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America’s aging baby boom generation—the people who were born from 1946 to 1964—is nearing retirement. The following January 1999 article from the Encarta Yearbook, written by Pulitzer Prize-winning author Robert N. Butler, founding director of the National Institute on Aging, discusses the challenges an aging population poses for society, as well as the research scientists are conducting into the aging process itself.
By Robert N. Butler
As the 20th century draws to a close, an aging population is changing the face of the United States.
At the time of the American Revolution (1775-1783), colonists could expect to live to age 35, and only 2 percent of the population attained the age of 65 or older. In 1900 the life expectancy for most Americans was 47. By 1998 the average life expectancy at birth had jumped to 76, and a full 80 percent of all deaths occurred after age 65. When the post-World War II generation of Americans—those born between 1946 and 1964 and commonly known as the baby boomers—reach the age of 65, they will make up 20 percent of the population. Barring a calamitous epidemic or war, the percentage of persons over 65 will continue to be over 20 percent in the generations that follow.
The phenomenon is not confined to the United States. At the beginning of the 20th century, only 1 percent of the world's population lived past the age of 65. By 2050 it is likely that 1 in 5 people in the developed nations of Western Europe, North America, and Japan, and more than 15 percent of the population in many developing nations will be 65 and older. In the near future, 2 out of every 6 persons over 65 will live in India or China. Other nations with huge populations of older people will include Russia, Indonesia, and Brazil.
There are many reasons for this trend. Improvements in medical care and advances in nutrition have contributed to improvements in life expectancy. Eventually scientists may find ways to slow the aging process itself.
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The rise in the number of older persons has created enormous challenges as well as great opportunities. As this trend continues, the United States will have to make vital policy decisions based on realistic projections of society's changing needs. How will a large retired population living on social security benefits and needing medical care impact the economic fortunes of the United States? Will older people sap needed resources away from younger generations? Will the differing needs of older and younger people lead to intergenerational conflict? These are among the questions raised by the phenomenon some experts call the “new longevity.”
The unprecedented advance in longevity that occurred during the 20th century has, on average, added 25 years to the life expectancy of people living in the industrialized world. This gain is nearly equal to that attained during the preceding 5,000 years of human history. In fact, there is little evidence that any gains in life expectancy were achieved during the first 100,000 years of the existence of homo sapiens sapiens (modern human beings).
The first advances occurred during the Neolithic period, which began in some parts of the world around 8,000 BC. It was at this time that humans developed agriculture and animal husbandry (the care and breeding of domestic animals such as cattle and sheep), and the food supply became more plentiful, varied, and stable. People banded together for mutual protection and communities developed. New technologies such as pottery, which helped keep food separate from excrement and other unclean substances, also contributed to improvements in health. Even so, the life expectancy at the time was a mere 20 years. Most people barely lived long enough to reproduce.
This state of affairs remained unchanged for many centuries. Women frequently died in childbirth, and infant and childhood mortality rates were high. Life expectancy during the Bronze Age in Europe (2200 to 700 BC) was about the same as that during the Neolithic period.
The second great wave of advances in longevity did not occur until the Industrial Revolution, which began in the 18th century. The Industrial Revolution resulted in the widespread replacement of manual labor by machines and brought about improvements in health conditions, nutrition, and the standard of living, and resulted in important advances in scientific knowledge. In 1796, for example, the English physician Edward Jenner discovered that an injection of dead cowpox virus could immunize people against the deadly smallpox virus—a major cause of death at the time. Jenner's experiments laid the foundation for the fields of immunology (a branch of medicine that deals with the immune system) and virology (the study of viruses and viral diseases).
The years since have witnessed an explosion of new medical discoveries and techniques. In the 19th century physicians and scientists developed diagnostic tools such as the stethoscope, and discovered X rays. They also learned the importance of keeping hospitals and operating rooms germ-free, which drastically improved patient mortality rates.
Twentieth-century discoveries include new vaccines for diseases such as polio, the discovery of antibiotics such as penicillin and streptomycin, and improvements in medical procedures such as blood transfusions, transplant surgery, and new heart medications that can prolong the lives of patients suffering from a variety of illnesses and conditions.
People are not only living longer, they are living better. A 1997 study by researchers at Duke University in Durham, North Carolina, showed that the number of older Americans suffering from disabilities has declined since the early 1980s.
According to the United Nations (UN), people over age 60 will outnumber those under 15 years of age by 2050. This is partially due to a decreased number of deaths combined with a drop in the number of births. The change is especially notable in developed countries such as Japan and many Western European nations. In the United States, the annual number of deaths per 100,000 people dropped from over 800 in the 1950s to about 490 in 1996. The birth rate, meanwhile, has dropped from about 24 per 1,000 women to about 15 per 1,000 women during the same period.
This unprecedented rise in the number of older people will have lasting effects on society. The growing number of older persons throughout the world is already affecting the global economy. In the same way that the 1960s had a “youth market” that targeted the baby boomer generation, today there is a growing “mature market”—called the “silver industries” in Japan—that focuses on serving the needs of the older population. The growth of the “mature market” has prompted an economic boom in many industries, including the health care, pharmaceutical, financial services, tourism, and recreational industries.
The United States health care industry accounts for one-seventh of its economy and provides more than 10 million jobs. Geriatrics is one of one of the industry's fastest growing segments. Physicians and nurses trained in geriatrics are in great demand. But trained professionals are in short supply. In 1998 the United States had fewer than 9,000 physicians certified in geriatric medicine, according to the American Geriatrics Society (AGS).
While many older people remain able to care for themselves, others require assistance to live comfortably. Many older Americans need help with activities such as eating, getting dressed, getting out of bed, preparing meals, and doing housework.
To answer these needs, the health care industry has developed several alternatives to the traditional institutional nursing home, including assisted-living facilities, continuing-care retirement communities, home care, and hospice. Each offers a variety of living arrangements that incorporate health, social, and recreational services. Assisted-living facilities, for example, allow residents to maintain independent lifestyles while also offering help with housework, food preparation, and access to medical care. Home care, meanwhile, allows older people to receive the care they need while remaining in the comfort of their homes.
Since people are living longer, they will probably also work longer. Some will continue to work because of financial need, while others will continue working because they enjoy what they do. The 1967 Age Discrimination in Employment Act prohibits employers in the United States from discriminating against employees because of their age.
Older workers are likely to prompt changes in the American workplace. For example, job sharing, when two part-time employees do the work of one full-time employee, would allow older workers to reduce their working hours while maintaining a portion of their income. More companies may offer on-the-job training and sabbaticals (leave of absence) for workers who wish to learn new skills. It is also likely that many older workers will want to work from home or become self-employed.
Blue collar workers pose a special challenge. As they age, these workers may no longer be up to the physical rigors of their jobs. In some cases, blue collar workers who want to remain on the job may be retrained, or their jobs may be modified to fit their changing abilities. Experienced blue collar workers may also be used to train younger workers.
Older women are another group that faces unique challenges. In the late 1990s American women could expect to live about six years longer than men, meaning that many women outlive their spouses. For some women this means a catastrophic loss of income as their husbands' pension and social security income disappears.
Employers have good reasons to adapt to the needs of older workers even though older workers are more expensive than younger workers because employer-paid health insurance and the wages and salaries of long-time employees are higher. But studies by ICF Kaiser International and the American Association of Retired Persons (AARP) have shown that older workers are usually more reliable than younger employees and miss work less often. Older workers are also more experienced and have the maturity and judgment that come with age.
Employed older persons often have higher standards of living than unemployed retirees, and they contribute to the health of the economy by spending more money on goods and services. They also pay income and social security taxes.
Retirement may also change, with the introduction of phased and trial retirements. A phased retirement allows workers to gradually cut down their working hours as they move toward retirement. Trial retirements allow workers to return to their job if they change their minds and decide not to retire.
Some people fear that older Americans will use their growing numbers to dominate national politics, triggering a rift with younger generations. This is unlikely, however. While organizations representing older people, such as AARP and the National Council of Senior Citizens, have helped influence federal policy on social security and Medicare, they are far less influential than those organizations representing corporate America. Finally, because the majority of the voting population will always be under 65, it is unlikely that persons over age 65 will ever have enough power to unilaterally influence political affairs.
Surveys by major polling organizations suggest that fears of intergenerational conflicts are unfounded. For example, many young Americans favor expanding programs that support the aged, although many young people fear social security and other government-sponsored support systems will “not be there” for them when they retire.
If older adults were all financially independent and in excellent health, there would be no problems, but a significant minority will require expensive medical care. As the United States moves into the next century and the baby boom generation reaches retirement age, the challenge of controlling rising health care costs will continue to mount.
Government health care in the United States is administered primarily through two publicly financed systems, Medicare and Medicaid. Both programs are administered by the Health Care Financing Administration (HCFA), a division of the U.S. Department of Health and Human Services. In the mid-1990s more than 23 percent of Americans aged 65 and over depended solely on Medicare or Medicaid for health insurance.
Medicare provides health insurance to persons aged 65 and over, as well as to the disabled and certain other groups. The system went into effect in 1966, and in 1997 there were 38.1 million people enrolled in Medicare. The system is financed through payroll taxes, monthly premiums paid by participants, and general revenues, and helps cover the cost of inpatient and outpatient hospital care, doctors' fees, and medical equipment.
Medicaid is a joint federal and state program that provides basic medical care to low-income individuals, a category that included about 4.5 million older people in 1995. While many of these people also qualify for Medicare, the program does not cover the costs of long-term care, forcing them to turn to Medicaid for assistance. Medicaid eligibility and services vary by state, but the program generally pays for basic services such as hospital care, laboratory fees, and X-ray services. The system is financed jointly by federal and state governments.
As the number of older people rises, so does the cost of financing these programs. Some observers have voiced concerns that the current system cannot possibly keep up with demand. In 1970, for example, Medicare and Medicaid totaled about $9 billion, about 3 percent of the federal budget. By 1997 this figure had risen to about $400 billion, about 20 percent of the federal budget. In April 1998 the board of trustees of the Social Security Administration (SSA) reported that declines in the ratio of taxpayers to Medicare recipients meant that one of the two trust funds that support Medicare will be unable to meet its obligations in about ten years.
Such reports have prompted calls for reform. Some reformers have proposed “means-testing” Medicare beneficiaries to screen out those who can afford to insure themselves. But this proposal has met with vigorous opposition from taxpayers who feel their contributions to the program entitle them to its benefits. Others believe significant savings can be realized by concentrating on disease prevention and efforts to make geriatric care more cost-effective and affordable.
The Balanced Budget Act of 1997 attempted to address concerns about Medicare costs by allowing Medicare recipients to join health maintenance organizations (HMOs). HMOs seek to reduce medical costs by restricting patients to doctors and hospitals within the HMO plan. But because the cost of caring for elderly patients is often high, many HMOs will no longer accept Medicare patients.
Social security, like Medicare, also faces potential financial difficulties. Begun in 1935, social security is managed by the SSA and provides monthly payments to retirees, the disabled, widows, widowers, children, and others. The system is financed by payroll deductions that are then deposited in social security trust funds. Some of this money is used to pay benefits, and the remainder is invested in U.S. government bonds.
Federal spending on social security rose from $28 million in 1940 (less than 1 percent of the federal budget) to more than $30 billion in 1970 (15 percent), and more than $360 billion in 1997 (23 percent). Government experts predict that the number of social security beneficiaries will rise from 27 million in 1997 to more than 75 million in 2075.
In 1982, responding to concerns that social security would not have enough money to meet its obligations to future retirees, then-President Ronald Reagan appointed a committee to examine the problem and recommend solutions. Congress enacted many of the committee's recommendations in 1983, including raising the eligibility age for full social security benefits from 65 to 67 for people born after 1960.
But those measures were not enough. According to the SSA's board of trustees, the trust funds that support social security will begin to fail by 2032. Unless the system is changed, benefits will be reduced to 77 percent of what current retirees receive. After 2090 benefits would drop to 70 percent of current levels.
A variety of solutions have been proposed. About 3 million state and municipal employees do not presently contribute to social security. Including these workers in the program might help allay part of the shortfall. Other suggestions include recalculating social security's annual cost-of-living adjustment (COLA, an annual benefits increase tied to rising consumer prices), raising the retirement age to 70, and raising the payroll taxes that fund the program. President Bill Clinton has called for money from federal budget surpluses to be applied toward shoring up social security.
Others suggest that the government transform social security from a social insurance program into an investment program. This might allow individuals to exercise control over how their social security payments are invested. This proposal raises serious concerns, however. For example, what would be done for retirees who made poor choices and lost their retirement funds in the stock market, or for those whose retirement plans were jeopardized by a stock market crash?
Another option would be for the federal government to invest social security funds in the stock market. This approach has raised concerns that the enormous sums of money involved would allow the government to exert undue control over the stock market.
Not all experts agree that Medicare and social security are facing a crisis. In a January 1999 report, the National Academy on an Aging Society argued that rising numbers of older Americans do not necessarily foretell the collapse of these programs. Economic growth may well offset rising costs, the report argued. The report also noted that future generations of older Americans are less likely to need public assistance because they will be healthier and better off financially than previous generations. For the time being, however, the question of how to ensure that future retirees have access to government health and pension plans remains unanswered.
In the span of one century the average life expectancy in the United States jumped from 47 to 76 years. Can it be extended further? Many experts on aging hope that the practical application of future scientific discoveries will help people lead even longer and more productive lives.
One of the most promising avenues of inquiry is an international collaborative effort known as the Human Genome Project, which aims to decode human deoxyribonucleic acid (DNA), the basic genetic blueprint of a human being. By “mapping” this genetic code, scientists hope to gain insight into why some people are more susceptible than others to certain diseases. The genes (units of genetic material that carry inherited characteristics) associated with hereditary diseases such as cystic fibrosis, muscular dystrophy, and Huntington's disease, have already been identified. The completion of the Human Genome Project, scheduled for 2003, is likely to mark an important step toward making it possible for people to control their susceptibility to these and other diseases.
In 1961 Leonard Hayflick, an American microbiologist at the University of Pennsylvania's Wister Institute of Anatomy and Biology in Philadelphia, and Paul Moorhead, an American cytogeneticist also working at the Wister Institute, found that human cells replicate 50 times before they no longer divide and begin to senesce (age). Scientists have a number of theories to explain why this happens. Some believe free radicals may play a role. Free radicals are molecules that are missing an electron, an electrically charged atomic particle, making them unstable and highly reactive. Although free radicals are a normal by-product of cellular activity and perform helpful functions such as fighting disease and injury, they can also damage living tissue through a process known as oxidation.
Oxidation occurs when a free radical attempts to balance its electric charge by stealing an electron from a neighboring molecule. Some researchers have found that molecules known as antioxidants can help prevent this by neutralizing free radicals. A diet of foods high in antioxidants such as vitamin C (found in oranges and broccoli), and vitamin E (found in wheat-germ oil and sunflower seeds) is associated with a decreased risk of cancer and heart disease, according to several studies. The results of these studies have been inconclusive, however, and researchers are continuing to investigate the potential benefits of antioxidants.
Other scientists are examining how the end sections of DNA, known as telomeres, influence the aging process. Each time a cell divides, the telomeres shorten, eventually depleting after about 50 divisions. Some studies have shown that the enzyme telomerase helps rebuild the telomere, and scientists are investigating ways to employ telomerase to slow the aging process.
Human embryonic stem cells may one day play an important role in combating the aging process. Embryonic stem cells are undifferentiated cells, which means they have yet to develop into specialized types of cells, such as heart cells, liver cells, or skin cells. Scientists foresee many applications for embryonic stem cells. For example, some believe embryonic stem cells could be injected into a patient to replace diseased cells. But scientists do not yet understand how to control the differentiation process, and practical applications for these types of cells remain unrealized. A major breakthrough in embryonic stem cell research came in November 1998 when two teams of researchers announced they had succeeded in culturing embryonic stem cells in the laboratory. This breakthrough was important, many experts said, because a steady supply of cells will be key to unlocking the potential of embryonic stem cells.
Another potential means of intervening with the aging process is hormone replacement therapy (HRT). Hormones are chemicals that govern growth, metabolism (the process of breaking down food into energy), and many other functions within the human body. As the body ages, levels of some hormones drop. Women who reach menopause (the cessation of menstruation), for example, experience a drop in the level of the hormone estrogen. This decline coincides with an increased risk of heart disease in women and can lead to osteoporosis, a thinning and weakening of the skeleton. Replacing estrogen through HRT may help alleviate these and other side effects of the aging process. But estrogen therapy can also have negative consequences, such as a possible increased risk of breast cancer and a definitive increased risk of uterine cancer.
Some scientists believe that testosterone, dehydroepiandrosterone (DHEA), and melatonin may also serve as “antiaging” hormones. But the safety and effectiveness of these substances have not yet been determined. Human growth hormone (hGH) has also been proposed as a potential antiaging hormone, but most experts believe hGH is unsuitable for this purpose.
Clearly, this demographic revolution has led to many positive developments in society. People are living longer, healthier lives and are staying active well into their later years. Multigenerational families have become increasingly common. Further advances in medicine may one day extend the average life expectancy even further.
These changes have been accompanied by challenges, such as the financial difficulties facing Medicare and social security. But these challenges are not insurmountable. Indeed, they must be surmounted, because the aging of America will not wait for a solution.
About the author: Robert N. Butler is president of the International Longevity Center (ILC), a nonprofit organization devoted to the study of population aging and its effects on society. He is also a professor of geriatrics at the Henry L. Schwartz Department of Geriatrics and Adult Development at Mount Sinai School of Medicine in New York City and was the founding director of the National Institute on Aging (NIA). His book, Why Survive? Being Old in America, won the 1976 Pulitzer Prize for general nonfiction.
Further reading:
Allard, Michel, Lebre, Victor, and Robine, Jean-Marie. Jeanne Calment: From Van Gogh's Time to Ours—122 Extraordinary Years. W. H. Freeman, 1998.
Butler, Robert N. Why Survive? Being Old in America. Harper, 1975.
Butler, Robert N., and Lewis, Myrna I. Aging and Mental Health. Allyn and Bacon, 1998.
Coles, Robert. Old and On Their Own. W. W. Norton, 1998.
Hayflick, Leonard. How and Why We Age. Ballantine Books, 1996.
Rowe, John W., and Kahn, Robert L. Successful Aging. Pantheon, 1998.
Suzman, Richard M., Willis, David P., and Manton, Kenneth G. (eds.) The Oldest Old. Oxford University Press, 1995.
Source: Encarta Yearbook, January 1999.
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Nursing Home; United States (People); Hospice; Medicare and Medicaid; Gerontology; Aging; Geriatrics
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