The world is growing up and growing old. By 2050, between 10% and 43% of nations’ populations will be older than age 65. And America’s in the thick of it.
The National Academy of Medicine sees aging as a critical challenge that will impact every country in the world, according to Dr. Linda P. Fried, a professor of medicine, director of the Age Boom Academy at Columbia University and dean of its school of public health.
It’s also an opportunity. Societies thrive if people can age well, she said during a press briefing at the annual scientific meeting of the Gerontological Society of America, held in Indianapolis in early November.
Fried’s been immersed in the issue of healthy aging worldwide as co-chair of the international commission that months ago released the “Global Roadmap for Healthy Longevity.” The over-65 population has been the fastest-growing during the past century and within a few years — by 2030 — “for the first time in recorded history the old will begin to outnumber the young,” per the report.
That report and the scientific meeting carry similar messages about aging — both what could be hard and the rewards to be had. If the older years are marked by health and solid relationships, adequate resources and opportunities like working if one so chooses, then gifts from time and experience let older individuals thrive. But ageism, ill health, poverty, pollution and inequality provide brick walls that can shatter older lives, as the report, research and aging experts point out.
The conference, which was expected to draw 3,000 professionals, included 450 scientific sessions on aging-related topics. Here are four takeaways on aging in America:
To age well, exercise.
Physical activity is a major key to cognitive health, not just physical well-being. And even those who already have mild cognitive impairment — which increases the risk of developing dementia — can improve their brain health by getting enough exercise.
The sweet spot is around 150 minutes of moderate activity — or more — a week, Tomiko Yoneda, a postdoctoral researcher at Northwestern University, said during a panel discussion.
She said physical activity reduces the risk that neurocognitive decline will progress and noted the more active people are, the more likely they are to transition back to mildly impaired functioning if deterioration has begun. Cognition can improve with exercise.
“My hope is that research like this will motivate older adults to engage in activity,” she said.
Tons of research support the conclusion that physical activity — what’s good for the heart — is also good for the brain. The National Institute on Aging and the Alzheimer’s Association are among those funding randomized clinical trials to study how behaviors including activity impact one’s health.
In June 2020, the institute announced that healthy lifestyle behaviors like exercise “substantially” lower the risk of Alzheimer’s disease. The findings were from long-term studies that followed 3,000 participants, noting healthy choices include exercising at least 150 minutes a week, mental stimulation, a nutritious diet, not smoking and no more than moderate alcohol intake.
Dr. Klodian Dhana, assistant professor at Rush University, who led the research, told the Deseret News at the time that practicing two or three of the positive lifestyle choices lowered the risk of Alzheimer’s by 37%, while those who embraced four or all five had 60% reduced risk, compared to those with none or just one of the healthy lifestyle factors.
Experts emphasize that starting late in life is better than not starting at all, though lifelong physical activity is ideal.
America relies on unpaid helpers
Within the last two years, more than half of adults over 50 have helped someone over 65 — a friend, a spouse, a relative — with health issues, personal hygiene, taking care of their home or with their finances.
That’s according to a new University of Michigan National Poll on Healthy Aging released at the scientific meeting. Of those who provided the help, 7 in 10 were aiding someone with whom they do not live.
Some were actual caregivers; others could be classified as helpers.
The survey, conducted for the university’s Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine, found those providing help generally felt great personal satisfaction in the task. But they also were more taxed by the tasks than expected. Being a supportive caregiver was especially challenging for those who helped someone who had multiple needs or who had neurocognitive challenges, from mild cognitive impairment to dementia.
The survey’s example of the tasks people did to help older adults included shopping for or with someone, helping with housework, bathing and dressing an individual, going to medical appointments, managing medications, taking on some financial tasks or at least helping with them and doing home repairs, among others.
Those types of help — and that category of helpers — are nearly always unpaid.
The researchers said that more than 3 in 10 people over 50 had helped an older adult with home maintenance, while a like number helped with shopping or meal preparation. More than 1 in 5 had helped someone over 65 manage their finances.
On the health side, 1 in 3 helped by going to a doctor’s appointment or communicating with a health care provider for the older adult, while 1 in 7 helped manage medications and a similar number helped the older person “navigate” their health insurance coverage.
Finally, 16% helped an older person dress, bathe and otherwise manage personal care. The researchers noted that formal caregivers like home health aides are trained to do those tasks, while the informal but robust network of friend/family/neighbor caregivers are not.
The poll was based on findings from a nationally representative survey that NORC at the University of Chicago conducted for the Michigan researchers. Administered online and by phone in July 2022, the survey included 2,163 adults ages 50 to 80 and was weighted to represent the population.
In a separate briefing, Jacqueline Boyd of The Care Plan, who was not involved with the survey, said she learned about caregiving by doing it, first as a big sister to five siblings who became a certified nursing assistant at age 18 and later as someone who with her dad shared caregiving for her mom. While she described it as a privilege, she said it’s an emotional labor whose cost is “hard to describe if you haven’t done it.” She noted caregivers are largely under-resourced and so are those they care for. And increased stress and lack of knowledge about caregiving resources and how the health care system works at that level are big barriers, she said.
She created The Care Plan, she said, because people need the types of services it provides, including individualized services to folks and their families who need ethical and kind help navigating what is often a challenging health care system.
Sarah M. Powers, a research scientist with the Benjamin Rose Institute on Aging, described the challenges she faced as a primary caregiver to her aunt. Powers lived in Cleveland, her aunt in Cincinnati. She said that professional knowledge doesn’t overcome all the challenges when you’re thrust into the role of being a caregiver. “I’ve been in the caregiving space since 2010 and was still having a hard time navigating” the challenges, she said in a panel discussion on diversity in health care.
Telehealth made care accessible
Telehealth was a “godsend” for millions of Americans receiving health care services during the pandemic, while ensuring the spread of the virus was kept to a minimum, especially among older adults, according to John Graham, a member of the senior staff of the Senate Special Committee on Aging, working with ranking member Sen. Tim Scott, R-S.C.
Scott and colleagues reintroduced the bipartisan Telehealth Modernization Act, which would update coverage restrictions that have long prevented life-saving telehealth services for many of the nation’s Medicare beneficiaries, he said.
COVID-19 highlighted the urgency of updating telehealth rules in Congress, which provided temporary emergency waivers. Medicare beneficiaries turned to telehealth services to minimize exposure risks and receive medically necessary care in safe and accessible settings. Those were well-used, with more than 4 in 10 Medicare primary care visits done by telehealth in April 2020, for instance. Overall, more than 10 million Medicare beneficiaries used telehealth instead of having to go to a health care setting.
But without some congressional action, he added, that help for older adults ends with the public health emergency for which the flexibility was created.
Andrew MacPherson of Healthsperien, a health care policy consulting firm, pointed out that the public health emergency designation is set to expire in January and the moment it does, many of the flexibilities that providers have provided, like telehealth, will disappear,
Right now, he added, there’s tension in Congress over whether some telehealth flexibility will be extended.
MacPherson suspects with the COVID bivariant and flu season — “a double threat” — Health and Human Services Secretary Xavier Becerra is unlikely to let that expire in January. “I also think he wants to let Congress have a little bit more time to potentially pass legislation to extend some of those flexibilities,” he said, adding that it’s also difficult to take away a benefit once it’s been given.
“We’ll see how it plays out; there is a lot of bipartisan support for telehealth in particular,” MacPherson said.
Healthcare costs are worrisome
Healthcare is one of the most pervasive and top priorities for Americans on a bipartisan basis and there are four primary areas of concern, MacPherson told journalists: medical bills, health insurance deductibles, prescription drug costs and insurance premiums.
“People are really concerned about how they’re going to afford their health care in this country,” he said. “Health care is an issue that people really care about on both sides of the aisle.”
He cited a poll that found 90% of Americans say that prescription drug prices are at least somewhat to very important.
Healthcare costs, he said, are a concern for half of adults, not just older adults. He noted a Kaiser Family Foundation poll that showed that when adults are asked about their household worries, 58% say they are concerned about unexpected medical bills and 45% worry about the cost of long-term care. Their health insurance deductible — what they have to pay before health insurance kicks in — is a concern for 44% of adults. In that poll, 43% worry about their prescription costs, too.
MacPherson is among several experts who told the Deseret News that they think Medicare solvency will be a focus for Congress in the near term.
Editor’s note: This article was written with the support of a journalism fellowship from the Gerontological Society of America, the Journalists Network on Generations and the Silver Century Foundation.