By Judith Graham JANUARY 16,
2020
Within
10 years, all of the nation’s 74 million baby boomers will be 65 or older. The
most senior among them will be on the cusp of 85.
Even
sooner, by 2025, the number of seniors (65 million) is expected to surpass that
of children age 13 and under (58 million) for the first time, according
to Census Bureau projections.
“In the
history of the human species, there’s never been a time like [this],” said Dr.
Richard Hodes, director of the National Institute on Aging, referring to the
changing balance between young people and old.
What
lies ahead in the 2020s, as society copes with this unprecedented demographic
shift?
I asked
a dozen experts to identify important trends. Some responses were aspirational,
reflecting what they’d like to see happen. Some were sobering, reflecting a harsh
reality: Our nation isn’t prepared for this vast demographic shift and its
far-reaching consequences.
Here’s
what the experts said:
A
crisis of care. Never have so many people lived so long, entering the
furthest reaches of old age and becoming at risk of illness, frailty,
disability, cognitive decline and the need for personal assistance.
Even if
scientific advances prove extraordinary, “we are going to have to deal with the
costs, workforce and service delivery arrangements for large numbers of elders
living for at least a year or two with serious disabilities,” said Dr. Joanne
Lynn, a legislative aide on health and aging policy for Rep. Thomas Suozzi
(D-N.Y.).
Experts
caution we’re not ready.
“The
cost of long-term care [help in the home or care in assisted-living facilities
or nursing homes] is unaffordable for most families,” said Jean Accius, senior
vice president of thought leadership at AARP. He cited data from the Genworth Cost of Care Study:
While the median household income for older adults was just $43,696 in 2019,
the annual median cost for a private room in a nursing home was $102,204;
$48,612 for assisted living; and $35,880 for 30 hours of home care a week.
Workforce
issues are a pressing concern. The need for health aides at home and in medical
settings is soaring, even as low wages and poor working conditions discourage
workers from applying for or staying in these jobs. By 2026, 7.8 million workers of
this kind will be required and hundreds of thousands of jobs may go unfilled.
“Boomers
have smaller families and are more likely to enter old age single, so families
cannot be expected to pick up the slack,” said Karl Pillemer, a professor of
human development at Cornell University. “We have only a few years to plan
different ways of providing care for frail older people to avoid disastrous
consequences.”
Living
better, longer. Could extending “healthspan,” the
time during which older adults are healthy and able to function independently,
ease some of these pressures?
The
World Health Organization calls this “healthy life expectancy” and publishes
this information by country. Japan was the world’s leader, with a healthy life
expectancy at birth of 74.8 years in 2016, the most recent year for which data
is available. In the U.S., healthy life expectancy was 68.5 years out of a total average life
expectancy of 78.7 years.
Laura
Carstensen, director of Stanford University’s Center on Longevity, sees some
cause for optimism. “Americans are beginning to exercise more” and eat more
healthful diets, she said. And scientific studies published in recent years
have shown that behavior and living environments can alter the trajectory of
aging.
“With
this recognition, conversations about aging societies and longer lives are
shifting to the potential to improve quality of life throughout,” Carstensen
said.
Other
trends are concerning. Notably, more than one-third of older adults are obese, while 28% are physically inactive,
putting them at higher risk of physical impairments and chronic medical
conditions.
Rather
than concentrate on treating disease, “our focus should shift to health
promotion and prevention, beginning in early life,” said Dr. Sharon Inouye, a
professor at Harvard Medical School and a member of the planning committee for
the National Academy of Sciences’ Healthy Longevity Global Grand
Challenge.
Altering
social infrastructure. Recognizing the role that social and
physical environments play in healthy aging, experts are calling for
significant investments in this area over the next decade.
Their
wish list: make transportation more readily available, build more affordable
housing, modify homes and apartments to help seniors age in place, and create
programs to bring young and old people together.
Helping
older adults remain connected to other people is a common theme. “There is a
growing understanding of the need to design our environments and social
infrastructure in a way that designs out loneliness” and social isolation, said
Dr. Linda Fried, dean of Columbia University’s Mailman School of Public Health.
On a
positive note, a worldwide movement to create “age-friendly communities”
is taking hold in America, with 430 communities and six states joining an effort
to identify and better respond to the needs of older adults. A companion effort
to create “age-friendly health systems”
is likely to gain momentum.
Technology
will be increasingly important as well, with aging-in-place likely made easier
by virtual assistants like Alexa, video chat platforms like Skype or FaceTime,
telemedicine, robotic caregivers and wearable devices that monitor indicators
such as falls, according to Deborah Carr, chair of the sociology department at
Boston University.
Changing
attitudes. Altering negative attitudes about aging — such as a widespread
view that this stage of life is all about decline, loss and irrelevance — needs
to be a high priority as these efforts proceed, experts say.
“I
believe ageism is perhaps the biggest threat to improving quality of life for
[older] people in America today,” Harvard’s Inouye said. She called for a
national conversation about “how to make the last act of life productive,
meaningful and fulfilling.”
Although
the “OK Boomer” barbs that
gained steam last year testify to persistent intergenerational tension, there
are signs of progress. The World Health Organization has launched a global
campaign to combat ageism. Last year, San Francisco became
one of the first U.S. cities to tackle this issue via a public awareness
campaign. And a “reframing aging” toolkit developed
by the FrameWorks Institute is in use in communities across the country.
“On the
bright side, as the younger Baby Boom cohort finally enters old age during this
decade, the sheer numbers of older adults may help to shift public attitudes,”
said Robyn Stone, co-director of LeadingAge’s LTSS (long-term services and
supports) Center @UMass Boston.
Advancing
science. On the scientific front, Dr. Pinchas Cohen, dean of the
Leonard Davis School of Gerontology at the University of Southern California,
points to a growing recognition that “we can’t just apply one-size-fits-all
guidance for healthy aging.”
During
the next 10 years, “advances in genetic research and big data analytics will
enable more personalized — and effective — prescriptions” for both prevention
and medical treatments, he said.
“My
prediction is that the biggest impact of this is going to be felt around
predicting dementia and Alzheimer’s disease as biomarker tests [that allow the
early identification of people at heightened risk] become more available,”
Cohen continued.
Although
dementia has proved exceptionally difficult to address, “we are now able to
identify many more potential targets for treatment than before,” said Hodes, of
the National Institute on Aging, and this will result in a “dramatic
translation of discovery into a new diversity of promising approaches.”
Another
potential development: the search for therapies that might slow aging by
targeting underlying molecular, cellular and biological processes — a field
known as “geroscience.” Human
trials will occur over the next decade, Hodes said, while noting “this is still
far-reaching and very speculative.”
Addressing
inequality. New therapies spawned by cutting-edge science may be
extraordinarily expensive, raising ethical issues. “Will the miracles of
bioscience be available to all in the next decade — or only to those with the
resources and connections to access special treatment?” asked Paul Irving,
chairman of the Milken Institute’s Center for the Future of Aging.
Several
experts voiced concern about growing inequality
in later life. Its most dramatic manifestation: The rich are living
longer, while the poor are dying sooner. And the gap in their life expectancies
is widening.
Carr
noted that if the current poverty rate of 9% in the older population holds over
the next decade, “more than 7 million older persons will live without
sufficient income to pay for their food, medications and utilities.” Most
vulnerable will be black and Latina women, she noted.
“We now
know that health and illness are affected by income, race, education and other
social factors” and that inequalities in these areas affect access to care and
health outcomes, Pillemer said. “Over the coming decade, we must aggressively
address these inequities to ensure a healthier later life for everyone.”
Working
longer. How will economically vulnerable seniors survive? Many
will see no choice but to try to work “past age 65, not necessarily because
they prefer to, but because they need to,” Stone said.
Dr.
John Rowe, a professor of health policy and aging at Columbia University,
observed that “low savings rates, increasing out-of-pocket health expenditures
and continued increases in life expectancy” put 41% of Americans at
risk of running out of money in retirement.
Will
working longer be a realistic alternative for seniors? Trends point in the
opposite direction. On the one hand, the U.S. Bureau of Labor Statistics suggests
that by 2026 about 30% of adults ages 65 to 74 and 11% of those 75 and older
will be working.
On the
other hand, age discrimination makes it difficult for large numbers of older
adults to keep or find jobs. According to a 2018 AARP survey, 61% of
older workers reported witnessing or experiencing age discrimination.
“We
must address ageism and ageist attitudes within the workplace,” said Accius, of
AARP. “A new understanding of lifelong learning and training, as well as
targeted public and private sector investments to help certain groups
transition [from old jobs to new ones], will be essential.”
Judith
Graham: khn.navigatingaging@gmail.com, @judith_graham
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