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Aging in America

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Deborah Carr provides a portrait of aging in the United States. The US population is older than ever before, raising new challenges for families, caregivers, health care systems, and social programs like Social Security and Medicare.

Image courtesy of interviewee. March 27, 2024

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This video discusses the changing demographics of older adults in the United States and globally, highlighting the increase in the older population and the accompanying challenges and rewards. By 2050, the number of Americans aged 65 and older is projected to rise from 60 million to 82 million, representing about 23% of the population. This video demographic shift brings significant challenges in healthcare, economic support, and caregiving, notably exacerbated by a shortage of caregivers.

The author, who has written a book called "Aging in America," explains how perceptions of older adults have evolved over time. Initially, older individuals were revered in colonial America, but attitudes shifted during the industrial revolution as ageism emerged. Today, views are bifurcated; while some older adults are seen as vibrant and active, others face stereotypes of incompetence and incapacity.

The discussion highlights that although many older adults live longer, healthier lives due to improved medical care and lifestyle changes, certain subgroups face significant challenges, such as poverty and health issues like dementia. This video emphasizes the impact of societal inequalities on older adults, particularly regarding the effectiveness of social support systems like Social Security and Medicare.

Overall, the author stresses the need for comprehensive policies that address these inequalities from an early age, ensuring that future generations are equipped to age healthily and economically secure. The narrative concludes by raising concerns about the economic challenges facing younger generations like Gen X and millennials, warning of increasing income inequality and reduced opportunities for a healthy and secure old age.

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Here are five key points from the video about aging populations, particularly in the United States:

1. **Aging Population Trends**: The United States population is aging significantly, with projections indicating an increase in the number of older adults (age 65 and older) from approximately 60 million today to 82 million by 2050, which constitutes an increase from 17% to 23% of the total population. This demographic shift presents both opportunities and challenges in meeting the healthcare, economic, and caregiving needs of older adults.

2. **Caregiver Shortage**: There is a notable shortage of caregivers in the U.S. and worldwide, complicating the ability to meet the increasing demands for care as the population ages. This shortage results in challenges in addressing the healthcare and caregiving needs of the growing number of older adults.

3. **Bifurcated Perception of Aging**: The societal perception of older adults is varied, comprising both positive images (active, healthy older individuals) and negative stereotypes (ageism). While some older adults serve as inspiring role models, there is also a prevalent belief that all older individuals suffer from incapacity or cognitive decline, contributing to a stigmatization of aging.

4. **Economic Disparities Among Older Adults**: Despite advancements in overall health and longer life expectancy, many older adults, especially women and people of color, continue to face poverty. These economic disparities are perpetuated by historical inequalities in education, employment, and wealth accumulation, emphasizing the need for policies that address these inequalities.

5. **Impact of Social Policies**: Social Security and Medicare are highlighted as crucial policies that have lifted millions of older adults out of poverty and essential healthcare coverage. However, these systems are not flawless and do not address all the underlying socioeconomic inequalities. The importance of continuing and strengthening these policies, as well as considering broader public investments in education and health, is emphasized to ensure better outcomes for future generations.

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Here are some key quotes from the video you , which discusses aging in America and the challenges and nuances surrounding it:

1. **Population Demographics**:
- “The United States population and the global population are older than ever before.”
- “...the proportion of people who are age 65 and older...will increase from about 60 million to 82 million by the year 2050.”

2. **Healthcare and Caregiving Needs**:
- “...comes remarkable rewards, but also remarkable challenges in terms of meeting their healthcare needs, their economic needs, and most importantly, their caregiving needs.”
- “...we do have a dramatic shortage of caregivers in the US and in many other parts of the world.”

3. **Historical Perspective on Aging**:
- “There has been tremendous waxing and waning over time of how we think about older adults.”
- “Older adults in the colonial United States in the 18th century... were very rare. People didn’t live that long.”

4. **Ageism**:
- “We have amazing role models, um, those people who are running marathons...But alongside that, we really have tremendous ageism where older adults are maligned...”
- “Ageism led to a persistent view that they're not competent, that they don’t understand technology...”

5. **Diverse Family Lives**:
- “The family lives and personal lives of older adults today are more diverse than ever before.”
- “...older adults divorce when they were younger and are in a second marriage or even a third marriage.”

6. **Health Trends**:
- “Through most of the 20th century, life expectancy increased meaning that older adults are living longer than ever before...”
- “...we have seen since about 2015, a slight diminishing of life expectancy...”

7. **Public Policy**:
- “...the two big aging policies in the United States...social security and Medicare.”
- “...these have been two of the most successful social programs in recent history.”

8. **Inequalities in Aging**:
- “Inequalities in old age...don’t come about magically on one 65th birthday. They are the end result of accumulated adversities or accumulated advantages to go back to early life.”
- “...although it’s fantastic that some of the images of aging today are very positive, we need to recognize that there are some people who do not have the economic benefits...”

9. **Future Generations**:
- “The generations that follow the baby boomers have higher levels of education...which will bode well for the future.”
- “...young college graduates today who are saddled with educational debt cannot afford to buy a home.”

These quotes reflect critical themes from the video regarding the aging population, societal perceptions, healthcare challenges, and the implications of public policies on older adults.

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The United States population

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and the global population are older than ever before.

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Um, in the United States today, the proportion of people

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who are age 65

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and older, which is our definition for an older adult,

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will increase from about 60 million to 82 million

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by the year 2050.

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And that proportion is about 17% up to 23%.

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So one in four people will be an older adult

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by the year 2050.

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And with that comes remarkable rewards,

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but also remarkable challenges in terms

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of meeting their healthcare needs, their economic needs,

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and most importantly, their caregiving needs.

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Because we do have a dramatic shortage

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of caregivers in the US

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and in many other parts of the world,

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my latest book is called Aging in America.

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And this book really synthesizes research done not only

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by me, but by other scholars.

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It synthesizes data collected by the Census Bureau

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by the United Nations

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and really gives a statistical portrait of what is going on

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with older adults today.

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But then importantly, it in terms of theories of aging

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and in terms of policy and potential policy impact.

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And in fact, one of the most interesting aspects

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of writing the book was really to think about

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how older adults are understood from a

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historical perspective.

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There has been tremendous waxing

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and waning over time of how we think about older adults.

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So for example, in the colonial United States,

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you might recall seeing pictures of people

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with white powdered wigs, for instance.

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And that was a sign of respect for older adults.

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Older adults in the colonial,

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United States in the 18th century,

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for instance, were very rare.

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People didn't live that long.

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And so if someone did make it to 65

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or 70, they were political leaders,

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they were religious leaders, they were really revered

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by our society.

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But then things took a turn

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and things were not so good for older adults, particularly

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around the industrial revolution,

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when there was an emphasis on being strong

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and able bodied, being able to use one's body at work

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and understand technology.

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And so ageism really did increase during

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that time period when older adults were viewed as obsolete.

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For instance, since that time, we would like

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to think it has gotten better, but not uniformly.

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Today we really have this bifurcated portrait of

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what older adults are like.

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On one hand, we have amazing role models, those people

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who are running marathons or running corporations at age 70.

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But alongside that, we really have tremendous ageism

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where older adults are maligned, where we presume

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that all older people have dementia, that they're incapable

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of doing everything from caring for themselves

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to leading a major nation.

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So really, our views

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Of older adults go up and down.

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And that waxing and waning base is based part on demographic

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factors, how statistically rare or common older adults are,

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but also related to things like technology

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and the pace of daily life.

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Um, today, daily life is very quick, right?

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We expect a response to our texts instantaneously.

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And for some older people who move a little bit more slowly,

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they may malign for doing so.

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In addition to some of the, themes I just gave,

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you know, I would say seeing

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that I talked about the past already,

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I think we can talk a little bit about views of aging today.

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And I think the view of aging today,

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as I previously said, is very bifurcated.

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You know, on one hand we have this vision of older people,

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like the ones we see in pharmaceutical ads.

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They're healthy, they're running marathons,

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they have beautifully appointed homes, they're sailing,

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they have plenty of money, and they're active,

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and that there is some kernel truth to that.

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But some of these very positive images of aging

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that we have today neglect the fact

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that not all people in old age live like those individuals

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in pharmaceutical ads.

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We have large pockets of older adults who live in poverty.

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For instance, we know that women

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of color are far more likely than white married men,

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for instance, to live in poverty.

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So although it's fantastic that some of the images

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of aging today are very positive, we need to recognize

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that there are some people who do not have the

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economic benefits or health benefits that enable them

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to live in that way.

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So we have that positive image.

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But alongside that, we still have tremendous ageism.

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And ageism, like any ism is a negative

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or stereotypical belief about members of a particular group.

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And with older adults, again, we have this persistent view

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that they're not competent,

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that they don't understand technology,

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that they all have dementia

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and that they've lived past their prime.

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Um, we saw that absolutely during the Covid pandemic,

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you might recall seeing things like the boomer remover

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and really horrible, horrible, hashtags out there

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that suggested, let 'em die.

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They're old anyhow.

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They really don't have many more years left

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to do anything productive.

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And that's an utterly false and harmful assumption.

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Uh, we know that ageism hurt older adults.

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It, it leads to depression,

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it makes them less compliant with healthcare.

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Um, it shatters their self-concept.

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And so we do have on one hand really positive images

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that maybe conceal some problems.

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But then on the other hand, we have these very negative

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images that are pervasive and cruel and counterproductive.

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I'll start off talking a bit about families

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and social relationships

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and then we can make our way to health.

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Um, so the family lives

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and personal lives of older adults today are

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More diverse than ever before.

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We used to have this notion of older people being married

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to their long-term sweetheart married for 60, 70 years

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until death do them part.

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Or alternatively, we have a vision of a widow, a widower

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who just doesn't move on

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and they're just wed in their mind to their late spouse,

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in perpetuity.

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And what we see today is that fam, the family lives

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of older adults are just as varied

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as they are among younger people.

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So of course, we have those people

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who married their high school sweetheart

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or college sweetheart,

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and they're still married, 70 years later.

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But we also know that rates of divorce were high

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during the 1970s and eighties.

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So a lot of older adults divorce when they were younger

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and are in a second marriage or even a third marriage.

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We also know that rates of

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what we call great divorce have increased dramatically since

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the 1990s,

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and that's divorce of people when they're age 50 or older.

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And so what we're seeing today is

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that there are some married people who are 50, 60, even 70,

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they know that they're probably gonna

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live another several decades.

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And some of them say,

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do I really wanna spend those next few decades

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with this person in my life?

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Some are deciding at older ages to divorce

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and to find new partners.

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So we see a large number of older adults

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who are either on a second or third marriage,

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or they're cohabiting without legally marrying their

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partner, or they are dating

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or they have another relationship called living apart

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together, which means this is your long-term steady,

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but you maintain your own home.

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Um, people often want their own privacy,

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and sometimes older adults don't wanna mess up

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their children's inheritance.

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They don't wanna sell their house

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and then move them with their new partners,

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so they maintain their separate homes,

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their separate assets,

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but then they really are a very close-knit couple,

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who share their lives, even if not their homes.

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So that's a bit of what's going on on the family front

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for older adults, really very varied.

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It's not like people are

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who are older adults are sitting at home.

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Some of those who aren't in a permanent

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partnership are dating.

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Um, one of the most successful innovations

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that a A RP put out in the United States, which is again,

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the organization for retired aged persons is

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dating websites.

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The most rapidly growing dating websites are

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used by older adults.

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So they're certainly out there forming these new

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relationships, but with those new relationships come

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re merging of families, right?

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If a couple divorces

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and then they each remarry, they may have stepchildren.

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And so they're navigating relationships

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with their biological children, their stepchildren,

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their former spouses,

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and that really can raise a lot of challenges for how it is

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that you line up your caregivers.

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How you think about estate

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Planning and who it is

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that you engage in your long-term care planning.

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So lots of complexities, with older adults, family lives

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and the health of older adults today is kind of a,

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a good news, bad news story in many ways.

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Um, through most

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of the 20th century life expectancy increased meaning

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that older adults are living longer than ever before,

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and a lot of that is a good news story.

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We have better medical technologies than ever before.

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People are more highly educated

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and coming along with being highly

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educated means lower rates of smoking, low rates

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of having a high fat, high salt diet, knowing to exercise.

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So on the whole older adults are absolutely living more than

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in the past, longer lives than in the past.

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Rates of things like heart disease have been going down,

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rates of lung cancer have been going down due in part

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to these healthier behaviors.

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So that's the good news story.

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But with the good news comes a little bit

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of bad news as well.

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We have seen since about 2015, a slight diminishing

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of life expectancy not due only to covid,

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due to other factors.

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There's something happening today called deaths of despair.

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And this is something that happens more often

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among lower income people,

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but there are people for whom they faced a lot

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of economic adversity.

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They have unhealthy jobs,

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their homes are in unhealthy neighborhoods.

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And so there is this pocket of adults

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who do have early onset of things like diabetes.

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They have obesity which lends itself

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to other harmful health conditions.

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And, and most oddly,

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they have higher rates of suicide, right?

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Given these lives of, of what are called lives of despair.

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So when we look at the health of older adults,

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it's really important to recognize

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that even if there's a good news picture overall,

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there are some subgroups

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that really face tremendous disadvantage

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that shorten their lifespans.

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So we have that going on on the physical health front.

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Then finally, one other dimension of health

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to touch on is cognitive health

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and rates of dementia are relatively high in the number

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of people in the United States and worldwide with dementia

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and specifically Alzheimer's disease has been increasing.

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In part it's just a numbers game.

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As we have more people living to 80 90

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or even a hundred coming along with very long lifespan,

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is that elevated risk of dementia.

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And anybody who's a family caregiver for dementia knows

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that it is grueling to care

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for older adults whose mental capacities are diminishing.

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And this is one of our larger social problems,

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I think facing the world right now.

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How will we care for these millions of older adults

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who will end up with Alzheimer's disease at the end of life?

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There are two main public policies in the United States

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that bear on older adults,

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and there are many other smaller ones,

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but the big two are social security and Medicare.

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And by and large, these have been two

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of the most successful social programs in recent history.

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Um, social security provides a monthly kind

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of minimum income

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for people once they reach their retirement age.

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And then likewise, Medicare is health insurance, right?

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State provided health insurance for older adults.

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And I know in other parts of the world they had even more

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generous, safety nets in in particular nations

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of Europe, you know, less so, in some parts of Asia

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and certainly less so in some nations of the global south

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that don't have the economic means

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to provide these supports.

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So at least in the United States, social security

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and Medicare really have lifted millions of older adults out

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of poverty and have

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provided absolutely critical health insurance for them.

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So that's the good news part of the story.

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But like any public policy, it is not a cure-all

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for these persistent underlying inequalities in how it's

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that people live their lives.

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So in the case of social security, for instance,

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it's wonderful for people

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who have richer economic resources.

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They don't have to live only on their monthly social

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security check, which is usually an average of about,

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you know, 2000 a month depending on one's,

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marital status.

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But for low income people, they cannot supplement that

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with things like interest income.

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So we recognize that for that fairly large share

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of us adults, especially women and especially black

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and Hispanic women, they don't have savings in part

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because of it's more difficult for women to save, given

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that they have more precarious work lives.

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So social security has lifted many people out of poverty,

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but it certainly hasn't kept all people out of poverty

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because it can't possibly undo years of inequality

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that start percolating many years earlier due

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to things like unequal opportunities for education

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and employment and pension wealth, specifically on the basis

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of gender and race ethnicity.

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So, moving forward,

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it would be fantastic if social security would

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of course persist and that there would be efforts

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to really ensure that those people at that very bottom of

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that income distribution will receive, you know, that bump

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that they need to maintain some minimum quality of life.

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Um, so that's, one really powerful public policy.

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The other that I referenced earlier is Medicare,

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which is again that health insurance for older adults

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who are of retirement age.

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And again, it's a wonderful, wonderful program,

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but there are some challenges that we still recognize

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that benefit kicks in when people are in their sixties.

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And for those people who really have led lives of adversity,

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they are lucky to survive until 65, someone

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who does not have the privilege of being a professor,

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but someone who's working on a road crew, someone

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who is working in a factory who faces very dangerous jobs,

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they may be injured at 45 or 50

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and really need that health insurance earlier.

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And so what, despite all this, strengths of Medicare,

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some people will need that kind

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of health insurance at a younger age.

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And so those are some

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of the debates you see happening in the United States.

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A debate between should Medicare be available

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to people of all ages?

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Should it be brought down to those who are maybe 55

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or 45 given that aging happen sooner, right?

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Aging bodies happen earlier for those

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who have had lives of greater challenge.

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So those are just some of the challenges,

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and successes that we've seen on the policy front,

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specifically in the United States.

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And if I would have one takeaway message,

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I think it would be this, that we think about social

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security and Medicare is the two big aging policies in the

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United States, but inequalities an old age,

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how healthy we are, how wealthy we are at age 70 or 80.

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Those differences don't come about magically on one

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65th birthday.

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They are the end result of accumulated adversities

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or accumulated advantages to go back to early life.

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So we can also think about a healthy aging policy

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as also encompassing investments in public schools,

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investing in the climate, investing in safe

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and secure housing so that people have a secure

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and healthy base when they were child and an adolescent

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and that set, set foundations so that they can continue

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to grow and thrive

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and do well, which would lead to a healthier old age.

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When we think about older adults, we tend to think about,

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you know, the aging baby boomers.

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And when we think about how the generations

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that follow will experience old age, you know,

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my generation Gen X

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and then the millennials that follow, you know,

365
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I wish I could be an optimist about it,

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but yet it's kind of a good news, bad news story.

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The generations that follow

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the baby boomers have higher levels

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of education, for instance.

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And so that is linked with some better health behaviors,

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which will ab bode well for the future.

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Like I said, diminishing rates

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of things like smoking and binge drinking.

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Um, also we see a tremendous open-mindedness

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among those subsequent generations, especially for sexual

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and gender minorities, for instance.

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They're more accepted in those younger populations.

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And so I think those are all advantages that will help them

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to age well and to be able to carve out lives

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and partnerships that that do well for them.

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So there are definitely reasons for optimism,

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but there are also reasons

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for tremendous pessimism when we think

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specifically about the economic futures of Gen X

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and much more so millennials,

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our generations have been straddled

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with much more educational debt than our predecessors.

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We also know that housing prices have increased dramatically

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over the past couple decades.

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And so young college graduates today who are saddled

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with educational debt cannot afford to buy a home,

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and they certainly cannot afford to buy homes

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that were in the same kind of

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neighborhoods where they grew up.

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And so what does that mean?

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Younger people today,

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even middle-aged people today are amassing less well.

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And that is of critical importance for late life

399
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because as we know, social security isn't enough

400
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to really support someone's life in a,

401
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a tremendously lavish way.

402
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And if someone has a major illness

403
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or injury at the end of life and they require long-term care

404
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or nursing home care, owning a home that they can sell

405
00:18:32.105 --> 00:18:34.965
or having money in the bank that they can use to pay

406
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for those very large expenses is absolutely critical.

407
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And those are two of the challenges that millennials

408
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and Gen X will face.

409
00:18:44.585 --> 00:18:45.805
You know, there's some research

410
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that says millennials in particular might get a

411
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little boost down the road.

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They're predicted to inherit a fair amount

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of wealth from their boomer parents.

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But again, that's those who have wealthy parents, those

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who do not, are not going to inherit that wealth.

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So the level of income inequality,

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or what we call the gaps between the haves

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and have nots between the rich

419
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and the poor will be all the larger

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among millennials relative to those generations that follow.

421
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So again, coming back to this, best of times, worst

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of times, some millennials are going to have a wonderful

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retirement with plenty of wealth

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and, boutique healthcare,

425
00:19:25.065 --> 00:19:27.605
but others will have a much more difficult go.

426
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So again, this theme

427
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of inequality is absolutely persistent when we think about

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aging through the generations.

Challenges and Changes in Aging Population

00:00:00 - The United States population and the global population are older than ever before. in the United States today, the proportion of people who are age 65 and older, which is our definition for an older adult, will increase from about 60 million to 82 million by the year 2050. And that proportion is about 17% up to 23%. So one in four people will be an older adult by the year 2050. And with that comes remarkable rewards, but also remarkable challenges in terms
00:00:36 - and most importantly, their caregiving needs. Because we do have a dramatic shortage of caregivers in the US and in many other parts of the world, my latest book is called Aging in America. And this book really synthesizes research done not only by me, but by other scholars. It synthesizes data collected by the Census Bureau by the United Nations and really gives a statistical portrait of what is going on
00:01:04 - But then importantly, it in terms of theories of aging and in terms of policy and potential policy impact. And in fact, one of the most interesting aspects of writing the book was really to think about how older adults are understood from a historical perspective. There has been tremendous waxing and waning over time of how we think about older adults. So for example, in the colonial United States, you might recall seeing pictures of people
00:01:37 - And that was a sign of respect for older adults. Older adults in the colonial, United States in the 18th century, for instance, were very rare. People didn't live that long. And so if someone did make it to 65 or 70, they were political leaders, they were religious leaders, they were really revered by our society. But then things took a turn and things were not so good for older adults, particularly around the industrial revolution,
00:02:06 - and able bodied, being able to use one's body at work and understand technology. And so ageism really did increase during that time period when older adults were viewed as obsolete. For instance, since that time, we would like to think it has gotten better, but not uniformly. Today we really have this bifurcated portrait of what older adults are like. On one hand, we have amazing role models, those people
00:02:42 - But alongside that, we really have tremendous ageism where older adults are maligned, where we presume that all older people have dementia, that they're incapable of doing everything from caring for themselves to leading a major nation. So really, our views Of older adults go up and down. And that waxing and waning base is based part on demographic factors, how statistically rare or common older adults are,

Perceptions of Aging in Modern Society

00:03:12 - and the pace of daily life. today, daily life is very quick, right? We expect a response to our texts instantaneously. And for some older people who move a little bit more slowly, they may malign for doing so. In addition to some of the, themes I just gave, you know, I would say seeing that I talked about the past already, I think we can talk a little bit about views of aging today. And I think the view of aging today,
00:03:43 - You know, on one hand we have this vision of older people, like the ones we see in pharmaceutical ads. They're healthy, they're running marathons, they have beautifully appointed homes, they're sailing, they have plenty of money, and they're active, and that there is some kernel truth to that. But some of these very positive images of aging that we have today neglect the fact that not all people in old age live like those individuals in pharmaceutical ads.
00:04:14 - For instance, we know that women of color are far more likely than white married men, for instance, to live in poverty. So although it's fantastic that some of the images of aging today are very positive, we need to recognize that there are some people who do not have the economic benefits or health benefits that enable them to live in that way. So we have that positive image. But alongside that, we still have tremendous ageism.
00:04:46 - or stereotypical belief about members of a particular group. And with older adults, again, we have this persistent view that they're not competent, that they don't understand technology, that they all have dementia and that they've lived past their prime. we saw that absolutely during the Covid pandemic, you might recall seeing things like the boomer remover and really horrible, horrible, hashtags out there
00:05:15 - They're old anyhow. They really don't have many more years left to do anything productive. And that's an utterly false and harmful assumption. we know that ageism hurt older adults. It, it leads to depression, it makes them less compliant with healthcare. it shatters their self-concept. And so we do have on one hand really positive images that maybe conceal some problems. But then on the other hand, we have these very negative images that are pervasive and cruel and counterproductive.
00:05:48 - and social relationships and then we can make our way to health. so the family lives and personal lives of older adults today are More diverse than ever before. We used to have this notion of older people being married to their long-term sweetheart married for 60, 70 years until death do them part. Or alternatively, we have a vision of a widow, a widower who just doesn't move on and they're just wed in their mind to their late spouse,

Varied Family Lives of Older Adults Today

00:06:18 - And what we see today is that fam, the family lives of older adults are just as varied as they are among younger people. So of course, we have those people who married their high school sweetheart or college sweetheart, and they're still married, 70 years later. But we also know that rates of divorce were high during the 1970s and eighties. So a lot of older adults divorce when they were younger and are in a second marriage or even a third marriage.
00:06:48 - what we call great divorce have increased dramatically since the 1990s, and that's divorce of people when they're age 50 or older. And so what we're seeing today is that there are some married people who are 50, 60, even 70, they know that they're probably gonna live another several decades. And some of them say, do I really wanna spend those next few decades with this person in my life? Some are deciding at older ages to divorce and to find new partners.
00:07:21 - who are either on a second or third marriage, or they're cohabiting without legally marrying their partner, or they are dating or they have another relationship called living apart together, which means this is your long-term steady, but you maintain your own home. people often want their own privacy, and sometimes older adults don't wanna mess up their children's inheritance. They don't wanna sell their house and then move them with their new partners,
00:07:52 - their separate assets, but then they really are a very close-knit couple, who share their lives, even if not their homes. So that's a bit of what's going on on the family front for older adults, really very varied. It's not like people are who are older adults are sitting at home. Some of those who aren't in a permanent partnership are dating. one of the most successful innovations that a A RP put out in the United States, which is again, the organization for retired aged persons is
00:08:22 - The most rapidly growing dating websites are used by older adults. So they're certainly out there forming these new relationships, but with those new relationships come re merging of families, right? If a couple divorces and then they each remarry, they may have stepchildren. And so they're navigating relationships with their biological children, their stepchildren, their former spouses, and that really can raise a lot of challenges for how it is
00:08:53 - How you think about estate Planning and who it is that you engage in your long-term care planning. So lots of complexities, with older adults, family lives and the health of older adults today is kind of a, a good news, bad news story in many ways. through most of the 20th century life expectancy increased meaning that older adults are living longer than ever before, and a lot of that is a good news story.

Health Trends and Challenges in Aging Populations

00:09:26 - People are more highly educated and coming along with being highly educated means lower rates of smoking, low rates of having a high fat, high salt diet, knowing to exercise. So on the whole older adults are absolutely living more than in the past, longer lives than in the past. Rates of things like heart disease have been going down, rates of lung cancer have been going down due in part to these healthier behaviors.
00:09:55 - But with the good news comes a little bit of bad news as well. We have seen since about 2015, a slight diminishing of life expectancy not due only to covid, due to other factors. There's something happening today called deaths of despair. And this is something that happens more often among lower income people, but there are people for whom they faced a lot of economic adversity. They have unhealthy jobs,
00:10:26 - And so there is this pocket of adults who do have early onset of things like diabetes. They have obesity which lends itself to other harmful health conditions. And, and most oddly, they have higher rates of suicide, right? Given these lives of, of what are called lives of despair. So when we look at the health of older adults, it's really important to recognize that even if there's a good news picture overall, there are some subgroups
00:10:56 - that shorten their lifespans. So we have that going on on the physical health front. Then finally, one other dimension of health to touch on is cognitive health and rates of dementia are relatively high in the number of people in the United States and worldwide with dementia and specifically Alzheimer's disease has been increasing. In part it's just a numbers game. As we have more people living to 80 90 or even a hundred coming along with very long lifespan,
00:11:31 - And anybody who's a family caregiver for dementia knows that it is grueling to care for older adults whose mental capacities are diminishing. And this is one of our larger social problems, I think facing the world right now. How will we care for these millions of older adults who will end up with Alzheimer's disease at the end of life? There are two main public policies in the United States that bear on older adults, and there are many other smaller ones, but the big two are social security and Medicare.
00:12:04 - of the most successful social programs in recent history. social security provides a monthly kind of minimum income for people once they reach their retirement age. And then likewise, Medicare is health insurance, right? State provided health insurance for older adults. And I know in other parts of the world they had even more generous, safety nets in in particular nations of Europe, you know, less so, in some parts of Asia

Challenges and Successes of Aging Policies

00:12:36 - that don't have the economic means to provide these supports. So at least in the United States, social security and Medicare really have lifted millions of older adults out of poverty and have provided absolutely critical health insurance for them. So that's the good news part of the story. But like any public policy, it is not a cure-all for these persistent underlying inequalities in how it's that people live their lives.
00:13:08 - it's wonderful for people who have richer economic resources. They don't have to live only on their monthly social security check, which is usually an average of about, you know, 2000 a month depending on one's, marital status. But for low income people, they cannot supplement that with things like interest income. So we recognize that for that fairly large share of us adults, especially women and especially black
00:13:39 - because of it's more difficult for women to save, given that they have more precarious work lives. So social security has lifted many people out of poverty, but it certainly hasn't kept all people out of poverty because it can't possibly undo years of inequality that start percolating many years earlier due to things like unequal opportunities for education and employment and pension wealth, specifically on the basis
00:14:08 - So, moving forward, it would be fantastic if social security would of course persist and that there would be efforts to really ensure that those people at that very bottom of that income distribution will receive, you know, that bump that they need to maintain some minimum quality of life. so that's, one really powerful public policy. The other that I referenced earlier is Medicare, which is again that health insurance for older adults who are of retirement age. And again, it's a wonderful, wonderful program,
00:14:42 - that benefit kicks in when people are in their sixties. And for those people who really have led lives of adversity, they are lucky to survive until 65, someone who does not have the privilege of being a professor, but someone who's working on a road crew, someone who is working in a factory who faces very dangerous jobs, they may be injured at 45 or 50 and really need that health insurance earlier. And so what, despite all this, strengths of Medicare,
00:15:12 - of health insurance at a younger age. And so those are some of the debates you see happening in the United States. A debate between should Medicare be available to people of all ages? Should it be brought down to those who are maybe 55 or 45 given that aging happen sooner, right? Aging bodies happen earlier for those who have had lives of greater challenge. So those are just some of the challenges, and successes that we've seen on the policy front, specifically in the United States.

Challenges and Opportunities for Aging Generations

00:15:42 - I think it would be this, that we think about social security and Medicare is the two big aging policies in the United States, but inequalities an old age, how healthy we are, how wealthy we are at age 70 or 80. Those differences don't come about magically on one 65th birthday. They are the end result of accumulated adversities or accumulated advantages to go back to early life. So we can also think about a healthy aging policy
00:16:16 - investing in the climate, investing in safe and secure housing so that people have a secure and healthy base when they were child and an adolescent and that set, set foundations so that they can continue to grow and thrive and do well, which would lead to a healthier old age. When we think about older adults, we tend to think about, you know, the aging baby boomers. And when we think about how the generations that follow will experience old age, you know,
00:16:44 - and then the millennials that follow, you know, I wish I could be an optimist about it, but yet it's kind of a good news, bad news story. The generations that follow the baby boomers have higher levels of education, for instance. And so that is linked with some better health behaviors, which will ab bode well for the future. Like I said, diminishing rates of things like smoking and binge drinking. also we see a tremendous open-mindedness among those subsequent generations, especially for sexual
00:17:16 - They're more accepted in those younger populations. And so I think those are all advantages that will help them to age well and to be able to carve out lives and partnerships that that do well for them. So there are definitely reasons for optimism, but there are also reasons for tremendous pessimism when we think specifically about the economic futures of Gen X and much more so millennials, our generations have been straddled with much more educational debt than our predecessors.
00:17:51 - over the past couple decades. And so young college graduates today who are saddled with educational debt cannot afford to buy a home, and they certainly cannot afford to buy homes that were in the same kind of neighborhoods where they grew up. And so what does that mean? Younger people today, even middle-aged people today are amassing less well. And that is of critical importance for late life because as we know, social security isn't enough
00:18:20 - a tremendously lavish way. And if someone has a major illness or injury at the end of life and they require long-term care or nursing home care, owning a home that they can sell or having money in the bank that they can use to pay for those very large expenses is absolutely critical. And those are two of the challenges that millennials and Gen X will face. You know, there's some research that says millennials in particular might get a little boost down the road.

Generational Wealth and Persistent Inequality

00:18:52 - of wealth from their boomer parents. But again, that's those who have wealthy parents, those who do not, are not going to inherit that wealth. So the level of income inequality, or what we call the gaps between the haves and have nots between the rich and the poor will be all the larger among millennials relative to those generations that follow. So again, coming back to this, best of times, worst of times, some millennials are going to have a wonderful
00:19:32 - and, boutique healthcare, but others will have a much more difficult go. So again, this theme of inequality is absolutely persistent when we think about aging through the generations.

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