One subject of much importance today is that of an aging American population and what issues it presents for the nation in both the short- and long-term future. One respected author and expert in the field of aging, Marc Freedman (1999, p. 11), describes America as being in “the midst of a demographic revolution, one that will ultimately transform the country into an older nation.” Another widely touted expert and best-selling author, Ken Dychtwald (1999, p. 1), puts it this way…

America is becoming a “gerontocracy,” and four outcomes are certain: 1) More of us will live longer than in any previous generation; 2) The epicenter of economic and political power will shift from the young to the old; 3) We will need to change our mindset about how to spend our extra years of life; and 4) How we decide to behave as elders will, in all likelihood, become the most important challenge we will face in our lives.

Statistics on the aging in the United States give meaning, confirmation, and emphasis to these expert observations and views of Freedman and Dychtwald. According to the U.S. Bureau of Census and the federal Administration on Aging, the nation’s population for those 65 years and older was 35.6 million in CY 2002 (the most recent data available). This number equates to 12.3% of the total U.S. population or roughly one in every eight citizens. In the year 2030, the population of 65 and older will double to 71.5 million persons or 20% of the total U.S. population (i.e., one in five persons).¹

With these views and figures in mind, the questions that present themselves are significant and straightforward. For example, what are the aging demographics for the present and what will they be in the future? What influences do and will the baby boomers (their numbers, attitudes, and needs) have on the aging of America? What challenges loom for the U.S. as it grows older in terms of economic, health, and quality of life issues? And what is the status of the aging population in South Carolina?

In this article these questions will be briefly addressed. As such, the intent is not to present a comprehensive and definitive exploration or study of aging and its various associated issues, but rather, it is to broach the subject matter of aging and its challenges in an effort to foster awareness and promote more deliberative study.

To do this, the aging demographics of the U.S. will be examined. Attention will be given to the older population generally and some focus will be devoted to marital status, gender, race, education, and income. Next, the phenomenon of the baby boomer will be touched upon, defining the cohort and its projected varying affects on society as a whole. More specifically, this will be followed by a concise examination of aging and its relation to health and economic issues. And finally, a look at aging in South Carolina will be reviewed.

Demographics
Circa 1900, the aging of America is described in the literature as being “relatively slow.” It was not until the mid-1930s that some recognition was given to the fact that persons 65+ were “increasing rapidly.” In the 1960s, however, demographers and economists began to give far greater attention to the rising older U.S. population, but often in a general and sometimes vague way. However by the 1980s, the aging of the baby boomers began to strike home and experts in several fields of study began to speak seriously about the “graying” of America. By the late 1990s, experts and casual observers alike began to see the aging population as potentially problematic. One author, in fact, called it the “Titanic headed for an ominous, impassable iceberg.”²

Indeed, these facts become even more illuminating when presented statistically. In the year 1900, there were 3.1 million Americans who were 65 years and older, representing about 4% of the total population. In 1935, according to the U.S. Committee on Economic Security, older Americans made up over 5% of the total U.S. population and were increasing quickly. By the early 1960s, the 65+ cohort totaled 17 million, equaling approximately 9.5% of the total U.S. population. In 1990, the over-65 population had grown to 34 million. In other words, considering only the period from 1960 to 1994, those 65 years and older had increased 100% or doubled (Freedman, 1999, p. 11).

Today, as stated earlier, the older population (ages 65+) totals in the order of 35.6 million persons (12.3% of the U.S. total population). Of significance, this is a 10.2% jump from the year 1992. Further, in 2002 alone, 2 million persons became 65 years of age.

Thus, in a retrospective view of the 20th century, from 1900 to 1997, the U.S. Census data indicate that the over-65 population “has increased more than eleven-fold, from 3.1 million to over 35 million.”³

Speaking in general terms, the median age of Americans has increased as well. The median age of the U.S. population is now 35.3 years. In contrast, the median age in 1980 was 30 and in 1900 it was 23.⁴ The government resources section of about.com reports:

The median age in America reached its highest point ever at 35.3 years, up from 32.9 years in 1990, according to recently released data from Census 2000. By “median age,” the Census Bureau means that half of the American people are now older and half younger than 35.3 years.⁵

Life expectancy is also up. In CY 2002, according to the U.S. Bureau of Census, those who were 65 years of age could expect an additional average life expectancy of 17.9 years. By gender, women age 65+ have an additional average life expectancy of 19.4 years, and for men, 16.4 years. Also, the possibility of a 65 year-old surviving to the age of 90 has doubled since 1960, from 14% then to 25% (in CY 2002).

Additionally, the “oldest of the old,” those persons in the U.S. aged 85 and over, are increasing in number faster than any cohort or group of the total population. Data show that 3.8 million persons were 85 or older in CY 1996. This number increased to 4.6 million in CY 2002. From 1960 to 1994, the 85+ population increased overall by roughly 280%.⁶

Gender
There are proportionally a greater number of older women than older men. Further, as people age, these differences in the number of women to men increase substantially.

In CY 2002, data indicate that there were 33 million women and 26.6 million men ages 55 and older. This is a ratio 100 females to 81 males. However, the gender ratio gap increases significantly for the older population or group who are ages 75 to 84, that is, for every 100 women there were 67 men in the year 2002. For the cohort ages 85 and over, the ratio was 100 to 46 (Smith, April 2003, pp. 1-2).

Significant differences also exist between older women and older men in relation to other factors, including education, economic/financial well-being, and workforce participation. Here older men have a statistical advantage. For example, in CY 2002, for those aged 65 to 84, 22% of men were college graduates as compared to 11% of women. In terms of the status of economic or financial well-being, 6.9% of men ages 65+ lived at the poverty level as compared to 11.8% of women of the same age group. And lastly, 18.6% of men ages 65+ still remained active in the workforce compared to 10% of women 65+.⁷

Marital Status
In CY 2002, martial status (i.e., married, spouse present) among the elderly is notable in that it differed significantly between men and women according to age. For those persons ages 55 and older, for instance, men were more likely to be married than women, 74% versus 50%. Of note as well was that this difference magnified itself for each age ascending sub-group: those men and women ages 55 to 64 were 75% and 63%, respectively; those ages 65 to 84 were 74% and 45%, respectively; and, those ages 85 and older were 58% and 12%, respectively.

Viewed in the context of the widowed, since women live longer statistically than men, it is equally notable that 31% of women and just 9% of men were widowed according to 2002 data. Looking at ascending age groupings, the percentages of women widowed increased considerably: 41% of women ages 65 to 84 were widowed, and 79% of women 85 and older were widowed (Smith, April 2003, p. 2).

Race/Ethnicity
In terms of the racial or ethnic composition of older Americans, there are noticeable differences from the total U.S. population. The total U.S. population in CY 2000 consisted of approximately 75% Caucasian, 12% African American, 4% Asian, and 12% classified as “other” (mainly Hispanics). For the same year, those persons in the cohort of ages 65 and older and Caucasian were 86%, a statistically greater and significant proportion relative to the total population percentiles. African Americans were 8% of this 65+ cohort, Asians were 2%, and Hispanics were roughly 5%.^{8 9}

Of interest too, it is estimated that by the year 2030, elderly Caucasians (ages 65+) should decrease slightly to 84.5%. Contrarily, elderly African Americans are expected to increase to 9.9%, Asians to 5.3%, and Hispanics to 11.2%.¹⁰ These increases are due to higher past fertility rates (among African Americans) and immigration (among Asians).¹¹

Education
High school education completion percentiles vary among the subgroups of those ages 55 years and older. Further, men have higher educational attainment than women among the older population.

In CY 2002, 84% of those persons ages 55 to 64 had completed high school. Of those ages 65 to 84, 71% had high school diplomas. In comparison, 58% of those persons 85+ had completed high school. In most age subgroups, the percentages of men versus women that were likely to have completed grades K-12 were about equal.

However, with regard to higher education, men were evidenced to have received a college degree more often than women (in 2002). The comparative percentiles are as follows: for those ages 55 to 64, men with a bachelor’s degree were 31% and women were 22%; ages 65 to 84, men were 22% and women 13%; and those ages 85+, men were 17% and women 12%.

Income
Income levels vary according to age, martial status, education, and workforce status, just to mention a few of the possible variables or factors. Income level and poverty status among age groupings in the cohort of persons ages 55 and over, however, present some interesting findings.
For example, in CY 2001, 77% of those married-couple households (families) with a person aged 55 and older had an income of $35,000 or more. In comparison, 49% of married-couple households, ages 65 and over, had incomes of $35,000 or more.

In terms of poverty status, 9.8% of persons 55 and older were below the poverty level in 2001. For those aged 65 and over there were 10.1% who were below the poverty level status. Older women were generally below the poverty level more than older men, 12.4% compared to 7%, respectively (Smith, April 2003, pp. 2-4).

Future Growth
Again, the older population is expected to increase significantly in the future. One fifth of all Americans will be aged 65 and over by the year 2030. In particular, the 85+ population is projected to increase from 4.6 million in 2002 to 9.6 million in 2030.¹²

In terms of race and ethnicity, all non-Caucasians 65+ (basically all African Americans, Hispanics, and Asians) are estimated to increase from 17.2% in 2002 to 26.4% in 2030. This represents a 77% projected increase for older Caucasians for the 28-year period, and a 233% increase for older minorities. More specifically, for the 65+ cohort, Hispanics are expected to increase by 342%, African Americans by 164%, and all “others” (Asians, American Indians, and Pacific Islanders) by 302%.¹³

Of note also is that elderly women will in the future continue to outnumber men. It is projected, for instance, that in 2050 women aged 85+ will exceed men 85+ by more than 4 million, or roughly by 60%.¹⁴

Baby Boomers

The force of this demographic quake [the aging of baby boomers] has been reverberating through society’s institutions…. Although it began as a baby boom, it is now rising up into an age wave, destined to crash upon society’s shores, transforming everything in its path (Dychtwald, 1999, p. 57).

The baby boom generation includes those Americans born between the years 1946 and 1964. This age cohort comprises currently about 76 million persons and represents the largest growth of population in American history. In 2001, the oldest boomers turned 55 years of age. They are expected by all accounts to have a profound affect on all aspects of everyday life, especially over the next three decades.

Experts typically attribute the baby boom phenomenon to the aftereffects of the Depression of the 1930s and more importantly the end of World War II in 1945. The Depression Era contributed to a drop in fertility rates which was sustained during the war years from 1942 through late 1945. With the return of American soldiers, births skyrocketed and many families began a migration to the suburbs. This phenomenon was sustained, in varying degrees, until the mid-1960s coinciding with the beginnings of U.S. involvement in the Vietnam War and the emergence of “flower power.”

Early on, baby boomers were a fundamentally different generation from those of their parents and grandparents before them. Generally speaking, they were free from the economic hardships, and social and political uncertainties that plagued the majority of Americans during the early to mid-1900s. With the exception of the vagaries of the Cold War, baby boomers—on the whole—lived relatively stable and comfortable lives in an age marked by prosperity and hope. Educational and job opportunities were readily available for those desiring them. Indeed, the number of college students tripled from 1965 through 1975.

Well-educated, confident and ambitious, baby boomers wanted and took opportunities to realize the American dream. Trading “love beads” and “peace pendants” for money-making careers and stocks, baby boomers made and spent money. When cash wasn’t readily available, credit cards were used to buy more goods and services.

In the present day, most baby boomers (roughly 75%) have had children, many of whom are now in or graduated from college, and approximately two-thirds of baby boomers are homeowners. Most households have dual incomes and 49% of the workforce is female (compared to nearly 30% in 1950).

According to a study by the American Association of Retired Persons (1998, pp. 3-4), most boomers are generally satisfied with their personal lives and are “upbeat about the future.” Baby boomers do express some concerns about their personal finances and leisure time activities. With regard to their expectations for the future, boomers generally express the following views about their impending retirement:

• Most boomers expect to work during their retirement years, at least part-time (16% state that they will not work);
• Approximately one-third of boomers expect to scale back their lifestyles during their retirement years;
• Only 16% of the boomers believe that they will have serious health problems at retirement;
• Less than 48% of boomers believe that Social Security payments will be a major source of their retirement income.

Whether or not these more or less optimistic views will come to fruition for the baby boomer generation remains to be seen. In other surveys,¹⁵ a polarization among the boomers views is pointed out, especially when income is a factor. For example, those boomers who have current annual household incomes of $70,000+ are more optimistic (36%) about their retirement years than those earning $30,000 or less (18%).

Aging Boomers and Future Marketplace Impacts
Currently, the baby boomers cohort has a significant influence on society and the marketplace. This will become increasingly so—in a variety of ways—as boomers age, thus determining or realigning many societal needs and demands. In the literature, there are a number of major factors cited which will impact what is termed the “emerging silver market.” These include: 1) the concerns and needs for health care and the postponement of the aging process, 2) the mounting sums of available “discretionary” monies, 3) new, multifaceted and creative older lifestyles, 4) a sharp swing from “purchasing possessions” to acquiring “gratifying experiences,” and 5) a general “absence of disposable or free time due to new, more complex lifestyles” (Dychtwald, p. 70).

One such area that will be impacted by aging boomers—to be discussed more fully later—is health care. For instance, greater emphasis is already being placed on “genomics,” that is, the study of genes and their relation to the aging process (as indicators of health, mental vitality, and the potential for longevity). Additionally, greater attention is and will be given to specialty diagnosis and treatment, medical technologies, cloning of body parts, and eldercare and home assistance programs. Anti-aging products, therapies, and surgical procedures, etc. will also increase in response to the baby boomers’ attempt to stay active and maintain more youthful appearances.

Another area that has already begun to influence the baby boomers and will likely accelerate its affect on them in the future is financial management services. This area of financial services will, for example, assist boomers with long-term care issues and problems, especially those developing chronic health diseases or disorders. Bill–paying services, investment management, estate management and trust services will also likely become increasingly reshaped to meet aging baby boomer needs.

Housing and transportation arrangements for aging boomers will also become increasingly important and, in many cases, redefined according to customer needs. Retirement communities will expand, “maintenance-free” homes will be popular, and home security will expand and advance technologically. Transportation assistance services for the elderly will be enhanced to accommodate everyday travel needs. Motor vehicles will be increasingly designed and fitted to serve the older population, particularly in terms of style and utility.

Baby Boomers and Key Concerns for the Future
The literature speaks clearly to some primary areas of concern with regard to the aging baby boomer population. Most specifically, Dychtwald (1999, pp. 78-80) identifies five areas that could prove highly problematic unless Americans act immediately to counter their possible future detrimental effects. These five areas include: 1) the problems associated with elderly entitlements beginning at age 65, 2) the projected increase in chronic ailments among older Americans, 3) the anticipated burgeoning need for care-giving, 4) the poor economic or financial status of many future boomers, and 5) the lack of purposeful and enriching opportunities or activities for many boomers in old age.

The problems associated with elderly entitlements beginning at age 65. The average age life expectancy at birth (for men and women in the U.S.) has been increasing steadily over the past 100 years or so. This trend is expected to continue.

In 1900, the average life expectancy (ALE) for Americans was 49.2 years. In 1950, the ALE was 68.1 years, and by the 2000, it was 76.5. In 2020, the ALE is to hit roughly 80 years,¹⁶ and in 2030, the ALE is projected to be 83.9 years.¹⁷

As stated earlier, by 2030, there will be over 70 million older Americans, more than doubling the 1990 number. In the year 2000, about 13 percent of the population was 65+. In 2030, that rate will increase to 20 percent, or one in every five Americans.

Based on these projections, many experts believe that using the age of 65 as the point when typically old age entitlements become available (“full” Social Security benefits, Medicare, etc.) is both outdated and illogical. As evidenced above, there is little reason to doubt that 65 year-olds are statistically healthier today and can expect to live longer than their parents and grandparents. This will only intensify exponentially as the baby boomers grow older.

Considering the growing costs involved in maintaining the 65 year-old threshold for the wave of aging boomers over the next 30 years, the fiscal sustainability of entitlement programs comes into serious question. Thus, it is argued by many experts and observers that some adjustment to using 65 as the prime demarcation for old age should be revised to avoid possible fiscal bankruptcy of existing entitlement programs.

The projected increase in chronic ailments among older Americans. Despite current and anticipated medical breakthroughs, experts believe that chronic and long-term health care needs will expand.¹⁸ Overall, the National Center for Chronic Diseases reports that:

Currently, at least 80% of seniors have at least one chronic condition, and 50% have at least two. These conditions can cause years of pain, disability, and loss of function. About 12 million seniors living at home report that chronic conditions limit their activities. Three million older adults say they cannot perform basic activities of daily living, such as bathing, shopping, dressing, or eating. Their quality of life suffers as a result, and demands on family and care-givers can be challenging.¹⁹

According to the Agency for Healthcare Research and Quality, the number of Americans who will suffer functional disability due to arthritis, stroke, diabetes, coronary artery disease, cancer, or cognitive impairment is expected to increase at least 300 percent by 2049. With this in mind, it is believed that more focused attention and resources should be given to this approaching problem of chronic diseases. Prevention (healthy lifestyles, self-management techniques, early diagnostic testing, etc.), in particular, is pointed to frequently as a way to offset the magnitude of this coming surge of chronic disease among the elderly.²⁰

The anticipated burgeoning need for care-giving. Related to the chronic disease statistics and forecasts for the future, are the issues of general living assistance and care-giving for the aging baby boomers. Specifically, families—generally the children and grandchildren of baby boomers—are expected to become increasingly involved in caring for their parents. Indeed, families provide currently 80% to 90% of care for older persons. Interestingly, most are women family members.

Care-giving is defined in the literature as generally any activity provided to older persons to assist in their daily living needs and activities. While baby boomers see themselves as being less dependent on assistance in the future, the facts remain that as time progresses care-giving intervention to some extent will be inevitable. Elderly boomers will need supportive services ranging from personal care to housekeeping tasks to transportation services.

Children and relatives should become prepared for these eventualities. As care-givers, these family members will be advised to seek out some degree of educational and support services. Counseling will likely become important to deal with the stress and other effects of providing eldercare for their aging boomer parents. In the literature, the emotional impact of care-giving on families is one of the most commonly identified problems associated with aging.²¹ Thus, families of aging boomers should prepare themselves for the tasks associated with eldercare and the personal stress related to such care-giving.

The poor economic or financial status of many future boomers. Much of the literature supports the notion that many aging baby boomers are headed for a financial crisis—many facing the probability of poverty. Experts acknowledge that many boomers have accumulated considerable debt and, additionally, have failed to save money.

Percentage-wise, there is sufficient evidence over the past few decades to verify this acknowledgement by experts, especially with regard to savings. Consider for example that in the 1950s the average U.S. household savings rate was 11.7%. In the 1970s this rate had decreased to 10.8%, and by the 1990s, the rate was down to an all-time low rate of 4.9% (Dychtwald, 1999, pp. 80-81).

With the uncertainty of pension fund plans, negligible social security payments, and universally rising costs, many aging baby boomers are anticipated by economists and financial experts to be obliged to work in their retirement years. While boomers tend to be predisposed to stay in the workforce longer than previous generations, still the time will come for many to accept retirement for health or other reasons. Hence, greater attention should by given now to offset millions of aging baby boomers from being financially strapped in old age. This means seriously acting now to reduce debt and increase savings.

The lack of purposeful and enriching opportunities or activities for many boomers in old age. Today, 35+ million retirees watch an average 43 hours of television weekly. Other retirees spend a considerable amount of time napping, walking around malls, and surfing the Web. Is this the future for the aging baby boomers as well?

Many baby boomers anticipate being more physically active, being involved in part-time work, and participating in a variety of hobbies. Whether or not this becomes a reality for some, still there will be millions of aging boomers with time on their hands and not much opportunity to be active or to be doing something constructive.

As such, the challenge is to begin now to plan for a wide-range of purposeful things for boomers to do in the future. Leaders in the public and private sectors both need to concentrate on creating an environment that will make use of older people—their energies, talents, and experiences. Work and leisure should be integrated into systems, programs, and lifestyles that maximize the time which will be available for senior boomers to be creative and productive. Volunteerism is, for example, one area that needs particular attention and expansion. Retirement communities partnering with colleges and universities to continue life-long learning is another area of potentiality. Additionally, organizations specifically charged to engage the elderly in activities that have a “social context” for aging boomers to meet and interact should be focused on and built into communities across America.

Health Care and the Aged
Health care and quality of life for the aged 65+ are major issues and problems today, and will become increasingly so in the years ahead. For example, again, in the U.S. today roughly 80% of all persons ages 65 and over have at least one chronic condition, and 50% have at least two. These chronic conditions and their impact on older Americans breakdown as follows:

• Arthritis—This is the most common or prevailing chronic condition among the aged. It varies from a mere nuisance to complete disability. For those ages 65+ with arthritis, 89% are technically (by definition) “disabled.” According to the Centers for Disease Control and Prevention, 21 million adults aged 65 and older have arthritis.²²

• Diabetes—This is the 5th deadliest disease in the U.S. In CY 2002, more than 213,000 died from diabetes and its related complications. The total annual economic cost of diabetes in 2002 was estimated to be $132 billion, or one out of every ten health care dollars spent in the U.S. Approximately half of all diabetes cases occur today in people older than 55 years of age. The risk for “type 2” diabetes increases with age. Approximately 18.3% (8.6 million) of the U.S. population ages 60 and older have diabetes. ²³

• Heart Disease—This is the leading cause of death in the U.S. Three health-related behaviors—tobacco use, lack of physical activity, and poor nutrition—contribute markedly to heart disease.²⁴ It accounts currently for one-third of U.S. deaths among those aged 65-74, and 44 percent of deaths in those 85 and older.²⁵

• Injuries (and falls)—In CY 2001, approximately 2.7 million seniors were treated for injuries, especially falls. Many of these injuries resulted in long-term disabilities.²⁶

• Osteoporosis—This disease affects nearly one in four women over age 60, and almost half of women over age 75.

• Obesity—About 17% of adults aged 70 and older are currently obese. This percentage is expected to rise over the next decade. Obesity contributes to a host of other chronic diseases.

• Cancer—Individuals in the U.S. over 65 years of age are ten times more likely to develop cancer than those under 65, mainly due to weakened immune systems and longer exposure to cancer causing toxins.

• Stroke—After age 50, the rate of stroke doubles with each ten years of age. The major risk factor is high blood pressure.

• Alzheimer’s—Among those over 85 years-old, 45% are disabled by Alzheimer’s disease. ²⁷

Health Care Costs
In the U.S., greater and greater monies and resources on health care are spent each year. Consider, for example, that in 1960 health care costs represented about 5.2% of the gross national product (GNP). This percentage increased to 12.2% by 1990. Today the health care costs in the U.S. represent more than 14% of the GNP and are in excess of a trillion dollars annually. If this trend continues, which according to experts is likely, health care costs will increase to 31.5% of the GNP by the year 2020 (Dychtwald, pp. 112-113). According to the U.S. Department of Health and Human Services (2003, p. 2):

The aging of America will trigger a huge demand for health care and social services. Health care expenditures for a 65 year-old are now four times those for a 40 year-old. Seniors account for one-third of health care dollars spent in the United States, or over $300 billion each year. Because the population will be older and greater in number, overall U.S. health care expenditures are projected to increase 25% by 2030.

The population ages 65+ make up a disproportionate or uneven portion of these rising health care costs. Data clearly show, for example, that currently 13% of seniors utilize 24.1% of all physicians’ services, including 44% of all hospital-beds. Moreover, the costs associated with chronic diseases among the elderly have been described as “prodigious.”

For instance, heart disease is again the leading cause of death in the U.S., especially for seniors and, most particularly, for those aged 85 or older. In terms of costs, heart disease expenditures amount currently to over $185 billion annually in the U.S. One third of men suffer some form (direct or contributory) of cardiovascular disease, ranging from angina to arteriosclerosis to high cholesterol. One fifth of women also suffer from some form of heart ailment.

Cancer afflicts some 8.2 million seniors in America at a present cost of $107 billion annually. The rate of cancer accelerates with age, and some forms of cancer—like breast and prostrate cancers—are more prominent among the elderly.

Strokes among the elderly in the U.S. are the third leading cause of death. For those seniors that survive, the costs of treatment and rehabilitation total currently around $45 billion annually. Stroke victims also generally account for a high percentage of costs associated with long-term health care.

Arthritis is a generic term that includes a host of conditions affecting human joints and tissues. These include, for instance, osteoarthritis (“wear and tear” arthritis), rheumatoid arthritis, fibromyalgia (“musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances”), lupus, gout and bursitis. Most Americans 65+ are afflicted with some form of arthritis. It is calculated that direct and indirect health care costs associated with arthritis and osteoporosis are more than $80 billion.

Finally, Alzheimer’s is an extremely costly disease, amounting to well over $100 billion annually in health care expenditures. Alzheimer’s is a degenerative disease that affects memory and judgment and leaves patients unable to function normally. It generally affects persons aged 60 years and over, and increases substantially with age. For example, 2% of people aged 60+ currently have Alzheimer’s; 15% of those aged 75+ years have the disease; and 45% of those over 85 years-old are disabled by Alzheimer’s disease (Dychtwald, 1999, pp. 112-119).

Remedies and Solutions to the Health Care Crisis
Aging should not be synonymous to poor health. Granted as people age the body becomes more susceptible to disease and injury, but these can be minimized or eliminated altogether by adopting preventive measures or lifestyles. There is a great deal of scientific evidence to support such preventive strategies as those involving diet, exercise, non-use of tobacco, and the practice of other healthy behaviors. Thousands of Internet sites can be accessed speaking to the benefits of healthy behaviors, including the early detection of diseases, immunizations, injury prevention, and various health self-management techniques.

What preventive strategies are most effective in assuring good health for older persons? One overarching strategy is, of course, actively pursuing a healthy lifestyle by being physically active, eating a healthy diet, and avoiding tobacco. In terms of exercise, three important factors are undisputed in the literature. These are: 1) Physical exercise strengthens your body and makes it more fit and resilient; 2) exercise and physical activity will improve your health and fitness; and 3) physical exercise is an imperative for the older adult.

Mainly, the literature states that it is important to do something physical every day, for at least 20-30 minutes. This includes, for example, walking instead of driving short distances, or taking the stairs instead of using the elevator. Other recommended physical activities for seniors include yard work, cleaning your house, and simply doing chores of any kind that require physical exertion. Additionally, participating regularly in some type of physical recreation is encouraged among experts. Most importantly, aerobic exercise is a major factor in gaining and maintaining a healthy body. “Aerobic exercise elevates the heart rate and breathing for a sustained period. Aerobic activity improves the efficiency of your heart and lungs, helps control weight, and increases muscle and joint flexibility. Aerobic exercise will improve your health and fitness.”²⁸

Diet is similarly important, especially for older Americans. According to the Federal Interagency Forum on Aging-related Statistics, “diets were rated ‘good’ for a higher percentage of the population ages 65 and older (21%) than for persons ages 45 to 64 (13%). Even so, a majority of older persons reported diets that needed improvement (67%).”²⁹ Seniors should eat a balanced diet, one that includes the right mix of grains, vegetables, fruits, dairy products, and meat and poultry. A good diet will help fend off acute diseases as well as chronic ones. Statistics show that those older Americans that have balanced diets, eat in moderation, and have good vitamin regimens are less likely to get sick.³⁰

Another major strategy for improving seniors’ health is the early detection of diseases. Screening for the early detection of disease is imperative according to the literature. This is particularly true for older adults. However, for example, 50% of Americans 65+ have not had an examination for colorectal cancer, as recommended by the Centers for Disease Control and Prevention.

By all accounts, the most single important thing a senior can do to make possible the early detection of disease is to get an annual physical examination. Physicians will also examine blood and urine to see if there are any signs of disease. Often, a stress test is conducted to check cardiovascular and respiratory health.

Immunizations are another important strategy for the prevention of disease, especially influenza. According to the most recent available data, more than 50,000 people aged 65 years and older die each year from influenza. Immunizations are the surest way to prevent getting influenza and avoiding the risk of death. Nevertheless, in CY 2000, 34% of those persons 65+ were not immunized against influenza.

An additional health care strategy for older Americans is injury prevention. Again, falls present the largest risk for serious injury to persons 65+. The literature states that 50% of those aged 65 and over with a hip fracture, for example, do not return home after being hospitalized, without the provision of long-term care. Of this percentage, 25% die within one year after the fracture occurs.

More specifically, “greater than one-third of adults ages 65+ fall each year. In CY 2001, for instance, more than 1.6 million seniors were treated in emergency departments for fall-related injuries and nearly 388,000 were hospitalized. The most common fractures are of the vertebrae, hip, forearm, leg, ankle, pelvis, upper arm, and hand. In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion. Estimates are that this number is currently much higher. Lastly, given aging population projections, by the year 2040, the number of hip fractures is expected to exceed 500,000.” ³¹

Finally, one strategy for acquiring and sustaining good health as an older American is the utilization of self-management techniques. These self-management techniques can be gained by reviewing the appropriate literature and by instructional programs offered through various sources. The techniques are focused on processes that one can use to reduce the physical and emotional effects and costs of chronic diseases. Self-help courses dealing with the reduction of pain for arthritis, by way of example, has been evidenced to be of benefit to 20-40% of persons 65+.³²

Financial Issues and Preparedness for Retirement
As briefly stated earlier, many of those persons who will retire over the next 30 years—the so-called “baby boomer” generation—face possibly dire financial problems. More specifically, it is estimated that one-third of the baby boomers, again that cohort of individuals born from 1946 through 1964, have no ample savings to speak of, few if any investments, no pensions, and no possibility of inheritance. Based on the best available data, from CY 1999, it is worthy of note that over 25 million baby boomers possess “average household net assets of less than $1,000.”

Further, because of the combined lack of savings and the accumulation of debt, mainly speaking, it is estimated that another one-third of the boomers will likely be required to work a minimum of five years after the age of 65 in order to be financially secure in retirement. The remaining one-third of the baby boomers is expected to be financially “safe and sound.” This third group of boomers are described in the literature generally as those who have earned relatively high salaries, have saved adequately, and have good pension plans.

Today there are approximately 4 million elderly poor. Considering that roughly 20-25 million baby boomers (a third) will become elderly poor in the future, the consequences are—especially with regard to government entitlement programs—no less than catastrophic. This becomes more emphatic if one understands that over a twenty-year period, from 2010 to 2030, the 65 and older population will increase by 75% while those paying income taxes will increase by as little as 5% (Dychtwald, 1999, pp. 173-174). ³³

According to Dychtwald (1999, pp.174-175):

In the year 2013, just two years after the first baby boomers begin turning 65, the annual surplus of Social Security tax revenues over outlays will turn negative. By 2030, when all the surviving boomers will have reached 65, Social Security alone will be running an annual cash deficit of $666 billion.

If many boomers are expected to be poor at 65+, and government entitlement programs (e.g., Social Security, Medicaid, and Medicare) are to be overstretched, or even worse, what measures must be undertaken to remedy the impending situation? Again, Dychtwald offers four solutions. These include: 1) increase personal savings, 2) make pensions portable and flexible, 3) modify entitlement programs to fit those of greatest need, and 4) privatize some aspects of Social Security to increase returns.

Increase personal savings. One key to minimizing the future financial crisis of many aging baby boomers is to secure a fiscal plan and enact it immediately to pay off debt and save money at maximum earning rates. Many boomers, particularly those born between 1956 and 1964, have many more years in the workforce. It is by no means too late to buy less, use cash, and save more. Credit cards are a huge contributor to debt. In fact, overall, credit card debt is estimated to be somewhere in the neighborhood of $1.5 trillion in the U.S. today. However, boomers can greatly reduce or eliminate debt with good planning, according to experts, within the next five to seven years without major impact on their lifestyles. Similarly, careful savings can be planned and implemented over the next 10 to 20 years that will provide substantial resources when the late boomers finally retire. One study completed for Fortune magazine showed that if a 40 year-old couple simply set aside $150 monthly in a 401(k) plan, earnings would amount to $170,000 at age 65 (Wyatt, August 1996).

Make pensions available, portable and flexible. Pensions are the second leading income source for retirees, following Social Security. However, those who are included in pension plans makeup only half of the existing workforce in the U.S., or approximately 53 million persons. Hence, over 50 million workers, many of whom are employed by small businesses, i.e., those with less than 100 workers, have no pensions. This presents obvious widespread problems for the financial stability of millions of future retirees or baby boomers. Small businesses should, therefore, consider offering 401(k) plans or other pension programs. It is believed that many small businesses can afford to do this, for example, because they are hi-tech or companies that are prosperous due to current markets and profitability. Employees should be encouraged to be proactive in foregoing high salaries in small entrepreneurial companies for pension plan options.

In many cases, if an employee is vested and eligible for a pension, the employee is reluctant to move to another employer since the pension is in all likelihood non-portable. However, given the nature of today’s economy, workforce needs and opportunities, many people—especially the late boomers—take jobs and lose the full potential of their former pension plans. Frequent job changes, which is well within today’s norm, is a tough reality, but is unavoidable, and accepted among millions of workers. Greater incentives to allow for pension portability would offset the financial stress of future retirees. Additionally, elected officials may want to revisit the concept of mandatory pension portability, a topic or issue of considerable concern and interest in the 1990s.

Modify entitlement programs to fit those of greatest need. Many entitlement programs, including Social Security, are available to everyone whether rich or poor. Estimates currently indicate that there are over a million senior millionaires who are eligible to receive Social Security and other government benefits. Additionally, government entitlements of more than $15.5 billion are currently going to persons 65+ who have incomes over $100,000. Thus, in the opinion of many experts, huge sums of entitlement monies are going to those who, in reality, do not need them.

Many seniors with little or no additional income currently depend on Social Security and other government entitlement programs to survive. More than 10% of seniors who are ages 65 to 74 are presently in poverty. For those 75 years and older, some 12.5% (well over two million) live in poverty. If these groups are looked at by race and ethnicity, African Americans and Hispanics suffer most.

One solution to this problem is to “means test” entitlement programs based on need or income. This concept has been rejected by a majority of the members of Congress, despite repeated attempts, since the 1950s. But some experts argue that a government program that evaluates the real financial needs of those persons 65+ would be more fair and equitable. Thus, instead of determining Social Security payments solely on how much a beneficiary has contributed to the system, assessing the real financial needs of a beneficiary would be more productive—i.e., providing targeted assistance to the elderly and poor.

With one-third of the baby boomers predicted to become likely financially strapped in old age, is it reasonable to look at “means testing” Social Security in some way? Many experts believe it is, mainly in light of a humanistic purpose or aim to assist those who have struggled for whatever reasons to make a living, have had no opportunity to have access to a pension plan, and have not been able to save or make investments because of low wages. Other experts and observers look beyond mere compassion, and believe that it does not make sense to jeopardize the financial stability of Social Security to serve the well-off or wealthy that have essentially no need of entitlement benefits.

Privatize some aspects of Social Security to increase returns. Privatization is a process whereby functions that are normally run by the government are delegated (transferred, sold or divested) to the private sector. These include some type of contracting or “outsourcing,” franchising, bidding competitively, selling assets outright, etc. Many experts and observers alike believe that privatization creates value-added competition which in turn promotes innovation, efficiency, and greater effectiveness. Such competition, it is argued, invariably drives down costs and ratchets up performance. Further, it is believed that competition forces management to identify the true cost of doing business and obliges government to use some form of performance measurement to gauge results.

To remedy a possible (many would say probable) financial collapse of the Social Security system due to the on-coming pressures of the aging boomers, it is suggested—at least by some—that privatizing some portion of the Social Security system makes good sense. This means specifically that some Social Security funds, with strict oversight and sound fiscal management practices, be placed in the markets. Such an influx of public monies into stocks and mutual funds would not only invigorate the marketplace but, more importantly, yield higher returns for Social Security growth. Many experts believe that the current method of directing all Social Security investments into low-return treasury securities is both outdated and fiscally irresponsible.

Proponents of privatizing some portion of Social Security funds argue that many states have already done this and that the returns, over the long-term, have proven successful in increased earnings. Some of these states include California, New York, Texas and Florida (also South Carolina). Opponents argue that though some states’ pension or retirement plans have benefited from the bull-markets of the mid-to-late 1990s, downswings in the value of stocks and mutual funds have erased much of the states’ overall earnings.

Aging and South Carolinians
As is the case nationwide, South Carolina possesses a relatively large segment of population that is growing older rapidly. Currently, South Carolina has approximately 638,000 persons who are age 60 and over. It is estimated that by 2025 this number will more than double to 1,290,000 persons (AARP, 2000, p.1). Other estimates are even greater.³⁴

Today, the fastest growing segments of this “gray wave” are those South Carolinian’s aged 75-84, and those 85+. Data indicate that from 1980 to 2000, those persons 75 to 84 years old grew by 123.9%. For the same period, those aged 85 and over increased by a noteworthy 240.9% (AARP, 2000, p. 9).
Furthermore, in CY 2000, 27.9% (1,121,000 persons) of the state’s population were aged 50 and older. According to U.S. Census data,³⁵ several characteristics are additionally significant with regard to South Carolina’s population ages 50+. These characteristics include:

• 75.6% are Caucasian, compared to 67.2% of the total population. This is an increase from 66.7% of the 50+ population in 1950.
• 55.3% are female, compared to 51.4% of the total population. Females 50+ outnumbered males 52.8% to 47.2% in 1950.
• Life expectancy for a 55 year-old female is 82 years, which is 5.4 years longer than for a male. In 1950 life expectancy for females was 71.1 years, which was 5.5 years longer than for males.
• 50,997 persons 50+ “moved” (net in-migration)³⁶ into the state between 1997 and 2002.
• 42.3% of residents 65+ have less than a high school education.
• As of CY 1999, 11.7% of those 65–74 had incomes below the poverty level, and 17.0% of those 75 and over lived in poverty. Percentages increase significantly among African Americans—28.2% of those 65–74 and 34.3% of those 75 and over were below the poverty level. The 1999 poverty level was $8,667 for one person and $11,214 for a two-person household. The 2002 poverty level is $8,860 for one person and $11,940 for a two-person household.

Financial Status of Older South Carolinians
For those South Carolinians ages 50+, Social Security and pensions are the main income sources for those retired. Of this group, greater than 25% rely entirely on Social Security.³⁷ In CY 2000, the state was composed of 411,216 retired persons who received Social Security benefits averaging $812 per month. This computes to a total annual benefit payout of approximately $4 billion.³⁸ Overall, regarding all income sources, a 2002 survey showed that state non-working retirees incomes broke out, on average, in the following ways: 44% Social Security; 25% employer-funded plans; 17% personal savings; 5% other government benefits; 5% sale of home; 1% other; and 0.5% family support.³⁹

U.S. Census data for CY 2000 indicate additionally that 13.5% of all state residents had incomes below the poverty level. Those persons 65+ who were at or below the poverty level composed 13.9% of the state population in this age group. The poverty level per annum currently is $9,310 for one person ($776 per month) and $12,490 ($1,040.83 per month) for a two person household. According to the most recent data available (August 2004), 37.5% of those state residents 65+ have incomes less than 200% of poverty, that is, $18,620 per annum for one person and $24,980 per annum for two persons.⁴⁰

Older women and African Americans are most affected by poverty in South Carolina. Women are at particular risk of financial hardship in old age, especially African American women. As discussed earlier, women on average live longer than men, and many women have not worked and are dependent on their husband’s Social Security and other benefits.

More specifically, in CY 2000, the annual median income for women in South Carolina who were aged 65 and older, and living alone, was $13,721. This contrasts with single men aged 65+ whose annual median income was $19,330. Further, roughly 35% of African-American women aged 65+, and single, lived in poverty compared to 11.8% of their female Caucasian counterparts. And in terms of strictly race, statistics showed in CY 2000 that 9.2% of Caucasians 60+ lived in poverty in South Carolina. This contrasts significantly with 30.8% of African Americans.

It should be mentioned that an important contributing factor to the financial stability of older South Carolinians is educational attainment status. Generally, educational attainment differs among state residents 65+. For example, in CY 2000, 42.3% of those aged 65+ had less than a high school education, and 22% had less than a ninth-grade education. Those older South Carolinians with a high school diploma or higher equaled 57.7%. In terms of college attainment, only 15.5% of seniors possessed a bachelor’s or higher degree. Those aged 65+ with a graduate degree were 5.4%.

Lastly, a number of South Carolinians at retirement age still work, either full- or part-time. Most of those persons 65+, who receive some form of retirement income, work part-time to supplement Social Security and other sources of retirement income. In CY 2001, U.S. Census data indicate that employment, on average, provided 24% of income for those 65 years and older (12.5% of the total South Carolina workforce). In particular, over 42.2% of those ages 60-64 were employed, but with increasing age, fewer older South Carolinians were in the workforce. Of those persons ages 65-69, 22% were working; and for those ages 75+, only 5.4% were employed.

Health Status for Older South Carolinians
In South Carolina, as might be expected, many seniors suffer from chronic health problems similar to those experienced nationally. Obesity, arthritis, heart problems, stroke, etc. all are chronic ailments affecting thousands of older South Carolinians. To give one example, South Carolina is currently grappling with the impact of Alzheimer’s and dementia. It is estimated that the current “lifetime cost” for treating and caring for those in the state with Alzheimer’s is approximately $174,000 on average. Additionally, those having the disease currently vary with age: 3% of those aged 65-74; 18.7 % of those aged 75-84; and 47.2 % of those aged 85+. In CY 2000, there were an estimated 43,020 persons in South Carolina with Alzheimer’s. By the year 2025, this number is expected to increase to 125,190. As stated previously, costs associated with Alzheimer’s are enormous. In CY 2000, the total related costs for those with Alzheimer’s in South Carolina were $794 million. By 2025, the costs are projected to be nearly $8 billion (AARP, 2000, p. 6).

Prevention against chronic diseases again is a major initiative of the state and its local governments, including private health experts and practitioners across South Carolina. Millions of dollars are spent annually to increase the awareness and importance of diet, exercise, and the cessation of smoking. For instance, the State Department of Health and Environmental Control provides a program for in-home prevention services, which currently operates in 12 counties. It is a program that is free to those persons 65+ and basically provides for a registered nurse to make home visits for health screening and health planning purposes.

Mortality rates also help shed light on the health of older South Carolinians. For those state residents who are ages 65-74, the primary diseases that cause death include cancer (31.8%), heart disease (26.9%), respiratory disease (6.7%), stroke (6.3%), and diabetes (4.1%). All “other causes” account for the remaining 24.4% of deaths. For those persons 75+, the main causes of death are as follows: heart disease (30.7%), cancer (17.4%), stroke (11.1%), respiratory disease (5.2%), Alzheimer’s disease (4.4%), and “other” causes (31.2%).

The principal causes of hospitalization for older South Carolinians reflect the age groupings cited above. Chest pain is the most frequent symptom among all ages 45+. For seniors 65 years and older, the chief causes are heart failure and shock. Total hospital admissions for those persons hospitalized in FY 2002, ages 65-74, were 73,142. For those ages 75+, total hospital admissions numbered 97,693.

Nursing home and health long-term care are other important areas of need for older South Carolinians. It should be noted though that Medicare generally does not cover the expenses associated with long-term care. It does cover, however, specifically “skilled nursing care,” but this care is limited to 20 days. Partial payments are also made for nursing care that extends beyond 20 days, not exceeding 100 days total.

In South Carolina, as is the case nationally, Medicaid provides for the bulk of nursing home and extended care for seniors. This is limited of course by the criteria for eligibility, which is based mainly on income status. Eligibility requires a person to be 65 years of age, and further, requires income limitations equal to $1,657 per month (FY 2003). Other eligibility requirements may additionally apply.⁴¹

In South Carolina, approximately 40% of those persons 65+ utilize nursing home facilities for less than 12 months at a stretch, while 16% stay for less than three months. As of FY 2001, the most recent data available, the daily cost of nursing home care averaged about $103. The federal and state governments pay for roughly 85% of this nursing home care and patients pick up the remaining 15%.

There are presently approximately 19,000 licensed nursing beds in 196 facilities across South Carolina. Occupancy rates are high. In January 2003, the occupancy rate was 92%. Typically, there is a waiting list for nursing home placement in South Carolina.⁴²

Home health care is another avenue for serving the needs of older South Carolinians as well. Many seniors do not require institutionalization, but simply need assistance or care that can be provided for in their own homes. Because of frailty or other health reasons, seniors may require assistance daily activities like those associated with shopping, preparing meals, etc. Others may require physical therapy, health screening, or some other specialized heath care procedure or assistance. According to data provided by the S.C. Department of Health and Human Services, 29% of those South Carolinians ages 55-64 currently require home health care services. Forty percent of those 65-74 require home care services as well, and for those ages 75-84 the percentage increases to 67%. The most elderly, i.e., 85+, require intensive home care assistance (87%).⁴³

Seniors use more medications and with greater frequency than their younger counterparts. In South Carolina, those 65+ use medications four times more per capita as non-seniors. In a study conducted in the early 1990s, it was found that many seniors were either under-medicated or over-medicated. For those seniors taking too much medication or suffering from adverse reactions, it was discovered that 28% required hospitalization. The percentages of those age groupings using medications are as follows: 63% for those ages 55-64; 75% for those ages 65-84; and 82% for those 85+.⁴⁴

The costs associated with health care services for seniors in South Carolina are high and are increasing rapidly. In FY 1990, for example, the costs associated only with nursing home care and home care, including drugs, totaled $232 million. In FY 1995, costs had risen to $403 million. By FY 2002, the total costs were $623 million. The FY 2002 figures breakdown as follows: $93.6 million for home and community health care; $318.8 million for nursing facilities; and $111.9 million for prescription drugs.

Finally, it should be recognized that the mental health of many seniors presents some serious problems for the state. The S.C. Department of Mental Health and the S.C. Department of Health and Human Services, based on data contained in a report entitled Mature Adults in South Carolina 2003, found that 25% of seniors “felt lonely or depressed.” Another 15% stated that they suffered from stress, 22% had difficulty sleeping, and 17% “felt afraid or like crying.”⁴⁵ Additionally, the state Department of Mental Health reported that in FY 2001, 907 persons 50+ were hospitalized for some psychiatric disorder and 840 seniors were treated in nursing care facilities for mental health-related problems. These data of course do not reflect private mental health problems and services of seniors, including those seniors who do not seek or refuse mental health services.

Conclusion
The “aging of Americans” is not only of statistical importance, but the challenges it poses are of equal significance. Those Americans, ages 65 and over, will double in 25 years to nearly 72 million persons. Such an unprecedented population boom of oldsters will, by all accounts, transform society. The issues associated with older Americans and their health and financial well-being particularly stand out.

In this article, the demographics of aging Americans have been reviewed speaking to not only population figures but also other critical factors, including gender, race, marital status, income and education. Additionally, focus was given to the aging baby boomers and their impact on the future marketplace, health care, and financial stability.

Particular attention was devoted in this article to the health of the aging. Those chronic ailments that are and look most prevalent for the future were discussed briefly. Also, health care costs and various solutions were discussed succinctly.

Financial issues and the preparedness of seniors for retirement were touched upon as well. Of concern are personal savings, investments and pensions. The literature and data indicate that for many aging Americans, their financial situations may not be good.

And finally, some limited discussion was given to older South Carolinians. Specifically, their demographics were reviewed as were their financial and health status. Like the nation at-large, many aging South Carolinians face problems that need to be more fully examined today so that their futures will be positive ones.

References
Administration on Aging. (2003). Statistics on the aging population. Retrieved June 28, 2004 from http://www.aoa.gov/prof/Statistics/statistics.asp.
Agency for Healthcare Research and Quality. (n.d.). Retrieved July 23, 2004 from http://www.ahcpr.gov/research/elderdis.htm#Introduction.
American Association of Retired Persons. (1998). Baby boomers envision their retirement: An AARP segmentation analysis. Executive summary. Washington, DC: AARP.
Association of American Retired Persons. (2000). Investing in South Carolina’s seniors. Washington, DC: AARP.
American Association of Retired Persons. (2003). Boomers at midlife: The AARP life stage study. Executive summary. Washington, DC: AARP.
American Association of Retired Persons. (2004, June). Baby boomers envision their retirement II. Statistics from Roper survey. Washington, DC: AARP. Retrieved July 21, 2004 from http://research.aarp.org/econ/boomers_envision_2.pdf.
Dychtwald, K. (1999). Age power: How the 21st century will be ruled by the old new. New York, NY: Putnam.
Employee Benefits Research Institute. (2002). Retirement confidence study. Retrieved August 10, 2004 from http://www.scmatureadults.org/MA03_who.asp.
Freedman, M. (1999). Prime time: How baby-boomers will revolutionize retirement and transform America. New York, NY: PublicAffairs, Perseus Books Group.
National Center for Chronic Diseases. (2002). Retrieved July 23, 2004 from http://www.cdc.gov/nccdphp/aag/aag_aging.htm.
Office of the Lieutenant Governor. (2004, August). State plan on aging: 2005-2008. Draft. Columbia, SC: Bureau of Senior Services, Office of the Lieutenant Governor.
Peterson, P. (1996). Will America grow up before it grows old? New York, NY: Random House. Quoted in Freedman, M. (1999).
Smith, D. (2003, April). The older population in the United States: March 2002. Current Population Reports. Washington, DC: U.S. Census Bureau.
U.S. Department of Health and Human Services. (2003). Healthy aging: Preventing disease and improving quality of life among older Americans. Washington, DC: U.S. Department of Health and Human Services.
Wyatt, J. (1996, August 19). “What you need to know to survive and prosper.” Fortune. In Dychtwald, p. 188.

About the Author
Richard D. Young, B.A., M.A. is director of governmental research with the Institute for Public Service and Policy Research at the University of South Carolina. He conducts research on a myriad of public policy and public adminis-tration topics relating to state and local governments. Mr. Young can be reached at young-richard@sc.edu.

Endnotes
1. Administration on Aging. (2003). Statistics on the aging population. Retrieved June 28, 2004 from http://www.aoa.gov/prof/Statistics/statistics.asp.
2. Peterson, P. (1996). Will America grow up before it grows old? New York, NY: Random House. Quoted in Freedman, M. (1999), p. 14.
3. Retrieved June 29, 2004 from http://www.aoa.gov/prof/Statistics/profile/2003/2.asp.
4. Retrieved June 29, 2004 from http://www.prcdc.org/summaries/aging/aging.html.
5. Retrieved June 29, 2004 from http://usgovinfo.about.com/library/weekly/aa051801a.htm.
6. Op. cit., http://www.prcdc.org/summaries/aging/aging.html.
7. Retrieved July 15, 2004 from http://www.factfinder.census.gov/jsp/saff/SAFFInfo.jsp?_pageId=tp2_aging.
8. Op. cit., http://www.factfinder.census.gov/jsp/saff/SAFFInfo.jsp?_pageId=tp2_aging.
9. Percentages sum greater than 100% since individuals could classify themselves as more than one race.
10. Percentages sum greater than 100% since individuals could classify themselves as more than one race.
11. Op. cit., http://www.prcdc.org/summaries/aging/aging.html.
12. Retrieved July 19, 2004 from http://www.aoa.gov/prof/Statistics/profile/2003/4.asp.
13. Ibid.
14. Retrieved July 19, 2004 from http://www.aoa.gov/prof/Statistics/future_growth/aging21/demography.asp.
15. American Association of Retired Persons. (2004, June). Baby boomers envision their retirement II. Statistics from Roper survey. Washington, DC: AARP. Retrieved July 21, 2004 from http://research.aarp.org/econ/boomers_envision_2.pdf.
16. Retrieved July 23, 2004 from http://www.prb.org/Content/NavigationMenu/Other_articles/April-June_20001/Immigrations_Role_in_U_S__May_Increase_as_Last_Boomers_Retire1.htm.
17. Retrieved July 23, 2004 from http://demog.state.nc.us/demog/extrends.html.
18. Today, according to Dychtwald, there are 47% of those aged 85+ who have some form of dementia. Alzheimer is one such chronic disease. Disabilities also contribute to many chronic conditions of the aged (85+), such as hip fractures and stroke.
19. National Center for Chronic Diseases. (2002). Retrieved July 23, 2004 from http://www.cdc.gov/nccdphp/aag/aag_aging.htm.
20. Ibid.
21. Retrieved July 25, 2004 from http://www.hec.ohio-state.edu/famlife/bulletin/volume.2/bull24f.htm.
22. Retrieved July 27, 2004 from http://www.aoa.dhhs.gov/.
23. Retrieved July 27, 2004 from http://www.diabetes.org/diabetes-statistics/seniors.jsp.
24. Retrieved July 27, 2004 from http://www.cdc.gov/aging/health_issues.htm#chronic.
25. Retrieved July 27, 2004 from http://www.biorap.org/rg/rgagemostcommon.html.
26. Retrieved July 27, 2004 from http://www.subnet.nga.org/ci/brief2.html.
27. Retrieved July 27, 2003 from http://www.biorap.org/rg/rgagemostcommon.html.
28. Retrieved August 3, 2004 from http://naturalhealthperspective.com/.
29. Retrieved August 3, 2004 from http://www.agingstats.gov/chartbook2000/healthrisks.html#Indicator%2023.
30. See http://healthlink.mcw.edu/article/1002896094.html.
31. Retrieved August 4, 2004 from http://www.cdc.gov/ncipc/factsheets/falls.htm.
32. See http://www.geronto.org/Vitalaging/May2001/arthritis.htm.
33. See discussion by the Congressional Budget Office (2004, March) at http://www.cbo.gov/showdoc.cfm?index=5195&sequence=0.
34. For South Carolina, the U.S. Census Bureau estimates that the 2025 population of ages 60+ will be 1,359,120. Office of the Lieutenant Governor. (2004, August). State plan on aging: 2005-2008. Draft. Columbia, SC: Bureau of Senior Services, Office of the Lieutenant Governor, p. 1.
35. Retrieved August 9, 2004 from http://www.scmatureadults.org/MA03_who.asp.
36. Net in-migration is the total amount of persons coming into or moving out of the state.
37. The data source is the U.S. Census 1990.
38. Retrieved August 9, 2004 from http://www.scmatureadults.org/MA03_who.asp.
39. Employee Benefits Research Institute. (2002). Retirement confidence study. Retrieved August 10, 2004 from http://www.scmatureadults.org/MA03_who.asp. 40. Retrieved August 10, 2004 from http://www.scmatureadults.org/MA03_who.asp.
41. Retrieved August 10, 2004 from http://www.scmatureadults.org/MA03_how.asp.
42. Ibid.
43. Ibid.
44. Ibid., p. 9.
45. Retrieved August 10, 2004 from http://www.scmatureadults.org/MA03_how.asp.