for non-Hispanic White women (13%). Older Black men (28%) were more likely to live alone than older non-Hispanic White men (19%), older Hispanic men (15%), and older Asian men (12%). Older Hispanic men (17%) were more likely to live with relatives other than a spouse when compared with Black (12%), Asian (8%), and non-Hispanic White (4%) men. Older non-Hispanic White women have lower rates of living with relatives other than a spouse compared with older Black women (13% vs. 35%, respectively). Older men have higher rates of living with a spouse compared with women (72% vs. 42%, respectively). Older women were more likely to live alone compared with older men (37% vs. 19%, respectively).

The recommended response is a.

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Federal Interagency Forum on Aging-Related Statistics. Older Americans 2012: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington DC: US Government Printing Office. June 2012. Accessed January 13, 2014.

4.The labor force participation rate is defined as “the percentage of the population that is in the labor force”. Which of the following statements about labor force participation rates for older adult Americans is most accurate?

  1. The gap between men and women in labor force participation rates has decreased over time for older Americans.
  2. The labor force participation rate has continued to decrease since the mid-1990s for men age 65-69.
  3. The labor force participation rate has continued to decrease since the mid-1990s for men aged 70 and over.
  4. The labor force participation rate for women age 55 and over has decreased since the mid-1960s.
  5. The labor force participation rate for Americans 65 years and older is greater than 50%.

Rationale: The gap between older men and women aged 55-61 in the U.S. who work has decreased over time, from 46% in 1963 to 10% in 2011. Overall, the labor force participation rates for men aged 65-69 and aged 70 and over both decreased compared with the mid-1960s (43% and 21%, respectively in 1963), reaching a low of 24% in 1985 for men aged 65-69 and a low of 10% in 1993 for men aged 70 and over. However, starting in mid-1990s, these rates have started to rise (37% and 15 %, respectively in 2011). In contrast, the labor force participation rate for women age 55 and over has increased since the mid-1960s. The largest increase has been in women age 55-61 from 44% in 1963 to 65% in 2011 (mostly after 1985). However, for women aged 62 and over, the most increase for labor force participation rates have occurred since the mid-1990s. These changes are likely related to differing experiences with work among generations of women, with younger generations active in the work force at higher rates. Overall, the minority of older Americans > 65 years continue to work.

The recommended response is a.

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Federal Interagency Forum on Aging-Related Statistics. Older Americans 2012: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington DC: US Government Printing Office. June 2012. Accessed January 13, 2014.

5.Which one of the following older adult groups has the highest poverty rate?

  1. Black women living alone
  2. Black women living with children
  3. Black men living with a spouse
  4. White men living alone
  5. White women living with a spouse

Rationale:

Although poverty rates are lower among older adults than younger adults, older adults who are minorities, women and living alone are at greater risk of living in poverty. In the year 2011, over 3.6 million elderly persons (8.7%) were below the poverty level. Older women had a higher poverty rate (10.7%) than older men (6.2%), similarly elderly living alone were much more likely to be poor (16.5%) than were older persons living with families (5%). The incidence of poverty among African Americans and Hispanics exceeds that of whites by several times. The highest poverty rates were experienced by older Black women (32.3%) and older Hispanic women (38.8%) who lived alone.

The recommended response is a.

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Administration on Aging Administration for Community Living. A Profile of Older Americans: 2012 U.S. Department of Health and Human Services 2011. .

Accessed January 13, 2014.

6. Which one of the following lists contains the four leading causes of death for adults age 65 years and older in the United States?

  1. Heart disease, cancer, Alzheimer’s disease and stroke
  2. Heart disease, cancer, chronic lower respiratory disease and stroke
  3. Heart disease, cancer, stroke and pneumonia/influenza
  4. Heart disease, stroke, Alzheimer’s disease and diabetes
  5. Heart disease, stroke, cancer and diabetes

Rationale:The top four leading causes of death for older Americans age 65 years and older are: heart disease, cancer, chronic lower respiratory disease and stroke. Between 1981 and 2009, death rates decreased for heart disease and stroke by > 50%. Death rates for chronic lower respiratory disease rose by 57%. Other causes of death in older adults age 65 years and older include: Alzheimer’s disease, diabetes mellitus and pneumonia/influenza. Between 1981 and 2009, age-adjusted death rates for all causes of death among people age 65 and over declined by 25 percent.

The recommended response is b.

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Administration on Aging Administration for Community Living. A Profile of Older Americans: 2012. U.S. Department of Health and Human Services, 2011. Accessed January 13, 2014.

7.Which of the following statements about functional limitations is most accurate for older adults in the U.S.?

  1. Disability rates are similar across differing racial and ethnic groups.
  2. From 1997 to 2009, the rate of reported disability in the Medicare population age 65 years and older has been stable.
  3. From 1997 to 2009, the proportion of the Medicare population age 65 years and older who reported functional limitation and were in facilities increased.
  4. Men report higher levels of disability than women.
  5. The majority of older adults age 65 years and over who are enrolled in Medicare report functional limitations.

Rationale: Reported functional limitations (defined as limitations in Activities of Daily Living or Instrumental Activities of Daily Living or residing in a long-term care facility) for Medicare enrollees age 65 years and older have been relatively stable from 1997 to 2009 and represent the minority of the population (41% in 2009). Disability rates vary across differing racial and ethnic groups and between men and women, with lower rates in non-Hispanic Whites and in men. From 1997 to 2009, the proportion of this population who reported functional limitations and were in long-term care facilities decreased.

The recommended response is b.

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Administration on Aging Administration for Community Living, A Profile of Older Americans: 2012. U.S. Department of Health and Human Services, 2011. Accessed January 13, 2014.

8.Most older Americans perceive the status of their physical health to be which one of the following?

  1. Fair
  2. Fluctuating from poor to fair
  3. Good to excellent
  4. Poor
  5. Very Poor

Rationale: 76% of American adults age 65 years and older reported their health as good to excellent in 2008-2010. Older men and women had similar rates of health. The rate of good to excellent health decreased in the oldest old across racial and ethnic groups. Older non-Hispanic Whites reported higher rates of good to excellent health compared with Non-Hispanic Blacks and Hispanics.

The recommended response isc.

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Administration on Aging Administration for Community Living. A Profile of Older Americans: 2012. U.S. Department of Health and Human Services, 2011. Accessed January 13, 2014.

9.The average life expectancy of a child born in the United States in 1900 was 47 years, while a child born in the year 2011 has an average life expectancy of how many years?

  1. 50.8 years
  2. 69.4 years
  3. 78.7 years
  4. 84.2 years
  5. 91.1 years

Rationale: Increase in the life expectancy in the first half of 20th century were due largely to decrease infant mortality and decreased mortality from infectious diseases. According to data from 2010, the average life expectancy of a child born in the U.S. is 78.7 years. Women have a longer life expectance than men. The gender gap was 4.8 years; that is, men and women are expected to live on average of 76.2 and 81.0 years, respectively. Although life expectancy at age 65 has increased for older adults in the U.S., rates in several other developed countries are higher. Variability in life expectancy rates is also found by race.

The recommended response is c.

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U.S Department of Health and Human Services. Health, United States, 2012. Accessed January 13, 2014.

Administration on Aging Administration for Community Living. A Profile of Older Americans: 2012. U.S. Department of Health and Human Services, 2011. Accessed January 13, 2014.

10. Which of the following statements about health literacy in older adults is most accurate? Adults with inadequate health literacy are more likely to be younger.

  1. Health literacy is not associated with health status in older adults.
  2. Inadequate health literacy is a more powerful predictor of mortality in older adults than years of education.
  3. Inadequate health literacy is not a predictor of increased mortality risk in older adults after controlling for sociodemographic variables and chronic conditions.
  4. Older individuals with inadequate health literacy have higher risk-adjusted rates of death due to cancer compared with death from cardiovascular disease.

The recommended response is c.

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Rationale:In a prospective cohort study of 3260 Medicare managed-care participants, reading fluency was used as a proxy for health literacy to examine the relationship between health literacy and mortality among older adults. Inadequate health literacy was a more robust predictor of mortality in this population than years of education, even after controlling for sociodemographic and baseline health status. Adults with inadequate health literacy were more likely to be older than younger. Health literacy has been associated with poorer health and self-reported health. Older individuals with inadequate health literacy have higher risk-adjusted rates of death due to cardiovascular disease; however, the risk-adjusted rates of death from cancer was not found to be elevated in this group.

Baker DW, Wolf MS, Feinglass J, et al. Health literacy and mortality among elderly person. Arch Intern Med. 2007; 167(14):1503-1509.