Why Everyone Should Care About Population Aging (And What's Being Done About It in Terms of Policy)

Written by SNAP member Edith-Marie Green

Footnotes are denoted with superscript. References are denoted with brackets.

I was scrolling through social media when I saw some pictures from a recent local event, including one of my friend Lucy.¹ Lucy and I go to church together, and our church is located downtown, right across from the state capitol building. Our church has often been known as a beacon of social participation due to its location. The next time Lucy and I saw each other, we chatted about the event and how we’ve been, as good friends do. Seeing Lucy always brings joy to my day, whether it’s a photo or in real life. Whenever she sees me, she always throws her arms around me for a big hug, and I feel so incredibly grateful for our friendship.

By the way, I’m in my twenties, and Lucy is in her eighties.

Population aging

Friendships like Lucy and I’s could become more common as the population ages. The World Health Organization (WHO) estimates that the number of people aged 60 and older worldwide will increase from 1.1 billion in 2023 to 1.4 billion by 2030. [1] In the United States specifically, the number of people aged 65+ is projected to increase from 58 million to 82 million between 2022 and 2050. This represents an increase in the share of the total national population that is above 65 from 17% to 23%. [2] As someone who researches aging and end-of-life healthcare, I see this growing population as an opportunity for new friendships to form across generations, and I hope to inspire other people my age to see the value in building relationships with older adults. This viewpoint is especially informed by my dissertation research, where I’m studying the impact of loneliness on dementia risk.

Population aging is due in large part to increases in life expectancy linked to healthcare improvements, but this also presents strains on the healthcare system and individuals who care for older adults. Many older adults are working beyond 65 years of age as the Social Security system has been depleted and greater funds overall are needed to sustain extended life expectancy, as individuals collect payments until they are deceased. Specifically, expenditures for Social Security and Medicare are expected to increase by 2.5% by 2035, but the funding allotted for the programs is not. [2] More older women are living alone, as men have shorter life expectancies, and the loneliness these women often experience has been found to have a major impact on both cognitive and physical health. The caregiving system is ill-equipped to give older adults adequate support as they age without also burning caregivers out. There is a gap between how many older adults need care and how many providers there are; there is also a shortage of gerontologists (doctors who work with the elderly). [3] In addition, most in-home caregivers are either under- or unpaid, and as people live longer, the strain on their families grows.

Despite the expansion of our aging population, a friendship like Lucy and I’s is still uncommon. This is in large part due to ageism. WHO defines ageism as “the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age.” [4] While anyone can experience ageism, it’s often levied at older adults. A WHO study conducted by the Demographic Change and Healthy Ageing Team found that roughly half of respondents had negative attitudes towards older adults, and ageism is associated with earlier death, poorer health (both physical and mental), and slower recovery from disability for older adults in the United States. [4] The American Psychological Association refers to ageism as “one of the last socially acceptable prejudices,” [5] and it pervades our lives. Think about walking down the skincare or makeup aisle at the store–how many of the displays are about staying youthful, removing lines, or “anti-aging” products? This same phenomenon is observed in media as well; the American Society on Aging found that only 1.5% of characters on television in the U.S. are older adults, and only 5–10% of marketing budgets are devoted to attracting people 50+. [6] Ageism is also associated with restriction of treatment options, underdiagnosis of health issues, and pain mismanagement in medical settings. Sadly, 82% of adults over 50 in the U.S. report experiencing ageism, and older adults are also less likely to seek medical help because of ageism, including dementia diagnosis avoidance. [6] In short, ageism shapes how older adults are perceived in society, leading them to often be pushed aside or forgotten, and leading to very real negative health impacts.

Policies about aging

The United Nations (UN) Decade of Healthy Ageing’s action areas include combatting ageism and creating age-friendly environments. [1] These goals are being accomplished, in the U.S., through policy initiatives and plans that are specifically focused on older adults’ well-being. Ongoing national initiatives include the Healthy Brain Initiative Road Map (created by the Alzheimer’s Association and updated for 2023–2027) [7] and Healthy People 2030 (from the federal Department of Health and Human Services and the Office of Disease Prevention and Health Promotion). [8] Both of these programs provide actionable frameworks and research goals towards reducing dementia risk and improving care for the disease. However, Healthy People 2030’s data is undergoing changes due to research actions from the federal government; researchers have been asked to remove certain variables from datasets and objectives from the framework. Federal government actions also shape dementia treatment in other ways; one example is that many older adults use both Medicare and Medicaid to cover their care (long-term care insurance is prohibitive and expensive in the U.S.) but those programs are being defunded. [9]

One organization that advocates for older adults is the non-partisan Elder Justice Coalition, which is a cornerstone group pushing for increased protections for aging adults. The coalition, founded in 2003 in conjunction with the Elder Justice Act in Congress and with over 3,000 members, hopes to “raise awareness of elder abuse, neglect, and exploitation and help develop and advocate for national policies to end this crisis.” [10] The organization has backed a variety of pieces of legislation and programs, including most recently Nurses Belong in Nursing Homes Act, Adult Protective Services, Long Term Care Ombudsmen, the “Caring for Caregivers” legislative agenda, the Strategic Task Force on Scam Prevention Act, and many others.² They also create toolkits and fact sheets, especially those geared towards preventing elder abuse. Most recently, they have been supporting and advocating for the New Elder Justice Reauthorization and Modernization Act, which would update the original Elder Justice Act for the current decade.

A major piece of legislation addressing the needs of older adults is the Palliative Care and Hospice Education and Training Act (PCHETA), which is a bipartisan initiative currently spearheaded by Tammy Baldwin (D-WI) and Shelly Moore Capito (R-WV). [11] The goal of PCHETA is to create a variety of initiatives and a funding stream ($100 million distributed over five years) to support public awareness of palliative care, research into the topic, and promote palliative care education and training for nurses and other medical professionals. In the 1990s, concerns about hospice fraud were rampant; federal warnings were issued about it, and research found that 7 out of 10 of the largest hospice companies (which are for-profit and seeking payouts) in the U.S. had been sued at least once under the federal False Claims Act. [13] These concerns led to the creation of the PCHETA. Despite its importance and bipartisan support, PCHETA has been introduced into Congress at least eight times since 2004. [12] Sadly, if a bill doesn’t pass a chamber or make it out of committee, it has to be reintroduced, which delays the process and means that no progress is being made towards improving care for people approaching the end of life. While palliative care and hospice are important resources that will become more salient due to population aging, they don’t seem to be political priorities, as, despite frequent reintroduction of the bill, other pieces of legislation are in the forefront.

The issue of population aging becomes especially salient when we zoom out and look from a global perspective. worldwide, especially in countries typically thought to be still developing, the population is aging. It is, as the Brookings Institution refers to it, the “invisible crisis shaping our future.” [14] Fertility is declining globally while longevity is increasing. Though these changes are estimated to have impacts on economic production levels in virtually every country and also shape resource use that could impact the climate, aging tends to fly under the radar as a key policy issue around the world. Many believe that there is no clear “antagonist” when it comes to population aging; thus, “In many cases, country strategies to mitigate this crisis are a zero-sum game.” [14]

Ageism as the catalyst of crisis

I would argue, however, that there is an antagonist to rally against in the case of the population aging crisis, and that’s ageism. Population aging is only seen as a crisis because society tends to be designed around youth. Ageism also intersects with ableism (discrimination against people with disabilities), as many older adults face disability as they age. Society is designed around people being able-bodied. If our systems shifted to be accommodating to all, especially older adults and disabled individuals, neither of these things, nor their intersection, would be considered a crisis, at least not outside of the potential economic impacts (and even those concerns are shaped by whether people “deserve” social safety nets).

Unfortunately, ageism has been deeply entrenched in society. As just one example, a recent report from the Department of Health and Human Services found that some nursing homes misdiagnosed patients with schizophrenia to avoid notice of the fact that they were misusing antipsychotic drugs on elderly patients. [15] These misdiagnoses artificially inflated the ratings of these nursing homes and skirted Medicare patient protection regulations and safeguards. Schizophrenia drugs have a “black box” warning and are expressly not permitted for dementia treatment; however, “Nursing homes gave antipsychotic drugs to residents with dementia to manage their behavior for the benefit of staff, despite FDA’s warning that these drugs may increase the risk of death.” [15] In some nursing homes, staff referred to this misdiagnosis practice as company policy; “At one nursing home, company officials reportedly instructed staff to add schizophrenia even though physicians had not diagnosed it.” [15] In this very real example of the impacts of ageism, older adults are treated as an inconvenience or something to get rid of, rather than real, complex, and meaningful human beings.

My friendship with Lucy, and all the other wonderful older adults I spend time with, flourishes because I’m aware of the dangers of internalized ageism and how important socialization is for older adults. In the community that Lucy and I are a part of, older adults drive most civic participation and advocacy, and without them, our social safety networks would collapse. In order to help older adults have the best aging experience possible, we should be attempting to shape policies that center the importance of older adults rather than pushing them aside. I hope to grow old in a world where one day I’m in Lucy’s position, with a lively intergenerational social network of my own.

Recognition:

Edith-Marie Green is a PhD Candidate in Population Health Sciences at the University of Wisconsin-Madison. Her research broadly focuses on aging and end-of-life healthcare, as well as global health and the rural-urban continuum.

Special thanks to fellow SNAP members who provided feedback on this article: Emily Selland, an ecologist and public health scientist whose research focuses on sustainable and economically viable innovations for infectious disease control, and Mikayla Smith-Craven, who received her doctoral degree in Pharmaceutical Chemistry from the University of Kansas where she focused on drug development and delivery.

Footnotes:

This name has been changed for privacy.
I know about these initiatives because I’m on their email list, but you can learn more about the coalition’s advocacy on their website: https://elderjusticecoalition.com

Why Everyone Should Care About Population Aging (And What's Being Done About It in Terms of Policy)

Population aging

Policies about aging

Ageism as the catalyst of crisis

Recognition:

Footnotes:

References:

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