Contact DHS

Aging in the 21st Century

Stanford University, with support from several foundations, initiated a “Difficult Dialogues Program.” One of these, “Aging in the 21st Century” helps clarify the ways in which America has changed and explores the social and political challenges an aging society presents. The following contains excerpts form the report.

For the past 5,000 years, life expectancy was a mere fraction of what it is today. In pre-agricultural times, life expectancy ranged from 20 to 40 years of age. By 1900, it was 48 years. During the last century life expectancy rose dramatically, adding roughly 60 percent — nearly 19 years — to average life expectancy.

Declining infant mortality, longer lives and falling fertility rates have resulted in not only aging individuals, but also an aging society. This markedly new reality has already raised fresh challenges for individuals, families and political institutions. And change is not finished with us yet. Mortality rates continue to decline. The remaining life expectancy of 65-year-olds could even reach 24 years by the end of this century.

There is plenty of good news in the report. Longer lives for the most part have been accompanied by better lives. Fully 60 percent of people over 80 years of age live independently in the community.

There is plenty of good news in the report. Longer lives for the most part have been accompanied by better lives. Fully 60 percent of people over 80 years of age live independently in the community.

In one major study, more than half of people followed from 60 to 80 years showed no deterioration in cognitive abilities. In fact, 8 percent demonstrated measurable gains in performance on tests designed to measure thinking prowess.

While members of the aging population may become more vulnerable to physical ailments in later years, they also become more resilient psychologically. Added years often bring deep emotional satisfaction. As people grow older they tend to become more satisfied with their personal relationships.

On average older people are living added years in better physical and mental health and with more freedom from pain than ever before.

While much attention has been given to cognitively impaired individuals among the 65-plus population, less has been given to the fact groups over age 65 include the wisest and richest people in our society.

Most people are healthy most of their lives, but rarely is anyone healthy to the end. Advanced age is associated with poorer health, of course. Not only are older people more likely than the young to develop diseases that require health care interventions, but they are also more likely to suffer concurrent chronic conditions, like arthritis, Parkinson's disease, and diabetes, which require ongoing management. So, as the proportion of the aged population grows, health care expenditures can be expected to increase as well. It's important in this context, though, to fully understand the chief causes of rising health care costs. The care of older people accounts for only a relatively small part. Up to one-half of the increase in health care costs is tied to technological advances in medicine and health care which serve patients of all ages.

Steady application of new knowledge, particularly biomedical innovation, has extended lives and improved their quality for young and old patients alike.

What is largely missing from the discussion about medical breakthroughs and rising health care costs according to the report is a consideration of what kinds of care and future research should be supported with public funds. Despite clear evidence of its benefits, health promotion and preventive care are woefully underfunded.

The report finds that neither public nor private institutions have kept pace with a vastly changed "aging" world. Enacted in 1965, Medicare has its origins in 1940s style insurance plans. Key challenges faced by practitioners and their patients today were not anticipated years ago. Neither were the rising needs for home care and extended care in an aging society.

Similarly, Social Security was designed in 1935 on demographic data from the 1920s. The mismatch of current reality and archaic structure can be particularly punishing toward women. Woman receive no credit under Social Security for the care provided to children, disabled adults or parents — despite the overwhelming need for this unpaid care and it inarguable social value. The failure to credit such needed provision of care later penalizes those women who have taken on the bulk of unpaid caregiving in earlier years. Their benefits end up being reduced precisely whey the need support most — in the latter stages of life when they are more likely to have been widowed.

The report reminds us nearly three decades have been added to the average life span in this century. It's time, the authors say, to nurture a changed culture that supports elongated lives in much more creative, thoughtful, and respectful ways.

For a copy of the report, contact the Institute for Research on Women and Gender, 556 Salvatierra Walk, Stanford, CA 94305-8640 (Phone 650-725-0369). It can be downloaded from www.stanford.edu.