Even if scientific advancesprove extraordinary, "we are going to have to deal with the costs,workforce, and service delivery arrangements for large numbers ofelders living for at least a year or two with seriousdisabilities." (Photo: Shutterstock)

Within 10 years, all of the 74 million baby boomers in theUnited States will be 65 or older. The most senior among them willbe on the cusp of 85. Even sooner—by 2025—the number of seniors (65million) is expected to surpass that of children ages 13 and under(58 million) for the first time, according to Census Bureau projections.

"In the history of the human species, there's never been a timelike [this]," said Dr. Richard Hodes, director of the NationalInstitute on Aging, referring to the changing balance between youngpeople and old.

What lies ahead in the 2020s, as society copes with thisunprecedented demographic shift? I asked a dozen experts toidentify important trends. Some responses were aspirational,reflecting what they'd like to see happen. Some were sobering,reflecting a harsh reality: Our nation isn't prepared for this vastdemographic shift and its far-reaching consequences.

Here's what the experts said:

A Crisis of Care

Never have so many people lived so long, entering the furthestreaches of old age and becoming at risk of illness, frailty,disability, cognitive decline, and the need for personalassistance.

Even if scientific advances prove extraordinary, "we are goingto have to deal with the costs, workforce, and service deliveryarrangements for large numbers of elders living for at least a yearor two with serious disabilities," said Dr. Joanne Lynn, alegislative aide on health and aging policy for Rep. Thomas Suozzi(D-N.Y.).

Experts caution that we're not ready.

"The cost of long-term care [help in the home or care inassisted-living facilities or nursing homes] is unaffordable formost families," said Jean Accius, senior vice president of thoughtleadership at AARP. She cited data from the Genworth Cost of Care Study: While the medianhousehold income for older adults was just $43,696 in 2019, theannual median cost for a private room in a nursing home was$102,204; $48,612 for assisted living; and $35,880 for 30 hours ofhome care a week.

Workforce issues are a pressing concern. The need for healthaides at home and in medical settings is soaring, even as low wagesand poor working conditions discourage workers from applying for orstaying in these jobs. By 2026, 7.8 million workers of this kind will berequired, and hundreds of thousands of jobs may go unfilled.

"Boomers have smaller families and are more likely to enter oldage single, so families cannot be expected to pick up the slack,"said Karl Pillemer, a professor of human development at CornellUniversity. "We have only a few years to plan different ways ofproviding care for frail older people to avoid disastrousconsequences."

Living Better, Longer

Could extending "healthspan," the time during whicholder adults are healthy and able to function independently, easesome of these pressures?

The World Health Organization (WHO) calls this "healthy lifeexpectancy" and publishes this information by country. Japan wasthe world's leader, with a healthy life expectancy at birth of 74.8years in 2016, the most recent year for which data is available. Inthe U.S., healthy life expectancy was 68.5 years out of a total average life expectancy of78.7 years.

Laura Carstensen, director of Stanford University's Center onLongevity, sees some cause for optimism. "Americans are beginningto exercise more" and eat more healthful diets, she said. Andscientific studies published in recent years have shown thatbehavior and living environments can alter the trajectory ofaging.

"With this recognition, conversations about aging societies andlonger lives are shifting to the potential to improve quality oflife throughout," Carstensen said.

Other trends are concerning. Notably, more than one-third ofolder adults in the U.S. are obese, while 28 percent are physically inactive, putting them at higherrisk of physical impairments and chronic medical conditions.

Rather than concentrate on treating disease, "our focus shouldshift to health promotion and prevention, beginning in early life,"said Dr. Sharon Inouye, a professor at Harvard Medical School and amember of the planning committee for the National Academy ofSciences' Healthy Longevity Global Grand Challenge.

Altering Social Infrastructure

Recognizing the role that social and physical environments playin healthy aging, experts are calling for significant investmentsin this area over the next decade.

Their wish list: make transportation more readily available,build more affordable housing, modify homes and apartments to helpseniors age in place, and create programs to bring young and oldpeople together.

Helping older adults remain connected to other people is acommon theme. "There is a growing understanding of the need todesign our environments and social infrastructure in a way thatdesigns out loneliness" and social isolation, said Dr. Linda Fried,dean of Columbia University's Mailman School of Public Health.

On a positive note, a worldwide movement to create "age-friendly communities" is taking hold inAmerica, with 430 communities and six states joining an effort toidentify and better respond to the needs of older adults. Acompanion effort to create "age-friendly health systems" is likely to gainmomentum.

Technology will be increasingly important as well, with aging inplace likely made easier by virtual assistants like Alexa, videochat platforms like Skype or FaceTime, telemedicine, roboticcaregivers, and wearable devices that monitor indicators such asfalls, according to Deborah Carr, chair of the sociology departmentat Boston University.

Changing Attitudes

Altering negative attitudes about aging—such as a widespreadview that this stage of life is all about decline, loss, andirrelevance—needs to be a high priority as these efforts proceed,experts say.

"I believe ageism is perhaps the biggest threat to improvingquality of life for [older] people in America today," Harvard'sInouye said. She called for a national conversation about "how tomake the last act of life productive, meaningful, andfulfilling."

Although the "OK Boomer" barbs that gained steam last year testifyto persistent inter-generational tension, there are signs ofprogress. The WHO has launched a global campaign to combat ageism.Last year, San Francisco became one of the first U.S.cities to tackle this issue via a public awareness campaign. And a"reframing aging" toolkit developed by the FrameWorksInstitute is in use in communities across the country.

"On the bright side, as the younger baby boom cohort finallyenters old age during this decade, the sheer numbers of olderadults may help to shift public attitudes," said Robyn Stone,co-director of LeadingAge's LTSS (long-term services and supports)Center at UMass Boston.

Advancing Science

On the scientific front, Dr. Pinchas Cohen, dean of the LeonardDavis School of Gerontology at the University of SouthernCalifornia, points to a growing recognition that "we can't justapply one-size-fits-all guidance for healthy aging."

During the next 10 years, "advances in genetic research andbig-data analytics will enable more personalized—andeffective—prescriptions" for both prevention and medicaltreatments, he said. "My prediction is that the biggest impact ofthis is going to be felt around predicting dementia and Alzheimer'sdisease as biomarker tests [that allow the early identification ofpeople at heightened risk] become more available," Cohencontinued.

Although dementia has proved exceptionally difficult to address,"we are now able to identify many more potential targets fortreatment than before," said Hodes, of the National Institute onAging, and this will result in a "dramatic translation of discoveryinto a new diversity of promising approaches."

Another potential development: the search for therapies thatmight slow aging by targeting underlying molecular, cellular, andbiological processes—a field known as "geroscience." Human trials will occur over thenext decade, Hodes said, while noting "this is still far-reachingand very speculative."

Addressing Inequality

New therapies spawned by cutting-edge science may beextraordinarily expensive, raising ethical issues. "Will themiracles of bioscience be available to all in the next decade, oronly to those with the resources and connections to access specialtreatment?" asked Paul Irving, chairman of the Milken Institute'sCenter for the Future of Aging.

Several experts voiced concern about growing inequality in laterlife. Its most dramatic manifestation: The rich are livinglonger, while the poor are dying sooner. And the gap in their lifeexpectancies is widening.

Carr noted that if the current poverty rate of9 percent in the older population holds over the nextdecade, "more than 7 million older persons will live withoutsufficient income to pay for their food, medications, andutilities." Most vulnerable will be black and Latina women, shenoted.

"We now know that health and illness are affected by income,race, education, and other social factors" and that inequalities inthese areas affect access to care and health outcomes, Pillemersaid. "Over the coming decade, we must aggressively address theseinequities to ensure a healthier later life for everyone."

Working Longer

How will economically vulnerable seniors survive? Many will seeno choice but to try to work "past age 65, not necessarily becausethey prefer to, but because they need to," Stone said.

Dr. John Rowe, a professor of health policy and aging atColumbia University, observed that "low savings rates, increasingout-of-pocket health expenditures, and continued increases in lifeexpectancy" put 41 percent of Americans at risk ofrunning out of money in retirement.

Will working longer be a realistic alternative for seniors?Trends point in the opposite direction. On the one hand, theU.S. Bureau of Labor Statistics suggests thatby 2026 about 30 percent of adults ages 65 to 74, and11 percent of those 75 and older, will be working.

On the other hand, age discrimination makes it difficult forlarge numbers of older adults to keep or find jobs. According to a2018 AARP survey, 61 percent of olderworkers reported witnessing or experiencing age discrimination.

"We must address ageism and ageist attitudes within theworkplace," said Accius of AARP. "A new understanding of lifelonglearning and training, as well as targeted public- andprivate-sector investments to help certain groups transition [fromold jobs to new ones], will be essential."

Kaiser HealthNews is a nonprofit news service coveringhealth issues. It is an editorially independent program of theKaiser Family Foundation, which is not affiliated with KaiserPermanente.

From: BenefitsPro