Within 10 years, all of the nation鈥檚 74 million baby boomers will be 65 or older. The most senior among them will be on the cusp of 85.
Even sooner, by 2025, the number of seniors (65 million) is expected to surpass that of children age 13 and under (58 million) for the first time, according to .
鈥淚n the history of the human species, there鈥檚 never been a time like [this],鈥� said Dr. Richard Hodes, director of the National Institute on Aging, referring to the changing balance between young people and old.
What lies ahead in the 2020s, as society copes with this unprecedented demographic shift?
I asked a dozen experts to identify important trends. Some responses were aspirational, reflecting what they鈥檇 like to see happen. Some were sobering, reflecting a harsh reality: Our nation isn鈥檛 prepared for this vast demographic shift and its far-reaching consequences.
Here鈥檚 what the experts said:
A crisis of care. Never have so many people lived so long, entering the furthest reaches of old age and becoming at risk of illness, frailty, disability, cognitive decline and the need for personal assistance.
Even if scientific advances prove extraordinary, 鈥渨e are going to have to deal with the costs, workforce and service delivery arrangements for large numbers of elders living for at least a year or two with serious disabilities,鈥� said Dr. Joanne Lynn, a legislative aide on health and aging policy for Rep. Thomas Suozzi (D-N.Y.).
Experts caution we鈥檙e not ready.
鈥淭he cost of long-term care [help in the home or care in assisted-living facilities or nursing homes] is unaffordable for most families,鈥� said Jean Accius, senior vice president of thought leadership at AARP. He cited data from the : While the median household income for older adults was just $43,696 in 2019, the annual median cost for a private room in a nursing home was $102,204; $48,612 for assisted living; and $35,880 for 30 hours of home care a week.
Workforce issues are a pressing concern. The need for health aides at home and in medical settings is soaring, even as low wages and poor working conditions discourage workers from applying for or staying in these jobs. By 2026, of this kind will be required and hundreds of thousands of jobs may go unfilled.
鈥淏oomers have smaller families and are more likely to enter old age single, so families cannot be expected to pick up the slack,鈥� said Karl Pillemer, a professor of human development at Cornell University. 鈥淲e have only a few years to plan different ways of providing care for frail older people to avoid disastrous consequences.鈥�
Living better, longer. Could extending 鈥渉ealthspan,鈥� the time during which older adults are healthy and able to function independently, ease some of these pressures?
The World Health Organization calls this 鈥渉ealthy life expectancy鈥� and publishes this information by country. Japan was the world鈥檚 leader, with a healthy life expectancy at birth of 74.8 years in 2016, the most recent year for which data is available. In the U.S., healthy life expectancy was out of a total average life expectancy of .
Laura Carstensen, director of Stanford University鈥檚 Center on Longevity, sees some cause for optimism. 鈥淎mericans are beginning to exercise more鈥� and eat more healthful diets, she said. And scientific studies published in recent years have shown that behavior and living environments can alter the trajectory of aging.
鈥淲ith this recognition, conversations about aging societies and longer lives are shifting to the potential to improve quality of life throughout,鈥� Carstensen said.
Other trends are concerning. Notably, more than one-third of older adults are , while 28% are , putting them at higher risk of physical impairments and chronic medical conditions.
Rather than concentrate on treating disease, 鈥渙ur focus should shift to health promotion and prevention, beginning in early life,鈥� said Dr. Sharon Inouye, a professor at Harvard Medical School and a member of the planning committee for the National Academy of Sciences鈥� .
Altering social infrastructure. Recognizing the role that social and physical environments play in healthy aging, experts are calling for significant investments in this area over the next decade.
Their wish list: make transportation more readily available, build more affordable housing, modify homes and apartments to help seniors age in place, and create programs to bring young and old people together.
Helping older adults remain connected to other people is a common theme. 鈥淭here is a growing understanding of the need to design our environments and social infrastructure in a way that designs out loneliness鈥� and social isolation, said Dr. Linda Fried, dean of Columbia University鈥檚 Mailman School of Public Health.
On a positive note, a worldwide movement to create 鈥溾�� is taking hold in America, with 430 communities and six states joining an effort to identify and better respond to the needs of older adults. A companion effort to create 鈥溾�� is likely to gain momentum.
Technology will be increasingly important as well, with aging-in-place likely made easier by virtual assistants like Alexa, video chat platforms like Skype or FaceTime, telemedicine, robotic caregivers and wearable devices that monitor indicators such as falls, according to Deborah Carr, chair of the sociology department at Boston University.
Changing attitudes. Altering negative attitudes about aging 鈥� such as a widespread view that this stage of life is all about decline, loss and irrelevance 鈥� needs to be a high priority as these efforts proceed, experts say.
鈥淚 believe ageism is perhaps the biggest threat to improving quality of life for [older] people in America today,鈥� Harvard鈥檚 Inouye said. She called for a national conversation about 鈥渉ow to make the last act of life productive, meaningful and fulfilling.鈥�
Although the 鈥溾�� barbs that gained steam last year testify to persistent intergenerational tension, there are signs of progress. The World Health Organization has launched a global campaign to combat ageism. Last year, became one of the first U.S. cities to tackle this issue via a public awareness campaign. And a 鈥� developed by the FrameWorks Institute is in use in communities across the country.
鈥淥n the bright side, as the younger Baby Boom cohort finally enters old age during this decade, the sheer numbers of older adults may help to shift public attitudes,鈥� said Robyn Stone, co-director of LeadingAge鈥檚 LTSS (long-term services and supports) Center @UMass Boston.
Advancing science. On the scientific front, Dr. Pinchas Cohen, dean of the Leonard Davis School of Gerontology at the University of Southern California, points to a growing recognition that 鈥渨e can鈥檛 just apply one-size-fits-all guidance for healthy aging.鈥�
During the next 10 years, 鈥渁dvances in genetic research and big data analytics will enable more personalized 鈥� and effective 鈥� prescriptions鈥� for both prevention and medical treatments, he said.
鈥淢y prediction is that the biggest impact of this is going to be felt around predicting dementia and Alzheimer鈥檚 disease as biomarker tests [that allow the early identification of people at heightened risk] become more available,鈥� Cohen continued.
Although dementia has proved exceptionally difficult to address, 鈥渨e are now able to identify many more potential targets for treatment than before,鈥� said Hodes, of the National Institute on Aging, and this will result in a 鈥渄ramatic translation of discovery into a new diversity of promising approaches.鈥�
Another potential development: the search for therapies that might slow aging by targeting underlying molecular, cellular and biological processes 鈥� a field known as 鈥�.鈥� Human trials will occur over the next decade, Hodes said, while noting 鈥渢his is still far-reaching and very speculative.鈥�
Addressing inequality. New therapies spawned by cutting-edge science may be extraordinarily expensive, raising ethical issues. 鈥淲ill the miracles of bioscience be available to all in the next decade 鈥� or only to those with the resources and connections to access special treatment?鈥� asked Paul Irving, chairman of the Milken Institute鈥檚 Center for the Future of Aging.
Several experts voiced concern about growing . Its most dramatic manifestation: The rich are living longer, while the poor are dying sooner. And the gap in their life expectancies is widening.
Carr noted that if the current poverty rate of 9% in the older population holds over the next decade, 鈥渕ore than 7 million older persons will live without sufficient income to pay for their food, medications and utilities.鈥� Most vulnerable will be black and Latina women, she noted.
鈥淲e now know that health and illness are affected by income, race, education and other social factors鈥� and that inequalities in these areas affect access to care and health outcomes, Pillemer said. 鈥淥ver the coming decade, we must aggressively address these inequities to ensure a healthier later life for everyone.鈥�
Working longer. How will economically vulnerable seniors survive? Many will see no choice but to try to work 鈥減ast age 65, not necessarily because they prefer to, but because they need to,鈥� Stone said.
Dr. John Rowe, a professor of health policy and aging at Columbia University, observed that 鈥渓ow savings rates, increasing out-of-pocket health expenditures and continued increases in life expectancy鈥� put at risk of running out of money in retirement.
Will working longer be a realistic alternative for seniors? Trends point in the opposite direction. On the one hand, the suggests that by 2026 about 30% of adults ages 65 to 74 and 11% of those 75 and older will be working.
On the other hand, age discrimination makes it difficult for large numbers of older adults to keep or find jobs. According to a , 61% of older workers reported witnessing or experiencing age discrimination.
鈥淲e must address ageism and ageist attitudes within the workplace,鈥� said Accius, of AARP. 鈥淎 new understanding of lifelong learning and training, as well as targeted public and private sector investments to help certain groups transition [from old jobs to new ones], will be essential.鈥�