THE NUMBER OF PEOPLE age sixty-five and over in the United States increased dramatically during the 1900s as life expectancy at birth rose from forty-seven years in 1900 to more than seventy years by the end of the century. Affecting each of us personally in our families and communities, a demographic explosion is taking place; the number of older adults will become larger and more diverse ethnically and racially in the twenty-first century. The number of people age sixty-five and over is projected to increase from about 34 million in the late 1990s to 80 million by 2050. The most rapidly growing proportion of the population, those age eighty-five and over, is expected to increase fivefold between 1996 and 2050. The phenomenon of a rapidly increasing older adult population is not limited to the United States; it is part of an unprecedented change that is occurring throughout the world.
Relatives and friends continue to provide the majority of assistance to older adults, but major societal changes since the 1970s have resulted in alterations in caregiving for this age group in the United States and other industrialized countries. In addition to increased life expectancy, more women are engaged in paid employment outside the home and more marriages are ending in divorce, two other developments that have contributed to changes in the family and other social institutions.
A reality of modern life is that older adults and their families often find that care provided by family and friends, even when supplemented by home care from paid caregivers, is inadequate to meet their needs. Although many dread nursing home placement, the changes in life expectancy and the lack of availability of family members to serve as caregivers have meant that more people are turning to nursing homes to provide the nec-