BRACING FOR
THE SILVER TSUNAMI
James H. Johnson, Jr.
Frank Hawkins Kenan Institute of Private Enterprise
Kenan-Flagler Business School
University of North Carolina at Chapel Hill
May 2013
OVERVIEW
• Disruptive Demographics
• The Greying of America
• Challenges & Opportunities
• A Social Purpose Venture
6 DISRUPTIVE TRENDS
•
•
•
•
•
•
The South Rises – Again
The Browning of America
Marrying Out is “In”
The Silver Tsunami is About Hit
The End of Men?
Cooling Water from Grandma’s Well…
and Grandpa’s Too!
May 2013
3
THE GREYING OF
AMERICA
Key Drivers
• Changes in Longevity
• Declining Fertility
• Aging of Boomer Cohort
LIFE EXPECTANCY AT BIRTH
YEAR
1900
1930
1960
1997
2007
2010
2030
AGE
47.3
59.7
69.7
76.5
77.9
78.3
101.0
Centenarians in the U.S.
Year
1950
2010
2050
Number
2,300
79,000
601,000
COMPLETED FERTILITY FOR WOMEN
40 - 44 YEARS OLD
Year
Percent
Childless
Avg.
Number of
Children
Percent
Higher
Order
Births*
2006
20
1.9
28
1976
10
3.1
59
*Three or more Children
TOTAL FERTILITY RATES OF U.S.
WOMEN BY RACE/ETHNICITY, 2007
Race/Ethnicity
Hispanic
Non-Hispanic White
Blacks
Asian
Native American
Total Fertility Rate
3.0
1.9
2.1
2.0
1.9
THE
SILVER TSUNAMI
U.S. POPULATION CHANGE BY AGE,
2000-2009
2009
Absolute
Change
2000 - 2009
Percentage
Change
2000 - 2009
104,960,250
5,258,492
5.3
25-44
84,096,278
-1,898,345
-2.2
45-64
79,379,439
16,977,567
27.2
65+
39,570,590
4,496,886
12.8
307,006,550
24,834,593
8.8
Age
<25
TOTAL
U.S. POPULATION TURNING 50, 55, 62,
AND 65 YEARS OF AGE, (2007-2015)
Average Number/Day
Average Number/Minute
Age
50
Age
55
Age
62
Age
65
12,344
11,541
9,221
8,032
8.6
8.0
6.4
5.6
ABSOLUTE AND PERCENT CHANGE IN U.S.
POPULATION BY AGE
Age
2005
2050
% Change
Total
296
438
50.0
0-17
73
102
39.7
18-64
186
255
37.1
37
81
118.9
65+
POPULATION CHANGE BY AGE IN THE
SOUTH, 2000-2010
2010
Population
Absolute
Change
2000-2010
Percent
Change
2000-2010
114,555,744
14,318,924
14.3
<10 (Gen Z)
10-29 (Gen Y)
30-44 (Gen X)
15,346,300
31,624,788
22,820,248
1,284,900
3,247,518
-401,156
9.1
11.4
-1.7
45-64
(Boomers)
29,870,423
7,731,944
34.9
65+ (PreBoomers)
14,893,985
2,455,718
19.7
Age
Total
NC ABSOLUTE POPULATION
CHANGE BY AGE, 2000-2010
Tier 3
Counties
Tier 2
Counties
Age
All Counties
All Ages
<25
25-44
45-64
65+
1,486,170 1,088,946 327,859
449,385
369,818 85,481
73,209
159,248 - 36,139
698,545
410,705 199,101
265,031
149,175 79,416
Tier 1
Counties
69,365
- 5,914
-49,900
88,739
36,440
THE BIG CHALLENGE
And The Big Opportunity
Total and Elderly Population Change,
2000-2010
Total
Population
Percent
Change
Absolute
Change
Elderly
Population
Percent
Change
Absolute
Change
U.S.
9.5
26,884.972
U.S.
10.7
3,787,660
South
14.3
14,318,924
South
19.7
2,455,718
The
Carolinas
17.4
2,099,702
The
Carolinas
28.2
411,572
North
Carolina
18.5
1,486,170
North
Carolina
27.3
265,031
South
Carolina
15.3
613,532
South
Carolina
30.2
146,541
Elderly Share of Net Population
Change, 2000-2010
Area
Total
Population
Change
United States 26,884,972
South Region 14,318,924
The Carolinas
2,099,702
North Carolina 1,486,170
South Carolina
613,532
Elderly
Population
Change
3,737,660
2,455,718
411,572
265,031
146,541
Elderly Share
of Net Change
13.9%
17.2%
19.6%
17.8%
23.9%
GROWING DEPENDENCY
A Train Wreck in the Making
DEPENDENCY RATIOS IN THE
AMERICAN SOUTH
Source: Census 2010
NC COUNTIES WITH THE LARGEST ABSOLUTE
POPULATION GAINS, 2000-2010
NC COUNTIES EXPERIENCING POPULATION
DECLINE, 2000-2010
Counties with Biologically
Declining Populations, 2009
Alleghany
Northampton GatesPasquotank
Ashe
Camden
Surry Stokes
CaswellPerson VanceWarren
Hertford
Granville
Currituck
Rockingham
Halifax
Watauga Wilkes
ChowanPerquimans
Yadkin Forsyth
Franklin
Avery
Guilford
Bertie
Orange
Mitchell
NashEdgecombe
Durham
CaldwellAlexander Davie
Alamance
Washington
MadisonYancey
Martin
Iredell Davidson
Tyrrell Dare
Wake
McDowellBurke
RandolphChatham
Wilson
Catawba
Rowan
Pitt Beaufort
HaywoodBuncombe
Johnston
Greene
Swain
Hyde
LincolnCabarrus Montgomery Lee
Harnett
Wayne
HendersonRutherfordCleveland
Graham
Stanly
Jackson
Moore
Gaston
Lenoir Craven
Polk
Mecklenburg
Macon Transylvania
Pamlico
Cherokee
Cumberland
Jones
Union AnsonRichmondHoke
Clay
SampsonDuplin
Scotland
Carteret
Onslow
Robeson Bladen
Pender
Columbus New Hanover
Brunswick
Legend
Deaths > Births
Deaths < Births
4
0
37.5
75
Miles
150
Age-Related Challenges
•
•
•
•
•
•
•
Mobility Limitations
Hearing Loss
Vision Impairments
Mental Disorders
Substance Abuse Issues
Chronic Disabilities
Economic Constraints
The Triple Whammy
• Aging Boomers Face Mortality
• Elder Care Responsibilities
• Raising Grandchildren
The Elder Care Economy Innovations Hub
Fostering &
Facilitating Success
Aging in Place
Ventures
• Person- Centered
• Built-Environment
Centered
•
•
•
•
•
Scholar &
Practitioner
Network
Noel Greis
Monica
Nogueira
Sharon
Williams
Mary Altpeter
Ellen Roberts
Kenan
Institute
of Private
Enterprise
White Papers
Policy Briefs
Business Plans
Workshops
Conferences
Center for
Aging &
Health
R.L. Mace
Universal
Design
Institute
AARP
AIP
Ventures
Mobilizing Collective
Ambition
Leveraging Intellectual
Capital
Leadership Team
Johnson
Aging in Place Clearinghouse
•
•
•
•
•
Institute
on Aging
Research and
Demonstration
Projects
DilworthAnderson
CarterEdwards
BusbyWhitehead
Duncan
New Venture Creation Lab
Galloway
McCoy
Social Innovation Fund
Digital Health
Entrepreneurs
Digital Literacy
Succession Planning
Research Fellows
Initiative for
Emerging Scholars
and Practitioners
Evaluation
Assessing Progress and
Building the Research
& Evidence Base
27
AGING IN PLACE
RESEARCH FRAMEWORK
PersonCentered
Activities
Seniors
Caregivers
Service
Providers
Assistive
Technologies
Senior
Population
Digital
Literacy
•Remote Care
Systems
•Online Health
Promotion
•Sympathetic
Devices
•ICT
•AAL
Built
Environment
Centered
Activities
•Dwellings
•Neighborhoods
•Communities
•Cities/Regions
•Nation-states
Successful
Aging in
Place
SAFE: Secure Audits
for the Elderly
Anatomy of an Intervention
Falls Among Older Adults
• One out of three adults age 65 or older falls
each year.
• Among seniors, falls are the leading cause of
injury-related death.
• 2.3 million nonfatal fall injuries treated in ERs
and more than 662,000 of these falls victims
were hospitalized in 2010.
• Direct medical costs of falls was $30b in
2010, projected to rise to $55b by 2020.
Joint Venture Partners
•
•
•
•
•
Kenan Institute, Managing Director
UNC Center for Aging and Health
Universal Design Institute
Athletic Concepts, LLC
AT&T & Other Private Sector Firms
Program Goals
• Reduce Falls & Falls-Related Injuries &
Deaths Among Seniors
• Create Jobs and Nurture Small Business
Growth and Expansion
Program Components
• Falls Prevention Education
• Home Audits and Modifications
• Senior Fitness Parks and Wellness
Centers
• Formative and Summative
Evaluations
SMART SLIPPERS
GLOWCAPS
SENIOR PLAYGROUNDS
SENIOR PLAYGROUNDS
Senior Wellness Center
Integrated Health Modules
Cardiorespiratory
Fitness
Strength/Endurance Balance &
Proprioception
Prevention
Education
Low impact
aerobics
Circuit training
Tai Chi
Healthy Back
Dance
Weight equipment
Yoga
Disease processes:
BP, Diabetes, COPD,
CHF*, OA, RA
Treadmill, Cycling,
etc.
Resistance tubing,
bands
Balance exercises
Nutrition
Proprioception
exercises
Suggestions from
Seniors
Aquatics
Human Resource Demand
•
•
•
•
•
Lay Health Professionals
Wellness Advisors & Fitness Instructors
Home modification experts
Architects
Landscape Architects
Target Markets
Gender Composition of Elderly
Population by Age, 2010
Age
The Carolinas
North Carolina
South Carolina
All Elderly (65+)
1,865,953
1,234,079
631,874
% Female
57.3
57.5
56.7
Young Old (65-74)
1,066,610
% Female
53.8
Middle Old (75-84)
% Female
Oldest Old (85+)
% Female
581,165
59.0
218,178
69.9
697,567
54.0
389,051
369,043
53.4
192,114
59.2
58.4
147,461
70,717
70.0
69.7
Distribution of Widowed Elderly Women by
County, The Carolinas, 2010
Alleghany
Northampton GatesPasquotank
Ashe
Camden
Surry Stokes
CaswellPerson VanceWarren
Hertford
Granville
Currituck
Rockingham
Halifax
Watauga Wilkes
Chowan
Perquimans
Yadkin Forsyth
Avery
Franklin
Guilford
Bertie
Orange
Mitchell
NashEdgecombe
CaldwellAlexander Davie
Durham
Alamance
Washington
MadisonYancey
Martin
Iredell Davidson
Tyrrell Dare
Wake
McDowellBurke
Randolph
Wilson
Chatham
Catawba
Rowan
Buncombe
Beaufort
Pitt
Haywood
Johnston
Greene
Swain
Hyde
LincolnCabarrus Montgomery Lee
Harnett
Wayne
HendersonRutherfordCleveland
Graham
Stanly
Jackson
Moore
Gaston
Lenoir Craven
Polk
Mecklenburg
Pamlico
Cherokee Macon Transylvania
Cumberland
Cherokee
Jones
Union AnsonRichmondHoke
Clay
SampsonDuplin
York
Spartanburg
PickensGreenville
Scotland
Carteret
Lancaster
Oconee
Onslow
Union Chester
Chesterfield
Robeson Bladen
Pender
Anderson Laurens
Marlboro
Fairfield Kershaw Darlington Dillon
Newberry
Columbus New Hanover
Abbeville
Lee
Greenwood
Marion
Brunswick
Florence
Richland
Saluda
Sumter
Horry
McCormick
Lexington
Edgefield
CalhounClarendonWilliamsburg
Aiken
Legend
Georgetown
Orangeburg
Barnwell
Berkeley
51% or more
Bamberg
Dorchester
41% - 50%
Allendale
HamptonColleton
36% - 40%
Charleston
JasperBeaufort
4
0
37.5
75
Miles
150
25%-35%
North Carolina Elderly Population
Living Alone, 2010
Gender
Total
Number
Population Living
Alone
Both Sexes 1,234,079 326,252
Male
523,956
83,408
Female
710,123 242,844
Percent
Living
Alone
26.4
15.9
34.2
Distribution of Elderly Female Householders,
No Husband Present, The Carolinas, 2010
Alleghany
Northampton GatesPasquotank
Ashe
Camden
Surry Stokes
CaswellPerson VanceWarren
Hertford
Granville
Currituck
Rockingham
Halifax
Watauga Wilkes
ChowanPerquimans
Yadkin Forsyth
Franklin
Guilford
Bertie
Orange
MitchellAvery
NashEdgecombe
CaldwellAlexander Davie
Durham
Alamance
Washington
MadisonYancey
Martin
Iredell Davidson
Tyrrell Dare
Wake
McDowellBurke
RandolphChatham
Wilson
Catawba
Rowan
Buncombe
Pitt Beaufort
Haywood
Johnston
Greene
Swain
Hyde
LincolnCabarrus Montgomery Lee
Cleveland
Harnett
Wayne
HendersonRutherford
Graham
Stanly
Jackson
Gaston
Moore
Lenoir Craven
Polk
Mecklenburg
Macon Transylvania
Pamlico
Cherokee
Cumberland
Cherokee
Jones
Hoke
Union
Richmond
Clay
Sampson
Anson
York
Duplin
PickensGreenvilleSpartanburg
Scotland
Carteret
Lancaster
Oconee
Onslow
Union Chester
Chesterfield
Robeson Bladen
Pender
Anderson Laurens
Marlboro
Fairfield Kershaw Darlington Dillon
Newberry
Columbus New Hanover
Abbeville
Lee
Greenwood
Marion
Brunswick
Florence
Richland
Saluda
Sumter
Horry
McCormick
Lexington
Edgefield
CalhounClarendonWilliamsburg
Aiken
Legend
Georgetown
Orangeburg
Barnwell
Berkeley
15% or more
Bamberg
Dorchester
10% - 14%
Allendale
HamptonColleton
5% - 9%
Charleston
JasperBeaufort
4
Less than 5%
Demonstration Sites
• Bertie County
• Guilford County
• Henderson County
Indicators of Social Wellbeing
in Demonstration Site Counties
Indicator
North
Carolina
Henderson
County
Guilford
County
Bertie
County
Total Population,
2009
9,543,537
106,740
488,406
21,282
Unemployment
Rate, 2011
10.4%
8.0%
11.1%
12.8%
Per capita income,
2008
$38,534
$35,901
$35,294
$28,888
Percent Uninsured,
2008-09
19.7%
19.7%
19.5%
20.4%
Percent Medicaid
Eligible , 2010
17.0%
14.0%
15.0%
27.0%
Percent Dually
Enrolled in
Medicare, 2010
14.5%
16.4%
13.2%
24.1%
Strategic Alliance
Partners
Fall Prevention campaign will involve wide-ranging partners
May 2013
47
Anticipated Outcomes
•
•
•
•
•
Fewer Falls
Reduced hospitalizations
Extended independent living
Reduced unemployment
Sustainable model of falls prevention
IMPACT
•
•
•
•
Reduced Medicaid Burden
Lowered Caregiver Stress
Greater Health Equity
Healthier Communities
THE END