Impressive longevity gains have been well documented, although it turns out longer lives are not being enjoyed by everyone. Longevity follows the money: Better-educated people are capturing an outsized share of longevity gains, just as they have with wealth.
Inequality aside, living longer and healthier lives sounds pretty good. Living extra years with pain, disease and disability doesn't. If better health was associated with a relatively brief period of decline at the end of life, most people would sign up for this option.
Researchers have reached conflicting conclusions on this topic, as a recent study by Harvard University and the National Bureau of Economic Research acknowledges. The study concludes that longevity is causing healthier lives and what's known as "compressed morbidity" – shorter periods of decline at the time of death.
The study, "Evidence for Significant Compression of Morbidity in the Elderly U.S. Population," is based on 20 years of health, illness and death statistics. The information was gathered from more than 250,000 people age 65 and older who participated in the Medicare Current Beneficiary Survey.
The results of this and related work are of far more than passing interest to aging and quality of life issues. For anyone who is approaching or in older age, it's possible to paint an increasingly detailed picture of what the rest of life will look like, at least in terms of how long good health may last and what reality looks like over the next 20 and 30 years.
"Longer life is valuable to people, but it is even more valuable if the additional years lived are in good health," the study said. "For the public sector as well, the consequences of longer lives depend on their quality. Medical spending for healthy seniors is modest; spending for the severely disabled is much greater."
The Medicare data is a dependable foundation on which to build a portrait of later life, the researchers reported. Nearly all seniors use Medicare, and the database tracks people over 20 years, gathers detailed information about health conditions and follows all participants until their death.
"Our major conclusion is that time spent in poor physical functioning is being increasingly compressed into the period just before death," the study said. Limitations in daily living such as bathing, dressing and eating are falling for those not near the end of life, as are more severe functional limitations, the study said.
"Less severe functional limitations are constant, and overall disease prevalence is rising," it added. "People have more diseases than they used to, but the severe disablement that disease used to imply has been reduced."
Looking at a 65-year-old person, life expectancy increased by seven-tenths of a year between 1991-1993 and 2003-2005. However, because the gains in later-life wellness were so pronounced, "the increase in disability-free life expectancy was greater than the total increase in life expectancy – 1.6 years in total."
People who were 65 in the 1991-1993 period could look forward to 17.5 more years of life on average, with 8.8 of those years being disability-free and 8.7 years being spent with some disabling health conditions. By the 2003-2005 period, average life expectancy was 18.2 years, but the healthy-unhealthy split had shifted to 10.4 disability-free years and 7.8 disabled years. Wellness results were more favorable for women than men (although men made greater overall longevity gains during the period), and more favorable for whites than non-whites.
The authors are careful to note there are different definitions of healthy aging, and their work is hardly the last word on the topic. Their detailed accounts of later-life physical challenges are also sobering. While the overall message here is clearly positive, the fact remains that chronic and debilitating diseases become the norm, not the exception, in our final years; 80 percent of older Americans near death have at least one major health condition.
Here are two tables with detailed reports on what ails us as we age. Which problems might you avoid or minimize by starting today to embrace healthier eating, exercise and other lifestyle changes? What are the financial planning consequences of significant old-age health problems? If the odds are substantial you will face the loss of independence in those final 7.8 disabled years, what should you do about it?
|Major Medical Events for Seniors, 1991-2009|
|(Ages 65+; incidence higher in later years)|
|Event||Average Prevalence (%)||ADL/IADL* Limitations (%)|
|*Bathing, dressing, walking, eating, driving, cooking and other loss-of-independence disabilities|
|Source: Bankers Life and Casualty Co. Center for a Secure Retirement|
|Senior Functional Health Status, 1991-2009|
|(Ages 65+; incidence higher in later years)|
|Lifting/carrying 10 pounds||39%|
|Extending arms above shoulder||29%|
|Walking 1/4 mile of 2-3 blocks||47%|
|Activity of Daily Living (ADL)|
|Bathing or showering||15%|
|Going in or out of bed or chairs||15%|
|Using the toilet||8%|
|Using the telephone||10%|
|Doing light housework||16%|
|Doing heavy housework||34%|
|Preparing own meals||14%|
|Shopping for personal items||18%|
|Source: Medicare Current Beneficiary Survey|