Aging in the Future and Course Summary    
   
   

Objectives

  • Become aware of the trends for aging and aging services in the future
  • Understand the changing demographics of minority populations
  • Be able to discuss the ways in which different aspects of the study of aging contribute to the provision of services for older adults-"putting it all together"
  • Be able to identify and discuss the future of research in aging.
   
   
   

Future Projections and Predictions: Benefits, Consequences and Problems

 

   
   
   

 

As you have studied in Week 1 ("Why Study Aging?") and Week 2 ("Demographics of an Aging Population") lectures, population issues are very important to understanding aging processes. We have looked at how changes in life expectancy over the twentieth century have increased the number of individuals living in old age. We have discussed why such changes in the population have occurred and what type of social and psychological problems have arisen from such changes. Let's know look at how projections and predictions can be used to anticipate and plan for future issues related to the aging of our society.

The benefits of projections is that they permit public sector and private planners to anticipate trends that may affect their agencies and businesses. For example, one obvious result of the "baby boom" from 1946 to 1964 was the predicted need for more elementary schools at first, followed by more secondary schools, and finally a need for more capacity at our colleges and universities. Today, we can project the aging of the baby boomer population and attempt to predict their needs. Therefore, if you work for a major construction company specializing in housing, you may be influenced by these projections to begin to plan for a shift in your emphasis from single family or apartment housing to retirement community and assisted living facilities.

During this century, one of the problems with projections is that they rely heavily on previous trends. The Census Bureau of future growth of the older population have consistently underestimated the gains in life expectancy. As a result their projections for the number of older Americans has consistently been lower than the actual numbers. Another problem in projecting the future growth of the older population is that one cannot anticipate all the possible factors that can influence these projections such as changes in immigration and longevity. For example, a breakthrough in cancer research that cured cancers, would add a few years to average life expectancy while a series of influenza epidemics might shorten life expectancy.

Therefore, please examine the following projections and predictions with the knowledge that they are based on current knowledge and data, but are no guarantee of what will occur in the future as population ages.

   
 

 
   

The Continued Aging of Our Population

The impressive gains in life expectancy at birth, from 49 to 76 years, that we have witnessed in the twentieth century will continue into the next millennium. The United States Census Bureau projections for the increase in life expectancy project life expectancy gains ranging from -1 to 13.5 years by the year 2050. Their middle series, which is the most widely quoted projects an average life expectancy of 82.0 years by the year 2050.

The census uses three different scenarios, called Low Series, Middle Series, and High Series assumptions, when forecasting future population. These scenarios differ in how fertility, mortality, and immigration are forecasted. Check interactive exercise 2 below for graphs that describe and show the results of such predictions. The middle series forecasts that by year 2050 life expectancy for men will increase to 79.7 years while women will increase to 84.3 years. As you can see from the two graphs attached here, the broad differences between these series makes it hard to predict all specific needs for US aging population, however they provide some insight in what might happen to the population.

As mentioned earlier, the US Bureau of Census has consistently underestimated the increases in life expectancy that have happened in the twentieth century and we have no reason to doubt that they will continue this tradition into the next century. Data from specific locations around the world make us believe that current predictions underestimate future life expectancy.

For example, today, life expectancy for women in Okinawa already surpasses the projection (82.0 years) for the life expectancy of all Americans in the year 2050. There are several trends that we believe should result in gains in life expectancy beyond what is currently forecasted in the upcoming decades. These trends include:

  1. the narrowing of the difference in life expectancy between American men and women,
  2. the continued declines in deaths from 2 of the 3 leading causes of death, heart disease and strokes,
  3. improved health habits and nutrition,
  4. advances in medical care.
While the Census Bureau projects a modest increase in life expectancy in the next five decades, we believe that these trends could add as much as 10 to 15 more years to our life expectancy and that life expectancy in the year 2050 could be between 85 and 90 years.

Our predictions for the future are based on current trends continuing. Of course, the possibility exists that aging research might produce a major breakthrough which might lead to a dramatic slowing of the aging process and to radical increases in life expectancy. For example, dietary restriction in rodents leads to a 40 to 50% increase in their life expectancy. It is possible that through research we may find ways to increase human life expectancy at birth by 40 to 50%. However, even a major breakthrough of this nature would take decades to substantially increase average life expectancy of the entire population since the slowing of the aging process would have its greatest effect on younger populations.

To better understand how life expectancy differs for each of series from the US Bureau of Census, go to exercise 1 and interpret the different scenarios. There are 36 different graphs that can be compared in sets of three.

The future increases in life expectancy, conservative or radical, will both result in substantial increases in the older American population. Even the conservative Census Bureau middle series projects an increase in those 65 years old and over from 33.5 million in 1995 to 78.9 million in the year 2050.

The increase in those ages 85 and above, the frailest segment of the population, the group in greatest need of health and social services, is projected by the Census Bureau middle series to increase from 3.6 million in 1995 to 18.2 million by the year 2050. If the vast majority of baby boomers survive to 85 or more years, the number in this age group could be as high as 70 million. This is a very distinct possibility.

Use the below exercise to investigate the projections for US population 65 and over and 85 and over under the three scenarios used by the Bureau of Census.
Exercise 1

   
   
   

The Impact of the Aging of the Baby Boomer Cohort

As we have discussed in the lecture from Week 2, the 78 million baby boomers born between 1946 and 1964 have had a major impact on almost every aspect of our population. The impact of this "Pepsi generation" will continue at each stage of its aging and will exert its influence on almost every aspect of our society. On January 1, 1996, the first baby boomer became 50 years old. Every day 10,000 baby boomers turn 50. On January 1, 2011, the first baby boomer will turn 65 and the flood of baby boomers will begin into the major federal entitlement programs for senior citizens. Their needs will put great stress on our economy as government expenditures for the elderly will increase at a quick pace. However, as baby boomers enter retirement, they will also provide great opportunities for the public and private sector to expand their programs related to an aging population. For example, the Southern tier of states that have experienced an increase in migration of retiring seniors in the last few decades need to start preparing for the flood of migration that will accompany the retirement of the baby boomer cohort assuming that they share the values of their predecessors. Thousands of companies will be formed to provide services for this enormous cohort of aging Americans.

   
   
   

Financing the Entitlements of the Aging Baby Boomers

When the baby boomers reach old age, there will be large numbers of older Americans expecting Social Security retirement benefits and Medicare coverage for their health care costs. However, since these plans are both currently based on revenues derived from the working population and the ratio of workers to retirees will be at historically low levels (as discussed in Week 2, "Dependency Ratio"), there will be massive deficits in these programs. This critical issue has been the center of our nation's budgetary debates for the last few years. While short term solutions are being applied such as increasing the age of eligibility for retirement, capping certain Medicare costs, and increasing co-payments for Medicare Part B, the long term solvency of Social Security and Medicare have not been assured for the baby boomer generation or the generations that follow them.

Will there be Medicare and Social Security benefits for the current baby boomer cohort or the cohorts that follow? A recent survey of Generation X, those born after 1964, found that more of them believed in UFOs than in their possibility of receiving Social Security benefits.

This pessimism is unfounded. The ability of Social Security to be able to pay benefits in the future is excellent. This is a historically important program not only for the United States but similar programs form the bedrock of social benefits in countries worldwide. Social Security is part of the retirement planning of the majority of Americans and it is inconceivable that this nation would abandon this program. Furthermore, the financial solvency of Social Security can be resolved by relatively small adjustments. The possible ways to secure Social Security include a minor reduction in the cost of living adjustment (COLA) for one or two years, a slight increase in the employee or employer contribution to the program and/or more effective investments of current Social Security surpluses. There is also the distinct possibility that individuals will be able to elect to not participate in Social Security and be able to set up their own Social Security-like retirement programs where the individual has the ability to invest their retirement funds. Even more, US Bureau of Census population forecasts predict that by year 2030 the dependency ratio will be back to the 1980 level. This means that the ratio of workers to retirees will allow for Social Security programs to stay solvent.

There is little doubt that one or more of these changes will be made in the upcoming years to secure this program that is vital for the economic well being of today's, and tomorrow's, aging population.

The Medicare problem is more troublesome. In the case of Medicare, there are several factors that may produce massive increases in the costs of this program:

  • Increasing numbers of older Americans
  • The aging of the oldest populations resulting in proportionally more older persons in the oldest age groups
  • The higher health care costs of the oldest age groups.
Over the last two decades a number of approaches have been tried to reign in the costs of Medicare such as defining payments for certain disease conditions, capping Medicare payments to hospitals, and encouraging managed care and HMO approaches. The success of these approaches has usually been limited to a few years after which Medicare continues its exponential growth. Thus these approaches have been only "band-aids" trying to contain a condition which needs radical surgery.

The only real solution to the financing problem of Medicare is through improving the average health of Older Americans by expanding the Healthspan, the healthy portion of the lifespan. This would result in less expenditures for each older person because of the diminished impact of disease and disability. However, these improvements would have to be substantial to compensate for the projected massive increases in health care costs. This would require a major national effort placing the conquest of the diseases and disorders of aging at the highest priority level. Substantial increases in funding would have to begin immediately to increase the intensity of programs in prevention as well as research aimed at finding ways to prevent or successfully treat those diseases and disorders which are currently not preventable. As we discussed in Week 3, "Promoting Successful Aging", prevention efforts would be placed on exercise, nutrition and health behaviors that might modify the course of diseases such as osteoporosis and osteoarthritis. The research programs would focus on conditions that are not currently preventable such as Alzheimer's and Parkinson's diseases.

An example of the impact of prevention is the potential of preventive interventions such as exercise, hormone replacement therapy and calcium supplementation to delay the progression of osteoporosis through the lifespan and thus preventing hip fractures. The risk of hip fracture currently increases exponentially with aging.

The estimated costs of hip fractures today is over $10 billion a year. In the future the costs related to hip fractures will skyrocket as the number of the oldest old population increases. It is estimated that slowing down the progression of osteoporosis by 5 years would result in a 50% reduction in the incidence of hip fractures.

The potential of research programs that lead to total prevention and/or total cure of specific diseases is even greater. For example, if research yielded approaches that would totally prevent or successfully treat Alzheimer disease, the savings would surpass $100 billion a year.

While we remain convinced that prevention and research offer the best possibility for long term success in reducing future health care costs for an aging population, there has been little evidence that Congress will support the massive program needed. In the past, through pressure from organizations such as the Alzheimer Association and through the efforts of Drs. Butler and Williams, the Directors of the National Institutes of Health there has been increased funding for aging research. However, the budget of the National Institute on Aging, the federal agency responsible for the health of our older population, is still among the smallest of the institutes of the National Institutes of Health and there is little evidence of this changing in the near future.
Exercise 2

   
   
   

The Changing Ethnicity of Aging America

The higher fertility and higher immigration patterns of African-American, Hispanic, and other minorities population over the last few decades will continue to change the ethnicity of our aging population in the next few decades. The rate of change in the number of those aged 65 and over is predicted to be much slower for Whites compared with African-Americans, Hispanics, Asian-Americans, and other minorities. For example, in the middle series projections, the number of Whites aged 65 and over will double by year 2050, while Hispanics and Asian-Americans and Pacific Islanders will increase about 10 fold and African-Americans and other minorities will increase about 4 fold. Beside the population changes due to the increasing number of minorities, the US Census also anticipates changes in the life expectancy of minority populations. Use the exercise below to investigate the different patterns of life expectancy for each specific minority identified by US Bureau of Census.

Furthermore, continued immigration will augment this trend to more and more older Americans being of different ethnic background than White. The increased heterogeneity of the American aging population will be need to be recognized, and the programs and policies that will be implemented will need to be sensitive to the distinct needs introduced by each specific characteristic of these older population.

   
   
   

A New Look at Lifespan with Increased Longevity

In previous centuries retirement was not common and only the wealthy had the luxury of leaving employment. When the legislation for Social Security was passed by Congress and signed into law in 1935, life expectancy at birth was around 62. Therefore, it seemed reasonable to create a retirement program that would encourage individuals to retire at age 65, and as a result to decrease unemployed during the Depression. Today, with the average retirement age at 62 and life expectancy at 75, many individuals spend two, three and even four decades in retirement. Individuals who can retire early, in their 50's, can expect to spend more time in retirement than they spend in the workforce. In the upcoming decades, these trends could continue as life expectancy increases for today's retirees and more and more of them will survive into their 80's and 90's.

A second important trend is the disappearance of lifetime employment by a specific company or organization. In previous decades, after graduation from an university, a prospective employee would look for a company where they would be employed in one specific area for 25 or 30 years and then look towards retirement. Today, it is far more likely for a graduate to be looking at several careers with a variety of companies or organizations. Furthermore, more and more seniors who have ostensibly "retired" have re-entered the workforce. If this trend continues, then the time out of the workforce will decrease. Thus the pattern of employment is changing from that of one job and then retirement of the pre-baby boom generation to a pattern of multiple job transitions followed by a more fluid and delayed retirement period that will characterize the baby boomers.

   
   
   

Anticipation of Longer Life Expectancy Should Improve Health Habits

"If I knew I was going to live this long, I would have taken better care of my body" said George Bernard Shaw in his 90's. The baby boomer generation, through increased awareness of good health behaviors and perhaps because of the knowledge of their increased longevity and their fears that Medicare will not be there for them, is very health conscious. As a result, they do take better care of their bodies and should be a healthier generation than their parents. Current forecasts of life expectancy by the US Bureau of Census may prove to be too conservative because of the better health habits entertained by baby boomers. Nevertheless, awareness of the effects of health behaviors on health outcomes will not be seen until few decades from now.

   
   
   

Global Considerations

As we discussed in Week 2, Population Pyramids, there are many countries that have and will experience even greater proportions of their populations reaching old age in the upcoming decades.

Japan, with the world's highest life expectancy, will, in a few decades have the largest proportion of older inhabitants. With the average Japanese family residing in a relatively small living area, often under 1000 square feet, more and more families are finding it difficult to keep their aging parents with them. With little space available to build nursing homes or assisted living facilities, Japan will face the difficult problem of where to house their aging population. The great advances in life expectancy in the developed countries in the first part of this century is now being replicated in the developing countries worldwide. China, today has over 100 million residents ages 65 and over and this number will grow to over 300 million by the year 2020. The developing countries will be even more strained than the developed countries to support programs for the economic and medical welfare of their aging populations. With increasing dependency ratios due to lower fertility and higher life expectancy, developing countries will have declining resources available for public programs. Therefore, they may be faced with the difficult decision of whether to limit the growth of their emerging economies in order to support their aging populations.

   
   
   

Career Opportunities

As we discussed in lectures from Weeks 11, 12, and 13, there are many different areas in any society that provide services for the elderly. The increased aging of the planet's populations should provide enormous job opportunities for professionals in many fields. In the upcoming decades, the majority of the patients entering a doctors office will be 65 years old or older, the majority of all hospital patients will be 65 or older, and the majority of prescriptions will be written for those ages 65 and above. More and more patients seeing dentists will be seniors as the effects of good dental hygiene and fluoride decrease the number of visits by children and young adults. An increasing percent of social workers will be involved in the care of older clients. More and more lawyers will be involved in elder law. The service needs of aging baby boomers will create millions of new job opportunities.

   
   
   
   
   

Key Points

  • The benefits of population projections is that they permit public sector and private planners to anticipate trends that may affect their agencies and businesses. The major problem with projections is that they rely heavily on previous trends. To overcome this problem, the Census Bureau has used three different scenarios, called Low Series, Middle Series, and High Series assumptions when forecasting future populations.
  • It is believed that current predictions underestimate future life expectancy. There are several trends in the US that could result in gains in life expectancy beyond what is currently forecasted in the upcoming decades.
  • The future increases in life expectancy will result in substantial increases in the older American population. Significant increases in those 85 and above, the frailest segment of the population, are projected by the Census Bureau.
  • The baby boomers are an enormous cohort of aging Americans who will, at the same time, stress our economy as government expenditures for the elderly increase and also provide great opportunities for the public and private sector to expand their programs related to an aging population.
  • Projected massive deficits in the Social Security and Medicare programs is a critical budgetary debate in our nation. Although some short-term solutions to the deficits have been proposed, some adjustments to the funding of these programs is necessary to avoid long-term problems.
  • The number of Afro-Americans, Hispanics, and other minorities over 65 will increase significantly over Whites within the next 50 years. This is due to the higher fertility rates and immigration pattern of these groups.
  • The pattern of employment is changing from that of one job and then retirement of the pre-baby boom generation to a pattern of multiple job transitions followed by a more fluid and delayed retirement period that will be characterized by the baby boomers.
  • The baby boomers have been more aware of better health habits and may be a healthier older generation than their parents; however, awareness of the effects of health behaviors on health outcomes will not be seen until a few decades from now.
  • Both developed and developing countries will experience greater proportions of their populations reaching old age in the upcoming decades. This will create strains on countries to support programs for the economic and medical welfare of their aging populations particularly in developing nations.
  • The future needs of the aging baby boomers will create millions of new job opportunities for professionals in many fields. This will be particularly true in the medical and social services fields.