The Bob Butler Tribute: Day 1 – Aging Demographics

Aging Demographics
Mike Magee

Former President Jimmy Carter, in his book The Virtues of Aging, said, “You are old when regrets take the place of dreams.” (1) His title is especially fitting today, since aging is making real advances in quantity and quality of years.

Clearly, we have entered an era of new longevity. One need only look at the trend lines to see that the senior block is growing in leaps and bounds. There are now approximately 184 million global citizens over the age of 65. This number is projected to increase to 678 million by the year 2030. (2) In 2000, there were some 35 million Americans over the age of 65. This number will more than double to 79 million by 2050.2 And the oldest old, those over 85 years of age, are growing as well, from 4 million in 2000 to a projected 18 million in 2050. (2)

The numbers alone imply a fundamental shift in the American family. Nearly 50% of all current 60-year-olds have at least one parent alive. This means that the four-generation American family has arrived. By the year 2050, there will be an estimated 1 million Americans over the age of 100, making the five-generation American family commonplace. (3)

Even today, we can see the impact of these demographics on our day-to-day lives. Despite the fact that we’ve seen a 15% drop in the presence of chronic disability and institutionalization in our older population, largely as a result of improvements in medical care, technology, and lifestyle behavior, we still have a long way to go. (4)

One need not look far for evidence that American families are having trouble keeping up with changing demographics. Home care of dependent, frail seniors falls predominantly on third-generation women, who struggle to manage up and down the generation divide. Family and friends provide 80%of long-term care. (5)The inability to adequately address chronic disease insures organ damage and disability. This cycle has created the “The Sandwich Generation,” which finds itself squeezed between children and grandchildren on the right, and parents and grandparents on the left.

While clearly the demographics of aging seem overwhelming, reinforced by “boomers,” who begin to hit 65 in 2011, there are forces deflecting the impact. In fact, poor health is not as prevalent in the elderly as we once thought. A full 75% of 65- to 74-year-olds consider themselves in good health, and 67% of those over 75 give themselves similar grades. (6)

Dr. Gene Cohen, Director of the Center of Aging, Health and Humanities at George Washington University, has stated, “The better health, higher level of education, and larger number of individuals with ample financial assets among today’s older population – compared with earlier aging cohorts – speak to the greater collective role that those age 65 and older can play in assisting contemporary society.” (7)

It’s a race then, advancing age and traditional chronic, disease-instigated disability against advancing health and systems to support individual vitality and independence. Science and prevention must keep one step ahead of the demographic changes. A starting point is a clear understanding of the leading causes of death and disability in seniors.

The top five causes of mortality for those over 65 are heart disease, cancer, stroke, emphysema and pneumonia. The top five sources of disability are arthritis, high blood pressure, heart disease, hearing impairments and cataracts. (8)The risk factors most likely to interfere with successful aging include smoking, alcohol abuse, depression, lack of exercise and incontinence. (9,10,11)Addressing these behavioral issues can postpone the onset of disability by at least five years. (12)

Maintaining the functional capacity of aging Americans is critical to the long-term financing of healthcare. The direct healthcare costs for a chronically disabled senior are seven times greater than for a healthy senior. (12) The cost of care for a senior with dementia is 70% higher than a senior without mental impairment. (13) And none of this considers the indirect cost on family caregivers. A recent study of family caregivers of Alzheimer’s patients found the average caregiver missed 23 days of work per year. (14)

So the challenge is clear. There must be a concerted effort on two fronts if the advance of health is to keep step with the advance of longevity. The first front is health maintenance. Currently, the average 75-year-old in America has three chronic conditions and takes 4.5 medications. (3) Early diagnosis, effective treatment and healthy behaviors must continue to lower these numbers.

The second front is prevention. There’s a great deal that can be done to better manage the changes and disabilities that are associated with aging. One simple example is hip fractures – mainly the result of poor supervision and unsafe environments for seniors – growing at an alarming rate and projected to hit a half-million hip fractures per year by 2050, with half of the injured never regaining independence.(3) Good management could positively impact those numbers.

References

1.Carter J. The Virtues of Aging. New York, NY: Library of Contemporary Thought; 1998.

2.Brundtland GH. Speech on burden of disease concept at Hopitaux Universitaires de Geneve; December 15, 1998.

3.Alliance for Aging Research. Ten Reasons Why America is not ready for the Coming Age Boom. Spring 2002.

4.Manton KG, Corder LS, Stallard E. Monitoring changes in the health of the U.S. elderly populations: correlates with biomedical research and clinical innovations. FASEB J. 1997;11:923-930.

5.Havens B. Improving the Health of Older People. A World View, Oxford University Press. 1990.

6.Hobbs FB, Damon BL, eds. 65+ in the United States. Washington, DC: US Bureau of the Census; 1996.

7.Biomedical innovations, Baby Boomers and Aging. The Pfizer Journal. 3:1, 1999. p.5-6.

8.National Center for Health Statistics. 2010. http://www.cdc.gov/omhd/Populations/Disability/Disability.htm

9.Valliant GE, Meyer SE, Mukamal K, Soldz S. Are social supports in late midlife a cause or result of successful physical aging? Psychol Med. 1998; 28:1159-1168. Journal article is not available online without subscription to Psychological Medicine

10.Strawbridge WJ, Cohen RD, Shema SJ, Kaplan GA. Successful dying: predictors and associated activities. Am J Epideiol. 1996;144:135-141.

11.Vita AJ, Terry RB, Hubert HB, Fries JF. Aging, health risks, and cumulative disability. N Engl J Med. 1998;338:1035-1041.

12.Pardes H, Manton KG, Lander ES, Tolley HD, Ullian AD, Palmer H. Effects of medical research on health care and the economy. Science. 1999;283:36-37. Article not available without subscription fee or partial registration.

13.Alzheimer’s Association. 1998 National public policy program to conquer Alzheimer’s disease. Washington, DC: Alzheimer’s Association; 1998.

14.Koppel R. Alzheimer’s cost to U.S. business. Washington, DC: Alzheimer’s Association; September 1998.