U.S. faces oncoming aging boom

Political shake-up predicted as numbers of elderly set to double

Part One of Two

By ARTHUR JONES
San Francisco

The United States is aging -- rapidly.

That fact could markedly change the face of domestic U.S. politics. By 2030, as baby boomers become the retiree majority, one third of American voters will be over 55, somewhere between a fifth and a quarter of them over 65.

But the start of the political shake-up will come earlier than 2030, suggests Dr. Robert Butler, president and CEO of the International Longevity Center-USA, a think tank on aging issues.

“If the baby boomers do wake up -- they aren’t awake yet -- they could tackle the physical, social and economic realities of what late life will bring them,” Butler said. “I think they will wake up, and then there will be a dramatic political crisis in which no one will be elected dog catcher if they’re not responsive to this huge wave of [aging boomers], 25 to 30 percent of the vote.”

One issue will be the costs and uncertainty of long-term care -- now running at between $4,000 and $6,000 a month. “I think there is going to be a long-term care crisis, no question about it,” said Case Western Reserve University gerontologist Eva Kahana. “Boomers are less likely to accept what’s dished out to them. Tomorrow’s consumers are going to be more demanding. They are more educated. They are going to want to make many more choices. They will be somewhat more affluent so ‘care’ will have to change in order to get people willing to pay its high price.”

One other thing is certain. “Aging is a gender issue,” said Dr. Gresham Bayne, associate clinical professor of medicine at the University of California San Diego.

At last year’s U.S. Geriatric and Long-Term Care Congress here, Bayne said, “Caregivers are already a $40 billion Medicare subsidy provided by the women of America.”

As a physician who has made more than 10,000 house calls on the elderly, including Alzheimer’s patients, Bayne really laid it on the line.

“My wife wanted to be here today. We’d booked a hotel room for a little weekend vacation here, but two days ago her 90-year-old mother had her third stroke this year, so my wife’s flown out to New Jersey.

“My wife’s one of five daughters -- three are nurses, two are married to doctors -- and it’s her shift to move into the assisted living facility for which the family is paying $5,000 a month. The sisters can’t trust the system,” he said.

“Three months ago,” continued Bayne, when the mother suffered her second stroke, “we were notified in the middle of the night that she had been found after five-and-a-half hours. That five-and-a-half hours included 24 pushes on her supposedly monitored lavaliere emergency response system -- that had been ignored. This for $5,000 a month in a Medicare-certified facility. How much guilt can one family have?”

A women’s issue

“Aging is a women’s issue,” Butler agreed. The phrase was the theme of International Longevity Center’s current annual report. Butler told NCR that in the United States, “among older women, 40 percent live alone and 20 percent below the poverty line. [Older women] suffer the most elder abuse and make up more than 80 percent of the nursing home population.”

The rate at which the nation is aging is accelerating. Between now and 2030 the number of adults over 65 will double to more than 70 million, from 12 percent of the population to more than 21 percent.

Pope John Paul II has referred to “the third age” as “a value in itself.” Though “the condition of the elderly is ambivalent,” he said, “on the one hand less integrated into family and society, and the other, a role ever more important, especially for the care and education of grandchildren.”

In the United States there’s good news and not so good news. More and more Americans are living longer healthier. There’s a graying of the YMCA weight room, as elders get serious about their physical fitness and stamina.

Only 6 to 9 percent of the population is actually in a nursing home. The problem is, one never knows whom that percentage will include. In approaching aging, Susan McDonough of the Lexington, Mass.-based Catholic Covenant Health Systems told NCR that people are not planning well enough or soon enough. McDonough knows. A consultant in the field before she joined Covenant in 1996, she is Covenant vice president for elder services in a system that manages 32 institutions mainly concerned with elder care.

Focusing on life after retirement is a relatively new field. What has changed is life expectancy. In 1900 it was 46 for men, 48 for women. Not until midcentury did it get past 65.

That’s when Butler of the International Longevity Center was a medical student. “Aging” was little studied. In the 1950s, he said, “medical school, which was otherwise excellent, taught us nothing about aging.”

He realized even then “we were obviously going to have a large aging population” a half-century down the road. He was correct. By 2000 life expectancy had shot ahead: to 74 for men and 79 for women.

That potential, and the fact he had grown up with grandparents around, he said, stimulated his interest in the field.

Decades later, Butler created the International Longevity Center as a modest component within the Mount Sinai School of Medicine geriatrics department.

Now its own entity, the New York-based center is the only institution “exclusively focused on looking ahead in terms of the consequences of population, aging and longevity,” he said. “Its major concerns: 1) How do we finance longevity on an individual and a national basis; 2) how can we advance our health and quality of life now that we’re living so much longer; 3) how do we combat our prejudices with respect to age and the aging so [older people] don’t become marginalized?

“Minorities and women are not well financed for their longevity, and it’s clear that if one took away Social Security it would be even worse,” he said. “Social Security accounts for about 50 percent of the people not being below the poverty rate.”

With partners in France and Britain, he said, “we’ve launched a new initiative -- guidelines for a healthy future. Topics not much discussed but extraordinarily important: the preservation of vision, preservation of hearing, preservation of cognitive health and the preservation of balance.”

As a physician, he said, “I’m very much in favor of lifestyle improvement and the belief that it’s never too late to start. ‘Quality of life’ includes being engaged in something purposeful in society. It’s fine to be a loner if that’s your character -- as opposed to alone from reasons of anxiety -- but social engagement is essential, friendships, relationships.

“On the physical side -- and that’s not only aerobics -- more attention to muscle strengthening, posture, balance, stretching. When you think of all the hip fractures every year,” he said, “it’s not hard to realize balance has an important role.

“Cognitive health can be learning new languages -- it’s maintaining various forms of intellectual stimulation. And not least,” he said, “there’s the thing that really does require some early planning -- trying to build a basic financial base for old age.”

Boomers at risk

Butler sees boomers, those 55 and under, at risk “for a lot of reasons.” One example, for two-and-a-half decades U.S. physical disability rates had been improving. Not any more. Among people now in the 40s and 50s, those improvements are beginning to reverse themselves.

There’s a coming financial crunch. “By some estimates,” he said, “boomers have an average of $100,000 in savings toward retirement. ‘Average’ means that some people have nothing and a few have millions.”

Plus baby boomers, he said, are running into some ideological shifts in government policies. He has been surprised, he said, “at the power of the opponents of Social Security and Medicare in moving us away from solidarity in the sense of community -- from the sense of a universal risk pool to help protect us all. There’s a kind of hubris or notion that somehow it’s each man for himself or, more accurately, woman, since they live longer.

“And it’s hubris,” he said, “because none of us can predict who’s going to get Alzheimer’s disease or the disability injury, or suffer a stock market crash, or whatever. Yet despite these external vicissitudes over which no one has control, we nonetheless see a curious movement away from broad social responsibility.”

Like Butler, Case Western gerontologist Kahana became interested in aging issues when few people were aware it was a topic. In the 1960s, college student Kahana did an internship at a Massachusetts summer camp for the aged and “I really kind of fell in love with old folks.”

Since then, she and her clinical psychologist husband, Boaz Kahana, have co-published many aging studies.

Eva Kahana’s early studies into why the elderly were segregated in mental hospitals led to her dissertation findings that age integration is better than age segregation. In a sense, however, “I’ve come full circle -- if the segregation is voluntary.”

By that Kahana means that if older people decide to retire to communities in Florida or elsewhere populated mainly by older people, it is because “many people prefer and enjoy to live with people who are like them.”

Kahana and her husband spend a month each winter in Florida, the site of one of their National Institutes of Health studies into successful aging, now in its 15th year.

“The elderly of tomorrow are going to be different from the elderly of today,” she said, “it will be unlike my generation. My mother died nine years ago and lived in our home pretty much to the end of her days. For example, I have wonderful children. I have sons. I know no daughter-in-law of mine is going to take us into her home. It will have to be some kind of care facility or long term care insurance -- people going for the best insurance -- for the alternative of bringing caregivers into the home, as opposed to a nursing home.”

Fewer disabled years

There’s a hopeful sign, she said, “that collectively we all may have fewer disabled years. And that depends on health promotion and better medical care.”

Health promotion may be easer to achieve than better medical care. The latter isn’t likely until the United States undertakes to seriously examine what a minimum standard of health care looks like -- at each stage of life -- and swings its resources into making it happen.

That in turn will take political will and political clout.

And neither may occur until boomers come on stream as retirees and realize how ill-served they are as elders in need of good medicine and good care.

“Let me leave you with an optimistic message,” Kahana said. “I think boomers may have a great deal of control over their lives. Boomers will be able to make use of technology in ways that today’s elderly have not. They will be better health care consumers. They will be more into promoting lifestyles and healthier diets.”

And even for the majority aging today, said Kahana, who is now in her early 60s, “I actually think that the old age that looms on the horizon is not such a depressing prospect. It really holds some promise. We find the people we’ve studied for 15 years --average age now 85 -- have very high levels of life satisfaction. And I think -- if they can steer clear of the nursing home -- that they probably have many years of high quality life ahead of them.”

Arthur Jones is NCR editor at large. His e-mail address is arthurjones@comcast.net.

National Catholic Reporter, April 30, 2004