Successful Aging of Societies

Policy-makers and pundits are increasingly preoccupied with the negative economic effects of population aging on public health and pension entitlements, including Medicare and Social Security. The enormous unfunded future obligations of these programs, especially Medicare, tend to crowd out all other considerations. While these entitlement programs surely require modifications to ensure their sustainability and fairness, the current debate neglects other critically important issues related to the aging of America: future intergenerational relations and tensions; socioeconomic disparities and inequalities; changes in the structure and function of the family and its capacity to serve the traditional safety-net role; the impact of technology; and the critical importance of adaptation of core societal institutions, including education, work and retirement, housing, transportation, and even the design of the built environment (the supporting residential, recreational, commercial, and transportation infrastructure). Equally important, there is almost no acknowledgment of the substantial positive contributions and potential productivity of an aging society.

Our goal is to develop and help implement policies that assure our transition to a cohesive, productive, secure, and equitable aging society. Failure to reach this goal will leave us with a society rife with intergenerational tensions – characterized by enormous gaps between the haves and the (increasingly less-educated) have-nots in quality of life and opportunity – and unable to provide needed goods and services for any of its members, especially a progressively older and more dependent population.

Gloomy though this scenario is, it is avoidable. We have time to put in place policies that will help strengthen the future workforce, increase productive engagement of older individuals, and enhance the capacity of families to support elders. Many such policies may, at the same time, lessen the burden on Social Security.

How did we get here? Given the advance warning decades ago that an age wave was coming, why has U.S. society been unable to prepare? Part of the failure to act lies with a set of archaic beliefs regarding the true nature of societal aging. Stakeholders failed to realistically assess challenges and envision opportunities and squandered the time available to formulate appropriate public policy. The denial continues: a recent Pew Research Center survey of global attitudes on aging shows that less than 26 percent of Americans feel that an aging society is a “major issue”! Only Indonesia and Egypt ranked lower on the survey.¹ Contributing to this denial are two pervasive and disabling myths about aging in the United States: the first myth concerns the impact of the baby boom; the second assumes that an aging society is only concerned with the elderly.

The influence of the baby boom on U.S. population aging is not temporary. Contrary to what the popular myth suggests, the passing of the baby boomers through the age structure will not terminate population aging or return us to the age structure of earlier periods of U.S. history. Rather, the demographic changes that have taken place over the last century are permanent. The age structure of all current and future populations either have already been transformed or are about to permanently shift, aggravated in part by the unusually large post – World War II birth cohort, but driven primarily by the combined effect of unprecedented increases in life expectancy and decreases in birth rates.

The second widely accepted myth is that an aging society is defined by and is solely concerned with its elders. This belief tends to pit generations against each other, overlooking the critical fact that the proper unit of analysis for policy-makers is not one specific age cohort but rather society as a whole. Policy-makers must consider the intergenerational effects of their policies and design solutions that benefit all of society, not just any one interest group.

Whereas countries in Western Europe aged ahead of the United States – reflecting their post – World War II baby bust and sustained reductions in total fertility below the replacement rate – the U.S. baby boom and higher fertility rate have combined to delay by a few decades the emergence of an aging society (defined here as one with more individuals over age sixty-five than are under age fifteen). For instance, the United States will not meet Germany’s current population age distribution until 2030. And Germany’s age structure has not caused ruin for its society or its economy. Thus, one would think that the experiences of the Western European countries, which are like the United States in many ways, would provide a clear road map for the policies the United States needs to adopt for a successful transition to a productive and equitable aging society. But although the United States certainly has much to learn from looking at the experiences of older societies in Europe and even of Japan, differences across societies, cultures, and policy strategies may limit the utility of these comparisons, thus requiring the development of a uniquely American resolution to the issues presented by an aging society. In short, international comparisons can be valuable, but we must be cautious in generalizing experiences from other cultures.

The MacArthur Network has developed a set of closely related components that form the core of a theory of adaptation in an aging society. Although there is substantial overlap between these components, identifying each has value. To begin, a plan of action must first:

1) Analyze society and its institutions. The unit of analysis should be the society and the adaptation of its core institutions (such as family, work and retirement, education, media, religion, and civic affairs) and should encompass a multigenerational and intergenerational perspective, rather than focus solely on individuals of any one age group (elders or youth).

2) Take a long-term view and consider structural lag. The primary focus should be on adjusting and adapting core institutions – including education, work and retirement, health care, the design and function of housing and cities, and transportation – over the long term. It is important to keep in mind gerontologist Matilda Riley’s concept of structural lag: the recognition that most societal institutions are resistant to change and lag behind the shifting population of their members.²

3) Adopt a life-course perspective. U.S. society needs to adopt a life-course perspective that urges redistribution of life’s activities (such as education, work, retirement, childrearing, and leisure) across the individual life span. Stakeholders need to detail the impact of socioeconomic, racial/ ethnic, and gender differences on life-course trajectories and specify how they influence the effectiveness of various lifestyle related interventions.

4) Consider benefits and risks. Analysis of policy changes should consider both the possible benefits and risks to an aging society and should develop a unifying strategy that optimizes the balance between the two. As societies attempt to deal with the many challenges derived from demographic transition, too little attention is paid to its potential upside: the longevity dividend. This includes the previously unimaginable capability of older individuals to participate productively in society either through the workforce or through civic engagement. Older people have much to offer, including accrued knowledge, stability, unique creative capacities for synthetic problem solving, and increased ability to manage conflicts and consider the perspectives of other age groups. As a society, the United States should harness the life-stage-appropriate capabilities and goals of people of all ages, including older adults, to enhance societal benefits and reduce social stratification.

5) Focus on human capital. Policy-makers should focus on strategies that take advantage of all available talent in the population, employ social norms based on ability rather than chronological age, and transition from an emphasis on investment early in life to recognition that investments across the full life span can pay dividends. These payoffs will be individual, intergenerational, and societal (with both crossover and spillover effects); and because they can be positive or negative, the outcomes must be monitored.

The MacArthur Network has developed three strategies for policy analysis. First, it is critical to develop a toolbox of more sensitive and predictive economic and social indicators – including lifestyle dimensions – that permit accurate assessment of the current conditions and likely future trajectory of the population and society along the principal policy dimensions of interest. We need an alternative to the archaic old-age dependency ratio, which simply equates old age with dependency. Metrics that express the full array of benefits-to-costs relationships of a long-lived society, as well as alternatives for life-course trajectories, are also essential. This toolbox can be used to model possible outcomes of societal investment in factors that alter the impact of an aging population. Second, in order to encourage the identification of effective solutions, researchers and policy-makers must present and analyze multiple policy options, rather than advocate single proposals, and should target multiple factors (such as the financial, social, life-course evolution, behavioral, and physical). Further, policy-makers should consider and employ both private and public involvement and federal and local approaches.

Finally, policy analysis must assess policy impacts. The MacArthur Network suggests adopting a strategy similar to that used to assess the environmental impact of a planned development. Specifically, Network members propose that all policies be evaluated for the effects they have within each generation, as well as on the interactions between generations (known as assessing intergenerational effects), in order to be most effective.

In addition, the MacArthur Network has identified six high-priority domains for policy analysis. They include:

1) Intergenerational relations. This general area requires understanding at both the societal and individual family-unit levels. For society, the core question relates to cohesion. What is the potential for the widening gap between the haves and have-nots and for the increased competition over scarce resources being channeled into entitlements to tear at the fabric of our society and create a “war” between the generations?

The MacArthur Network prefers to use the term cohesion to describe the issues related to intergenerational relations (or tensions) because it focuses on age integration rather than age segregation and addresses intergenerational transfers, attitudes, multigenerational strategies, and changes in family structure. Cohesion can be viewed as the debate regarding the traditional social compact – which we prefer over the more commonly used legalistic “contract” – between the generations.

Substantial empirical evidence shows strong support by middle-aged and younger Americans for older Americans and highlights social cohesion’s benefits; but, as many observers have noted, the future increase of entitlement costs may place substantial stress on this balance.³ Depending on future economic and educational gaps, will future young-adult and middle-aged Hispanics, for example, reflect the same support for elderly white Americans? Further, what impact will future immigration policies, whose intent may be to eliminate the shortfall of skilled U.S. workers, have on these tensions?

2) Family (evolution, supports, changing roles). Families make up the front line of our adaptation to an aging society. For the family, the core question of the aging society relates to the uncertainty regarding its capacity to play its traditional role as safety net and exhibit adaptive capacities to respond to a variety of financial, social, and health-related needs. Factors threatening the family’s role include the emergence of an array of family forms with different capacities for support (such as a childless family unit), increased longevity, geographic dispersion, economic challenges, and likely future reductions in entitlements.

Moreover, these changes are amplified by the growing diversity that results from increased stratification. The strength and salience of intergenerational ties become more prominent features in an aging society, and the traditional life course is being altered in part because of increased longevity. The transition to adulthood comes five or more years later than it used to, placing parents of young adults in the challenging position of helping support their parents or even their grandparents while launching their own children toward independence.⁴ Families with resources can manage this balancing act relatively well, but a growing number of families will be overly burdened trying to contend with these competing demands without proven ways of managing the more complex, intergenerational family systems. Issues such as intrafamilial supports, housing, financial transfers, caregiving, and new familial roles will also inform critical policy decisions surrounding the changing face of U.S. families.

3) Productivity (work and retirement, functional status and disability, technology, roles of older individuals in society). The future roles of older individuals in society will have a dramatic impact on the likelihood that the United States will be productive, cohesive, and equitable. This set of issues can be conveniently divided between work and retirement matters and civic engagement matters, although they are closely interrelated. The likelihood of a retiree volunteering is very much influenced by whether that person volunteered while still in the workforce.⁵ Thus, approaches to encouraging people to volunteer while still in the workforce – via modifications in time and place of work, provision of opportunities for engaging in what individuals consider meaningful activities, and development of paid volunteerism strategies – may have a substantial positive effect on post-retirement engagement. Such engagement is beneficial not only for retirees but also for the general population.

Technology bridges the worksite to areas of civic engagement and, depending on the type of technology and its fit with the abilities and needs of older individuals, can wind up either facilitating or inhibiting their participation. Substantial opportunity exists for policy changes and technological and other worksite modifications and educational interventions that will not only make retention of older workers more attractive to employers, but will also take advantage of the many strengths older workers offer. It is important for policy-makers to be aware of the “lump-of-labor” fallacy and the growing body of empirical evidence indicating that older individuals need not be moved out of the workforce to make room for younger workers.⁶ In addition, policy should be informed by the most recent findings regarding trends in disability in populations of elders and near-elders. Much of the most recent work suggests that the severe disability rates (as measured by activities of daily living and instrumental activities of daily living scales) are now stable in older individuals, having halted their decades-long decline; and that, for unknown reasons, functional mobility impairments may be rising in individuals aged fifty to sixty-five.⁷ It will be important for policy-makers to understand the likely influence of these trends on the adequacy of the future U.S. labor force, as well as on the future demand for personal care services.

4) Human capital development (such as lifelong education and skills training). Some of the same societal forces that led to longer lives have also shortened the half-life of knowledge in science and technology. How can human capital be expanded at different points along the life course? Can the misalignment between education and work that is aggravated by increasing longevity be improved through a closer relationship between educational institutions and the workplace?

Stakeholders need to understand and employ the most effective approaches to keep young individuals in school and to provide a coherent approach to lifelong learning that gives individuals the skills and attitudes they need to continue to productively evolve within overall societal and work environments. Although returning to school – now common among younger adults – is still relatively rare among individuals over forty, providing access to educational institutions for the near-old and old is no less critical than keeping younger people in school. Education must be redefined as a lifelong experience.

5) Health and health care. Although it might seem that the ongoing national debate about health care reform may have exhausted this topic, the Network believes that some important and often neglected areas of the discussion are directly related to the demographic transformation. These include the development of a more geriatrically sophisticated health care system in which most providers (physicians, nurses, dentists, social workers, psychologists, pharmacists, and others) are competent in diagnosing and treating medical diseases and syndromes that are common in old age, as well as a strong reliance on new interdisciplinary models of care that are more effective in managing the health care problems of frail older individuals with multiple impairments. In addition, a reorientation to a life-course preventive health model is needed to strengthen education about healthy lifestyles and intervention implementation in at-risk groups so that future older individuals will enter the Medicare program healthier and at higher levels of functioning than their predecessors. Finally, the United States needs sustainable and clearly articulated policies that deal humanely with care at the end of life.

6) Relevance to successful aging of individuals. Over the past fifteen years, successful aging has been a major theme of gerontological research. Much of the work in the field has been stimulated by the model of successful aging proposed by the MacArthur Network on Successful Aging, which is focused primarily at the level of the individual.⁸ It is self-evident that the changes that occur at the societal level in response to the demographic transformation may have major positive or negative effects on the capacity of individuals to age successfully. While many of the issues and policy options discussed in this volume are relevant to individuals, our primary current focus is at the level of society. The interaction between societal change and the status of aging individuals represents fertile territory for future research.

These major themes and recommendations are explored in depth in the essays found in this issue of Dædalus. Among the essays are S. Jay Olshansky’s “The Demographic Transformation of America,” which looks toward the changing face of aging and life expectancy in America. Robert Hummer and Mark Hayward’s essay “Hispanic Older Adult Health & Longevity in the United States: Current Patterns & Concerns for the Future” explores the “Hispanic paradox” – that first-generation Hispanic immigrants have a greater life expectancy than both nonimmigrant Americans and residents of their native countries – in addition to troubling health and well-being warning signs for the future Hispanic population. Frank Furstenberg, Caroline Hartnett, Martin Kohli, and Julie Zissimopoulos have written “The Future of Intergenerational Relations in Aging Societies,” which examines the family’s capacity to respond to the growing challenges and demands for support of a rapidly aging America; while Lisa Berkman, Axel Boersch-Supan, and Mauricio Avendano point toward how adaptation of our expectations of the elderly can lead to a more productive and resilient society in “Labor-Force Participation, Policies & Practices in an Aging America: Adaptation Essential for a Healthy & Resilient Population.”

In our essay “Productivity & Engagement in an Aging America: The Role of Volunteerism,” Dawn Carr, Linda Fried, and I propose that the impact of volunteerism in an aging population be recognized and invested into, and that programs harness the social capital of older adults to improve the well-being of the elderly and address critical needs of society as a whole. And S. Jay Olshansky, Dana Goldman, and I contributed the essay “Resetting Social Security,” which considers the critical financial safety net of social security and what impact might result from further changes to its age of eligibility requirements.

In their essay “Global Population Aging: Facts, Challenges, Solutions & Perspectives,” David Bloom, David Canning, and Alyssa Lubet provide an overview of global population aging and its contributing factors; outline some of the major challenges associated with widespread population aging; and describe current and possible future responses to these challenges. Finally, Julie Zissimopoulos, Dana Goldman, S. Jay Olshansky, John Rother, and I conclude the issue with “Individual & Social Strategies to Mitigate the Risks & Expand Opportunities of an Aging America.” This essay discusses the major risks associated with aging at both the level of the individual and the level of society, and presents courses of action for policy-makers in education, work and retirement, financial security, health care, and social cohesion to promote the benefits and reduce the risks of longer life. Taken together, these policy options provide a broad blueprint for successful societal adaptation to the aging of America.

ENDNOTES

¹ Pew Research Center, Attitudes about Aging: A Global Perspective (Washington, D.C.: Pew Research Center, 2014).

² Matilda Riley and John Riley, “Structural Lag: Past and Future,” in Age and Structural Lag: Society’s Failure to Provide Meaningful Opportunities in Work, Family, and Leisure, ed. Matilda Riley, Robert L. Kahn, and Ann Foner (New York: Wiley-Interscience, 1994).

³ James Schulz and Robert Binstock, Aging Nation: The Economics and Politics of Growing Older in America (Baltimore: Johns Hopkins University Press, 2008).

⁴ Gordon Berlin, Frank F. Furstenberg, Jr., and Mary Waters, “The Transition to Adulthood,” The Future of Children 20 (1) (Spring 2010): 1–18.

⁵ Barbara A. Butrica, Richard W. Johnson, and Sheila R. Zedlewski, “Volunteer Dynamics of Older Americans,” The Journals of Gerontology: Psychological Sciences & Social Sciences 64 (5) (February 2009): 644–655.

⁶ Axel Boersch-Supan, Reduction of Working Time: Does it Decrease Unemployment? MEA Discussion Paper No. 2003 (Mannheim, Germany: University of Mannheim, Mannheim Research Institute for the Economics of Aging, 2002); and John Gruber and David Wise, eds., Social Security Programs and Retirement Programs Around the World: The Relationship to Youth Employment (Chicago: University of Chicago Press, 2009).

⁷ National Research Council, “Health and Disability in the Working-Age and Elderly Populations,” in Aging and the Macroeconomy: Long-Term Implications of an Older Population (Washington, D.C.: National Academies Press, 2012).

⁸ John W. Rowe and Robert L. Kahn, “Human Aging: Usual and Successful,” Science 237 (4811) (1987): 143–149; John W. Rowe and Robert L. Kahn, “Successful Aging,” The Gerontologist 37 (4) (1997): 433–440; and John Wallis Rowe and Robert L. Kahn, Successful Aging (New York: Pantheon Books, 1998).