What lies ahead in the 2020s, as society copes with this unprecedented demographic shift?
I asked a dozen experts to identify 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 vast demographic 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 furthest reaches of old age and becoming at risk of illness, frailty, disability, cognitive decline and the need for personal assistance.
Even if scientific advances prove extraordinary, “we are going to have to deal with the costs, workforce and service delivery arrangements for large numbers of elders living for at least a year or two with serious disabilities,” said Dr. Joanne Lynn, a legislative aide on health and aging policy for Rep. Thomas Suozzi, D-New York.
Experts caution we’re not ready.
Workforce issues are a pressing concern. The need for health aides at home and in medical settings is soaring, even as low wages and poor working conditions discourage workers from applying for or staying in these jobs. By 2026, 7.8 million workers of this kind will be required, and hundreds of thousands of jobs may go unfilled.
Altering social infrastructure. Recognizing the role that social and physical environments play in healthy aging, experts have called for significant investments in this area over the next decade.
Their wish list: make transportation more readily available, build more affordable housing, modify homes and apartments to help seniors age in place, and create programs to bring young and old people together.
Helping older adults remain connected to other people is a common theme.
“There is a growing understanding of the need to design our environments and social infrastructure in a way that designs out loneliness” and social isolation, said Dr. Linda Fried, dean of Columbia University’s Mailman School of Public Health.
Technology will be increasingly important as well, with aging-in-place likely made easier by Alexa, Skype, FaceTime and robotic caregivers, said Deborah Carr, chair of the sociology department at Boston University.
Changing attitudes. Altering negative attitudes about aging needs to be a high priority as these efforts proceed, experts say.
“I believe ageism is perhaps the biggest threat to improving quality of life for (older) people in America today,” Harvard’s Inouye said.
The World Health Organization 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 FrameWorks Institute is in use in communities across the country.
Advancing science. On the scientific front, Dr. Pinchas Cohen, dean of the Leonard Davis School of Gerontology at USC, points to a growing recognition that “we can’t just apply one-size-fits-all guidance for healthy aging.”
During the next 10 years, “advances in genetic research and big data analytics will enable more personalized — and effective — prescriptions” for both prevention and medical treatments, he said.
Addressing inequality. New therapies spawned by cutting-edge science may be extraordinarily expensive, raising ethical issues.
Several experts voiced concern about growing inequality in later life. Its most dramatic manifestation: The rich are living longer, while the poor are dying sooner. And the gap in life expectancy is widening.
Carr noted that if the current poverty rate of 9% in the older population holds over the next decade, “more than 7 million older persons will live without sufficient income to pay for their food, medications and utilities.” Most vulnerable will be black and Latina women, she noted.
Working longer. How will economically vulnerable seniors survive? Many will see no choice but to try to work “past age 65, not necessarily because they prefer to, but because they need to,” Stone said.
Dr. John Rowe, a professor of health policy and aging at Columbia University, observed that “low savings rates, increasing out-of-pocket health expenditures and continued increases in life expectancy” put 41% of Americans at risk of running out of money in retirement.
Will working longer be a realistic alternative for seniors? Trends point in the opposite direction. On the one hand, the U.S. Bureau of Labor Statistics suggests that by 2026 about 30% of adults ages 65 to 74 and 11% of those 75 and older will be working.
On the other hand, age discrimination makes it difficult for large numbers of older adults to keep or find jobs. According to a 2018 AARP survey, 61% of older workers reported witnessing or experiencing age discrimination.
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.