Within the next 20 years, the percentage of King County residents who are elderly will grow from 18 percent to 25 percent. Asian Pacific Islander elders will be one of the fastest-growing subgroups. The increase is due to the aging baby-boomer generation, as well as an increased life expectancy. There are numerous challenges that come with growing old, but those challenges have larger impacts for health care systems and communities when the population of elderly increases.
The elderly face barriers when it comes to transportation, affordability, and housing, as well as social engagement. In a city where affordability is a concern for people of all ages, the elderly—aged 65 and over—are particularly affected by increased housing prices, especially those living on a fixed income, whether that’s investment funds after retirement, or living off social security.
Irene Stewart, project manager for a City initiative called Age-Friendly Seattle, says this is a common occurrence in metropolitan areas across the country, but Seattle’s housing boom has exacerbated the issue of affordability of the elderly here.
The Age-Friendly Seattle initiative aims to study challenges like these, evaluating where the City stands in its accessibility for and inclusion of elderly people. Stewart says the project is currently in the assessment phase and will come up with a plan by the end of the year, to implement between 2018 and 2021.
Stewart also pointed out the gap in quality of life for elderly residents based on race and ethnicity. Twenty-eight percent of American Indian and Alaskan Natives; 18 percent of Blacks, Native Hawaiians, and Pacific Islanders; and 17 percent of Asians and Latinos live in poverty compared to 7 percent of whites, according to 2013 data from Aging and Disability Services for Seattle and King County.
“We look at respect and social inclusion and within that we look at ageism and racism and so that is why we are looking at those factors and trying to figure out how we will do things differently,” Stewart said. “The City of Seattle already has a pretty extensive race and social justice initiative and that is something that we are constantly striving toward.”
Stewart says there are eight aspects that contribute to a good quality of life for elders. Three are related to the built environment—namely housing and transportation—while the other five are largely social: civic and social participation, respect and social inclusion, communication and information, and community and health services.
Research shows that two things are a constant when making sure people live better as they age; physical activity and social connection. “So that is one reason why social participation is one of the key elements of age-friendly communities,” she said.
When it comes to the intersection of race and aging, social connections can be harder to come by. Sam Wan, CEO of Kin On, said elders in the API community have additional social and cultural challenges as they navigate growing old in the United States.
“In the old country, people respect elders. So when they immigrate to this country … they basically have to become dependent on the children,” said Wan. When elders have historically enjoyed respect and are honored, according to Wan, they can feel helpless in a society that doesn’t value them in the same way, adding an extra level of adjustment to navigate.
These social and cultural stresses can add to how elders manage health issues, especially as they try to understand a complicated and often foreign healthcare system.
“I believe our API elders immigrants who rely on Medicaid continue to be challenged with access—capacity and proximity—to high-quality, coordinated, culturally sensitive, and language-specific health care services across the care continuum,” said Jeffrey Hattori, CEO of Keiro Northwest, in an email.
This is where institutions like Kin On and Keiro Northwest—which both offer care, assisted living, and health services for the aging API community—can address health as well as social needs in a culturally-competent way.
Wan said it’s important to make sure people know about the kinds of resources that agencies like Kin On and Keiro can offer, especially when it comes to helping elders navigate the U.S. healthcare system. He said that unlike in their home countries, API elders struggle with reaching out for help and end up delaying treatment as a result. He emphasizes the value of preventative care and treatment so that elders can make sense of their health needs and can be equipped with resources and tools.
“In general, the healthcare policies address the symptoms of the sickness,” said Wan. “They will not come to play in terms of helping you out unless you have health problems or if you have an episode that puts you in the hospital.” He clarified that it is certainly important to take care of those who already have preexisting health issues, but that not enough resources are invested in educating and preparing the “young old.”
Wan explains how the aging population (age 65 and older) is split into three groups. The “young old” range from 60–75, the “middle old” 75–85, and the “old old” 85 and older. Wan suggests that the young old have a special capability to help those in the older groups, creating a kind of accountability model where the elderly help one another while also benefiting from community resources.
“They [the young old] can actually be a very contributing group to the overall population. I think sometimes society defines once you retire, you are basically not contributing much,” Wan said. He wants to look at how to “empower” and “energize” the young old so they can be prepared and support those in other age groups. This also creates a form of preparedness where once the young old group ages up they already have the tools and resources to navigate healthcare systems and their own healthcare needs.
“The aging of the population is unavoidable, but we can be prepared? I think actually make use of their experience, and while they have time they can help out and also be prepared [so] they can avoid some of the potential health issues down the road,” Wan said.
Hattori sees a three-pronged approach or “Triple Aim” to addressing the healthcare gaps and needs for API elderly by allowing for optimal clinical outcomes, cost containment, and customer satisfaction. “A way to achieve this is to provide care and services in the least institutional and high-cost settings,” he said in an email. “Home and community based services (e.g., care managers, home care/health, adult day social/health, transportation, meals) as well as Assisted Living are two major components that needs to grow and integrate with primary care, mental health, acute and post-acute care.” Keiro Northwest has created healthcare programs, such as assisted living, home care, social day programs and wellness workshops, that support aging adults to stay in the comfort of their homes for as long as possible.
These kinds of models for care and service are useful when considering a local and worldwide increase of an aging population. Stewart observed that in our youth-focused society, the idea of aging, and in particularly the elderly, are under-valued. She says the goal of aging services and the Age Friendly Seattle initiative is to change the negative ways people typically think about growing old.
“We’d really love to see anything that will break down the walls so that people of all ages not only respect their elders but want to become their elders,” she said.