Just as they have transformed every age they have crossed, the baby boom generation will change the basic concepts of health in old age. Some predict a great number of decrepit, avaricious oldsters gobbling up the resources needed for childcare and college educations. Yet others foretell the age of muscled "health club" oldsters in jogging suits dominating the scene. Predictions usually focus on the disproportionate number of old people and, particularly, on the ratio between the large number of retired ("unproductive") boomers versus the number of younger employed ("productive") generations that are expected. Boomers had fewer children than their parents, many delayed childbirth until well into their 30s and 4os, and death rates are declining. While this situation may indeed predict a large financial and physical burden of care, other scenarios are possible. Boomers may redefine old age and the concepts of productivity and independence by changing the basic conceptual framework. Here is a look at some of the major issues concerning the health and welfare of baby boomers as they age.
While aging baby boomers may not be as robust as some would portray, there is striking evidence that the burden of disability is declining (Manton, Corder, and Stallard, I997). Demographic data continue to show increases in life expectancy at every age. While the fastest growing segment of the population by percentage is those over age 85, the major social trend is an extension of the healthy middle years, pushing back the chronological age at which we consider a person "old" In fact, if people in their 7os and 8os are still working or otherwise productive, we tend not to think of them as old, which has come synonymous with "frail."
For one to predict a burden of overwhelming dependence, one must also predict that no significant advances in the prevention and treatment of chronic disease or reduction in rates of disability will occur. We are already seeing this latter prediction to be in error. In addition to the established trend in the decline in disability as noted above, we already have the tools to make a substantial impact on several major serious and costly afflictions, such as osteoporosis and cognitive impairment. As one example, in I984, the cost of medical care and lost earnings due to osteoporotic fractures in the United States was $6.I4 billion per year (Holbrook, 1984). Preventing and treating osteoporosis, even with costs of diagnosis and treatment considered, has the potential for enormous savings in medical costs and lost productivity, not to mention the dramatic impact on quality of life (Ross et al., 1988).
Probably the most chilling prediction about boomers in old age is that of a staggering number of people with serious cognitive impairments, such as vascular dementia and Alzheimers disease. Alzheimer's disease appears to double in prevalence every five years between the ages of 65 and 85, and some have predicted a quadrupling of cases over the next 5o years. However, a constellation of factors actually predicts a decline in the burden of dementia in future years. First, there are many indications that vascular dementia, which is related to smoking as well as to other cardiovascular risk factors, may be more prevalent now than was previously believed, but will be less so in the future. Examples are the dramatic declines in smoking in the boomer generation and a decline in cardiovascular mortality. Second, advances in understanding and treatment of Alzheimer's, combined with the characteristics of baby boomers, may foretell a more positive future regarding that disease. For example, the boomer generation is better educated and more intellectually stimulated than previous cohorts, and both education and intellectual stimulation have been shown to delay the clinical expression of Alzheimer's disease (Mortimer, I997). Current research may yield promising results in the ability to treat individuals at high risk for Alzheimer's disease with drugs to delay or prevent the disease. …