For more than two decades gerontologists have been debating the implications of one of the most important developments of the last half-century: that people are living longer. The debate centers on whether or not a longer life means a better life. What value is there to living longer if the extra final years are a time of weakness and infirmity?
In the 1980s, researchers hypothesized that better health care and healthier living habits would mean an active as well as a longer life. The gerontologist Sidney Katz and his colleagues came up with the idea of an “active life expectancy,” that is, how long one could expect to live actively. Since then researchers have used sophisticated demographic techniques to test the hypothesis that people could remain active and healthy into their seventies, eighties, and even nineties. Various longitudinal studies in the United States and Europe have tried to examine the issue as objectively as possible. And while their methodologies vary, the results of these studies really did point toward a significant reduction in the rate of functional decline in older people over the last three decades.
But the picture is not quite that simple. Mortality and morbidity statistics can be misleading. For example, although death from cardiovascular disease has declined, better treatment alone doesn’t explain the trend. Better and earlier diagnoses have led to the identification of individuals with early-stage disease, and so the decline may be due to the diagnosis of cardiovascular disease before people suffer heart attacks or other cardiovascular disabilities.
Still, gerontologists agree that older people are generally better able to function than they used to be, in part because they are now better educated about how to live longer. In addition, technology has made daily life less physically taxing. The average seventy-five-year-old in a developed country, for example, is more likely to drive an automobile requiring little strength, and is likely to live in a space that is architecturally barrier-free—on one floor or accessible by elevator. That same older person has a Social Security check deposited directly into a bank account, warms up meals in a microwave oven, and can order groceries by phone. Medical technology has also helped. New surgical techniques have virtually eliminated the disability of cataracts. Arthritic hips and knees are routinely replaced. And improvements in the medical management of strokes and heart disease clearly have made getting around independently much easier.
Sounds good, doesn’t it? The trouble is that other, more disturbing trends threaten to counteract at least some of these improvements. The sheer numerical increase in the size of the aged population over the next several decades will mean that the number of older persons who are dependent, disabled, and suffering the consequences of multiple chronic conditions will be larger than it has ever been—and far larger than most countries are prepared to manage.
Add to this the epidemic of obesity among the middle-aged, particularly in the United States, and the picture looks gloomy. Obesity among the middle-aged can restrict their independence as well as their ability to function and fill social roles as they age. This suggests that we may be in for a reversal of the hard-fought gains.
In other words, while advances in technology, the built environment, and medical care may have yielded benefits in the ability of older people to function better and maintain a higher quality of life, baby boomers and their successors may be literally eating away those social gains.
Gerontologist Vincent Mor chairs Brown’s department of community health.