US aging trends are more alarming than we thought

When it comes to our expectations for the age structure of the future U.S. population, the other shoe has just dropped. 

Several months ago, the National Center for Health Statistics reported that the long-term trend for declining birth rates had continued for yet another year; this set off intense speculation about the social and economic effects of declining fertility in the U.S.

{mosads}Today, the same federal agency reported that the increases in U.S. mortality rates that have attracted so much attention over the past couple of years are also continuing. Overall life expectancy in the U.S. declined from 78.7 to 78.6 years between 2016 and 2017, while the age-adjusted death rate increased by 0.4 percent.

Life expectancy for men declined from 76.2 to 76.1 years, while it held steady for women at 81.1 years. The increased deaths were greatest in the 25-44 age group. With respect to race, the increased death rates were greatest in non-Hispanic white men and women.

An important factor is the now familiar epidemic of drug overdoses. Drug-related deaths, which occurred at a rate of 16.3 per 100,000 in 2015 and rose to 19.8 per 100,000 in 2016, rose again to 21.7 per 100000 last year.

These were highest in the 25-54 age group, and the areas most impacted were West Virginia, Ohio, Pennsylvania and the District of Columbia. Suicides, which have been steadily increasing in recent years, rose 3.8 percent, especially in rural areas. 

It is well recognized that previously unimagined numbers of individuals are growing old in America as a result of longer lives for older persons and the aging of the baby-boomer generation.

In this setting, given declining birth rates and increases in middle-aged death rates, it now looks like the size of the future middle-aged cohort may fall short of prior projections.

Should these trends continue, the implications are ominous as the proportion of the overall population that is elderly will grow even more rapidly as the labor force shrinks.

This will limit the number of workers available to produce the goods and services needed by a rapidly increasing elderly population while decreasing the number of individuals contributing to the endangered Social Security and Medicare funds.  

As we contemplate the implications of a stable or shrinking workforce in the context of rapidly growing older populations, we must first understand that the key to productivity is not only the quantity of workers, but also the quality.

Thus, we must move forward with significant investments in education at all critical points in the life course, enhancing the quality of basic education and the likelihood that individuals will complete high school and beyond.

Special attention should be paid to job-retraining efforts, which can provide older workers with the skills necessary to remain in the workforce.

At the same time, we must advance efforts to make retirement a process rather than a cliff, with flexible approaches that permit gradual reductions in work over time, more seasonal work for retirees and incentives for employers to retain older workers.

Also on the agenda is consideration of resetting the eligibility for Social Security benefits to better reflect longer, healthier lives, increases in the strength of old-age volunteer programs to keep older persons productively engaged in society and a major enhancement of the capacity of our health-care system to provide needed geriatric care services. 

Given the recent demographic trends, we may have less time than we thought to assure that the United States will become a successfully aging society.

John W. Rowe is the Julius B. Richmond professor of health policy and aging health policy and management at Columbia University’s Mailman School of Public Health. He is also president of the International Association of Gerontology and Geriatrics (IAGG). From 2000 until 2006, he served as chairman and CEO of Aetna.