Transcript Challenges and Opportunities for Development of a Successfully Aging Society John W. Rowe, MD Columbia University.

Challenges and Opportunities for
Development of a
Successfully Aging Society
John W. Rowe, MD
Columbia University
• We are entering a dramatic demographic
transformation driven by advances in life
expectancy and the baby boom.
• The core institutions of our society are neither
designed nor equipped to support an aging
population.
• Successful adaptation at the societal level will
facilitate successful aging of individuals.
Goal: to facilitate research and policy
development that enables emergence of a
successfully aging society, a society that is
productive, cohesive, equitable, and resilient.
Key Principles:
• PRODUCTIVITY: the opportunity for individuals
to be effectively engaged in Society, either
through work for pay or volunteering.
• COHESION: mutually supportive interactions
between generations both at the level of the
family to preserve its traditional ‘safety net’
role and at the level of society to avoid
intergenerational ‘warfare.’
Key Principles (continued):
• EQUITABILITY: minimize the gaps in
opportunity, education and wellness between
the ‘haves’ and ‘have-nots.’
• INCLUSION: a focus not just on the status of
older persons but on the entire society.
• LIFE COURSE PERSPECTIVE: understanding the
cumulative effects of advantage and
disadvantage and the importance of
identifying critical periods in the life course for
investment.
Key Challenges:
• AWARENESS: There is a general denial by
society of the looming challenges and a hyperfocus on Social Security and Medicare.
• TIMING: Now is the moment. Progress is
urgently required if changes are to be in place
when needed.
Key Challenges (continued):
• METRICS: We need better ways to measure
societal success than the dependency ratio
and GDP.
• OPPORTUNITY: Assuring that society benefits
from the contributions each person can make.
Key Targets/Pathways:
• New roles for older persons
• Retirement programs and policies
• Savings and pensions
• Social Security resetting
• Education (what, when, and where)
• Family policy
• Health care and medical education
• Public and private
What Would Failure Look Like?
• Lack of capacity to meet societal demand for
goods and services.
• Wider gaps and greater tensions between
generations and socioeconomic groups.
• Failure to benefit from the potential
contributions of a very large, experienced,
health older population.
Recommendations in the following general
areas:
1.) Ensure that older persons are productively
engaged in society, either through paid work or
volunteering, including incentives for employers
and individuals and enhancement of life-long
learning.
2.) Encourage individual and societal financial
security including changes in Social Security
eligibility and incentives for individual savings.
Recommendations in the following general
areas (continued):
3.) Provide high-quality health care to all
including strengthening the geriatric health care
workforce and providing supports for caregivers.
4.) Strengthen the social compact between
generations at both the level of society and the
family.
The Demography of Aging:
What We’ve Learned and
Where We’re Headed
S. Jay Olshansky, PhD
University of Illinois at Chicago
What Is Population Aging?
Source: U.S. Census Bureau
Disparities in Longevity
Source: MacArthur Foundation Research Network
on an Aging Society, Health Affairs, 2012.
The Hispanic Paradox
“Despite having a much higher level of poverty and substantially lower levels of
educational attainment and health insurance coverage than whites, Hispanics
currently live longer lives, on average, than their more socioeconomically
advantaged counterparts.”
Source: Hummer, R.A., Hayward, M.D. 2015. Hispanic Older Adult Health & Longevity in the
United States: Current Patterns & Concerns for the Future. Daedalus
Competing Risks and
Longevity Exaggeration
U.S. Females
Maximum Lifespan Potential = 120
Maximum Observed Age at Death = 105, 113 *
Period Life Expectancy at Birth = 49, 80 *
1900
…and it would do so without increasing
the number of disabled.
Disabled Population 65 and Older
35
30
Millions
of
People
25
Baseline
20
Delayed Cancer
Delayed Heart Disease
15
Delayed Aging
10
2010
2020
2030
2040
2050
2060
Source: Goldman et al., 2013
Resetting Social Security
Did the 1983 amendments designed to raise
the full retirement age correspond to the rise
in life expectancy from 1935 to 1983?
How would subgroups with diverse survival
prospects be differentially influenced by
further increases in early and full retirement
ages?
What should the early and full retirement
ages be today if indexed to the rise in
longevity?
Olshansky, Goldman and Rowe. 2015. Resetting
Social Security, Daedalus
Did the Simpson-Bowles Commission get it
right when they proposed to further raise
the early and full retirement ages in this
century?
Olshansky, Goldman and
Rowe. 2015. Resetting Social
Security, Daedalus
How well did the two-year increase
in eligibility age for full retirement
benefits from the 1983
amendments correspond to the
proportional rise in life expectancy
from 1935 to 1983?
Answer
Too late and too slow
Olshansky, Goldman and
Rowe. 2015. Resetting Social
Security, Daedalus
How would subgroups of the U.S. population with
diverse survival prospects be differentially
influenced by further increases in early and full
retirement ages?
Answer
It would exacerbate economic disadvantage. Some
subgroups are less likely to reach the statutory
retirement ages, and even when they do, they live
shorter lives.
Olshansky, Goldman and
Rowe. 2015. Resetting Social
Security, Daedalus
Olshansky, Goldman and Rowe. 2015.
Resetting Social Security, Daedalus
What would the early and full retirement ages be
today had they been indexed directly to rising life
expectancy since Social Security’s inception,
holding constant the 1935 proportion of adult life
spent working to life in retirement?
Answer
Early: 66.5
Full: 69.4
Olshansky, Goldman and
Rowe. 2015. Resetting Social
Security, Daedalus
Did the Simpson-Bowles Commission get it
right when they proposed to further raise the
early and full retirement ages to 64/69 by 2075,
beginning in 2027?
Answer
The proposed early retirement age is off by one
century. It should have gone into effect in 1976.
The proposed full retirement age is off by 70
years, it should have gone into effect in 2005.
Olshansky, Goldman and
Rowe. 2015. Resetting Social
Security, Daedalus
Productivity in an Aging Society
Lisa F. Berkman, PhD
Harvard University
Overview:
• Work and Productivity generally are good for
your health— we need disability options.
• Evidence is particularly strong for work and
cognitive outcomes.
• Lump of labor fallacy.
• Life course models indicate multiple
“sensitive periods” Policies influencing early
and mid-career decisions are essential for
working longer.
1. Work and Cognition:
Mental Retirement
• Work appears to be especially important to
maintaining good cognitive function.
• Social engagement in particular is strongly
associated with the maintenance of cognitive
function. Both working in the paid labor force
as well as volunteering influence brain
function.
12
Slope: -4.9
United States
England
10
Denmark
Sweden
Switzerland
Germany
Netherlands
Austria
Belgium
8
Greece
Italy
France
4
6
Spain
30
40
50
60
70
80
Percent not working for pay
90
100
Rohwedder, Susann and Robert J. Willis, 2010, “Mental Retirement,” Journal of Economic Perspectives, 24(1), 119-38.
Figure 1. Drop in cognitive performance as a function of drop
in employment rate between men 50-54 and 60-64 years old
Source: Adam, et. al. (2007). Data drawn from ELSA for England, HRS for
United States, and SHARE for other countries. 2004.
See footnote 2 for full names of surveys.
Volunteering: One Experiment:
Experience Corps
Senior volunteer program designed for:
•High impact on childrens’ school success: learning
readiness, literacy, math, computing, attendance,
behavior;
•Social model for health promotion: designed to
increase cognitive, physical and social activity and
engagement;
high & sustained “dose” of prevention
(Freedman and Fried 1998; Fried et al 2004)
Experience Corps Model
•
•
•
•
•
•
•
•
Volunteers 60 and older
Serve in public elementary schools: K-3
Meaningful roles; important needs
High intensity: >15 hours per wk
Reimbursement for expenses: $150/mo
Sustained dose: full school year
Critical mass, teams
Health behaviors: physical, social, and
cognitive activity
• Leadership and learning opportunities
• Infrastructure to support program
• Program evaluation
-Fried and Freedman, 1999; 2004; 2013
EC Design Targets Executive Function in
Older Volunteers
Environmental complexity:
Broad vs. specific intervention design; and
Embedded within everyday activity.
Multiple domains of ability through multiple roles
(e.g., tutoring, library & math support):
Variety; and
Flexibly shifting among roles.
Problem solving with team members & teachers
Potential for generalizability to multiple cognitive
and functional outcomes
Intervention-specific Improvements in those With Poor
Baseline Executive Function at Baseline; EC pilot RCT
Carlson, Saczynski, Rebok, et al., 2008
2. Lump of Labor Fallacy:
• In economics, the lump of labour fallacy is the
contention that the amount of work available to
laborers is fixed. It is considered a fallacy by most
economists, who hold that the amount of work is
not static.
• Throughout the past century, migrants, women
and older people have been accused of taking
jobs from other ( non-migrants, men and younger
people).
Countries with high unemployment at older ages,
have high unemployment at younger ages.
3. Policies in Midlife Promote Working
Longer: The Long-ish Arm of Early &
Midlife Experiences:
• Training and family leave
• EITC, unemployment protection during recessions
• Employer-Provided Vocational Training and
Education Benefits
• Attention to lower and middle wage earners
• Long run benefits are not accounted for in costbenefit equations
Reasons for Time away from work and cognition:
HRS, SHARE, ELSA
Adjusted ORs for cognitive impairment by economic inactivity spells
Leist, Glymour, Mackenbach, Van Lethe, Avendano. Ann of Epid, 2013
Time away
#1 OR
95% CI
#2 OR
95% CI #3 OR
95% CI
unemployment
1.2
1.0-1.3
1.2
1.0-1.4
1.2
1.0-1.4
sickness
2.3
2.0-2.7
1.8
1.5-2.1
1.1
1.0-1.4
homemaker
1.6
1.4-1.8
1.2
1.0-1.4
1.1
1.0-1.3
training
.5
.3-.6
.7
.5-1.0
.8
.6-.9
maternity
.6
.5-.7
.7
.5-.8
.7
..6-.9
The Long-run Effect Of Maternity Leave
Benefits On Women’s Mental Health at
older ages
Avendano M, Berkman LF, Brugiavini A, Pasini G. Social Science &
Medicine (2015) doi:10.1016/j.socscimed.2015.02.037
This work was supported by NIA.
Women’s Depression score at older ages by
Full Wage Weeks of Maternity leave
Full-wage week of
maternity leave benefits
Low
High
working
not working
2,64
2,52
2,51
2,82
DiD
Difference
high-low
-0,13
0,30
-0,43
% change
-16,17%
Interpretation: 16.2% difference in depression score between
low vs. high country-specific cut-offs for full-wage weeks, with
respect to mean value among European women working at
childbirth
Implications
Depression in old age is linked to maternity leave policies
during the critical period of the birth of a first child:
•
Moving from a maternity leave with limited coverage to one with
comprehensive coverage at the birth of a first child reduces
depression scores by 16% in older ages
Depression is costly:
•
•
•
Older people with depression use more health services, homecare
and assisted living than older people without depression
Mean direct health care costs in old age per patient were €5241 per
year for depressed individuals, as compared to €3648 per year for
non-depressed individuals, corresponding to a 30% difference
Cost-benefit analyses should take into account the potential loss in
women’s welfare in old age resulting from diminishing the
comprehensiveness of maternity leave benefits
4. Policies for Older Workers Enabling Them to
Work Longer and Retire Successfully:
• Flexibility, part time, work redesign: fluidity
• Paid family leave and caregiving options
• Diversity of capabilities means different jobs over
the life course
• Schedule control
• Adaptive work environments and technology
• Addressing workplace discrimination
• Multiple trajectories to retirement: disability
trajectories, part time, flexibility
5. The Institutional Policies and Practices of the
Employers and Local and State Level:
• Most labor policies and practices and created
at state or local levels. We should not rely only
on federal regulation.
• Private sector policies and practices will be
central to efforts over the next decades.
Identify and create incentives for the private
sector to maintain possibilities for working
longer.
6. Metrics and Evaluation in all Policies:
• Environmental impact assessment model
has been done for health impact, could
be extended to aging population
productivity.
Conclusion: Recommendations
Ensure that older persons are productively
engaged in society, either through paid work or
volunteering, including incentives for employers
and individuals.
The Challenge:
Maintaining Cohesion Between Generations
Frank Furstenberg, PhD
University of Pennsylvania
1. Macro-Level Questions:
A. How to balance investment in both the
young and the elderly despite threats of
‘Intergenerational warfare.’
a. Little evidence to support a zero-sum
game between support for older and
young age groups (Preston, BoerschSupan).
b. Public opinion across all age groups
reveals strong support for Social Security.
B. Is the U.S. investing sufficient resources to
prepare the next generation to replace the
current aging one?
a. Lower attainment of health and education in
successive cohorts is possible if not likely.
b. The result of growing inequality and lower social
investment in lower and middle-income
individuals and families.
c. To combat rising inequality, there must be
targeted investment in the young.
C. The U.S. experiences a great amount of age
segregation.
a. Opportunities for programs that provide more
intergenerational exchange and support outside
of the family.
b. Center to School programs, community projects,
and the like could be stimulated with modest
funds.
D. Age groups in the future may be more
economically unequal, which could foster a
competition for resources.
2. Micro-Level Considerations:
The family’s traditional role as safety net-will it be up to the task?
A. Family resource allocation: approximately half
of the cost (money and time) of elderly care
will be born by family members.
B. Spouses and children are the main supports
when family members become frail and need
care.
C. The oldest generation continues to contribute
more income than they receive to younger
generations (Kohli et. al., Pew Study).
Changes in family structure and function that
threaten family support.
A. Families are becoming more unequal in their
ability to provide assistance.
a. Social class differences in family formation are
widening these differences:
i.
ii.
iii.
iv.
Marriage patterns
Union stability
Childlessness
Complexity of family forms
(continued):
b. Longer training for young adults increases
demands on the middle generation that
must provide support upward and
downward, often at the same time. More
“sandwiching” of G2’s.
c. How will the family manage this balance
when there are half as many older persons
in 2030 and fewer adult children that are
stably married with adequate resources to
provide support for elderly parents G1’s?
3. Policy Considerations:
A. Policies aimed at promoting education early in
life, strengthening education for
disadvantaged children and youth, and
affordable higher education.
a)
Best ways to strengthen the institution of marriage!
B. Family-leave and paid family-leave will permit
greater flexibility to care for older family
members.
C. Adjustments in Medicare arrangements that
provide compensation to families in order to
keep older members out of nursing care.