The following teleconference is supported by a grant from the
GTE Foundation Lectureship Program and
the Division of Research and Graduate Studies at Virginia Tech.
Welcome to a choices and challenges forum on Altering
the Aging Process teleconference from Virginia Tech. Our moderator
is media consultant and former news correspondent Peter Hackes,
Mr. Hackes. [Music]
[Music] Welcome
to this teleconference, another in the series under the
title, choices and challenges which come to you periodically
from the campus of Virginia Tech in Blacksburg, Virginia.
As you may know, this teleconference is concerned with
the aging process and specifically how can we alter the
aging process. And wouldn't it be nice if the
aging process could be altered? Many people are working
day and night trying to do just that. And
in fact there has been some success along those lines.
Some of which we may hear about today.
I am Peter Hackes. I spent a number of
years as a correspondent for NBC News, I retired
from that a couple of years ago. I am
now in the middle of the aging process. I
am 64 years old and getting older by the minute.
Uh and I work two days a week just
in passing to tell you for an organization called AARP,
the American Association of Retired Persons. I am their
media consultant and uh it is a small elite group
of now 30 million members and growing at the alarming
rate of 6000 new members a day. It boggles
the mind. But as you know, this is
the age group that is growing by leaps and bounds
in this country. And so this particular teleconference is
right on target. We have a number of people
here on campus who are interested and ready to ask
questions. We have people at 22 sites and locations
around the country who are equally eager to ask questions.
The format let me explain it to you
a little bit. We have a number of folks
seated here, each of whom has concentrated on one
or two or three or five different areas in the
field of aging for many years. They are in
fact the experts in this country. We will begin
with the first three gentlemen to my left. Uh
they will present their views on certain topics of altering
the aging process. They will then be critiqued and
challenged by the two gentlemen furthest away from me.
And what I will do now, first of all
very briefly is to introduce each of them to you.
And then just before they speak, I will
give you a little more information on their background.
So you know where they're coming from. To my
immediate left. Dr. Richard Lockshin, of the
department of Biological Sciences St. John's University, New York.
He is chairman of the biological sciences section of the
Gerontological Society of America. Seated next to him, Dr.
Robert L. Clark. Dr Clark is with the Department
of Economics and Business of North Carolina State University,
a senior fellow, Center for the Study of Aging and
Development and senior research fellow at Center for Demographic Studies
at Duke University. To his left dr George L.
Maddox. He is chairman of the University Council
on Aging and Human Development and the Department of Sociology
and Anthropology at Duke University. Then we have our
two commentators first Dr. Harry R. Moody, deputy director
of the bBookdale Center on aAing at Hunter College of
the City University of New York. He is editor
of Values, Ethics and Aging. And last, but certainly
not least, Dr. James Fozard who is associate scientific director
of the National Institute on Aging Gerontology Research Center,
Baltimore, Maryland and he is the director of the Baltimore
longitudinal study on aging and we'll discuss more about that
at some point later on. Alright, we are
ready now I think to begin hearing from these experts
uh as you know, altering the aging process is
a hope and a dream and a wish and a
plan and a goal of many, many people in
this world today. In fact, it goes back
to the beginning of time when a man has tried
to extend life and make the later years more interesting
and more productive. We have a distinguished panel as
I said. And so let's get right on with
it. Our first speaker Dr. Richard Lockshin let me
let me say before we go any further as we
go along, may I suggest that those of you
interested in developing this and asking further questions, jot
down whatever it is that you'd like to hear more
about. And when we get to the question and
answer period, you will be invited wherever you're located
at the 22 locations around the country. And I
suggest that it might be well to decide which of
the experts here you would like to direct the question
to and maybe have it written down when it gets
to the question and answer period, I'll remind you
again. Uh we'll give you a telephone number to
call wherever you are. Excuse me, give us
your name and your affiliation. We'd be delighted to
try to answer at least the questions that you pose.
Dr. Lockshin is from ST. John's as I said
before in New York, Chairman of the biology department
there, his interests among other things are what makes
body cells age degenerate and then die. Which after
all is pretty basic to our discussion, Dr. Lockshin
will present the scientific background and discuss what interventions may
be possible to alter the aging process. Dr. Lockshin,
Thank you. The related dreams of longevity and
immortality have haunted mankind since our earliest days. Virtually
all societies contained creation myths, including immortals. Among
the earliest written documents we have uh the sumerian God
Gilgamesh headed west to the mediterranean in search of eternal
life and in Eastern religions. A young prince horrified
by his first recognition of the deterioration of the elderly
went off to ponder the meaning of it and returned
as the gautama buddha. Considering this aspect of human
aspiration, it is no surprise that while I was
preparing this talk, I was chatting with our librarian
who asked me with some surprise why should life extension
be an ethical issue? I thought that I'd better
share those sentiments with you. I propose to review
review briefly. First, why it is an ethical
issue in which you'll hear about more later. Second
arguments that lifespan will not be extended without great cost
and effort. Third, arguments that we might actually
be able to extend lifespan. Fourth theories of aging
and possibilities for life extension and finally, my personal
conclusions as illustrated in the first slide that I have
, there are many reasons why life extension might be
an ethical issue. First, there are many fiscal
responsibilities which we have to consider. Second, there
is a substantial argument that there may be a noticeable
increase in morbidity. That is pain and an inability
, lack of agility or mobility and suffering. Third
, the benefits maybe only for a few and at
considerable cost. Let me illustrate these points first,
if we assume that anything similar to the working life
today and support mechanisms we have today, we can
expect that society will expect a substantial cost. First
, the proportion of retired to working population may reach
triple the ratio that we saw in 1950, which
is on the left of the screen By the time
. By the year 2050 in which we are calculating
a dependency ratio or the essentially the number of people
who are not working 65 or over. By that
calculation divided by those who are likely to be working
. And we see that the figure will rise to
approximately triple what it was in 1950 second. In
a family basis, the number of families supporting two
elderly generations will rise up to tenfold the red or
the darker lines there indicate the numbers of families supporting
one elder generation and the light or the lighter lines
are graphs indicate those who are expected to support Two
elderly generations by 2050 on the right. The numbers
will probably be 10 times what they are were in
1950 unless we change health patterns, this may cause
substantially increased suffering and societal burden. For instance,
if we looked at limitations in elderly among in activity
, the elderly suffer far more 10% of the population
at all ages suffer some substantial disability. The little
red mark on this graph here, This is about
6% of the young, but it's almost 40% of
the elderly shown in this figure here, A substantial
proportion of this disability is diseases which affect substantially only
the elderly for instance. Alzheimer's could by some calculations
. Disable up to 20% of the elderly in an
aging population. The problem is that it is not
clear that life extension will be inter calibrated or symmetrical
. Let me illustrate this point. The curve on
the left is essentially the expectation the number of survivors
at various ages and it terminates at about 100 years
there. The area under the little dotted line indicates
those who might be expected to be having some problems
. The curve on the far right Would be the
kind of curve that we would see if we essentially
inserted an extra 30 or 40 years of good,
healthy life substantially the age life as it is at
age 30 or so. But there's substantial argument that
in fact, we would get something more like the
middle curve in which all phases of life would be
equally extended. And in that case, what would
happen is that we would increase years of suffering and
disability. These kinds of arguments suggest that the benefits
may be only for the few. The justification for
this kind of argument is related to the biological arguments
against the extension of lifespan. These arguments may be
summarized as follows. First of all, there is
a substantial amount of historical data which suggests that lifespan
may not be extendable. Second, the disease patterns
that we see suggests that two and third and related
are what we call the mortality curves. The historical
record argues with mean not maximum lifespan has extended in
history In prehistoric times and the left of this figure
here, we expected a mean lifespan of about 22
. By today's standards. We expect a mean lifespan
of 70, about 72 or so. What that
means, of course though, is those figures are
the ages at which half the population which was born
has died. Uh And in prehistoric times. And
even roman times, most of the many, many
of the babies died and there was much higher mortality
all along life. The change, however, has
been to increase survival of the young, not the
elderly. This curve is typical for a gerontologist and
what it is we showed one a minute ago is
the probable survival of individuals. The number of individuals
born at various ages going out to the right of
the curve at about 100 In Prehistoric Times and Roman
Times. The curve was like that, that we
see in the lower portion there is that there was
a very high mortality of infants and throughout life,
40 year olds died of infections or various kinds of
problems that were not treatable As we move through history
towards about the beginning of the 20th century. The
curve turned toward the one more like that in the
middle and today it looks more like the upper one
. That is that most of the people born survive
to middle age and then death rates start increasing fairly
rapidly. The Outer limit of that curve has not
changed markedly. The maximum limit of about 100 has
not. There is however, some evidence that there
is some change in recent times. The main argument
though, for the limitation comes from what we describe
as the exponential rise with age in the force of
mortality. If we look at the rise in incidents
of death from from the majors killers, we see
a dismal picture. The upper line indicates the rise
in mortality. That is the probability that one will
die from all causes. And the red or middle
line there indicates that probability for cardiovascular disease is the
major killers of life below that are malignancy And influenza
. But those curves also tip up sharply at the
later ages of life. And if we were to
try to extrapolate those curves outward for almost any disease
, we would see that the curves tend to reach
100% mortality at about 120 years. Put another way
the force of mortality has decreased for the young,
but it's still extrapolates to the same point in this
figure, the force of mortality, the higher the
curve is, the higher the probability of dying.
And it extends from the life throughout the lifespan from
20 to 100 again, the higher the curve,
the green or upper air line, there is an
earlier time and we have moved to the lower or
the red curve, which indicates that the safest part
of life is in the late teens, early twenties
and then the probability of death increases steadily after that
. But the point is that all of these curves
extrapolate out and we can carry them to the termination
of 100% mortality somewhere around 101 115 or 100 and
20 years. In practical terms, what this means
is that the 65 year old has about the same
chance of reading reaching 85 as he or she did
about 80 years ago. It's just that far more
people reach 65 today. The force of mortality among
those of great age is immense. For instance,
if we took 10,098 year olds, what would we
expect for their survival? This is illustrated in the
next slide, the tail gets vanishingly small and it's
even much smaller than you can imagine because we simply
cannot put it on the curve By 110 of our
10,098 year olds. We have three survivors against this
picture of today's reality. However, there are arguments
that life span may be extended. These arguments come
from three general areas. First, lifespan is a
genetic trait. Second, comparative gerontology and third,
the presumed evolution of human lifespan. Although our own
tracing of history again suggests a maximum of over slightly
over 100 years, one Pharaoh was noted to be
remarkable for living 98 years. There are suggestions to
the contrary. For instance, if we look at
our own culture, we see quite a different phenomenon
. The figures may be a little small for you
to read, But its lifespans in genesis and we
go from Adam and in ash and the Hallowell and
so forth down. And we find that most of
them including Methuselah and Noah lived over 900 years.
Some of course something might be wrong there. After
Noah begat Shem, ham and Japheth God said that
the days of man should be 120 years presumably.
Then shortly after, Uh, no, uh,
that must have been the first sign of environmental contamination
I guess. But lifespan started to decrease in any
event by the time we got to the time of
Abraham and Sarah Sarah of course laughed when old and
gray at 70, she learned that she would conceive
the Egyptians about the same time recognized there was a
determination to life and they sought cures to aging.
For instance, in the smith papyrus we find a
formula here which you can see if all of the
figures small that it was a on how to make
an old man young again. And you see as
it's, it's red actually from left to right,
uh, there and the old man throws away his
cane. The trans, the translation of it though
I'm told, I don't do that myself, is
that it's for a henna hair dye, which doesn't
sound particularly effective today. Um, although it's still
popular. The legends of the launch of its people
similarly are, to the best of our knowledge fictitious
. For instance, there is the legend of Old
Power Who lived in the 16th, 17th and 18th
centuries in England, Old Power and the liquor appeared
for him a while ago as a matter of fact
. But the best we can trace it. He
had a life tendency on a cottage and what that
meant is that of course the uh he lost at
at death and there's a strong suspicion that old Power
was Old Power, Old Power Junior and Old Power
the third to prove great longevity. You need a
valid birth or baptismal certificate, a valid death certificate
and proof that they both belong to the same person
. This has generally not been done this approach.
This problem applies to the most famous of the launch
of its peoples. As you probably know, they
allegedly come from three areas in the world in South
America in bulk from Vilcabamba Ecuador in soviet Georgia,
the region called Abkhazia. And in Pakistan the hormones
are raging From Abkhazia come two of the most famous
favelas urea who died at over 132 And Cheryl MS
LaMotta whose hearing was good. It was still good
according to the Soviet press until he died at 162
. How typically however, the story is more like
that of Mikhail Aqazadeh from Vilcabamba who is shown here
and there, she had a baptismal record proudly circled
in the church indicating that she was 102. Unfortunately
when her baptismal record was deciphered, it turned out
that the parents were not the same as those she
had named when she was asked about it. She
said, oh, that Michaela Aqazadeh, She was
my cousin. She was a lot older than I
was and she died a long time ago. That's
the kind of situation that we usually find less than
10% of the current Centenarians were born in areas where
birds were actually recorded. Nevertheless, species have characteristic
lifespans and since lifespan can be described for a species
, it must be of genetic origin in the same
sense, that size, color or nesting behavior is
from this information, we can begin to examine potential
causes of the aging process. For instance, size
and metabolic rate are inversely correlated with lifespan in the
up axis or the Y axis. Or uh or
we see lifespan going up to about 75 years and
metabolic rate from left to right here. And if
we also want to consider that we could take the
same curve and read size going from small to large
toward the left. In other words, we don't
expect a mouse to live 70 years or an elephant
to live three years. Uh, there are some
exceptions though, and the curve is not that accurate
. For instance, humans live 100 years, whereas
chimps fit more appropriately on the size on the line
for size at about 40 years and cats which are
generally smaller than dogs live longer than than they do.
.George soccer pondered this fact and came to the
conclusion that relative brain size was also a factor,
the larger of the brain, the longer lives the
animal. This hypothesis has led to several ideas in
the field of gerontology. First, by extrapolating the
idea of brain size into human evolution. Richard Cutler
has come to the startling conclusion that evolution evolved very
quickly in the last 60 million years of primate evolution
. That's the sort of ape type evolution. Lifespan
by that calculation may have evolved very, very quickly
from a few of about 10 or 15 years for
the smaller primates. However, the rate of evolution
may have slowed recently if we follow only the last
1.5 million years of humanoid or Haman oid longevity,
humanlike creatures. And it seems to have leveled off
now if this is the case and there are many
assumptions on which this is based. The extension of
lifespan is controlled by only a few genes. Since
selection can operate this fast on only a limited number
of genes, that's the prime primary driving idea that
in fact we would be able to alter it the
lifespan fairly easily. And this search has led to
this approach has led to a search for such genes
. The search for these genes focuses on several theories
of how aging occurs. These are all interrelated and
I'll discuss them briefly with you. The concept of
running out of program or pushing deleterious genes out to
the free future are somewhat related, What they basically
say is that uh we simply there was little probability
of reaching great age earlier. And so any gene
that acted way out, there would have no practical
effect. What that would do Would be to simply
that we would simply not be able to program.
Getting good survival beyond, say, the age of
about 40 or another thing would be that if we
had a disease and to evolved, to eliminate the
disease meant delaying it until we were probably dead of
something else would be the same thing. And so
the idea is that we simply never managed to evolve
mechanisms that would do us much good for the age
of 80 because there was so little probability of getting
there. The next consideration is a little related to
that. And it's a driving idea in some areas
and related to the size lifespan and metabolic rate argument
. And that is that something to do with our
metabolism uh could limit our lifespan. And we certainly
know that the burning of oxygen in our bodies produces
some very toxic products. And there is considerable interest
in learning how to control those. The next two
points deterioration of feedback control or central deterioration of the
central nervous system. The endocrine system or the immune
system are also interrelated in that we recognize that organisms
are exceedingly complex structures in which numerous cells depend on
each other for proper function. And certainly the only
organisms we know which do not have seem to have
limited, limited lifespan are very, very simple.
That if we cannot control the delicate balance in whereby
the nervous system tells a specific cells to carry out
a specific function in the endocrine system sets the the
hormonal balance just right for that. Then sooner or
later this sort of imbalance very much like a car
that's badly tuned will lead to various kinds of trouble
. And there is substantial argument to indicate that this
kind of affair occurs. Finally, there's what are
called the cellular or programmed death theories. And although
my own origins in biological research come out of that
, I'd have to say that there's very little evidence
that death is pro or senility is programmed in the
sense that it is a biological good to eliminate the
organism. And so a time bomb has been built
in. So these kinds of theories are what drive
what you see mostly in the newspapers now and without
trying to be to elaborate on it. We can
say we can say that when all is said and
done, uh, those are the areas which are
not that well understood. And we can finally ask
what is being done to see if we can extend
life. The primary approaches are illustrated in the next
slide, those are, and you're familiar with most
of them. The question of environmental supplements and contaminants
. The questions of diet and exercise and three,
the longevity, people's Longinus, people's will set off
very quickly. There is no evidence that they really
exist. The diet and exercise we can deal with
very simply. There's many reasons that exercise does a
lot of good for people. But currently it's not
, there's not particularly good evidence that it actually extends
lifespan would like to spend a minute more on the
environmental supplements and contaminants. Let me comment that the
one way we know to extend lifespan is to hold
an animal near starvation and that was discovered in the
19 thirties and we still do not understand how that
actually operates. But that's also been a major driving
force in such arguments such as the 120 year diet
and that those arguments of Roy Walford, uh the
environmental supplements and contaminants will address fairly briefly in terms
of them, we can easily eliminate one of them
without radically changing lifestyle, such as jogging four hours
a day or eating nothing but alfalfa sprouts. Uh
and that was very simply the primary Environmental contaminant is
tobacco. If we eliminated tobacco, we would get
extend mean lifespan about 10 years. If we're not
willing to do that, which is relatively minor change
in our society, then the rest is essentially meaningless
. The considerations of environmental carcinogens or other kinds of
things in the diet are almost trivial, clean comparison
If we looked at what we could do to extend
lifespan, if we eliminated cardiovascular and renal diseases,
we would extend mean lifespan again, not maximum about
12 years. If we eliminated malignancy cancers, we
would get another year extension of lifespan. If we
eliminated accidents, we would get another year. influenza
diabetes and infections are a bit less than that.
So what we come back to all the time is
we still have not gotten past what seems to be
this kind of wall in our lives in our limits
and then and the arguments that we can are really
very theoretical in summary and these I emphasize are really
my own personal viewpoints. We can come to the
following conclusions. First, human lifespan appears to be
approximately 120 years in length and we really have not
seen much evidence that it will change much beyond that
. Second, many of the diseases we consider that
we take today considered considered treatable were once considered to
be diseases of aging. As we push back each
disease we encounter another, but we decrease morbidity.
This increases mean mean lifespan and lessens pain in itself
a benefit. And this appears to be what we're
doing is gradually beating back the things that kill people
earlier. What aging really seems to be is to
is to terminate life by 120 in the book of
our efforts so far has been to eliminate the early
killers and we're pushing closer and closer to those kinds
of limits. If we get beyond 120 years,
there's some theoretical arguments that we might be able to
do that, but nothing practical at this moment and
were much likely to be doing it by simply knocking
down those earlier killers 1x1. And when we get
to that point then we will see how well do
the point is that we would like to eliminate the
morbidity rather than create a 200 year old person.
Thank you. Thank you very much. Thank you
. Thank you. Dr Lakshman. That's uh certainly
sets up some goals at least for the medical side
to work on. Dr robert Clark is an economist
. He teaches, as we said at north Carolina
state in Raleigh. His specialty is the economic aspects
of aging. How is aging affected by such factors
as inflation, retirement plans, Social security, pension
benefits and the cost of living longer. Dr Clark
. Thank you. My primary assignment for today's session
is to examine working retirement decisions among older workers in
the context of an aging society During the past half
century. The proportion of the population over age,
65 or in the older age groups in general has
risen as it was shown earlier by the slide on
dependency. In conjunction with this, we've observed substantial
changes in the work rates and retirement rates of older
persons and what I'd like to do today is to
examine several of these issues relating to work in retirement
, to see if we can't examine some myths and
some realities associated with labor supply, labor demand issues
in the economy among older workers. Several current perceptions
that are existing about older workers that we should examine
and see if we can tell whether they are in
fact reality for me. First, there is a
perception that there is a continuing trend towards early retirement
. Is it true are simply a myth. Secondly
, there is a perception among some people anyway that
early retirement or stopping work is bad for older persons
and that many older people are forced out of the
labor force and would like to continue to work.
And the third issue that I would like us to
think a little bit about today is whether or not
this trend toward early retirement is good or bad for
society. What does it mean for society as a
whole? First, some numbers, it is in
fact true that among older men, there has been
an increased tendency to leave the labor force younger and
younger ages Available evidence indicates that around the turn of
the 20th century, there were about 75% of men
over 65 in the labor force. That is three
out of every four men over age, 65 in
the labor force. By 1950, it was more
like one out of every two today. The labor
force participation rate or the proportion of men 65 and
older who are in the labor force is about 16%
. So down to about one out of every six
men working. So, in terms of our suggestion
of, is this really a myth or reality?
It is certainly reality among older men that there are
fewer and fewer older men working overtime. The rate
at which the proportion of men In the labor force
men over 65 in the labor force has been declining
, has not tended to moderate. It has in
fact been increasing over the past 15 or 20 years
. So this trend toward early retirement or fewer older
men in the labor force not only has existed for
now, almost 100 years that we can document,
but it seems to be quickening and the current proportion
of older men in the labor force is in fact
very small. If we back up and we look
at somewhat younger men, men aged 55-64, We
would observe that as late as 1970 Pardon me.
As late as 1960, of the men of his
age is were in the labor force. This is
declined until in 1986. Only 67% of these men
Are in the labor force men 55- 64.
And if you look at even younger men, 45-50
for you would find that that rate has dropped a
little bit. Beginning in about 1960 and 1970,
it's gone from about 95% in 1970 to about 91%
in 1986? So the answer clearly is that among
men, fewer and fewer older men are in the
labor force, a strong downward trend for early returns
. What about older women? Here we find a
completely different picture. As you may know, women
have been increasing their tendency to be in the labor
force. The labor force participation rate of women across
all ages has been going up and this has included
the older age groups. If for example, we
looked at women 45-54, The proportion proportion of these
women in the labor force in 1950 was about 1/3
. Today, it's about 2/3 substantial increase For women
55-64, the proportion in 1950 was about one out
of every four, It rose to about 40% in
1980 and has basically held constant since then. So
, when you hear people talk about the trend toward
early retirement, it's solely a male phenomenon. It's
not women, Women are entering the labor force and
they're staying in the labor force in greater numbers than
in the past. So, point number one is
the trend toward early retirement myth or reality. It's
reality for men, a myth for women. Perhaps
things may change in the future and women may be
affected by the same sorts of factors that are influencing
older men to leave the labor force, but to
date hasn't happened. What are the factors then that
might have influenced older men to leave the labor force
? And can we look to see if they may
in the future effect older women First, the evidence
would suggest that men have left the labor force in
response to increased lifetime income over the course of the
20th century. That is from one court to the
next men or the one cohort of the next of
of older men, the men have been richer than
their successors in each case than greater lifetime wealth may
have been one of the reasons why people have used
or spent some of that lifetime wealth in the form
of additional leisure time or extra years in retirement.
So the evidence would suggest that as people get wealthier
as society gets wealthier people spend some of that wealth
on more leisure. And one of the ways that
appears is through an increased length of time in retirement
and in fact earlier retirement ages, we could also
look at the growth and development of employer pension systems
. In the United States coverage rates were about 25%
of the paid labor force. In 1950 they rose
to about 50% and nine in the mid 19 seventies
and have held constant at about that level. Since
then, pensions provide a powerful incentive for many people
to retire. Not only do they promise income to
people that do retire to leave their company, they
get a benefit, but they also changed the total
compensation that people get if they stay on beyond a
certain year. For example, once a person becomes
eligible to retire and receive benefits. In fact,
if they keep working, they give up that year
of benefits. I'm sure you must have heard some
people talk about, well if I stay on and
work, I'm working for nothing and what they're doing
is they're comparing the pension that they could receive versus
their salary and they're adding in their Social Security and
they're taking an account of their tax differential tax treatment
and lo and behold they find out that they could
have retired and gotten about the same level of net
income and that's what they would mean by working for
nothing. And this is a powerful incentive. We
could do it a little bit more formally uh if
if we had the time and the desire to do
that, but basically it's an incentive for people to
retire. And as pensions spread throughout the economy as
they became more generous, these incentives have attracted many
people out of the labor force, many companies have
early retirement programs, they lower the age at which
a person can retire and receive benefits. In the
past 20 years. Companies have introduced retiree health insurance
plans where if the person retires, they may continue
to receive health coverage from the company. So retirement
benefits have grown, they've expanded and they have provided
a lure for people to leave the labor force.
Government programs have done the same sorts of things.
We've built up a Social Security system. There are
things like the earnings test for Social Security that have
provided a tax on people that continue to work.
They provide benefits for those that leave the Labor force
. Medicare and Medicaid also provide benefits to people once
they've reached a certain age and these benefits may make
it more attractive for people to retire health. Almost
all studies show that people that are in better health
tended to work longer now. Over time we would
think that if our health has improved with our life
expectancy as we were talking about it a minute ago
, perhaps that should have kept people in the labor
force longer. Ah hard to see any long term
effect of this particular variable, but it's certainly a
very powerful variable when we look across individuals. Are
you working or are you not? One of the
key factors, depends on a person's health. Now
, of course, we could also look at a
variety of other variables. Labor market conditions, things
like inflation, unemployment, technological advances and try to
assess their impact on long term trends toward retirement.
My basic assessment is that for the most part,
people are choosing to retire earlier and earlier. The
men and that this choice is based on the parameters
, the constraints that they see the fact that they
have more income than their fathers. The fact that
there are these pension incentives and Social Security incentives for
people to retire has led them out of the labor
force. Even when we had mandatory retirement policies,
they covered a relatively small portion of the total labor
force and relatively few people stayed on until those ages
. So for the most part we were observing people
choosing to retire under the constraints that we have provided
for them, the incentives that we've provided for them
as a country, as a society, as individual
companies. So I would say that it is a
myth that people are somehow forced out of the labor
force in large numbers. Over the long term.
Of course we have cycles up and down business cycles
and during downturns in the economy, companies try to
encourage older workers to leave and there has been some
of that. But if you look at the data
, you would find that the labor force participation rate
of older men has gone down in good times and
in bad times and it's a downward trend, not
a cyclical phenomena. Now, what's going to happen
in the future? One of the ways that we
might predict or look at trying to understand what the
effect of participation rates would be in the future would
be to see. How are these variables going to
change these things? We just talked about is determinants
of income. Well, first, as you may
know in 1983 we made some fundamental changes in the
social security system. These changes tend to reduce that
earnings test, we were talking about, they raised
the age of eligibility for full benefits starting in the
next century. In a sense, they reduced the
present value of Social security benefits. All of these
effects should have the effect of encouraging people to stay
in the labor force somewhat longer. All of the
studies that I've seen in my own work would indicate
, however, that this effect would be relatively small
, that these changes in and of themselves will not
tend to bring older men back in the labor force
pensions, Government regulation of pensions has increased year by
year. If you go back and you look at
what's happened over the 1980s every year. There's a
major fundamental change in pension regulation. Some of these
regulations have made it more difficult or have reduced the
ability of firms to give workers incentives to leave the
labor force last year, for example, uh The
key legislation was that people that work beyond the normal
retirement age, the age fixed in the pension that
you should retire. Not that you have to retire
, but that you should based on their formulas,
uh that companies have to continue to give credit for
work after that time, up until last year.
They didn't, they could essentially say, even though
the person continues to work after this age, we
don't have to account that in deriving your pension benefits
. Uh, so there are some things going on
in the pension world that should encourage older people to
stay in the labor force firm personnel policies again,
are very much regulated by employers and by the federal
government, the federal government regulating the employers age discrimination
, the elimination of mandatory retirement. Those factors should
make it easier for older workers to stay in the
labor force. Lifetime wealth continues to go up but
much more slowly than it did in previous years,
the last 20 years or so. We've had relatively
slow rates of economic growth. This reduction in life
time wealth should also tend to make people leave the
labor force uh less rapidly than in the past.
Thus, my assessment of these factors is that on
balance, they should encourage people to stay in the
labor force. But does that mean we will observe
a reversal of the trend toward early retirement among men
? I think the answer is probably no. That
while most of these effects are in the direction of
providing less incentive for people to leave the labor force
, the evidence suggests that the trend will maybe maybe
level out, it certainly cannot keep going down as
rapidly as it has been because of the relatively low
rate of participation now. But I've seen nothing that
uh, will tend to reverse that, or no
evidence that we have. That will tend to reverse
that trend in the near term. In the early
19 eighties, I wrote a book called reversing the
trend toward early retirement and put a question mark about
it after it and tried to look at these same
issues and said uh, that I didn't think it
was going to turn around then, and it certainly
hasn't has continued to go down, and that's sort
of my continued assessment here. What then do I
think would it take to reverse this trend toward early
retirement? Basically, I would argue that if we
look at firm personnel policies right now, for the
most part, firm personnel policies are aimed at giving
older workers incentive to leave. Now, there are
certain companies that certainly don't fit into this mode,
that these companies provide incentives for older workers to say
. But if we look across the most other companies
in the United States, pension plans are set up
to encourage older workers to leave personnel policies in general
provide these signals, Why are they doing that?
Well, it could be that older workers are more
costly to employ. It could be because of changes
in productivity, it could be because firms want to
hire younger workers. It could be because the firms
are faced with reductions in the overall demand for their
product, and they're trying to reduce the size of
their labor force for whatever reason, firms in their
own self interest or giving older workers incentives to leave
, and I think these are the incentives that are
important in dominating this particular issue. What I would
say then, is in order for this trend to
be reversed, something's got to happen to make firms
think it's in their best interest to try to retain
older workers. What might accomplish that some people point
to the demographics and they look and they see that
over time we're gonna have fewer and fewer young people
entering the labor force, we're going to have a
reduction in the overall growth rate of the labor force
. And the idea there than might be the the
demand for labor by firms will be increased in response
to that demographic change and therefore tend to encourage firms
to try to keep their older workers in the labor
force. In addition, it's clear that a faster
rate of economic growth would tend to encourage firms to
maintain their older workers. There are many things that
firms could do to provide signals to workers to stay
as opposed to providing workers incentives to leave. And
I think the firm's when they deem it to be
in their own self interest, they will begin to
modify these incentives and encourage older workers to stay.
It's clear that government regulation over the past five or
10 years has been aimed at trying to give firms
incentives to keep older workers. For the most part
, firms have plenty of degrees of freedom, ability
or flexibility in their pension plans and their personnel policies
to continue to provide workers incentives to leave and they've
been doing that, even though the government may be
changing this particular policy to cut off that as a
use of an incentive to leave firms have been able
to modify their personnel policies to continue. Are those
incentives? So I would look for change to come
, only affirms recognizing there it is in their interest
to keep older workers. I think that's possible based
on the demographics. I think it's more pa likely
if we have a recovery of faster economic rate of
growth in the future. Now, just by way
of conclusion, let me say that this issue of
early retirement and trends toward early retirement has received a
lot of of emphasis, perhaps untold emphasis in the
past few years who gains and who loses from early
retirement. Some people look at retirement and they say
, look, all these people are are being forced
out of the labor force. We've already addressed that
issue. But there is somehow a lost resource to
the government. They're lost resource to society. Well
, I would argue that some of that comes from
an incorrect assessment of what a nation in our society
is about. It seems to me that people value
their own time and they're making decisions to maximize the
value of their time. And in our national income
accounts, we don't take into account the fact that
some people enjoy their leisure time. Some people prefer
not to be in the market, but instead to
be in the non market activities, that may mean
their volunteers, they may be doing homework. There
are a lot of things that a person can do
with their time and be outside the labor force.
In one sense, I would argue that the institution
of retirement or years spent in retirement is really one
of the great success stories of the United States and
other developed countries. We have grown economically. People
have a sufficient amount of wealth that they don't have
to spend their entire lifetime working. They can in
fact choose to leave the labor force to spend some
of their time in leisure. And this is an
issue I think that we are still grappling with in
terms of how to evaluate trends in early retirement.
Let me further say that if you wanted to keep
older workers in the labor force, older people in
the labor force, I suppose you you pronounced that
as a public policy, I could certainly tell you
how to do that. What would you do?
You cut Social Security benefits, you'd cut Medicare,
you'd say to firms that you can't have pension plans
that would keep older workers in the labor force.
Is that what we really want as a society just
to keep them in the labor force? I would
think not so I would just argue that we want
to maintain the opportunity for people to retire if they
choose. We want to look at the options that
people have in retirement, I'm certainly against people being
forced to leave the labor force saying they can't work
at all. On the other hand, I'm against
people saying you have to stay in the labor force
. And so what I would urge us to think
about in terms of a long term policy. The
word retirement is what really happened with these retirement decisions
. Are they voluntary? Are people happy after retirement
? Do they have funds to finance their retirement decisions
? How are we going to alter social policy?
Don't just look at the cost of Social Security and
say if we kept more people in, we would
be able to reduce the tax on people to support
Social Security. So let me leave at this point
and say that uh the economics of working retirement decisions
become more important than an aging society simply because the
proportion of the total population in this area in these
age groups is larger. It therefore has a direct
impact on the cost of income transfers and on how
people plan their remaining work years. I think it's
something that we will continue to see much more about
in the coming years. It's my expectation that the
trend toward early retirement among men will continue that the
trend or non trend of women toward early retirement will
probably stay about as it is that the increased participation
rate of women across all ages will continue to push
up the participation rates in later life. Thank you
. Mm hmm, mm hmm, mm hmm.
Thank you very much. Dr clark as you can
see. I've seen some people touting down questions.
We have a number of areas, a number of
topics that you're you're all going to be queried about.
Our next speaker. Dr. George Maddox is chairman
of the council on aging at Duke and and Human
Development at Duke University Medical Center in Durham north Carolina.
Dr. Maddox is a social scientist and he approaches
this whole matter of aging. Uh the impact of
society on the aging process and perhaps vice versa.
Dr Maddox pay close attention to my title, constructing
the future of aging, the role of public policy
. Pay attention also to the audience being addressed,
that audience is you and me. We're not talking
about some hypothetical abstract collectivity of older people, any
public policy we have which remains unchanged. Any public
policy we devise which makes a difference. Has a
greater probability of impacting on you and me than any
abstract group called the elderly. When I was growing
up, there was a slogan in safety, highway
safety that went like drive carefully. The life you
save may be your own. If you don't pay
attention to what I'm saying, I am suggesting to
you, the life you affect will in fact more
likely be your own than anyone else's. The title
is significant. Also because it says, it suggests
at any rate that we can construct the future of
aging. if you believe that you are in fact
in tune with what gerontology has been trying to say
effectively for the last 40 years, 30 years of
my career have been in that discipline that has been
characterized by two important characteristics. They are one,
it's in a disciplinary T. That is a recognition
that aging is a complex interaction of both intrinsic,
hence biological and extrinsic factors. Bob clark is talking
about what in his discipline. Very frequently they talk
about externalities. Well, Gerontology has been recognizing the
interaction of international it ease and externalities and seeing that
the name of the game is understanding how these interact
. Gerontology also from the beginning has been interventionist in
part because there has been the recognition that we do
construct the future of our aging. We have done
so in the past for better or worse and we
are capable of doing so in the future. So
. The multidisciplinary T and the interventionists qualities of the
discipline was what I inherited when I began to be
interested in this particular field. I think we have
been right, I think events have proved us to
be right in terms of both those characteristics. Now
the complex story I'm going to tell you is done
in terms of three revolutions, easy to remember.
The first revolution is one that is known to you
from simply reading the sunday supplement. You don't have
to be a gerontologist to understand the demographic revolution is
called the graying of America believe it, but I
want to suggest to you that simply counting gray heads
misses the point. The issue fundamentally is getting straight
in our heads. What the meaning of dependency is
, it won't matter if we have lots of older
people if those individuals are capable of appropriate independence,
it matters a great deal if they are dependent.
Dr Lawson in fact showed you one of the most
important set of three lines in America today. It
had to do with the life expectancy line. You
saw that line shifting out to the right what the
demographers call the rectangular ization of the population. It's
the most hopeful statement is we all live to a
respectable age and then dropped dead without disability. But
there are two other lines that you have to pay
attention to. The one to the far left of
those three is in fact a line engaging when chronic
illness begins and in the middle there is the most
critical line of all the line that estimates when we
are significantly disabled. Some of you have read in
the literature, the works of James Fozard. I've
come to call that the freeze antifreeze debate and his
favorite word is compression and you don't have to be
a gerontologist to get the sense of what he's saying
About the compression of those three lines because if we
continue to see that right line of longevity slipping out
to the right If those other two lines don't at
least slip out to the right to the same degree
we are in trouble. And if those lines not
only are not compressed but decompressed, we can hardly
imagine the implications of that kind of thing. I
have argued all along that jim freezes a great optimist
. And I'm reminded of a favorite line that comes
from the biography of Albert commute. Germaine bree.
Writing about uh can you pointed out to us that
that commute was one of those persons who entered into
the God is dead debate and she said about him
. He did in fact believe that God was dead
. But he seemed genuinely sorry. I would submit
to you that when we begin to attack jim freeze
and say he's wrong about his compression argument. If
he's wrong, we're all going to be genuinely sorry
because what he's describing is a world in which we
have predictably large numbers of older people. And the
decompressing line with larger people who are disabled. But
the second part of that demographic revolution other than understanding
the freeze three lines and whether you can compress them
or not, it has to do with the way
in which our society does its business. We call
it our We call it our institutional arrangements pressuring income
providing healthcare, housing, transportation, education. How
does the society do business? Our our institutions adapted
to an aging society. I don't want to suggest
there's a simple answer to that question. But I'm
suggesting that when you talk about the demographic revolution do
not talk about counting the gray heads, talk about
the capacity of people to care for themselves and the
capacity of our institutions to provide what is necessary to
live adequately. And that's the demographic revolution. The
second revolution is a knowledge revolution. I'm going to
tell you four things Which I've learned in 30 years
of Gerontology. That summarized what I think I know
that's important to share with you and it has to
do with understanding the heterogeneity of all the populations.
And let me tell you why. I think that's
important. Second I want to talk to you about
how Shakespeare was right past is prologue and you'd better
believe it. And the third I want to talk
to you about the undervaluation of the potential for change
in late life. And fourth, I want to
talk to you about the importance of environments, which
will bring me full circle back to talk about why
public policy is important to discuss. Let me tell
you about those four pieces of information for types of
information. And then I'm going to come in my
last revolution, which is a revolution of expectations and
hopes to talk about the kinds of issues which were
already beginning to discuss and we'll be discussing, I
think in the next decade there's a transition between the
first revolution the demographic one and the new information.
I think historians have done us a service or epidemiologists
who are also historians have done us a favor by
pointing out that we have illustrated for a long time
in human history that we are capable of constructing policies
that make a difference in regard to aging. In
the 18th and 19th century. Public policy did something
very important, not in the interest of aging,
but it was called in the interest of public health
. And we had movements that took us towards sanitation
which made the greatest impact on human aging. The
world has ever seen. Public sanitation unlocked genetic potential
in the world. And we saw populations that produced
very few long life people beginning to produce as an
average expectation. People who live a long time bob
. Butler said it right when he talked about this
as a kind of grand revolution that had occurred a
human triumph, but it has turned to be a
bittersweet triumph for a very simple reason that we have
not been able to promise independence with those added ears
. But there's no question that public policy helped create
. We call it the first revolution of public health
. And it has led to the necessity of a
second revolution which has not yet occurred. That second
revolution is the discovery that after you set up a
clean environment that you have not yet fought all the
battles. The big battles turn out to be the
problems of human behavior and lifestyle and the second revolution
are trying to come to the terms to terms with
the implication of those lifestyles that given our longer expected
life, that is you can't depend on dying anymore
given that fact, what can you do to improve
the probability that you will remain independent? That's the
second revolution we're working on now and it's incomplete.
It's an unfulfilled revolution, but that's getting in a
way ahead of my story. One of the four
things we've learned, one is hetero genetic. What
we have discovered is human societies are grand experiments in
the effects of differential allocation of resources. Some of
you are aware that there are societies in the world
where average life expectation is 45 years. Some of
you are aware that the nordic countries and as you
might expect the longest lived people in the world now
in terms of average life expectancy or the people who
have been bringing you Toyotas and Hondas, the Japanese
almost double the life expectancy in some societies or why
? The answer is allocation of resources, not different
. Gene pools, differential allocation of resources. Look
within our own society, how are we going to
account for a six year difference in life expectancy that's
related to income over your life. Time. Poor
people die sooner. Minority peoples die sooner. We're
talking about society's experimenting with the differential allocation of resources
. It matters France. People are different in part
because of the way societies allocate resources. People are
different higher for other reasons. People don't grow the
same as male and female, Rich and poor,
jew and gentile. There are variants among us and
what I think is so important, it tells us
that human life can be affected differently. In terms
of what we do to organize our lives, aging
is not fate in some biological sense, it is
substantially responding to a world, which in part we
create construct and then have to respond to. Not
only are we are heterogeneous. Like when you've seen
one older person, you have not seen them all
people do not become more alike as they get older
. Quite the contrary. 2nd thing we've learned is
extreme importance is that Shakespeare was right past is prologue
. Now the scientific community loves to talk about this
in terms of risk factors. You know what a
risk factor is? Everybody's seen cancer, cardiovascular disease
is something typically that you do, maybe that you're
exposed to, that you're going to regret. It
changes the probability that something unfortunate is going to happen
that you just soon. Not. Alright. And
what are those risk factors? They're well known to
us. The first one we always mentioned dr locksmith
isn't the first one cigarette smoking. That's tough on
a person from Duke. So interestingly you can't smoke
cigarettes and do hospital anymore and you can't buy them
there anymore. You do something about cigarette smoking a
whole series of issues in relation to diet, familiar
to you exercise stress management, Okay, you don't
handle those things well while you do the wrong kinds
of things and past is prologue you've changed the risk
of some unfortunate outcomes. We've learned that now without
any doubt. But you know the people who talk
about risk factors don't name the three, which I
think personally can demonstrably have the greatest main effect on
our aging. And I usually give it as advice
to people about growing old. I say one don't
ever go into old age if you can help it
poor. Hmm. Don't ever go into old age
if you can help it ignorant and don't ever go
there without a viable support system. Hmm those are
risk factors and they are risk factors so palpably responsive
to public policy or its absence that you wonder why
we don't have those discussions more frequently than we do
, bob clark is giving another illustration of this kind
of thing saying we have public policy that's going to
affect how we think about workforce participation. Now I'm
not making an argument that there are simple answers to
what our public policy ought to be, but we
are no longer kidding ourselves that public policy doesn't matter
, implicit or explicit risk factors matter. We need
to get straight what are the risk factors to which
public policy ought to be addressed. So look at
that first, the heterogeneity which are reflects of the
way in which societies experimentally allocate resources. Second there
is the matter of past is prologue. Let's just
be sure we get the risk right. Third is
the discovery of the modify ability of many of the
processes we thought that nature had dealt to us and
for which there was nothing for us to do but
accept it. Gerontology as I've known it in these
three decades has come now to emphasize to believe and
to act upon one of the great maximum. I
call it the rediscovery of one of the great maxims
of clinical and experimental science. If you want to
understand something, try to change it now, that's
not a promise that anything you try to change.
You will change it to your liking. Well that
you can do it easily. But only that you
asked the question. You're no longer simply taking life
as flip. Wilson used to say what you see
is what you get. Gerontology has moved away from
that and said, hey, listen, but you
see maybe what you get but it's not what you
could get if you saw differently or wanted differently.
We're beginning to see people test the limits. Every
time I've seen my colleagues test the limits, they've
come up with interesting, powerful indications of modify ability
that they didn't expect a decade ago. Let's just
take the idea of aerobic exercise and cardiovascular physiology.
Well known in it's being applied to younger people.
Men. 30-39 have always interested us and we've always
been able to show that aerobic exercise matters. It
maybe even a preventative in some sense is certainly a
good rehabilitation device. Does that work for older people
? I asked a young colleague in the Duke Center
about that and he says, you know, we've
never raised the question about the effects of aerobic exercise
on 70 year olds. I said why not?
Well, to make a long story short. He
did. And you get aerobic benefit from aerobic exercise
of 70 year olds and more than that. You
get antidepressant effects free. The cheapest, least problematic
antidepressant you can get. There's aerobic exercise in a
social setting for older people and it works except it
takes a little longer. Our great good friend and
colleague Warner shire has had the question to ask him
. Does is that true in terms of cognitive function
? And the answer is yes. The information is
not definitive. But very tantalizing Warner argues that if
you knew what cognitive performance was 14 years earlier in
longitudinal research and followed these people Later in 14 years
and intervened to give them some training about how to
think how to problem solve. You can return them
to the level of performance seen 14 years earlier and
you say, Hey, wait a minute. What's
this about inevitable decline of all cognitive functions in later
life. Now, I'm not promising you cognitive function
never declines. I'm simply saying to take simply to
what you see and say ah that's what nature is
dealing, that's not where it's at at the present
time. Well the wonderful work of judy Rodin who's
taken some at Yale has taken some of the most
handicapped older people in long term care settings and knows
that the american environment is very important to keep self
respect by being in charge of your life and it
gets lost. She has found simple, straightforward techniques
to work with people to help them think differently about
being in charge of their lives and it in a
significant way transforms their behavior and more importantly than what
it does to the older person. It changes the
relation of the staff to them. Now. That's
winning. I can go on and on and illustrating
what we now are beginning to believe. If you
want to understand something, try to change it.
It's coming to aging. And this leads me back
to the end of my argument, which is to
say environment matters. If you were here for a
conference dealing with Children, I wouldn't be arguing with
you, you wouldn't be arguing with yourself that impoverished
environments have detrimental effects on Children. They have detrimental
effects on older people too. There are environments which
is very difficult to grow. This is a tough
society and we haven't made it easy to grow old
, but what we do in terms of public policy
because public policy tends to construct an environment that is
more or less difficult to grow old. That environment
matters, which leads me now to my 3rd revolution
. It's a revolution of expectation and hope is happening
everywhere. It's happening in professional communities, I'd like
to say to doctors. Even doctors have gotten the
message as a matter of fact among professionals, they've
been the last ones to make the move. But
even doctors have gotten the message that there's something to
be said in geriatrics that we now know, something's
about pharmacology that matter. We know something things about
the management of incontinence. We know some things about
the diagnosis of cognitive failure. We can distinguish between
depression and cognitive failure. We know a lot of
things now and is being taught to a lot of
young people who are going to practice in a way
that's going to make your medical care better. Believe
me, that's beginning to happen now. So professionals
have begun respond. The national government has begun to
respond. That's great significance for the creation of the
National Institute on aging has done a good job for
us or the Center for mental health problems of older
people. And NIH NIH Mh has done a good
job for us. The older americans act has done
a good job for many states in terms of ensuring
we think aging at the proper time, but the
greatest thing that has happened I think in american life
is to see have evidence of the revolution in the
heads and hearts of older people themselves. We have
a new breed of older person that's beginning to emerge
. The younger cohorts are coming to late life and
better health, better educated, more secure incomes,
more intention to participate in constructing the future in which
they will be all. So I'm saying science is
leading you somewhere that clearly says politics on it.
When we talk about constructing the future of aging,
science can help us tell us about some of the
possibilities and techniques. It's not going to tell us
what we want that's going to be constructed by us
as we play our political games. I intend to
be political myself in constructing the future which I am
about to inherit. And I recommend it to you
now, quickly in the time remaining That we emphasize
four policy areas that we will be spending our time
on. I think in the next decades, one
of the policy areas is I think largely resolved,
at least for the time being. And that's the
area of income maintenance. Social Security has proved to
be a grand piece of legislation adapted to the american
environment meaning flexible, funny odd in lots of ways
, but adapted to our own craziness and preferences.
Craziness meaning that we have some notion about who should
be paid what kind of money and under what circumstances
, but is adapted to the american environment has proved
to be flexible. It's being responsive increasingly to some
inequities that have been there. Women have ever have
had every right to be concerned about Social Security,
but the system is beginning to be responsive and can
be responsive. We have adapted it for inflation protection
against inflation. We have left a great glob of
people down at the bottom who are going to remain
permanently poor and I'm afraid that's part of what it
means to be adapted to the american environment. This
society is going to live comfortably with 7, 7%
unemployed and 10 or 12% in poverty if you don't
like it, fight it. But the Social Security
system has been basically sound. The second policy area
has to do with health care. We have learned
to live with a fragmented system that you're going to
learn to hate when you become dependent on it.
You're going to settle for doing case management, which
in fact is a clever way not to change the
system but try to do something with it. And
you're going to be plagued by the greatest problem in
american life in terms of, of, of health
, which is long term care. It's the last
great area of american life uninsured. And we don't
stand up prayer in terms of solving that issue in
the foreseeable future. We are locked into the spin
down Brookings estimates Brookings Institution estimates that 70% of those
in this room are going to be experiencing the spin
down and if you don't know what it is,
ask a knowledgeable person and when that happens to middle
class people, they're going to be properly traumatized by
it. But that's where we seem to be going
. The 3rd area of policy which is largely elected
and I'm pushing it. It's the area of housing
or shelter. It's the most neglected area of public
policy in american life. And I will argue before
we're through, we're going to discover it's the policy
number one that we should be working on. It's
a linchpin around which a lot of other decisions would
revolve once we come to understand how fundamental it is
. And the fourth issue is I'm going to be
part of the general discussion of all these other issues
. And it has to do with the notion of
intergenerational equity, an extremely important issue because we're going
to discover the problems we're dealing with are not the
problems of those older people. There are problems of
the society trying to arrive at a social contract in
which the generations can agree on what is an appropriate
allocation of our resources. You see intergenerational issues which
underlies so many of the answers we're going to give
to these questions in terms of Social Security and its
future. Looking bright second Healthcare looking pretty dark at
the present time. And the third an area we
have not yet begun to consider seriously, which is
housing. These are not the problems of those older
people, my friends, they are your problems and
my problems and if we don't solve them, the
lives we affect will in fact be our own.
Mm hmm. Thank you very much. Dr maddox
. We have now heard from our three presenters who
have I'm sure given us food for thought, food
for challenges. If you will and we will get
to that About 15 minutes from now and before we
get to your to your questions and their answers,
we have to intermediate challengers who are experts also in
the field and who may have something to say about
our original three presentations. So with that I would
remind you we will be back here underway 15 minutes
from now. If you can get here in 12
minutes or 11, that would be even better.
And in the meantime, think up some good questions
, some good tough ones because these are the folks
who will address them and give you the answers.
Thanks very much. Don't go far. Thank you
gentlemen. Mm mm mm mm mm mm mm mm
mm mm. Yeah. Mhm. Okay, mm
hmm. Welcome back ladies and gentlemen, participants and
people around the country wherever you are listening and watching
. We hope you're enjoying it as we are here
. We're learning a few things. We go now
to the next segment of our presentation which consists of
commentators to commentators who will perhaps challenge the three speakers
. We had originally we're still on the same subject
choices and challenges. Can we alter this entire process
of, of aging or any part thereof. Our
first speaker dr harry moody, the deputy director of
brookdale Center on aging of Hunter College of the city
University of new york. He lives in a town
which has a number of pollings and Hollings and he's
done years and years of work in this field and
I present dr moody if you will. Thank you
very much. You know, there's an old saying
in vaudeville that you shouldn't go on after Children are
trained dog acts and I would add not after George
Maddox either. So I'm delighted that we had a
coffee break between these two events. I want to
associate myself with much of what he said and I
will try very hard to criticize him. But there's
so much that I agree with it's difficult. Let
me begin with the first of our speakers dr rick
locke election because I think he had really set the
agenda for us with the discussion of biology and it
seems to me that the first point that we need
to make their about altering the aging process is that
this isn't something for the future. This is something
that's already happened in much the same way that we
imagined years ago, a world of videocassette players and
home computers and electronic databases. Well, it's here
and in the same way when Gulliver's travels painted this
picture of the strolled berg's these people who lived on
and on into old age and had their lives extended
but in a condition of complete ability that has come
to pass also, and it's called nursing homes and
we accomplished it not with technological marvels still to be
invented, but with penicillin. And it seems to
me that the question that we need to ask is
what we're going to do about that problem. And
I think that dr elections observation really, I think
arguing against the idea of a full scale assault on
the aging process in genetic terms is something that I
agree with not because it's not possible. And here
, I think we need to distinguish between the feasibility
of that kind of fundamental technological breakthrough and the desirability
of it. It may be feasible, but it
may not be desirable. It may be feasible that
we can go to mars it may be feasible to
develop an artificial heart, but these things may not
be desirable, all things considered. And I would
argue that in much the same way we should avoid
doing those things, not because they're not worthwhile doing
intrinsically, but because there are more important things that
we have to do right now. And that would
be my argument about pursuing this kind of anti aging
research. Let me turn to what bob clark had
to say about retirement and labor force participation, but
I think that was a very important, particularly his
laying to rest of the myth of a mandatory retirement
and that being somehow the the evil uh bugaboo,
that's forcing people out of the workforce, I think
americans like to believe that that somehow if we could
remove that obstacle mandatory retirement laws, then then we
would have removed something undemocratic and evil and all the
rest of it. And there was a great consensus
, I forget what the congressional vote was, but
it was some enormous figure. Let's get rid of
mandatory retire. Everybody's in favor of that. The
trouble is it doesn't have a great deal of consequences
. And and equally important, it doesn't really affect
the people who need to work, namely the poor
, including some of the poor who reach old age
and especially those poor people who because of ill health
are unable to work. And here I wanna perhaps
raise a few questions with the Doctor Clark's framework which
as I heard him, was really suggesting that in
our government policies with regard to Social Security and pensions
, private and public as well, we really adopted
a point of view, typically american of let the
individuals decide how they want to take their lifetime wealth
and convert that into time leisure work and so on
. I think that's very attractive. That idea of
autonomy and that's one of the reasons why we,
we were enthusiastic about abolishing mandatory retirement. We may
not be able to mobilize the political will to do
some other things, namely to target the resources on
the people in greatest need. And here I was
quite struck by some comments that George Maddox made namely
about the heterogeneity of the aged. Well that's a
point that's often made by gerontologists and of course it's
quite right. The aged as a group are heterogeneous
. They're very diverse. Individual differences increased with age
. They don't people don't get more alike, but
they get more different. But if that's the case
then why do we have our public policies constructed in
terms of age based entitlements and policies that direct things
in terms of age, Medicare, Social Security and
all the rest. Seems to me there's a certain
contradiction there. Likewise, we have a population of
older people who are growing healthier, wealthier, more
educated, more able to cope and at the same
time at least among the males, the retirement age
is dropped. So we have, in a sense
the contradiction of a perhaps it's not a contradiction,
but it certainly poses some problems of a larger and
larger segment of society who voluntarily as dr clark pointed
out, decided to take their time in later life
in the form of leisure. And I would suggest
to you that the fate of leisure classes as the
french revolution reminds us is not always a pleasant one
. And we're beginning to see some of that backlash
feeling of well, how come some of these older
people are not more productive now. I think a
lot of that backlash in the form of the so
called generational equity debate is not necessarily constructive. I
don't think it's constructive to inflame a war between generations
. I don't think there is such a thing,
but I do think there's a problem here and the
problem comes about because this demographic revolution, this increase
in the proportion of our population in the older age
groups is occurring at the same time as to other
revolutions are occurring. Namely a crisis of the of
the fiscal crisis of the state, which is occurring
not just in America but throughout the industrialized world.
We can't or are not willing to pay for all
the things that we want. It's called the federal
deficit. Okay. And we're beginning to push that
onto future generations. This is a problem. The
fiscal crisis and the third crisis is the one of
economic competitiveness, post industrial society, whatever you want
to call it. Uh let's face it, most
of us are not quite as confident about the american
future and its productivity as we were in the past
. And we've read those statistics about the downward mobility
of future generations and and all the rest of it
. So I think the simultaneous occurrence of these three
revolutions, a demographic revolution and aging population, a
fiscal crisis in the form of a deficit that prevents
us from taking the actions like a more comprehensive health
insurance and national health Insurance policy. That's not even
on the agenda anymore as it was a decade or
so ago. The same with all these other innovations
that we need to make to adapt our society.
And this is the point that was made earlier to
design institutions that will be adapted to an aging society
. These changes are not really occurring except as in
1983 under desperate crisis. And of course we did
do the necessary change in the social security system to
adapt as George Maddox said in this marvelous American way
, but that left a residue and the residue was
a lot of people, particularly younger folks, feeling
a lack of confidence in the future of Social Security
. And I think they're wrong to feel that lack
of confidence in the system as such. Nevertheless,
they're not wrong to be fearful about some of those
problems that are lingering. One of the greatest of
those problems doesn't have anything to do with work and
retirement, but does very much have to do with
health care. And I mentioned briefly the the point
that uh we shouldn't be talking about Karen ann Quinlan
, we should be talking about Karen and Quinlan's grandmother
. And that's the area where the ethical dilemmas,
particularly in the nursing home with life prolongation becomes so
serious and so difficult for us to address as a
society. We've recently seen a book on this subject
by Daniel Callahan called Setting Limits in which he argues
that we really can't afford to have a society in
which we're spending so much money on the health care
of the aged and maybe we ought to do what
some other societies do. And that is say everybody
over a certain age, 75, 80 or whatever
can't get certain expensive healthcare treatment. This is what's
done in Britain, for example, with kidney dialysis
. Well, this book, Callahan's book setting limits
, as you might imagine, caused a great hue
and cry and was not wildly received with enthusiasm by
people among aging advocates certainly. And I happen to
think the Callahan's proposal is is unwise and impractical.
Nevertheless, he does have the merit of talking about
what is a real issue, not necessarily rationing,
but priority setting. We can't do everything. And
one of my arguments against doing this research on altering
the genetic code is not because it's impossible to do
, but because I don't want to wait around 100
years to do those experiments to see whether we really
will increase the human lifespan. That's about what we'd
have to do to really see if it works out
in practice like Interstellar Travel. These are all wonderful
ideas, these science fiction ideas, but they don't
meet our practical needs today. My, my same
observation about dan Callaghan is that it's an interesting idea
, but it's not one that's going to be adopted
in american society. And in fact, we need
to think more deeply about how we can begin to
contain healthcare costs. Uh and there are ways of
doing that. I was in fort worth a couple
of weeks ago and I picked up the newspaper to
learn about an ophthalmologist there who earned$5.7 million dollars
from Medicare last year. Well, there's something wrong
with that kind of system. And I think that
we ought to begin to look there when we're thinking
about how to make those cuts. But having said
that at some point down the road and here Callahan
is right, we're going to have to make choices
. We're going to have to make priority decisions.
What I would hope is that we could make those
decisions and make those priority choices in terms of an
intergenerational framework that includes the entire lifespan. And I
think that one of the ways to move in that
direction is not to think about the science fiction scenarios
about altering the genetic code or things of that sort
. But rather think more and more practical terms about
policies that can command consensus based on the idea of
priority setting, living within limits and all the rest
. And I would propose a few of them to
you. One is of course, what's been mentioned
by other speakers, the need to devise an approach
to long term care insurance, whether under public or
private auspice or some combination. This could be done
in various ways. Congressman Pepper has proposed an income
related approach, part C of Medicare. We need
to develop a more accepting approach to issues of death
and dying if this compression of morbidity hypothesis is true
, then at some point we're going to have to
say to people okay enough is enough and we're gonna
have to I would argue allow them a greater voluntary
choice of terminating treatment and I think that that's the
way to go rather than setting an age limit or
something like that. But I think that we will
have to face those difficult decisions of death and dying
. I think with regard to what Professor Clarke was
saying, we need to have greater emphasis on productivity
and not just redistributing resources from young to old,
but facing up to the collective choices of how we're
going to enable that older population to be productive here
. I would not eliminate the voluntary aspect of retirement
but try to target the collective resources into areas like
the poor people who want to work. Older worker
retraining the title five program of the older americans act
, an excellent example of public service employment, private
companies are probably not going to help us out in
the short run with this and neither will ending mandatory
retirement. What we need are incentives that are built
into collective decision making. The last point that I
want to make concerns this generational equity issue and here
I think that We really are faced with two scenarios
and one is the scenario that we will have this
growing aged population who are healthier and wealthier and able
to make contributions, but for whatever reason are cut
off from the larger community. And this happened in
my own practical experience in my own little town of
1200 people. We had a vote not long ago
about whether or not we would become incorporated in order
to have greater environmental controls and protect ourselves against truck
traffic and pollution and all the rest. And we
almost won. I say we, you know which
side I was on, we almost won. But
at the last minute the opposition got the one industry
in our town, namely a local nursing home,
retirement home, went in there and terrorized the people
and said, hey, look, if they passed
this law, it will raise your taxes. And
you can imagine what happened, all the people from
that retirement community came out in busses and voted down
this kind of a thing because they were terrorized and
this has happened in some other jurisdictions with regard to
school bond issues and all the rest. Well,
that doesn't set up very good relations between young and
old. It leaves a bitter aftertaste. It's by
no means inevitable. And I've been involved with another
project, which takes a very different point of view
. This one in Brooklyn titled, they're all my
kids in which we have involved recently, retired minority
professionals, black folks who have gotten involved with the
local public schools because of their concern that kids today
, we're not getting the same kind of commitment and
values and so forth, that they experienced when they
were coming up. And in fact, I think
that that's an example of taking a group sometimes thought
of as a needy and vulnerable and all the rest
and saying, okay, what can this group do
by way of self help, by way of values
, education and all the rest? I think that
once we begin to look beyond the stereotypes that say
that some group of people, whether we're speaking of
minorities or the age of whatever are somehow unable or
vulnerable or ill equipped. Once we begin to ask
as George Maddox suggested about the nursing home residents with
judy rodent study what can people do for themselves.
I think that we will have some basis of confidence
and hope and having said that, I don't want
to suggest that self help is the answer to all
our problems, because there is a point of view
, a kind of a conservative ideology that says,
yeah, that's just what we said all along morality
and self help, get the government off our backs
. I don't believe that. I think what we
need is an approach to self help in which we
intervene, whether through the school system or the national
government to enable people to do more for themselves.
If we take that approach, we will develop a
more optimistic scenario and not the scenario that pits one
group against another, but I do think that we
are faced with those two scenarios, those two choices
and how we will respond to those choices is very
much within our power. And that's the point that
George maddox made about constructing the future. The point
that I would most want to associate myself with.
I thank you very much. Mm hmm. Yeah
. Mm hmm. Thank you very much doctor moody
. We have reached almost the point of participation by
those of you who have SAT out there in 22
different locations waiting waiting for the time. Let me
give you a little preview of what we hope you'll
be doing after our next speaker wherever you are located
. If you will find yourself a pencil, a
pen and a little piece of paper, please jot
down this telephone number. The area code is 703
And the telephone number is 552 8322. And there
are two extensions one of which you may call in
on Number is extension 1- seven. The second
is extension 116. Let me repeat that whole thing
again in order to register your questions from wherever you're
located Here is the telephone number area code 703.
And the phone number 552 8322. You see it
on the screen And the extensions 1-7 Or 116.
So now as we get to our second and are
final commentator you can be thinking of questions writing them
down and in fact starting you're telephoning that will not
be live, what I'm saying is start right now
, call in your questions, we'll take them down
, they'll be handed to me and you'll get a
chance to hear the answers start right in. Even
while dr fraser is speaking, he is our next
speaker. Dr James Fozard, associate scientific director of
what is now the longest and most comprehensive continuing study
of aging in the world for 27 years over in
Baltimore. They have been studying people like me incidentally
before that he headed geriatric research at the Veterans Administration
and he is up on such things as why we
forget boy, I'd like to know the answer to
that and various other mental processes and so I would
like to just with that introduce Dr. James Fozard and
don't forget get those, I'm gonna say calls and
letters, get those questions in Doctor Thank you Peter
, this has been a very exciting experience for me
. I've enjoyed the uh the speakers immensely. I've
been working in gerontology just long enough to realize what
Dr Maddox said about his third revolution. The change
the revolution of changing expectations is upon us and I'm
glad it is aging in old age have traditionally had
a terrible reputation, I know there's not a parent
in this room who would want their teenage daughter to
go out with a boy who had a reputation as
bad as old age or aging even in national institute
on aging, we talk about the process, we
don't like to talk about the product, but that's
changing and that's important because as dr Maddox points out
, aging is everybody's business. If you're lucky.
The cartoon I saw a while ago showed an old
man sitting on a park bench telling a friend,
you know, if I knew I was going to
live this long, I would have taken better care
of myself. The sentiment behind his remark in that
cartoon is fortunately getting to be a little bit more
obsolete now. I won't be able to tell that
story except as a historical curiosity in a few years
. And I think that's important. I'm glad that
the definition of aging is changing both in in in
public thinking and in scientific thinking. Mhm. With
respect to the science discussed in this forum today,
My feeling after listening to our three speakers and dr
moody, essentially what our challenges are more obvious than
our choice uh than our choices, and certainly more
important in shaping our thinking as scientists and as citizens
and as individual purposes. Persons prolonging life isn't as
much of a choice at this point. Getting the
most out of life. The life we have is
a challenge. Whether or not we can extend life
Dr Lakshman pointed out, we can and are increasing
the average number of years of life within our own
species, but whether that's going to change the upper
limit is certainly not obvious now, and it's it's
unclear whether it's even possible. The interesting research showing
that lowered caloric intake for example, it can take
a prolonged life and rodents uh needs to be verified
certainly at a primate level. Indeed, our colleagues
, the National institute on aging are working on just
just that issue, but until that time Better think
twice about the 120 year diet color is very cost
effective. Mm hmm. Thanks as scientists and clinicians
and practitioners and citizens, we can certainly continue to
make contributions to improving the quality of life. Successes
in this arena are going to increase choices for people
, especially older people and that's the right choice for
all of us. The point that's been made by
both dr maddux and dr luxan and echoed in a
variety of themes throughout this conference is that aging is
a universal process, but it's by no means a
uniform one, at least at the level at which
we study intact humans as Mr Harkins pointed out,
he's a participant in the Baltimore longitudinal study of aging
which is a long term long term uh study of
normal aging has been going on for 30 years now
involving over 1000 people. The if if we were
I'm asked all the time to sum up what the
what the messages from that study. Well, there's
a lot of messages, but the the one thing
that we've learn again and again as we haven't been
able to identify a single overriding principle governing aging process
. The idea of a master biological clock to which
all others, you know, which to which the
temporal aspects of all other systems are slaved in some
way has just hasn't been forthcoming. I guess the
correct analogy would be that would sort of like being
a person in a clock shop, which all the
clocks are running. Some of them have, they
have, they differ in the sense that they have
different kinds of alarms and other kinds of bells and
whistles and they all tell roughly the same time,
but it's certainly not the same time. And uh
it was interesting because the first one of the first
scientific ideas in gerontology was to say, well,
let's get a metric, that's better than chronological age
and that we and that hasn't, that hasn't gone
very, very far. And as George Maddox pointed
out, gerontology has become much more interventionist now and
and I think that's all for the good. It's
turning to dr clark's comments, he made very clear
the point that that the government may have been barking
up the wrong tree when they set up the eliminated
mandatory retirement. Well, it certainly hasn't changed things
very much absolutely correct in certain areas of work.
There are there are groups of people who want to
change things, for example, commercial airline pilots,
I don't like the idea of having to stop flying
commercial airlines at age 60 Actually, 20 years ago
. They were they were just as happy with that
. Now, they're they're not they're not happy with
it all. In fact, they've sued the government
for to try to get that change and the FAA
has to take to show cause why they hang on
to that to that rule. So there is,
there is change. But by and large, what
Dr Clark said is absolutely true. Made me think
that that the question of choice, it needs to
be put into a long temporal perspective, and that's
why I'm glad I'm in this meeting, and that's
why I'm glad you're here, because aging is everybody's
business and aging is something we've got to be concerned
with over our entire lives. one of the things
, for example, it might change uh the retirement
patterns is to think entirely differently about the way we
package up our work lives vis a vis our the
leisure time activities in which we have more choices,
Wouldn't it be nice to take, take five of
those retirement years out when you're 35 instead of when
you're 70. Um And the idea of being able
to change change careers, something which I think is
going to be required of all of us as we
, as we go on more and more. I
think I think we should take a long, long
term view about the balance between work and play in
our in our lives the same really applies to the
the uh activities relative to uh physical activity, exercise
in some sense, those are leisure time activities or
activities over which we have some choice. And dr
Maddox pointed out quite correctly that this is helps old
people as well as young young people. And indeed
that's the idea of restructuring, work and work and
play over the whole lifespan I think is an area
where we can we can all have an impact.
The the surgeon general of the United States recently held
a workshop on health promotion and aging. The workshop
participants generated recommendations on education, service, public policy
and research in nine different areas which they felt were
important to older people and you'll see if this is
, it's not just true of older people at all
. But here are the nine areas injury prevention.
Heard that one before alcohol use medication, use mental
health, nutrition, physical fitness and exercise preventive health
services, smoking cessation and oral health. Okay,
right. On these are the recommendations. Relative preventive
health services are particularly cogent, I think, to
the concerns of older americans and they address two goals
that were actually defined by the World Health Organization.
The two goals are to prevent physical, psychological and
entered Hyah. Transgenic disorders and to prolong the period
of independent living with particular attention to quality of life
. And the the participants go on to some 30
odd recommendations in this arena. The other areas I
think are things we can all address as citizens as
individuals. and as as policymakers. We're certainly addressing
them in the National Institute on aging Anyway, I'm
glad for one that I've lived long enough to see
that aging is getting a little better reputation than it
used to have. I'm glad to see the sentiment
of that cartoon pass out of favor and I just
would leave you with the, what I think is
a major theme of this conference is that aging is
everybody's business and it's time we all got on with
it. Now. I glad to be sharing that
that activity with you for the rest of our lives
. Thank you very much. Thank you dr blizzard
. Well we have had approaches to the entire aging
process from many different angles and many different studies.
I think there are enough thoughts out there to challenge
for hours and hours. But before, before we
get going any further, let me once again remind
those of you out there who would like to call
in with questions. We anticipate your joining our discussion
and that telephone number once again is as follows.
You will see it on the screen there. It
is now Area code 703 552 8322 and either extension
1-7 Or 116 if you'll get on the phone now
we will take your calls as they come in.
We solicit your calls. As a matter of fact
we have a few that have already come in and
uh I'll begin by asking anyone on the panel,
this is a call from a lady named Cheryl Peterson
. She is at the ST Petersburg Junior College in
florida and she asked anyone on the panel who cares
to express an answer, why do you feel that
women are entering and staying in the labor force longer
than men and why is this trend increasing for females
? Anybody want to take that? I guess that
came from some of the things that I said,
I want to be precise, I guess about what
I was saying. It's not that women are now
in the labor force more often than men But that
there's been a fundamental change in the lifestyle of females
over the last 50 years or so. The proportion
of the average woman's lifetime spending the labor force is
increasing and you can observe that by looking at the
proportion of women that are in the labor force at
any one particular point in time, I would attribute
that to a number of things. 1st. The
wage rates that women are offered and are receiving in
the labor market have gone up. Women are making
different sorts of investment decisions in their own skills than
they did in the past. The proportion of women
that are having Children and the frequency in which they're
having Children has changed. Women with fewer Children or
no Children have always been more likely to be in
the labor force than women with a lot of Children
. And so as we've had moved into an era
of low fertility rate, that's been one of the
effects, of course, causation runs in both directions
on that particular issue, the more women that are
in the labor force, the fewer Children they are
likely to have because the price of having Children goes
up in a sense that they have to leave the
labor force in order to help Children. Uh,
it's now more acceptable for a woman with a child
or especially a small child to take that child to
a daycare center than it was 20 or 30 years
ago A woman that took a small child to daycare
center or wherever they would have had to 3040 years
ago might have been thought of as a bad mother
. Now, it's it's sort of a commonplace thing
. The availability of daycare center certainly also makes it
easier for women to move in that direction. Now
, what I would tend to say about the trend
in late life is that for men, there is
this obvious downward trend that has reduced proportion of older
men in the labor force for women. What's happening
is that at all ages up, say through the
mid forties, those women are continuing to be more
and more in the labor force and that's what it
gives a momentum that carries through to the older ages
. And what we've seen in the Out of 54-60
55-64 Group in the last few years is that that
participation rate has sort of leveled out. And I
would say it's probably a function of on the one
hand, the momentum of each succeeding cohort entering into
that age group has had a higher percentage of the
women in the younger years in the labor force.
And so that sort of would have pushed it up
higher. But maybe the women are also now beginning
to respond to the same factors that men are and
that has sort of leveled off that increase. Uh
If you can follow along those, those two particular
effects on the one hand, more women in the
labor force throughout their entire life on the other hand
, leveling off at the older ends in the last
few years, we thank you sir. Question now
comes from palatine Illinois, from judy denture, I
believe it is William harper College and it is addressed
to robert clark. Are economist caller wants more data
and more basis on women in the workforce. And
why? What about women who are over 65?
You have stated, she says that there's no trend
too early retirement caller wants more data for this conclusion
. Are there data on women over 65 in this
, The data on women over 65? Just for
some numbers in 1950 10% of the women over 65
were in the labor force, one out of every
10 1970 was still one out of every 10 since
1970 it's gone down a little bit so that now
About 7% of all the women over 65 are in
the labor force. So some downward movement in the
1980s, but basically only a small change over the
last 35 years or so for women 55 to 60
for uh the labor force participation rate of the proportion
of women 55 to 64 in the labor force was
27% in 1950 32% in 1960 43% in 19 seventies
. So over that 20 year period was regularly increasing
Since 1970. That rate has held steady at about
40-43%. Well you asked for statistics and we have
it for you. Next question comes from florida,
from a gentleman at florida community college in Jacksonville.
His name is Jack Lemmon. He is the site
coordinator. As a matter of fact. And the
question is for dr maddox, how do you think
improved housing can be accomplished in our society? I
assume he's talking about for the elderly, great difficulty
, partly because of some cultural attitudes and preferences.
We still know what a person means when they say
my home is my castle. We are very prone
to want single dwelling living adapted to Children. And
then as we get older we discover that large houses
are albatrosses but we don't we can't shake the cultural
image of thinking it's right to be there. Second
, we haven't found simple mechanisms to make people think
differently about a legacy, The single greatest source of
wealth which older people have consistently is home, high
proportion of them have paid for those homes. They
think of that as part of the legacy where they
want to transmit to their Children. So the idea
of giving up those homes, it's very difficult for
them. So that while we now have some technical
solutions about negative mortgages, a whole series of technical
solutions to those problems, I think our cultural preferences
continue to stand in our way to a significant degree
. This may however, be a phenomenon that is
cohort bound in the sense that two decades from now
we might find some differences here. I think an
increasing number of americans are thinking somewhat differently about the
home is their castle. They think about moving around
more. They, I think more and more at
least of the upper middle class of thinking about life
care communities were thinking differently about our attachment to houses
, but let's concentrate one final moment about public policy
. This country has been fairly hostile to developing a
public policy in regard to housing in the Democratic administrations
. Prior to this one public policy always directed itself
to some extent to public housing. The current administration
has been very hostile to it. And so we've
gone through now eight years of large and largely of
indifference to the issue of housing? I think that
we're going to find in the next few years whichever
party we get. I think the issue is going
to be forced. We're going to come back to
public policy in regard to housing because we're going to
realize it is one of our best ways to deal
with a marginal population is not capable of living alone
, but does not need to be in long term
care facilities, that there are kinds of public housing
to which we attach minimal kinds of social and health
services. That is one of our best investments in
this society. Now, we have some people who
want to move in that direction now, but we're
still made it. We are waiting to see the
development of clear public policy in regard to housing as
part of the basic investment we need to make for
society. That's getting old clear public policy. Uh
, it's a buzzword and I think when you strip
away whatever it covers up, it gets down to
politics, And we shall see what happens in the
in the next little while, let me say to
this audience right here in this room, I don't
mean to cut you off from asking questions, please
feel free to raise your hand. And I will
recognize you and we will have participation in this room
as well as our 22 other sites around the country
. Is there anyone here at this moment who would
like to ask a question of anybody on our panel
? Yes, ma'am. And can you come up
here to this microphone please? We have to mix
at the bottom of each aisle and we invite your
participation. Could you please tell us your name?
I'm Virginia curry. I live in Blacksburg. Okay
. And are you a member of any organization or
Lots of them? Lots of organizations here here.
Dr clark has addressed something about women and aging,
but not to the extent that I think could be
addressed after all, women live longer, don't they
? And I think they have special needs. And
I'd like to have anyone who would like to discuss
this mention the needs of women and aging. Thank
you gentle be my guest. Well, I could
just say that if you look at overall poverty rates
Of the elderly, that is those people over 65
, you would see that they've come down dramatically.
They've fallen there now lower than the general population at
large. The poverty rate among people 65 and over
is about 12% for the general population is about 14%
. But among particular subgroups of the population of the
elderly population, they have pretty high poverty rates and
among those with the highest is um are women and
especially minority women. And if you look at how
they get there, they get there in a number
of ways. One is that with the death of
a spouse where some of the family income was too
, was related to the presence or the life of
that spouse. In the past, it might have
been pensions, it might have been earnings increasingly.
Now, people with employer pensions will have uh joint
survivorship options where much of that income will continue on
. It's not mandatory, but it's the first choice
under current pension pension regulation a few years ago,
Social Security was changed such that the widow now gets
100% the survivor the retiree's benefit. So some things
have been done, but still it's clear that with
longer life with the cessation of any potential earnings of
their spouse with the termination of some income directly related
to that spouse. Uh That and perhaps also with
the spin downs that are associated with adverse health conditions
preceding the death of the spouse that widowed women are
or have very high poverty rates. And you know
, for my money, if you were looking for
public policies in the future, it certainly would not
be a prudent public policy to start increasing benefits to
the elderly in general. But it would be a
prudent public policy to look at how one could target
those any future benefits or any new programs to the
poorest of the elderly, which would include primarily women
and minority women especially pick up on this thing.
We probably have done our best thinking in this country
in regard to public policy dealing with income maintenance.
I think we are more sophisticated in thinking about it
. I'm not arguing that we have good outcomes,
But we've been fairly sophisticated thinking about this. And
what we have seen is moving away from early good
intentions in 1935, where we had in mind a
simple world where we could design a system that was
predicated on a family that had a major breadwinner and
a dependent spouse and Children. Now it's gotten more
complicated than that. We've tended to hang on to
a view of the family, which has become progressively
unreal and part of the genius of the system is
is trying to respond to that now. But in
order to make a Social Security system responsive, we've
got to rethink family policy in this country until we
deal with some of those issues were never going to
break out of some of the inequities that we see
in regard to women. But we've seen some advances
on this particular point. I know at Duke University
, now, a male cannot simply declare what,
how, what kind of distributions are going to be
any more a spouse. If there's a spouse,
a spouse has to be present and agreed, it's
the law, what we're seeing is a system.
I think that has been responsive, but it's got
a long way to go and it goes and it's
in part our problem is a point to which which
harry was alluding someone in politics once told me that
effective law must be simply administered, which means we
go for big bureaucratic categories. And that's kept us
locked into the notion that is easy to talk about
age eligibility than it is to target because there's some
inequities that comes from targeting two that have to be
dealt with politically. But we find ourselves in dealing
with these broad categories leading to an equitable kinds of
outcomes that don't face the issue of the changing meaning
of the family. We've got to come to terms
with those issues. But what I was arguing is
that Social Security is has proved to be far more
responsive than most areas of public life in terms of
trying to come to grips with those. And then
we just have to decide what kind of nonsense we're
prepared to live with simply because some solutions present as
many problems as they saw. But this country is
working with that issue. I'd like to think we
had, we would have been as clever in dealing
with Medicare and Medicaid. I'm arguing that while we
were feeling so good about what we did in saving
saving Social Security, I would almost argue that the
press appeared the media appeared to be in some kind
of conspiracy that we will not talk about the bigger
problem which is Medicare and Medicaid and the press is
still not talking about that issue. And I agree
with that very strongly. And I think the point
that you made about complexity. You know, I
spent several hours last week with my wife trying to
figure out our insurance reimbursements. Okay, this is
very complicated stuff. And I'm not on Medicare when
we have people in our office calling about Medicare.
This is complicated and attempt to achieve that kind of
equity with targeting and deductibles and reimbursable people can't follow
it. And and I think that that's a real
problem for the future unless we get some way of
simplifying and making that healthcare system more access like National
Health Insurance. Well, I didn't I wouldn't want
to say any horrible words like, but the thing
that I want to say about National Health Insurance is
we shouldn't delude ourselves to thinking that that's somehow a
cornucopia which all needs will be met. That I
think is the great delusion when you go down that
collective system as they do in Britain and Scandinavia,
you end up turning down some people on certain on
certain kinds of surgery and dialysis and and those people
tend to be the elderly. Now, I think
that can be justified under some circumstances. I don't
think we can implement it as such in this country
, but it may be that we'll have to say
, okay, no more artificial heart research because we
got to first take care of some other disorder.
So I think that we need collective provision. Yes
, but we shouldn't believe that will eliminate priority choices
. And let's start talking about national health insurance as
though it's only only Britain and Scandinavia. We ought
to look to Canada Canada. We need to study
Canada. Canada is doing some kind of things that
I think are more nearly compatible with our preferences here
than anywhere else in the world. At the present
time. We probably know more, We know less
about it, saying we require. We ought to
inquire and learn about Canada the Canadian system as quickly
as we can. Doctor Prasad. Let me ask
you this uh to change the subject just a little
bit. You've been studying longevity for a long time
. Uh You have why don't you bring us up
to date? Where are we now? And what
can we expect as time goes on? And also
what kinds of studies, medical and otherwise are needed
to perpetuate this whole area? Well, I think
the the answer that question in my mind relates back
to the fact that the definition of aging itself is
changing again. As maddox. Put it up