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  • By Theodore Lewis

Prepare for a ‘very senior tsunami’

Updated: Jan 6, 2021

The first wave of a powerful tsunami has already reached Guam, and the second and third waves are on their way with exponentially increasing force. Specifically, I’m addressing the Very Senior Demographic Tsunami.

Let me explain.

The 2010 U.S. census of Guam shows that between 2000 and 2010 the total population increased by 2.9 percent. When the upcoming 2020 census is completed and published, the overall population in Guam will show about another 5 to 6 percent decade increase. However, the over-65 population from 2000 to 2010 went up by 31 percent.

When the 2020 census population is known, the over-65 population on Guam will have increased more than 40 percent since 2010.

Many people in the 65-74 age group on Guam live relatively tranquil lives and with the support of family, have little dependence or need for services outside the home. However, people in the very senior 75-84 and 85-plus age groups are much more dependent on others for maintaining a reasonable quality of life, as physical limitations have set in and the incidence of Dementia related problems go up dramatically.

Between the census of 2,000 and 2,010 the 65-74 Guam population only increased by 18 percent (from 5,860 to 6,919). However, the 75-84 Guam population increased by 57 percent (from 2,000 to 3,135) from 2000 to 2010. In that same time period, the 85+ population on Guam increased by 95 percent (from 355 to 693).

This huge increase in Guam's over-75 population is the “very senior tsunami” to which I am referring.

The 2020 census will show even greater numbers of population in each of these higher age groups. And let’s remember, 2020 is not some futuristic date. It’s already here.

Each one of these numbers is somebody's mother or somebody's father. So, what do we do with mom and/or dad?

A majority of the population on Guam are either Chamoru or Filipino. Traditionally, these cultures have taken care of their aging parents at home. As a result, independent living and assisted living options have not yet developed on Guam. Unpaid family caregivers, home health resources and day care programs have been providing for most of the long-term services and supports for the very seniors of Guam.

But there comes a point at which even the most caring families in today's world are unable to meet the demanding physical and/or emotional needs of their aging parents, particularly when dementia and Alzheimer’s occur.

Alzheimer’s is the most devastating disease affecting the elderly population of America today. Currently, 5.8 million Americans are afflicted with this dreaded disease, and 81 percent of these are over age 75. Additionally, 17 percent of people between 75-84 have the disease and 32 percent of those 85 and over have it.

Applying these national numbers to Guam's 2010 population means there could have been about 754 of Guam's 3,828 over 75 population in 2010 who had the disease. Understanding that Guam's 2020 population over 75 is now well over 5,000 means that there are currently more than 1,000 Guam residents over 75 who have Alzheimer's.

During the next few years, that number will grow substantially thus putting more burden on the already strained long-term services and supports on Guam.

As I look at the senior service options for the elderly outside of the home in Guam, I see that there are several excellent daycare programs, some specializing in caring for those with Alzheimer's.

Sadly, there are very few residency options for families who can no longer care for mom or dad at home.

There are only 100 nursing home beds on Guam, 60 beds operated by St. Dominic's and 40 beds operated by Guam Memorial Hospital. While U.S. utilization of nursing home beds in the past few years has softened somewhat, Guam's ratio of nursing home beds to 1,000 population over 85 is 69.3 compared to the U.S. national average of 269.9.

Where are the housing resources to help the people of Guam deal with this?

Currently there are no assisted living programs in Guam and zero assisted living memory care programs available in Guam.

Managing successful assisted living and memory care programs is not an easy thing and requires experienced operators. Perhaps some can now be persuaded to come to Guam.

It’s time to find a place for mom and/or dad.

Theodore Lewis is former CEO of Guam Memorial Hospital and has a healthcare consulting business based out of Portland, Maine. He is collecting stories about lessons learned in life and can be reached at


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