The television survey found that among the total prime-time population of 2,251 characters, only 67, or fewer than 3%, were aged 70 or older, and 13% were "older adults" roughly between the ages of 50 and 69. An earlier survey of prime-time characters on view during the decade 1982-1992 did not even make a distinction between "older adult" and "elderly" but simply reported that over that period, 1.9% of prime-time casts were "old males" and 2.5% were "old females." Semantically and numerically, seniors are making a little progress.
In 2000, 20.4% of Americans were age 55 or older. On prime-time television that fall, one-third of male characters were older than 40, while only 19% of the women were that age or older — even though in real life, older women outnumber older men.
There is more to the media than television, of course. Are we seeing plenty of positive images of older adults elsewhere? In the movies, perhaps? Maria D. Vesperi points out in Generations (Journal of the American Society on Aging) that the current image of older Americans has been honed for retirement community advertising. Those ads show older adults as "slender, healthy, financially secure, at leisure, casually but conservatively dressed, and heterosexual — usually depicted as couples or in leisure-time association with children and grandchildren." Similar images of senior citizens appear in ads for potency drugs (minus the children) or in ads for a nutritional supplement featuring senior citizen couples playing sports and frolicking on the beach. These advertisers may have heeded the advice of Paul Kleyman of the American Society on Aging to "Wake up and smell the demographics," but does anyone other than seniors see the ads? The ads were most likely placed in newspapers and magazines. We spent 152 hours per person reading newspapers and 80 hours per person reading magazines in 2000.35 Isn't it likely that the ads depicting senior citizens in a positive way were overlooked by everyone but seniors?
If it is true that the media can influence the way we feel about ourselves, do the images they see make the majority of senior citizens feel inadequate? Vesperi dates the current, more positive depiction of seniors to the late 1980s, when "the public dialogue shifted from discussion of the fragile, dependent aged to a focus on healthy older people with self-serving 'lifestyles.'" Vesperi calls this group "woofies" — well-off older folks. How many senior citizens fit the bill? Is there really a huge population of well-off, "active elders" out there, ready to strap on their backpacks and explore the backcountry? The median older householder income in 2000 was $23,048, not exactly in the jet-setting realm. And according to the Centers for Disease Control, the vast majority of senior citizens have chronic health conditions that do not permit strenuous physical activity, although they may enjoy a reasonably good quality of life.36
Whether positive media depictions of senior citizens are accurate or even absorbed by a wide audience, the huge Baby Boom generation is about to join the rank of senior citizens. For them, we end on this positive note from Elizabeth Benedict: "Old age seems poised to become a period associated with liberation, innovation, the next cool thing: a sort of Woodstock Nation redux. Except, of course, we won't want to thrash around half- naked in the mud anymore."
Sources: Maria D. Vesperi, "Media, Marketing, and Images of the Older Person in the Information Age," http://www.generationsjournal.org/gen25-3/intro.html. Small chart: "Fall Colors: 2000-01 Prime Time Diversity Report," http://www.childrennow.org/media/fc2001/fc-2001-report.pdf. "Comparison of prime time casts of 1982-92 and 1994-1997, by age group and gender," Screen Actors Guild, http://www.sag.org/diversity/Table3.html. Elizabeth Benedict, "When Baby Boomers Grow Old," The American Prospect, vol. 12 no. 9, May 21, 2001, http://www.elizabethbenedict.com/boomers.html. Statistical Abstract of the United States: 2001, Table 1125, "Media Usage and Consumer Spending: 1995 to 2004," primary source: Veronis, Suhler & Associates Inc., New York, NY, Communications Industry Forecast annual.
1 U.S. Department of Health and Human Services, "An Aging World," November 2001, www.census.gov/prod/2001pubs/p95-01-1.pdf.
2 National Institutes of Health, "Quality of Life for Individuals at the End-of-Life," August 2000, http://grants1.nih.gov/grants/guide/pa-files/PA-00-127.html.
3 National Institutes of Health, ibid.
4 George P. Smith, II, "Allocating Health Care Resources to the Elderly," Elder Law Review, Vol 1 (2002).
5 John Hood, "Senior Slump," National Review, October 23, 2000, p56+.
6 Michael Fossel, "Reversing Human Aging: It's Time to Consider the Consequences," Futurist, July/Aug 1997.
7 Older African Americans and older Hispanics are less likely to rate their health as good to excellent. In 1999, 26% of older whites said their health was fair or poor; the figures were 41.6% for blacks and 35.1% for Hispanics.
8 The Older Americans Act, first passed in 1965 and reauthorized from time to time afterwards, is designed to help seniors stay in their homes as long as possible by providing such services as home-delivered meals, home health care, and so on. According to AARP: "In fiscal year 2001, the total federal appropriation for the OAA is $1.1 billion, up from $830,000 in 1997. Funding has generally increased slightly each year, but has not kept pace with inflation and the growth of the older population." For more information, go to http://www.aoa.gov/aoa/pages/aoafact.html.
9 An emerging trend among seniors and others is home sharing. The National Shared Housing Resource Center, a network of more than 300 programs under the auspices of nonprofit agencies across the United States, matches home providers and seekers; see http://www.nationalsharedhousing.org/.
10 According to a 2002 General Accounting Office report: "Nursing homes in the United States play an essential role in our health care system, caring for 1.6 million elderly and disabled persons who are temporarily or permanently unable to care for themselves but who do not require the level of care furnished in an acute care hospital."
11 Assisted living facilities (ALF) are defined by ALFA "as a special combination of housing, personalized supportive services and health care designed to meet the needs … of those who need help with activities of daily living." Daily fees range from $15 to $200, paid by residents/families. Costs may be reimbursed by health insurance or other policies; some residences have financial assistance programs. Government payments for ALFs have been limited, but some state/local governments offer subsidies for rent or services and/or use Medicaid waiver programs to help pay for such services.
12 0f the 21.4 million households headed by older persons in 1999, 20% were renters. In 1999, about 1.7 million households headed by a person age 62 or older benefited from some kind of federal rental housing program, according to AARP. Data from the 1999 American Housing Survey (AHS) show that 55% of older renter households incurred "excessive expenditures" for housing, defined as housing costs in excess of 30% of income. In 1999 the median family income of older renters was $12,566. To be eligible for federally subsidized housing, the household income must be less than $18,375.
13 Between 1980 and 1997, the elderly population grew 33%, but the number of persons age 85+ grew 73%, and the total U.S. population grew by 18%. The oldest Americans made up less than 9% of the elderly population in 1980; they comprised more than 11% of the elderly in 1997 and may make up 23% by 2050. In 1997, 15% of the U.S. elderly population were minorities — 8% were African American. By 2025, 24% will be minorities.
14 A U.S. Department of Housing and Urban Development (HUD) program of federally subsidized apartment units for senior citizens. It is the only federally funded program designed specifically for the elderly.
15 A HUD program for the disabled.
16 NCEA is funded by a grant from the U.S. Administration on Aging, and consists of a consortium of six partners: National Association of State Units on Aging (NASUA), the lead agency; Commission on Legal Problems of the Elderly of the American Bar Association (ABA); the Clearinghouse on Abuse and Neglect of the Elderly of the University of Delaware (CANE); the San Francisco Consortium for Elder Abuse Prevention of the Institute on Aging (IOA); the National Association of Adult Protective Services Administrators (NAAPSA); and the National Committee to Prevent Elder Abuse (NCPEA).
17 "Elder abuse can be classified into 6 categories: (1) physical abuse, (2) sexual abuse, (3) neglect, (4) psychological abuse, (5) financial and material exploitation, and (6) violation of rights" (Collins et al.; see Source notes).
18 In 1997-98, 34% of low-income seniors in central counties of large metro areas had lost all their teeth, compared with 47% in the most rural counties. The prevalence of tooth loss is declining; persons aged 45-64 in 2000 can expect a better dental outcome than this as they age.
19 According to CDC: "Limitation of activity is assessed by asking respondents a series of questions about limitations in their ability to perform activities usual for their age group because of a physical, mental, or emotional problem. Respondents are asked about limitations in activities of daily living, or instrumental activities of daily living, play, school, work, difficulty walking or remembering, and any other activity limitations. For reported limitations the causal health conditions are determined and respondents are considered limited if one or more of these conditions is chronic."
20 The poorest Medicare recipients ("dual eligibles") have their medical costs partly paid through the Medicaid program. Unlike Medicare, this coverage includes benefits like prescription drugs, hearing aids, and payment for nursing home services. Medicaid coverage must be applied for; many eligible but unaware individuals do not receive it.
21 Services under Medicare Part A only, which include inpatient hospital services, nursing facility care following a hospital stay, certain home health services, and hospice care (hospice care for the terminally ill is not included on the chart). A yearly deductible of $792 on hospital stays must be paid, and beneficiaries also pay a substantial portion of the cost for long hospital and nursing home stays. All those eligible for Part A may choose Part B coverage (most do). Part B, Supplementary Medical Insurance, is financed through general tax revenues and through monthly premiums paid by beneficiaries.
22 A major issue in the 2000 presidential campaign was prescription drug coverage under Medicare.
23 Home health agencies provide skilled nursing care and other services in the home for the treatment of an illness or injury.
24 Medicare coverage for most preventive services was increased or initiated on January 1, 1998. Medicare has reimbursed one lifetime pneumococcal vaccination, including the cost of the vaccine since 1981 and the cost of administration since 1992. Since May 1, 1993, Medicare has reimbursed health-care providers for the cost of influenza vaccine and its administration. Having teeth that are well cared for is important to quality of life, but retired persons are less likely to have dental insurance. With few exceptions, Medicare does not cover dental care services, and few states provide adult dental coverage under their Medicaid programs.
25 So called by French social historian Philippe Ariés, according to Nuland; see Source notes. Furthermore, Ariés wrote: "The hidden death in the hospital began very discreetly in the 1930's and 1940's and became widespread after 1950…. Although it is not always admitted, the hospital has offered families a place where they can hide the unseemly invalid whom neither the world nor they can endure…."
26 Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Researchers from Johns Hopkins School of Public Health, George Washington University, and Beth Israel Hospital in Boston studied 9,000 individuals; their findings were published in the January 1997 Annals of Internal Medicine and are described by Marcus; see Source notes..
27 Doctors have lost their licenses for what drug regulators call over-prescribing of narcotics. After California voters approved the Medical Marijuana Initiative in 1996 (which holds that the state's criminal laws against marijuana do not apply when a seriously ill patient uses marijuana on the advice of a physician), the federal government announced that as part of the war on drugs, it would use its authority under the Controlled Substances Act to revoke a doctor's right to prescribe any drugs if the doctor recommended marijuana to a patient. A group of doctors and patients sued. In 2002 the case awaited a decision by the U.S. Supreme Court. See http://www.conantfoundation.org/commentary.html for more information.
28 Other names for living will include special medical power of attorney; power of attorney; verbal directions for future care; durable medical power of attorney; DNR — do not resuscitate; and organ donation.
29 After passage of Oregon's law, U.S. Attorney General John Ashcroft declared that writing lethal-dose prescriptions was not "legitimate medical practice." In May 2002 a federal judge ruled that Ashcroft had overstepped his authority in making that declaration.
30 It has been alleged that the Oregon data are sketchy and incomplete because of physician non-reporting and privacy concerns. By way of comparison, in 2000, 493 total suicides were reported in Oregon (http://www.ohd.hr.state.or.us/chs/finalabd/00/deathman.htm). The 2001 report and earlier data can be found at http://www.ohd.hr.state.or.us/chs/pas/ar-index.htm.
31 The average amount spent on Medicare enrollees who did not die was $3,663.
32 "On average, it costs Americans more than $30,000 above any insurance coverage to pay for the care required in their last year of life." Annals of Internal Medicine, March 2000: 132:451-459.
33 A prescription drug benefit like the one proposed in President George W. Bush's 2003 budget. See http://www.cbo.gov/showdoc.cfm?index=3304&sequence=0. In 1996 the lowest fifth, income-wise, of Medicare beneficiaries spent an average $12,602 on health care, compared to $6,371 for the highest fifth.
34 Veronis, Suhler & Associates; see Source notes.
35 Ibid.
36 For example, more than 65% of Americans aged 65 years or older have some form of cardiovascular disease; half of all men and two-thirds of all women older than 70 have arthritis.
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