Robert Butler regularly works 12-hour days, and he recently hopscotched, in the span of six weeks, from the Netherlands to Dubai to Davos, Switzerland, to drum up support at various conferences for research on preparing for the coming age boom. At 82, the scientist, expert on successful aging, grandfather, and Pulitzer Prize-winning author—who coined the term "ageism" four decades ago to describe discrimination against the elderly—is living proof that humans, like fine wine, can deepen in complexity with time. As 2009 drew to a close, he was "preparing to visit my daughter in Palm Springs before heading to Canyon Ranch for a week of exercise."
The head of the International Longevity Center, a research and policy organization he founded two decades ago to "maximize the benefits" of aging, is committed to identifying and spreading the word about ways to get older people out of their armchairs, eating more healthful foods, and engaged in work and learning along with their golf and bridge. Nonsense! he says in response to doomsday predictions of what's bound to happen as nearly 80 million baby boomers enter their twilight years—among them, that the skyrocketing costs will bankrupt the nation. Yes, action is called for, but catastrophe is hardly inevitable, Butler argues, and in fact, there's reason to look forward to a golden age of aging. Seniors today are living more independently; fewer of them are dying of lengthy and debilitating bouts of cancer thanks to improved screening, better treatments, and a drop in smoking; and they're happier than they were in the past, according to a 2008 University of Chicago study. "We need to alter our thinking about old age," Butler says, and realize that it "can be positive and constructive."
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This shift can't come too soon. The Census Bureau forecasts that the 65-and-over population will rise from 38.7 million in 2008 to 88.5 million by 2050 and that the 85-and-over slice will swell from 5.4 million to 19 million. The actual size of this "age wave," though, could reach tsunami proportions, if a December study from the healthcare policy journal Milbank Quarterly turns out to be prescient. It predicts an average American life span of 86 years for a man and 93 years for a woman by 2050—more than a decade longer than now—and a grand total of up to 108 million seniors.
Retirement = quaint. Transforming this explosion from a negative to a positive requires a complete overhaul in how Americans approach seniordom, Butler says: They should expect to work and learn longer, begin well in advance to protect themselves against chronic disease—some 50 percent of today's seniors live with disease or disability—and prepare to age at home. "I believe the word retirement in a decade will be a quaint, charming term that people used to use," says Larry Minnix, president of the American Association of Homes and Services for the Aging, a nonprofit trade group. Already, a handful of community colleges have begun offering accelerated courses to help the 50-plus set move from the private sector to a public-service job. Housing complexes and villages catering to seniors have sprung up across the country, enabling them to remain in place or even move back from a nursing home.
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But there's no coordinated national strategy, and health policy experts agree that one is urgently needed. Medicare, Medicaid, and Social Security require extreme makeovers; federal spending on the three programs is expected to rise in the next decade from 7 percent of gross domestic product to nearly 12 percent. A ballooning obesity epidemic, which threatens to halt those life-span extensions or even undo them, could greatly affect the quality of life of the elderly. Between 2005 and 2007, obesity rates among adults ages 55 to 64 rose in 49 states and were up in all 50 states for those 65 and over, according to a recent report commissioned by the Robert Wood Johnson Foundation.
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Another recent report projects that the number of people with Alzheimer's disease will nearly double every 20 years, putting enormous strain on elder-care resources and families. On a practical level, society isn't well organized for the aged. Many cities and suburbs, for example, lack sidewalks and efficient public-transportation systems to enable seniors to get around when they can no longer drive, points out John Rowe, a health policy expert at Columbia University Mailman School of Public Health. "We've got a lot of work to do," he says.
New careers for seniors. Priority No. 1, the experts agree, is keeping older workers in the workforce. "About two thirds of Americans today retire from their principal jobs when they're 62, the first year they can get partial Social Security benefits," says John Rother, executive vice president for policy at AARP. The economic downturn, meanwhile, has tripled the number of unemployed workers ages 55 to 64 over the past two years, compared with a doubling in the overall number. This trend, if not reversed, could push Social Security to the brink. The Congressional Budget Office had already predicted, before the recession, that the program would be doling out more than it took in by 2020, which would empty out the trust fund and cause a drastic cut in benefits by 2043.
Solutions may come in the form of an increased payroll tax from a rate of 12.4 percent to 13.7 percent, which the CBO recommends, or a further rise in the minimum age for full benefits, possibly to 70 or beyond for those just entering the workforce. Neither option is likely to be popular with taxpayers, which may be why policymakers are focused instead on the carrot approach: enticing citizens to work longer and businesses to let them. Arizona started a "mature workforce" initiative five years ago to help seniors make job connections; more than 40 companies have so far agreed to hire and train those over 50. Last April, Congress passed legislation to establish "encore fellowships" for retirees looking to retool for second careers in government and the nonprofit sector, with a yearly salary of $22,000. A model of this program was launched a year ago in Silicon Valley; computer manufacturers pay stipends to retired employees exploring public-service careers. "I was in high-tech for 25 years and really enjoyed it, but it just wasn't as exciting as it used to be," says Gina Cassinelli, 52, of Redwood City, Calif., who took early retirement in 2007 and is now doing a marketing fellowship at a nonprofit that provides after-school apprenticeship programs for kids. "I want to give back to the community but didn't know how to make connections with nonprofits. So this has been a huge benefit for me." Also available: Encore Careers, a free job-finding website, and Encore College, a community college initiative offering expedited coursework to retirees seeking new public-service careers.
The financial perks of a longer working life go without saying. But a recent University of Maryland study suggests, too, that seniors who remain in the labor force, even in part-time jobs, maintain their cognitive abilities, physical dexterity, and social connections much better than those who choose to retire while they're still healthy. "Most Americans like their work, finding it a source of their identity and meaning in life," points out Laura Carstensen, a psychology professor at Stanford University and founding director of the Stanford Center on Longevity. "Golfing is fun," she adds, "but for 30 years?"
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For people with savings, volunteer opportunities can provide the same antiaging benefits, and opportunities to do good at an advanced age are multiplying. Experience Corps has enlisted 2,000 volunteers over age 50 to tutor and mentor children in 22 inner-city schools; the federal government's Senior Corps of 500,000 volunteers over 55 renovate homes, act as companions for the elderly, and assist victims of natural disasters. "Here I am, serving in a rural village primary school, demonstrating good hygiene practices to the children," writes 85-year-old Peace Corps volunteer Muriel Johnston via E-mail from Morocco. "I've met a lot of wonderful people and am being tutored in Tashilheet," a language she's picking up bit by bit. But Johnston, who joined up last April after retiring as an office manager, is a rarity among retirees—a reality that could be remedied, Rowe thinks, by offering tax rebates to those who donate their time.
If only solving the obesity problem were so simple. As a consequence of the expanding girth of our nation, particularly among middle-aged folks, the annual cost of treating obesity-related conditions will rise from $361 per American today to $1,425 in 2018, a recent Emory University study estimates. And the obesity spike is expected to contribute to a doubling in the number of people with diabetes in the next 25 years; obese middle-aged people, research reveals, also have a much greater than average risk of Alzheimer's later in life. "Some people may not live as long as their parents because of this epidemic," says Caleb Finch, a professor of gerontology and neurobiology at the University of Southern California.
While attention is certainly being paid, the remedies have been paltry. New York, for example, last year required restaurants to post calorie counts on their menus, a move that might have some impact, according to a Stanford University study that found a 6 percent drop in calorie consumption at the city's Starbucks. (A similar provision was put forth by healthcare reformers.) Small pilot exercise initiatives such as AARP's 10-week walking program geared to those over 50 simply aren't widespread enough to have much of an effect. What the country needs, Rother says, are big national changes. The healthcare reform legislation sets aside $1 billion for obesity prevention programs; another potential weapon is a "sin tax" on soda, candy bars, and chips. A recent analysis published in the New England Journal of Medicine showed that adding a 1-cent-per-ounce tax on sugar-sweetened beverages could generate $14.9 billion in the first year alone for obesity prevention even as it theoretically encourages folks to drink fewer calories.
Independence. The ultimate goal of all these efforts is to keep the elderly living independently for as long as possible. Traditionally, many well-heeled seniors have turned to one of more than 2,000 continuing-care retirement communities, which charge an entry fee ranging from $70,000 to several million dollars as well as monthly fees to cover housing, transportation, meals, and nursing care for the rest of their lives (the entry fee is partially refunded to heirs when a resident dies). Now, those who don't have the money or desire to move are increasingly creating their own communities. In New York and a few other states, about 300 apartment complexes and communities with high concentrations of seniors have been transformed into "naturally occurring retirement communities" that provide residents with financial planning services, meal deliveries, disease-prevention programs, and other services. Elsewhere, seniors have organized "intentional communities" in their own neighborhoods, co-ops that provide discounted home repair services, social activities, home nursing care, and a community of friends for an annual membership fee of around $800. To date, 48 are up and running, from Palo Alto, Calif., to Boston, and an additional 80 are planned for the next year. Geraldine Zetzel, 82, knows she can simply call the office staff of Cambridge at Home, a co-op she helped found three years ago in her hometown of Cambridge, Mass., whenever she needs, say, a recommendation for a personal trainer to alleviate her hip bursitis or a tree trimmer. And the social activities, like her poetry group and art museum outings, are a big plus. "I've met neighbors that I never knew in my 40 years living here," she marvels. (They may be invited to a reading when Zetzel's first book of poetry is published this winter.)
While these villages may seem utopian, they don't address the exorbitant cost of serious long-term care, which now averages $70,000 a year in a nursing home. The government currently foots the bill for citizens without savings who qualify for Medicaid, costs projected to double to $90 billion a year by 2030. A federal law passed in 2006 has had some success in getting low-income nursing home residents back into independent living by allowing coverage for home healthcare services and subsidizing adaptations to houses and apartments. At NewCourtland Square in Philadelphia, which opened in December 2008 with 26 subsidized apartments designed for former nursing-home residents, every unit is outfitted with a state-of-the-art monitoring system that will alert a staff member if, say, a resident hasn't gotten out of bed that morning or has been in the bathtub for too long. But residents make their own meals and bathe themselves, paying an average of just $218 per month in rent. "I'm feeling the best I've felt in a long time," says Jesse Carter, 68, who moved into NewCourtland from a nursing home six months ago after becoming dependent on a wheelchair because of a painful nerve condition. "I can go wherever I want to go," he says, but he can also call for assistance if he needs it.
The bulk of Americans are on their own for long-term care, which explains why nearly 30 percent of the nation's adults currently serve as caregivers. That's a figure certain to rise if long-term care isn't integrated into health insurance. Health reformers have been pushing for a national long-term-care insurance program allowing employees to take deductions from their paychecks when they're young to pay for care down the road. But their plan, which would provide up to $150 a day for home healthcare services, wouldn't provide enough to fully cover nursing-home care or even costly round-the-clock care at home. And it would add to a separate strain on the system: the shortage of nurses and doctors that will occur if 31 million Americans gain medical coverage through health reform. According to the Bureau of Labor Statistics, more than 1 million new and replacement nurses will be needed by 2016, and 159,000 doctors by 2025.
Butler takes encouragement from the progress society has made since he founded the government's National Institute on Aging back in 1974, when old age was synonymous in the public's mind with senility. Still, there can be no resting on laurels. "Our aging society, like climate change, is an inconvenient truth," he says. "We don't want to think about it, but we can't afford not to."
[Slide show: See how 5 Longevity Researchers Stave Off Aging.]
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