Are We Heading Toward Shangri-La Or Geriassic Park?
Health is retirement’s biggest wild card, the difference between activity, independence, and financial security – or worry, constraint, and financial insecurity. Today’s newly minted Boomer retirees can look forward to longer and healthier retirements, perhaps extended by medical breakthroughs. But at the same time, more of them may spend more years later in retirement fighting the chronic and often debilitating diseases of aging.
So where are we headed? Will it be like Shangri-la, the fictional valley where people don’t age, with longer and healthier lives and accessible and affordable care? Or are we headed to Geriassic Park, with tens of millions constantly beset by chronic and degenerative diseases, taking a toll on themselves, their families, and their finances? Can we afford not to close the gap between healthspan and lifespan?
This is the ninth in a 10-part series on “The Future of Retirement” that we are posting over the course of several months. If you are interested in better understanding what’s ahead, we invite you to check out our new book What Retirees Want: A Holistic View of Life’s Third Age.
The pandemic has drawn great attention to the vulnerabilities of older adults and the quality of health care they receive – and often don’t receive. We hope this serves as a wake-up call because maintaining the health of elders was a growing challenge long before COVID-19. The crux of the challenge is the gap between life expectancy, or lifespan, and healthy life expectancy, or healthspan.
Thanks to better nutrition and medical advances, Americans’ life expectancy at birth vaulted ahead in the 20th century, from 47 in 1900 to 77 in 2000. The rate of increase has since slowed, but breakthroughs in anti-aging medicine may well cause another jump. Today’s life expectancy, at 79, is by no means at the top of the class. The United States ranks 33rd in the world, almost four years behind Canada and over five years behind Japan. However, did you know that the longer you live, the longer you’ll live? For example, or American men who have reached the age of 65, their life expectancy is 83, another 18 years, for women at 65, it’s a whopping 20.5 years. That’s the average. With the aging of the Boomers, more and more people are living longer into what we used to think of as “old age.” We’re living longer, but how well?
Healthspan is how long people live in reasonably good condition before illness, injury, or chronic medical conditions impair their ability to live as they like and take care of themselves. That doesn’t mean being in perfect shape. Recent research by Edward Jones, Age Wave (our research organization), and The Harris Poll finds that 91% of older Americans define “healthy” in terms of being able to do the things they want. Almost as many agree that one can be healthy while also living with a chronic condition or disability. Overall, however, the average lifespan-healthspan gap in the U.S. is ten years. That means that the average American will spend their last ten years of life, with health challenges, suffering, and all the costs and anxieties that accompany these cascading problems.
The gap is expensive in terms of both financial and family burden. The United States leads the world in health care spending at over $10,000 annually per capita, 25% more than Switzerland in second place. Over one-third of that spending is on people age 65 and older, who represent 17% of the population. On the family side, there are over 40 million family caregivers in America. They provide more than 1.3 billion hours of assistance a month to loved ones age 65+, and 40% of that effort assists older adults with dementia.
Most retirees say that one of their greatest fears is becoming a burden on their families. For most older adults and their families, the cost of professional care, whether in home or in care facilities, is expensive and most people haven’t planned for it. So is long-term care insurance. Whether it’s providing household support, personal assistance, financial caregiving, or continuous care, tens of millions of American families are coping with the healthspan-lifespan gap every day.
Closing the Gap
What will it take to improve the health of older Americans and enable healthspan to close the gap with lifespan? We believe it will take ongoing concerted effort on four fronts.
One, invest much more in the science that could lead to breakthroughs in reducing or eliminating the chronic conditions associated with aging. These include hypertension, heart disease, arthritis, heart disease, cancer, stroke, COPD, and Alzheimer’s. Nearly six in ten Americans 65 and older have hypertension, aka high blood pressure, aka the “silent killer” because it can lead to heart failure, kidney failure, and stroke. With hypertension so prevalent, it’s no surprise that 81% of those age 65+ have multiple chronic conditions.
As we discussed in an earlier post, the most feared condition among older Americans is Alzheimer’s and other dementias (not infectious diseases like COVID-19). And without breakthroughs, the number of Americans suffering from Alzheimer’s and other dementias will increase from 5.8 million today to over 50 million in 2050. The overall economic drain of chronic conditions is enormous. A Milken Institute study finds that the most common chronic diseases cost the U.S. economy $1.3 trillion a year. Another study finds that dementias alone cost $290 billion a year.
Two, address the current and growing shortage of geriatric care specialists. Reflecting our somewhat upside down priorities, plastic surgeons are the most highly paid physicians in America, while geriatricians are the lowest paid. There are only about 7,300 board-certified geriatricians in the U.S., and the American Geriatrics Society estimates that we will need four times that number by 2030. More medical schools are adding geriatrics programs, but there’s enormous catching up to do. There’s just one geriatrician for every 11,000 Americans age 65+. The number of older Americans is increasing rapidly. Without incentives to enter the field, the cadre of geriatricians may continue to fall behind.
Three, we must find ways to motivate healthier behaviors among Americans of all ages. Our recent research found older Americans close to unanimous in saying that it’s never too late to improve your health. Yet barely half say they maintain a healthy diet (55%) or exercise regularly (52%). It’s great when people take the opportunity to improve their health in retirement. Better still if they enter retirement already in shape because they’ve been taking good care of themselves as a life-long pursuit. Unfortunately, that seems the exception, not the rule.
Four, make basic health care more accessible and user-friendly. Americans 65+ have the safety net of Medicare, but it’s hardly a complete package. “Accessible” really means several things. Care must be available locally or, increasingly, remotely. The rapid rise in telehealth services precipitated by the pandemic represents real progress on this front. Care must also be affordable. Health care costs continue to rise at about three times overall inflation. Retirees pay out-of-pocket an average of over $6,000 per person per year for supplemental coverage and services. Add in average long-term care costs and a 65-year-old couple can expect to pay over $400,000 for out-of-pocket medical and long term care services in their retirement. And the process of receiving care must be understandable. Finding providers, choosing coverages, paying for services, making use of health-related social services – the system is a maze. Less than 20% of Americans with Medicare feel knowledgeable about the program. The problem is especially acute for older patients who have more conditions, use more providers, and have less technological access and aptitude for finding their way online.
Just as the Waze app helps us navigate through traffic to reach our destinations, older Americans (indeed, all Americans) need something like a “Health Waze” app for navigating each of our individual paths to optimal health.