Aging of U.S. May Outstrip Projections
Over the next half-century, the number of Americans over the age of 85 may grow to nearly 24 million--twice as many as the standard U.S. Census Bureau projection and 10 times the current level--according to new study released today by USC and the National Institute of Aging, an arm of the National Institutes of Health.
Moreover, by the year 2040, when most of the members of the baby boom generation will have entered their elder years, the population over age 65 in the United States may catapult to 87 million, or one-quarter of the entire U.S. population--a figure that is 20 million higher than what the census has projected and three times the current level.
Degree of Optimism
Although many variables can cause disparities in population projections, the major difference between the census figures and the new, higher projections is the degree of optimism that the USC and national institute researchers share about medicine’s ability to prolong life over the next 50 years. Unlike the census projections, which assume that there will be no overall decline in the rate of death, the USC and national institute projections predict a decline in the mortality rate of 2% a year.
If the more optimistic projections prove to be correct--and many experts are now saying they may be--then the government and families could face “some very complex and costly problems, the magnitude of which this nation has not even begun to estimate,” said Dr. Edward L. Schneider, USC’s dean of gerontology and one of three authors of the study.
According to the new projections, the average life expectancy of American men could rise by the year 2040 to 87 years--17 years longer than the current average and 11 years more than the most often quoted census projection.
The average woman in the year 2040, under the new projections, will live 92 years, compared to their current average of 78 years and a census projection of 83 years.
In making their calculations, Schneider and his colleagues at the National Institute of Aging, Dr. Jack M. Guralnik, and Machiko Yanagishita, acknowledge that they have challenged one of the prevailing assumptions about the aging process in America--that longevity has reached its peak and cannot be extended any further.
But in fact, mortality rates--that is, the number of deaths in given populations each year--have fluctuated over the years without much warning and in many cases without any apparent explanation, the researchers wrote in the study, published in the current issue of the Millbank Memorial Fund Quarterly, one of the country’s leading gerontology journals.
Mortality Rates Dropped
Between the turn of the century and the mid-1950s, for example, mortality rates dropped between 1% and 2% a year. Then in 1954 and continuing through 1968, the rates leveled off, suggesting, the researchers said, that “mortality rates had reached a lower limit and that there was little likelihood of any further decline.”
Without any apparent reason, in 1968 mortality rates began to drop at a rate of about 2% a year. Now, once again that drop has begun to wane, suggesting to many population experts that America may have finally reached a limit beyond which it cannot reasonably expect to extend life.
It was on the basis of such assumptions that the Census Bureau and the Social Security Administration made their predictions for the year 2040. But the USC and national institute researchers contend that to base projections for future populations, particularly elderly populations, on such uncertain assumptions is risky business.
Moreover, the researchers note, population projections have rarely proved to be an exact science, largely because there is no way of predicting the vast array of variables that can alter population figures dramatically. Census experts, for example, never anticipated the surge in fertility rates after World War II that resulted in the baby boom of the 1950s and led to an overcrowding of schools and colleges for more than two decades. Likewise, experts never counted on the population decline of the 1960s and 1970s, the most unfortunate consequence of which were hasty school closings and education budget cuts.
Unanticipated Variables
In addition, any of a number of unanticipated variables in the years to come are as likely as not to throw off future population projections.
Even though they too could be wrong, the USC and national institute researchers said the “prudent” approach is to assume that research advances will occur and that they will propel medicine ahead at least at its current rate for the next 50 years. If that happens, it is reasonable to assume that mortality will continue to drop at least at the current rate of about 2% a year, the researchers said.
“Just as the mortality declines of the past two decades have been unexpected, future declines of this same magnitude may also be unexpected but must be contemplated,” the researchers wrote.
In fact, the researchers argue, there is much evidence to suggest that some of the major diseases that now cause premature death will be reduced, if not eliminated, over the next half-century, a contention not shared by census experts.
The official census position is that, because mortality rates have been slowing in recent years, they will continue to do so, shortly reaching a point where they are at a standstill, with neither decreases nor increases in the annual American death rate. Since such an assumption could be wrong--just as the USC and national institute assumption could also be wrong--some census experts say privately and unofficially that they will be watching the situation carefully over the next few years for indications of change.
Changes in Life Style
The USC and national institute researchers said that change has already come. For example, over the last 50 years, the No. 1 killer in the United States, accounting for half of all the country’s deaths, has been heart disease. Yet, they noted, there have been recent and rather dramatic changes in life styles, exercise patterns and eating habits of young and middle-aged Americans. Combined with ever-increasingly sophisticated medical treatments and interventions, these changes are sure to bring about a substantial, if not a dramatic, reduction in heart attacks, strokes and related ailments in the years ahead, the researchers argue.
Likewise, cancer continues to be a major killer, accounting for 20% of all deaths. But most any breakthrough in either its prevention or treatment could have profound impact on overall mortality rates, the researchers said.
And, they added, countering the view of census officials, given the current progress of understanding the basic science of cellular growth, such breakthroughs are bound to be forthcoming, if not in the next few years, certainly in the new few decades.
“In offering this alternative projection,” the rearchers said, “we are not claiming that it is better or more accurate than the Census Bureau projections. It is presented to permit further discussion of future possibilities for population growth.”
Many of their colleagues, however, have already been persuaded that the optimism about medical advances is warranted.
Health a Question
“Who knows what the exact figures will be . . . but it is fairly clear we will be seeing a lot more people living into their 80s and 90s,” said Frank Williams, director of the National Institute of Aging. “The question is, will they be any healthier or will they have lives of prolonged disabilities?”
“I, for one, think they will be healthier,” Williams said, noting major advances that are already being made in correcting eyesight and hearing loses, reducing osteoporosis, controlling urinary incontinence and other debilitating ailments associated with aging.
And, Williams argued, in such devastating mental problems as Alzheimer’s disease, basic science is moving at such a rapid rate that major breakthroughs in prevention and treatment are surely not many years down the road.
Dr. Robert N. Butler, chairman of the department of gerontology at Mt. Sinai Hospital in New York, also agreed with the general thrust of the new projections, but argued that, rather than being a burden on society, the aging population of the United States will be a “fantastic boon for the economy,” bringing, for example, more jobs for youth who will provide goods and services to the elderly.
“It isn’t as gloomy as some people would make it out to be,” said Butler, former director of the National Institute on Aging and author of the 1975 Pulitzer Prize-winning book “Why Survive: Being Old in America.”
Can Produce Burdens
Even in the best of circumstances, however, “the aging of America . . . will produce burdens society has not yet come to terms with,” said USC’s Schneider.
Unless major changes are made in both public and private medical and social services in this country, there will not be adequate housing, sufficient transportation or appropriate and affordable medical care to support most members of the baby boom generation in their final years of life, Schneider warned.
For instance, the nursing home population, although it represents only a small fraction--5%--of all people over the age of 65, represents 25% of all women over the age of 85. “We’re talking in the future about 10 times that number . . . at an annual cost in today’s dollars of something in excess of $28,000. In fact, the costs aren’t that different wherever (people of that age) are being cared for. I’m not sure that we as a society or we as families are planning for what all this might mean. . . .
“These doom and gloom predictions, of course, could be changed,” Schneider added, “if we as a nation would just invest enough in research for the prevention and cure of the diseases associated with aging.”
PROJECTED RISE IN LIFE EXPECTANCY As life expectancy has risen over the years, so has the proportion of those over age 65 as a percentage of the U.S. population.
PERCENTAGE OF U.S. POPULATION OVER AGE 65
1900 4.0%
1980 11.3%
2040 20-25%
Scientists agree that life expentancy will continue to increase over the next 50 years. But there is disagreement between the Census Bureau and the National Institute on Aging over just how much longer we can expect to live.
LIFE EXPECTANCY: 1985
Men 71.2
Women 78.2
CENSUS BUREAU PROJECTIONS OF LIFE EXPECTANCY: 2040
Men 75.0
Women 83.1
NATIONAL INSTITUTE ON AGING PROJECTIONS: 2040
Men 85.9
Women 91.5
The differences in projected U.S. population over age 65 in the year 2040 can be expressed in a different way: the agecies disagree about the proportion of men and women over age 85. By comparison, among people over age 65, only 4% were more than 85 years old in 1900 and 9% in 1980.
BREAKDOWN OF PROJECTED 65+ POPULATION
CENSUS BUREAU NAT’L INST. ON AGING Age Men Women Total Men Women Total 65-74 49.3% 39.8% 43.7% 39.9% 34.6% 37.0% 75-84 36.8% 37.4% 37.1% 36.3% 35.7% 36.0% 85+ 13.9% 22.8% 19.2% 23.8% 29.7% 27.1%
