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Spearheading the Longevity Revolution

2008-07-17 11:28:51

Sounding a call to action, a renowned expert on aging examines the health, economic, and social challenges and opportunities of growing older in today's society. As people live longer than ever, tough questions surface about the impact of aging on our population as a whole. Can we afford old age? How can we make the extra years productive personally and rewarding for society? Will Social security and Medicare collapse under the pressure of growing numbers of retirees?

In his latest book The Longevity Revolution: The Benefits & Challenges of Living a Long Life, Robert Butler, M.D., an internationally recognized expert in the field of aging and gerontology, grapples with these issues and presents an agenda for action. The founding director of the National Institute on Aging and CEO of the International Longevity Center, Butler calls for a "colossal public-private research initiative" to combat disease, gain a better understanding of the biology of aging, and improve health promotion and healthcare. The man who coined the term "ageism" argues that the United States has not made the much-needed research investment in aging.

The Post spoke to the Pulitzer Prizewinning author about his latest book and what Americans can do to take advantage of the unprecedented leap in human life expectancy.

Q: What is the Longevity Revolution?

A: In Roman times, with the realities of infant mortality and women dying giving birth, the average life expectancy was about 20. In 1776, the average life expectancy in the United States was estimated by historical demographers to have been 35, with about two percent of the population over 65. By 1900, the average life expectancy was 47, with only four percent of the population over 65. By the end of the century, we suddenly have more than 12 percent with an average life expectancy essentially of 77. Nothing like this had happened in human history. It took 5,000 years to achieve. I call this unprecedented demographic transformation the Longevity Revolution.

Q: You've studied aging for more than 50 years and coined the term "ageism." American culture seems youth-oriented. As a society, are Americans increasingly afraid of getting older?

A: It's hard to answer that question with authority, but I can offer an impressionistic answer. We're a little more sensitive to aging than maybe we have been. I've had at least five calls from the press about John McCain, asking if he's too old to run for president, will he live long enough to live out his term, and should such an old person be elected president? I would remind them that Konrad Adenauer led post-World War Germany until age 87, while Charles de Gaulle was prime minister of post-World War France until age 78. Function is the issue, not age per se. I faced the same questions when Bob Dole ran. Many thought he would never outlive his presidency if elected. If he had been elected, he would have long since left the presidency and still be alive. While it's hard to give an objective measure, there may be some slight improvement.

Q: How do you get society to come to confront these important issues?

A: Perception depends a lot on the media. How did the media get people to consider that there might actually be climate change and global warming? It took a long time. Maybe the movie An Inconvenient Truth helped tip the scale.

I depend a lot on the media to sensitively discuss the issues of aging. Of course, we definitely need legislative support: discrimination doesn't wantonly occur. What can we do to improve the health of people? One issue that always seemed a very important part of people's fear of aging is dis ease and decrepitude. If we can finally eliminate Alzheimer's disease and frailty, people would look at aging in a very different way and wouldn't be so frightened by it.

Individually, we fear growing old. We don't want to think about it too much. I don't think we want to be morbidly preoccupied with aging, but we have to think about it some or we'll pay a personal price from lack of planning.

Q: Does discrimination play a role in routine preventive screenings?

A: I think so. While uncommon, it can occur. Our preventive strategies tend to be oriented toward young people, as they should be. But they should be oriented toward old people as well. For example, take falling and breaking the hip or injuring your head. Falls are the number 12 cause of death among older people. How often do doctors encourage older patients to develop techniques to assure better balance? There are ways to practice balance so that you're not as likely to fall. How often does the doctor say 'You've got to strengthen your thigh muscles-or quadriceps-to reduce the chance of falls?' Unfortunately, these issues are not part of the thinking of average doctors.

Q: When asked, a 71-year-old woman said she would love to live to 100 but feared that she might outlive her resources. How do we address these issues?

A: That is a very important fear. Only half of American adults know the difference between a stock and a bond. There is enormous financial illiteracy. We need a better-educated population to learn at least the basics of economics and savings. We don't have a real savings rate in this country. In fact, it's almost the other way around: we have more indebtedness than savings. That contributes to the fear of outliving resources. Of course, we need to teach our children to think about finances. People should save all of their lives: they can't depend upon Social Security.

Q: As a society, how are we going to be able to address that need?

A: We really have to take a "lifespan perspective" and teach children that they have responsibilities for their health and to save money. It can't just be the government that takes care of you In your old age; you have to prepare for It. Kids can be taught to invest; kids can be taught the difference between a stock and a bond; and kids can be put on exercise programs so they don't become overweight. As a doctor, I'm horrified to see ten-year-old children with adult-onset type-2 diabetes. It's terrible! Most of the responsibility for a decent old age rests with the individual and his family, not the government.

Q: Millions of baby boomers are nearing 65. Are they prepared?

A: Baby boomers who have a 401(K)-and not everyone does-have about $40,000. It's hard to believe that's going to carry them through retirement. They're really facing a critical issue. Baby boomers, in my judgment, are a generation at risk because we can't solve all the many issues that affect and will affect them. They may be transformative and help generations that follow, but baby boomers. I'm afraid, are going to potentially suffer.

Q: Obviously, many are going to have to work longer. In the book, you report on studies of older workers in the U.S., concluding that while reaction time may be slower, older workers demonstrated less absenteeism, higher job satisfaction, greater dependability, and experience. What stumbling blocks do employers face in hiring older workers?

A: Of course, the longer that someone's been on the job, the more expensive employees typically become. It's attractive for businesses to replace them with younger workers at lower pay. As a society, we may have to do some rethinking. Older people may have to be willing to take lower pay to preserve their jobs.

We might also change the way health insurance is paid. For example, the health insurer is often the first payer, not Medicare, even if It's a worker over 65. If that were to change by law. Medicare would become the first payer rather than health insurance. That would save employers a lot of money. We have to face the music that there are certain built-in financial disincentives that make it harder for employers to retain older workers. The payoff in the long run for society in general would be to change policies.

Q: Is working longer associated with Increased longevity?

A: Based on findings from studies we did years ago, it would appear that people who have a purpose in lifesomething to get up for that makes a difference-actually live longer and better than those who do not. It's also good for society that people continue to contribute on a volunteer basis.

Q: Do workers need to exert extra effort to adapt to the changing work environment by learning new skills?

A: We're going to have to be more self-inventive and learn new skills. Norway and Australia, as I write in the book, provide kind of sabbaticals for people so they have a chance to build new careers. We need to give people a shot at being able to change their status as workers in society. Of course, with all the emerging technological developments in the workplace, it's good to develop multiple skills.

Q: In the future, we will need more specialists In geriatrics to meet the demands. How can we. provide incentives to young doctors to enter the field?

A: There's no question that finances play a role. On average, a medical student leaves medical school with about $150,000 worth of debt, so it's very attractive to enter a specialty that makes more money. Geriatrics is not one of those fields. In Europe, most medical education is public and free. Students don't graduate with debts. In this country, South Carolina, for example, has a debt- forgiveness program for doctors who go into geriatrics. Last March, California Senator Barbara Boxer introduced legislation-The Caring for An Aging America Act-to do the same thing on a national level, so it would apply to all states. Q: We've read about problems with nursing homes and elder abuse for years. Why do these problems persist?

A: There's a scandal almost every couple of years. It goes back again to age discrimination. The thinking These are just old people- we've got more important ways to spend our money, so we don't have to worry about them' is part of it. The nursing home lobby is pretty effective in delivering a positive impression of the industry and in getting Uncle Sam to pay them more money.

Q: How does America compare to the rest of the world in treatment of its elders?

A: It varies. We have a lot of romance, thinking the grass is greener on the other side. Problems with prejudice and discrimination against older people exist in other countries, too. We may have a little more idolatry for youth than perhaps other countries do, which may have its disadvantages. We have a more superior medical research establishment than most Europeans and nations worldwide-which, of course, benefits older people. However, we don't have long-term care insurance coverage like Germany, Japan, and the Netherlands. We are definitely not where we should be.

Q: Dr. Lewis Thomas referred to AIzhelmer's as the "epidemic of the 21" century." Why is the investment in studying the biology of aging so vital?

A: Aging is the number-one risk factor for all diseases. Yet, we don't devote many resources to understanding what aging is all about at the molecular level. If we devoted more resources to understanding the basic biology of aging, it would help society deal with the wide array of diseases. Classically, we set up most research programs disease by disease-cancer, heart disease, etc. The National Institutes of Health spends roughly 200 million dollars on the biology of aging, whereas we spend some 29 billion dollars on all diseases. We need to gain a better understanding of why disease happens as people age by addressing basic questions. Why does 80 percent of all cancer occur after age 50? What is it about aging that makes that happen?

Q: What is the most effective approach to solve the riddle of Alzheimer's disease?

A: Many of the wonderful scientists studying Alzheimer's disease may be molecular biologists or biochemists, who may not know a lot about the brain itself. Collaborating with neuroanatomists and neurophysiologists who really know the brain is a very healthy step in research. We need a multi-disciplinary approach. In this modern world of science, it's almost impossible to expect one individual to know everything, so collaboration becomes more and more important.

Q: Many people want to "age In place" and live in their homes as long as possible. Is technology making that a possibility?

A: It's getting there. There are assistive technologies. In the book, I mention the efforts of Beacon Hill Village in Boston and other communities, where people form a 501(c) non-profit corporation and arrange for repair services ahead of time in the event something happens to their apartment or house, for food supplies should they be sick, for nursing, and so forth. In short, you create a system of care In advance that you bring Into your home so you can remain in your home as long as possible.

This type of community is called a naturally occurring retirement community (NORC) of older people. There's one in New York called Perm South. It's not just well-to-do communities, such as Beacon Hill Village, who figure out ways to bring into homes services that they will need. Lower-income communities are doing it.

Q: People vary in what they believe is middle age and old age. What do you think of the popular ad-based slogans on "70 is the new 60"?

A: With our declining disability rates and greater health, people are not only living longer, but also enjoying a better quality of life than 100 years ago. It opens the door for people to continue to work or volunteer longer as well as enjoy relationships with their families longer. While in humor, there is some truth behind it. People are simply healthier than they used to be.

Q: Why does prevention receive so little funding?

A: The marketplace doesn't really support prevention. It doesn't make money for doctors or hospitals. Prevention prevents costly things from happening. We need a public-health system that goes beyond the doctor-patient relationship and speaks for prevention. If we developed a more public health-oriented prevention program, it would save the country a fortune.

Q: What are some of the common factors and traits that centenarians share?

A: Unfortunately, a certain percentage has done everything wrong and yet managed to become centenarians. They drive us doctors crazy: they drank too much, or smoked or whatever and still lived to be 100, which probably is accounted for by the fact that they happened to be born with good genes. Genes appear to be related to longevity by about 25 percent, while 75 percent appears related to the environment. In the main, most centenarians have led a fairly healthy life. If you want to become a centenarian and are fortunate to have the genetic predisposition, the key thing is to take good care of yourself.

Q: What can individuals do to contribute to the revolution In adjusted needs of an aging society?

A: They should read and think about it. They should also try to help their fellow man. Not to sound sappy and sentimental, I think that we all should have some relationship to each other and concern for each other. Older people should volunteer more, such as helping our children. In a country with an abysmal educational record where kids from the perspective of math and science rank about number 18 among nations, people with skills in math and science could make a real contribution in after-school enrichment programs to help kids.

Q: How do you stay in good health?

A: I try to be thoughtful about my health habits. 1 eat plenty of fruits and vegetables, supplement with a multivitamin every day, and take very good care of myself. I joined a walking group that meets every Saturday and Sunday morning. We walk five or six miles. During the week, I have a treadmill at home, but I also work out with muscle resistance exercises for balance.

Q: Has your perspective on aging changed as you have aged?

A: There are no secrets. For a long time, I thought that maybe I'll discover things that never dawned on me. One thing that is interesting to me is that the fear of death goes down for whatever reason. You would think that since you're closer to death on a realistic basis and uneasy about the prospect of the unknown, you'd be more troubled as you grow older. That has not happened for me at all. I feel less threatened by the end of life than I perhaps did when I was 35.

"Baby boomers, in my judgment, are a generation at risk because we can't solve all the many issues that affect and will affect them."

Excerpt from The Longevity Revolution

by Robert Butler, M.D.

With the Longevity Revolution, the world enters a new and unprecedented stage of human development-the impact of which has been made greater because of its rapidity. We are no longer limited to a life view that must accommodate itself to the historic brevity of life, to random and premature illness and earth, as Thomas Hobbes described it. The Longevity Revolution is a great intellectual and social, as well as medical, achievement and an opportunity that demands changes in outmoded mind-sets, attitudes, and socioeconomic arrangements. Many of our economic, political, health, and other institutions, such as education and work life, have been rendered obsolete by the added years of life for many citizens. The social construct of old age, even the inner life and the activities of older persons, is now subject to a positive revision.

As Thomas Jefferson said, "Our laws and institutions must move forward hand in hand with the progress of the human mind." Just as societies have not yet adapted fully to the Industrial Revolution, with its pollution, unemployment, displacement, and other unsolved social and environmental issues, so too we have not yet fully adapted to the Longevity Revolution. But the revolution is fully launched. Adjustments are well under way. What will the 21st century bring?

Beacon Hill Village (top), a type of naturally occurring retirement community (NORC), enables residents of Beacon Hill, Boston, to remain in their homes and thrive. Penn South, a 2,800- unit co-op in midtown Manhattan, was the first official NORC program in the United States. These types of communities foster mutual support, care, and intellectual stimulation, while providing practical services, classes, and community connections for residents.

by Patrick Perry, M.P.H.