area? Well, I think the the answer to
that question in my mind relates back to the fact
that the definition of aging itself is changing again,
as Maddox put it so eloquently, what we used
to think was what was dealt, you know,
what was inevitably dealt to us by mother nature
our concept, our ideas are changing all the time.
The and that's what it certainly makes it exciting
for me to go to work. Because every day,
because every day one of our scientists is saying
that we're going to change the we're really pushing we're
pushing the definition of aging around more by advances in
what we learn about disease and other things. And
we are about what we learned about aging. In
fact, I worry that if I if we keep
keep this up too long, I won't have a
job because aging is in some sense is being defined
by default. It's it's it's not disease, it's
not this it's it's uh and that's that's that's a
sign of progress. But I think the some of
the most exciting work, has to come on
the deal with the kind of what I would consider
low tech interventions, changing of lifestyles, exercise,
diet, these kinds of things are easy to implement.
They they're getting to have a reasonable biological basis,
And I think this is where the where a
lot of research needs to go the future because dealing
relating nutrition and uh year long patterns of exercise to
outcomes on aging and as well as particular diseases are
very difficult business takes and that. But I think
that's where we need to do a lot more work.
I'll just make a very a couple of very
quick comments from standpoint of a biologist is one is
that the theoretical basis of understanding aging is very poor,
and the main reason for that is we have
a tremendous difficulty in confusing pathology with aging and what
we've been seeing, and I think that's where we're
heading clearly in the future. Is that, yes
quickest expansion of lifespan in this in this century
has been antibiotics and and probably the automobile and the
elimination of horses and horse can fly carried diseases in
the cities. Then we started saying, well that
atherosclerosis was inevitable when we begin to learn. Well,
yes, it does occur, but it can
be modulated by diet by various kinds of adaptations.
We go along and each one of these, we
keep finding that we can push them about far that
we can control them. Even something like Alzheimer's has
in some senses, as a character characteristics of a
disease of which there is a lot of interest in
it. And I think that's what we're really doing
here is we're I'm just going to keep pushing back
these things that we consider to be the major killers
of aging and find that we can push them back
a little bit more. Well, let me ask
you again, uh, and you can start in
on it if you wish, as we push them
back, maybe we'll get some other factors that we
hadn't really known about, what will be the major
causes of death. For example, in an aging
society, will they be Alzheimer's like disorders, cancer,
heart disease, or can, in fact,
you predict as we go along? Uh, I'll
take a stab at it right now, far and
away, the biggest problems that we see are the
cardiovascular and renal, which are somewhat associated with that
until we get those back. Uh, then it's
pretty hard to tell cancer is behind it. And,
and then then you have a rather serious ethical
problems. If you cannot control that, do you
want to substitute the rather long anguished and extremely painful,
uh, disappearance from this earth as opposed to
some one which can be considerably more gentle, at
least to the affected person. I think that I
think that we're moving towards a consensus in this society
that when people have a terminal illness, that maybe
you don't have to do everything that you possibly could
do to keep them alive, provided that's their choice,
of course. Uh, and there's a greater
acceptance of the idea of allowing to die, not
giving that extra treatment that might prolong life a little
bit more. I think that's that there are people
who have different views and they have to be respected
but I think there's an emerging consensus there.
The real question is how to implement that in terms
of whether it's a living will or a durable power
of attorney. And again, I think that's a
problem of legal strategy and something that can be done
by educating professionals and families and so forth. I'm
not so worried about those problems. To tell you
the truth, the problems that worry me have to
do with how we're going to think about Alzheimer's disease.
It's one thing to think about a person who
is dying within the space of days, weeks,
even months. It's another thing for a person to
have Alzheimer's disease and be dying over a period of
5, 10 years or more. Do we want
to think of Alzheimer's disease as a terminal illness?
Well, if we do, does that mean we're
justified in withholding treatment from people say a penicillin shot
at a certain age on what grounds poor quality of
life, by whose standards? This is where I
think Callahan's book and proposals raises some very, very
serious and disturbing questions. I saw one ethicist recently
boggled my mind in the literature, published literature of
medicine, philosophy saying that people in Alzheimer's disease really
should be considered like animals and not to have rights
in the human sense, but we should be kind
to them and so forth and maybe hurry them along.
Well. I think this is very distressing to
people, uh and particularly since many of us may
live long enough to. But on the other hand,
do we really want to say that we want
to allow heart transplants for Alzheimer's patients. Many of
us would be a little concerned about that too.
I'm speaking for myself in any event, but I
think somewhere between those kind of extremes we have to
find a social consensus. I don't know how though
dr maddox. I want to say a good word
for biology and biomedicine. Some of my best friends
work in this area when I said gerontology at its
outset, as I knew, it always paid attention
to both intrinsic factors which are the domain of biology
and biomedicine and the extrinsic, which belongs to the
social and behavioral sciences. Now I'm convinced that a
big part of what's happening in aging is extrinsic in
its origins and therefore it leads me to argue about
the importance of public policy because that has to do
with decisions about how we're going to allocate resources to
deal with those extrinsic factors. Now, having said
that, I want to come back and re emphasize
that this is not an argument against continued investment in
basic biomedical research. We've gotten a big payoff.
And let me tell you two of the big payoffs
that I'll just leave it at two. I'm sure
there are more than that. One is has been
the biomedical the scientists themselves that in exploring what they
can and cannot do have made one of the strongest
cases for belief in extrinsic factors. When I've spoken
on this issue? I say my best friends among
the biologists have been those who helped me understand why
it is so important for me to concentrate on the
extended factors. That's number one 2nd. There have
been some marvelous developments that have come from biomedical technology
for older people. If you've not been exposed to
. Not not the high tech talking about science fiction
, but really what's happening in an american hospital or
in the health care system from magnificent things have happened
and we had better be glad we can deal with
pain, we can deal with depression, we can
replace joints. I heard a presentation yesterday on joint
replacement. Some magnificent things in technology have occurred that
have literally transformed the lives of hundreds of thousands of
people that have kept them mobile. Don't play that
down 2nd. I would want to argue that in
other areas like corneal transplants, the new technology in
regard to eyes has transformed the lives of hundreds of
thousands of people and that doesn't come simply by fretting
retirement away casually. In the absence of of good
science. I want to keep that emphasis absolutely clear
. We've got to keep the intrinsic and that's the
genius of what I think gerontology has had to offer
over the years it has said. Never forget that
we're dealing with both intrinsic and extrinsic factors and we
get the most mileage from the time we spend in
worrying about the integration of those two. Not trying
to pit one against the other. I'm a believer
in basic biological research question from Iowa city, The
University of Iowa, a lady named Eleanor Dixon would
like someone on the panel to respond to this.
How can more jobs be created for older people who
would like to continue to work? I think perhaps
what she has in the back of her mind is
that there's a, in some areas and I won't
mention any areas in particular. There is a built
in, shall we say prejudice, not a legal
prejudice but a built in prejudice on the part of
employers and fellow workers against letting people go on working
forever. I mean there's a competition for jobs and
so on. How do you respond to this?
Well, there are a number of ways to work
besides working on your career job was touched on a
minute ago that there might be changes in job life
changes and careers over the course of a job life
. And you can look around and and think about
even though one leaves one job, they don't have
to, the choices not just to, to go
home and sit, I've been over to Japan recently
, I'm returning again to look at their retirement patterns
over there. And one thing is quite striking That
if you remember the numbers, I was just giving
you on us males over 65 comparable numbers for Japan
. Are that about 40% of the Japanese men over
65 are still in the labor force and still working
as compared to 15% or 16% of the United States
. Is that a recent, that is as of
last year, I mean, is it, come
on slowly, you know, their their participation rates
have not declined rapidly, they've been relatively stable over
the last 20 or 30 years so they've been high
and they stayed high. United States was low and
it's getting lower Now that might strike some of you
as strange relative to what the common perception is that
everybody in Japan had to retire at 55. Well
, first that's clearly not true, but In Japan
This 55 was retired from your company, Leave your
company. Well over time they've been raising that rate
and now the fixed retirement age for many companies in
Japan is more like 60 than 55. But even
that doesn't explain what are all these people doing,
it appears that uh many people, once they leave
their career job, go out and start new careers
and they start new careers as independent entrepreneurs and self
employed folks. It's clearly, I think maybe a
fundamental for many people, a fundamental change in their
lifestyle, their work life. It's that maybe we
might view it as a reduction in the status of
jobs. One reads about some executive that starts a
gardening company because they always like to be, they
always liked gardening. And so while I was over
there on tv, there was this person who had
uh retired from a company as an executive. And
uh first for a while he just put it in
his own garden and moped, and then he started
his own gardening company and he was roaming around uh
Tokyo selling services as as a gardener. So one
could imagine that there are lots of niches out there
that independent people starting their own companies or working in
this job or that could start in the United States
. For some reason we doesn't seem to be the
case. Another reason, I think that we find
low participation rates in the United States is is the
fact that we do have for many people uh relatively
generous pensions and social security and support payments. And
so when they look at the opportunities that are available
to them, what you might find is that the
job that they could get and you look around and
even in the depressed areas of the country, you
do find that there won't ads and and their jobs
available, but what you would find is that the
wage rate the person could get is low relative to
what they otherwise what they had prior to their retiring
or is low relative to what they expected to do
. Um So all that's a roundabout way of saying
, if people wanted to work, I think there
are ways in which they could work uh not necessarily
at the scale or at the status or at the
pay that they previously worked, but other than that
, I don't have any particular unique ideas that would
say how we could create jobs just for older people
. In particular areas of the country. Something we
have to work on the question now from River Grove
Illinois from Triton College and the name I believe is
George Michael at least. That's what it looks like
on here. And the question to anyone on the
panel, Do you anticipate a change in the field
of long-term care for the elderly within the next 20
years? And if so, how will the healthcare
system be delivered? Boy, that is a good
question. It goes right to the heart of the
matter and I expect that someone is going to have
to raise the head of politics. It seems to
me while long term care Is something that we necessarily
would talk about because at about 65 epidemiologists point out
a very important fact. Before then you have a
greater probability of being ill for what we call an
acute disease influenza. At 65, the probability is
that your illness is going to be chronic, it's
something you're going to experience very frequently, chronic illnesses
are, are internally based, something is not working
right in the system. If chronic illness is the
major issue, which means it's long term, then
you've got to think about long term care. Our
difficulty in this society was when we first thought of
long term care, we translated his nursing home.
We need to remind ourselves that the nursing home that
we currently know. It is a relatively modern invention
and it was invented simultaneously with the creation of Medicare
and Medicaid, particularly Medicaid. It's a created industry
since 1965. It's a major industry, but we
came to think of long term care as equal nursing
homes. What we then did is to have to
argue with ourselves that that's not the only way to
think about it. And we have never successfully convinced
ourselves that long term care doesn't mean nursing homes.
Now, those of you who are busily involved in
trying to think of care in the community, I
know that you're facing this imagery, that long term
care belongs to institutions that was not historically. So
It was not historically, so certainly before 1965 were
struggling with conceptualizing how we could or ought to respond
. We have not yet been successful in seeing genuine
alternatives to nursing homes. We still struggle with that
issue. I'm arguing that there's going to be enormous
pressure on us to find alternatives to nursing homes,
not just because they're cheaper, but because we can
demonstrate to ourselves that we can offer a better quality
of care somewhere else. We're going to have better
diagnosis prior to locating people. I think that's going
to be amazing. We're going to get better in
knowing how to locate people appropriately in the system.
We're going to do better organizationally. What we are
not what I'm not confident we're going to do better
about is not the organizational issue. It's the financing
issue this country is not yet willing even to begin
a conversation about serious public financing of long term care
. The brookings institution is about to release a book
called ensuring long term care is going to reach the
most pessimistic conclusion ever reached about this kind of thing
. And it ought to shock everyone of us in
this room. It says that most of us are
going to live in a world in the foreseeable future
, in which we experience the spin down. It's
not to spin down from those currently poor people.
It's gonna be the spin down that you're going to
experience. You're beginning to become a public ward of
the state, you like that. Well, unless
we do something very different, which means that we're
going to have to have a political discussion this this
country has not had and shows no inclination to want
to have at the present time. You and I
ought to go out of this room if we're concerned
about this issue and say, how are we going
to get this issue on the public agenda? What's
your answer? What we're gonna do? I want
us to take the first move towards National health Insurance
. The Canadians have shown that they can do it
, they can do it in the region. I
I'm fairly optimistic about the organization of it. And
the my several years I worked for the Veterans Administration
. I directed the Va's extended care programs and we
had the luxury and the V. A. Of
having everyone worked for the same employer. So there
are a lot of a lot of the difficulties on
who's getting reimbursed how and uh who got the most
money and whatnot wasn't quite the same kind of issue
as it is in the private sector. And indeed
the the alternatives are there. And it was,
it was nice to see it happen in a system
that was hospital oriented as any I've ever, any
, any I've ever seen. So I think the
the organizational part is there. But when you see
it translated into uh uh practical situation for the bulk
of citizens dr maddox is absolutely right. It's it's
hard to pay for john Burton who's in charge of
the geriatrics program at johns Hopkins Medical School. Uh
What he was saying, what a wonderful thing.
Respite care was. Respite care refers not to direct
care to the person who quote the nominal patients,
but for the person of the family, person who's
taking care of the of the patient. And it's
just what it says. It gives a person a
vacation from their from their job for which there is
no pay and no relief. Uh he said how
great it is. And then he then he said
, well it's fine except it costs$65-90 a day
. That's that's more, that's more money than you
could spend even going to a resort on a two
week, say it, you know, on a
on a on a package plan of some kind.
So there's the financing issue is is the paramount issue
here. And that's what we've got to face.
The we can we can put it together, the
system can be put together, but it's the decision
to face up to the cost and the allocation of
resource issues is what is what we've all got to
face right along these lines. As a gentleman in
Spokane Washington at Eastern Washington University, his name is
Dick May. He's the coordinator out there. And
he asks to continue this discussion, how can the
federal government afford, which is what we've been talking
about long term care. And he continues it by
saying, should private insurance companies like Blue Cross Blue
Shield and so forth, be selling long term care
insurance policies. There's a different theories on this.
People who favor public provisions are not always enthusiastic about
private insurance companies getting involved because they feel that if
the private insurance companies get involved, then that will
, in a sense, cream out the market of
the middle class people who can purchase private long term
care insurance. There are other people. And I'm
not sure George, maybe the brookings people are in
this camp. See a mix of public and private
uh for for dealing with this kind of situation perhaps
in the same way that we have a mix of
public and private financing of pensions in this country,
and many private pensions are correlated in some way with
what Social Security pays. So I don't know what
the future will hold, but it seems to me
the most important 0.1 can make about this is that
, um, however, we finance this, I'll
stick my neck out and say it must in some
way, be done in an income related way,
whether that's through the income tax system or through income
related premiums, something other than I think a regressive
payroll tax and in a pure and simple way,
because if you just go the regressive payroll tax route
, I don't think you're going to raise the money
that's needed in the long run for this. I
also don't believe that. And I think that the
brookings study shows this that a purely private approach will
bring in the people who need this. In the
in other words, there's a need for, I
hate to say it paternalism, we're not going to
buy the things that we quote need, whether it's
long term care, whatever it will wait until a
catastrophe happens and then have to spend down. Now
. I don't know what you do about that fact
. I don't like to call it paternalistic, but
that's probably what it comes down to. We had
a brief discussion in a prior few minutes ago.
Having to do with means test as against whatever other
tests you might want to you put on it.
I'd like someone to take that to. Its extreme
reasons for wanting to go for national health insurance is
in fact to bypass that is any any other system
that we can imagine which by which we would tamper
with. Our current strategy is going to be targeted
and mean tested. I don't think that's really an
option. Maybe we should just explain what we're talking
about. A means test means test is is that
you have got to show you qualify in some fashion
. The old the original means tests in regard to
aging was an age qualification. You had to be
65 or 62. The economic means test has to
do. You have to meet some income criteria.
Gotta be poor by somebody's standards. And so the
two big criteria in these areas are you qualified by
age? Do you qualify by your income? That
americans have said they are averse to doing that kind
of thing. That's been one of the powerful arguments
of saying don't raise the economic means test because that's
demeaning the brookings. People who have been Congress congressional
watches for a long time say, you know,
an awful discovery has been made in the Congress.
It is that they are significant minority of older people
who are rich. We've been talking about a significant
minority of older people who are very poor. There's
also a significant minority to very rich and brookings says
Congress has discovered that, and it affects public policy
. Because how do you make public policy for the
elderly simultaneously for those with income and without? Are
you saying you want means tests? Well, we
have a mean, as a matter of fact,
we do have a means test that I find tolerable
. I did not say that I'm opposed to all
means testing. We have means tests in terms of
our income of our our tax policy at its best
, which is to say we mean for it to
be a graduated tax. And if you read your
newspaper in regard to the most recent proposal about catastrophic
insurance, one of the first times, I think
in a long time we have a piece of insurance
that has built into it. The notion that there's
going to be progressive payment for that insurance. Okay
. I I think we really need to face this
issue right on and I don't want to use the
word means test to describe the way I pay for
my local public school financing. I pay a lot
more than my neighbor because my house is worth more
. That's a progressive taxation. I want. All
right, then let's let's say we're in favor of
progressive taxation, including the catastrophic health bill. But
let's not call out a means test because I think
for many older people, many people in this country
a means test means welfare S. S. I
. Medicaid. It means all of those things which
are degrading and stigmatizing. And I think we've got
to say that and acknowledge that people feel like,
and that's what the horror of the spend down and
we ought to admit it. So what we need
is an approach, I would say, and I
think you'll agree that is sensitive to people's resources.
You want to clean up the language, we want
to clean up the language. And I think if
we call it that we're going to mislead people,
that's why I let me let me change the subject
just slightly. But it's a very important point that's
been raised by a lady named Madeline johnson who is
with an aging agency. I believe in Courtland Virginia
, at least that's where she's calling from, the
Virginia Cooperative Extension Office. And she asked this question
, see if anyone wants to tackle it, what
do you suggest would be successful in promoting wellness and
health among the elderly, presumably in rural areas?
Well, I think I'd like try that one.
I think the the same things that work for people
in urban areas are going to work in principle in
rural areas, dr maddox pointed out the exercise the
social setting is a good way to do that.
That's that's work for people regardless of age. By
the way, the social stimulation of exercise programs making
a lot more tolerable than support for many ah in
the end, the the principles are the same,
no matter where you live the way in which you
exercise them. It may differ a little bit,
but probably more important, I suspect what's behind that
question is a question of education, how to get
the word word out how and that's that's an issue
. But jim there's something else to rural, rural
in our society means dispersed population that presents practical problems
that has nothing to do with whether people because they
are rural age differently. It's harder to get certain
kinds of essential services to rural people. And we've
known in the in the public school of the problem
bussing Well, there's a problem with bussing older people
to essential services in rural areas, interestingly, I
know are stereotypic notion that being in, you know
, God's rural areas makes for better health, better
health is contradicted by all of the kind of epidemiological
statistics and in part because we're seeing when we say
rural, there are in fact poor people very you're
near enough to Appalachian to know what we're talking about
. To be rural Appalachian is to be at risk
, in part because you're poor. They, so
that I'm not sure talking about dividing the world in
rural, non rural is all that helpful. It's
what rural connotes. And if it connotes poverty and
isolation, then you've got a problem that probably only
is indexed by rural is not really explained by,
by being rural well dr maddox are you then suggesting
which may well be a viable proposal and that is
stay in your bus. A program sponsored by the
county, the state private prayer organizations. I hate
to say it. The federal government. Well,
I don't want to I don't think any particular kind
of categorical program is necessarily the answer though. I
think transportation would have to be a key issue I'm
thinking of. There is a center for the Improvement
of mountain living at western Carolina college wonderful program that
tries to understand the culture of relatively people who historically
have been relatively isolated and have something of an identifiable
culture that that center for the Improvement of Mountain living
has shown a wonderful understanding of the self health tendencies
among these people and rather than thinking of governmental organizations
coming in to provide services externally, have found ways
to build on the kind of natural networks that these
people have done augmenting them whenever necessary with transportation and
so on. They've shown a wonderful way of taking
relatively small resources and understanding the local culture and getting
to the most remote areas, the 19 most remote
counties in western north Carolina have more access to family
support in the areas of Alzheimer's than many urban people
do. I'm glad you mentioned the self help because
I think with regard to social supports, which is
so important and we know epidemiologically to survival and health
and prospering in old age. We may have to
reinvent certain kinds of family contacts through mutual support networks
and that will require some effort and some intervention dr
election. Once we understand the factors and they are
somewhat changing as people respond to better medicine and a
brand new scientific breakthroughs as we understand these factors,
How realistic would it be to intervene with such things
as diet, vitamins regarding the whole aging process?
Well, I think there's at least there's several issues
there. It's very practical, I think, to
consider within the scope of what we have today.
Um, that is to say that we can identify
various risk factors to pick that up that are involved
in the development of atherosclerosis and we can act against
them populations haven't been very willing. As I say
, cigarettes have been fairly obvious and not too many
people have paid too much attention in the long term
, which the kind of thing that you find in
any typical health food store, you know, the
the super oxide dis mutates the vitamin E types of
things. Most of those are based on a reasonably
exotic theoretical basis and have virtually no likelihood in the
near future of having any effect whatsoever. There's in
the longer run. I suspect that a couple of
these more theoretical aspects primarily suppress the deterioration of the
immune system is very likely to have an effect.
Again, with the virtual worthlessness of prediction of by
even experts in an area. I would suspect that
probably one or two of the major physiological Areas might
be subject to attack and to show some realistic changes
within within 10 or 15 years. And then then
we'd have to make our social decisions as to what
what we wanted for that. That was my next
question, Doctor moody. I saw a smile.
Well, I think that it's all very well to
, you know, think about future scientific developments.
I remember Lord Kelvin described X rays as a hoax
. And the history of predicting the future of scientific
advances is not a very good one. So I
just think we should by all means invest in basic
biomedical research. I enthusiastically endorse what dr Maddox said
and keep our eye on the ball about practical things
we can do right now to help people in need
. Let's let's take this smoking business. I feel
authorized to to speak with great conviction on this and
the place that is built on cigarette money. Mhm
. Something good came from smoking. But while we
can be pessimistic about how few people have have paid
attention and stopped smoking, I would submit to you
. We've seen a long term downtrend of the number
of people who smoke. And that's a plus.
I'll take I'll take that develop. So rather than
emphasizing what we haven't done, I wanna emphasize what
we have done and it's been right. I encounter
a certain number of older people who at 70 or
75 have been smoking all their lives and say don't
fool around with me. Don't tell me to stop
smoking doc. It's too late for that. And
I want to tell you they're wrong, stopping smoking
at any point in your life gets benefits and we
can document what they are. And I want to
continue to push this point. I want to say
we have done well enough so far in getting people
to stop that. I want to redouble efforts to
get more to stop and I want to be sure
they understand it's not just a matter of living and
dying. It's a question of living. Well,
we've got to stop people smoking. And the people
, I point my finger to the people who have
been most resistant to changing have been younger women get
the words out, sisters that whatever you're trying to
do and taking up that habit, it's moving the
wrong direction. You've come a long way baby,
but not long enough. It's going to be shorter
than you think if you don't give up that habit
. We have another in house question. Yes,
ma'am. I'm Martha Janelle. I'm a registered nurse
from paris burg Virginia. I've really enjoyed the conference
, especially listening to dr maddox. And I agree
wholeheartedly with many of his comments. I personally believe
we need a national type of health care. Um
I see a lot of inequities with patients who really
don't have the money who I know do without care
because they just don't have that. And I just
don't think that anyone in our country should have to
do without. I guess I have several other opinions
to about aging in general. I think we're going
to have to come to grips with dying, you
know, is a part of living and we're going
to have to discuss that in our families as surely
as we grow up in our Children, we're gonna
have to just be comfortable with talking about what if
situations and I wholeheartedly believe in living wills. I
think there are many physicians who are not comfortable with
dying either and they don't really tell families and patients
the true story of what the outcome would be.
And sometimes that's left up to the nurse sometimes to
talk with families, they don't know what to do
. They don't know how their family member feels about
what to do in a code situation. A lot
of people if you said, um, do you
want everything done that? Maybe how the doctor will
phrase it and they really don't know what everything is
. I think we need more education to what everything
is. I've been putting that position a few times
and probably went beyond the bounds of what the physician
thought I should do, but I did what I
, I thought I should do as a nurse and
told the family and they appreciate it because they really
didn't want a full code, they didn't want a
respirator. And I think we're going to have to
come to grips with what are the chances of the
outcome for this person if we put them through um
a full code and maybe put them on a ventilator
and having to make the choice of possibly pulling them
off. We need to come to grips with death
and dying, discuss it with our families, what
do we want done? And basically, I think
that's an issue we all have to face and I
hope we can correct some of the problems that are
wrong in healthcare. I work presently in education and
wholeheartedly agree with all the things he's saying. But
I feel like I'm a one voice crying in the
wilderness, but we need to get government behind education
if they funded, let's say for instance, our
healthcare, we would find more money spent towards education
and we need to start in the schools at the
young age a little bit more than what we're doing
now. Thank you very much. One of the
things that comes to my mind a proposal of some
of the chat, we've had discussions, we're in
the middle of an election year. There are many
, many people running for office in addition to those
who are running for president and some of those high
offices. We have mayors, we have city council
people, we have county officials, we have state
officials. It might be interesting to find out where
they stand on some of these issues. And I
don't say anymore. I sound like the AARP which
I am. Well, you know what AARP has
financed. They financed the national committee that's not so
clearly identified with them, but it's largely financed by
AARP That has a nice 15 minute video presentation about
what you should need to know. What I'm saying
is that this organization is not leaving to chance having
these conversations. They've engineered conversations where every candidate has
been asked where they stand on long term care.
So we don't know where they stand is because we're
not listening. I would tell our people listening and
watching around the country, we have exactly five minutes
to go. I know we could go on for
five hours, but if you want to get a
question and now is the chance to do it before
we have to close out. Um I would ask
uh dr clark what are some of the economic implications
without going fully into detail of an aging workforce?
The competitiveness, for example, with younger workers people
being displaced or feeling they're being displaced? How do
we cope with that? Well, the economics of
of an aging population would include questions about what's the
relationship between age and productivity? How does that,
how does the average person change even though we recognize
that there's heterogeneity of the population. Can one determine
general trends and ability to perform on certain jobs.
You'd worry about the mobility of the labor force and
the ability of the labor force to respond to changed
economic conditions such as new innovations and technologies? How
can you retrain the labor force overtime? Redirect the
labor force toward new jobs and new opportunities from a
company standpoint? You would worry about the cost of
a particular worker at one age versus another. You
would worry about, you know, how, how
they perform on the job. You'd worry about absentee
rates, You would worry about a whole host of
things, uh, some of which favor the older
worker and some of which are the older worker is
uh adverse circumstances. I in terms of government support
systems, you worry about the increasing cost of supporting
the growing elderly population. But there's an offset in
terms of the reduced cost of supporting the shrinking in
relative terms younger population. So, in terms of
looking at the overall impact of the economy, I
personally have argued, and I think uh more people
are coming to this view that just age structure changes
in and of themselves should not be an adverse effect
on the economy. Uh, and one of the
reasons I would argue that is because uh economic free
economy tends to adjust pretty well to changes in in
events. And the history would show that as the
, you know, the wonderful thing about aging populations
is that it occurs slowly Uh if you all of
a sudden change the age structure of the population from
having a 10% older population to 20% overnight, then
perhaps it would be fundamental changes that you had to
worry about shifting out of schools and into nursing homes
. But over time, uh, institutions can evolve
and I don't think that just an aging of the
population should have an adverse effect on the economy.
Dr clark. I I'm afraid that's the last word
we have concluded or almost concluded our three hours.
It's been a very interesting discussion. We hope that
you have enjoyed it and not only found it interesting
, but got something really solid out of it,
we hope it's been helpful. We'd like to thank
all of you up here who have taken part.
It's it's a pleasure to be associated with you.
Dr Doris Tytler Zelin, who is in charge of
this project, should also be thanked and she reminds
me that at some point in the future we hope
to have or she hopes to have some VHS videotape
Additions of this, which you will be told about
and you can receive through the mail. I'd like
to wind up our discussion on an interesting note,
at least it was to me the other day,
a young fellow named George Burns, who is 92
years old, received an honorary doctorate degree in New
York or in in Connecticut. And uh, he
said, among other things and this is the spirit
that I think 92 year olds should have and even
less than 92 year olds, he says he's very
happy to receive this honorary doctorate. He couldn't wait
to run home and tell his mother about it.
He also said he was very glad to receive it
because she always wanted him to be a doctor.
He then said now that he's an honorary doctor the
next time he has to have open heart surgery,
he'll do it himself. And on that, on
that happy, upbeat note, we do bring these
proceedings to a close. I'm Peter Hackett in Blacksburg
Virginia, thank you very much, mm hmm,
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hmm mm hmm, mm hmm. Mhm. Mhm
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mm hmm. Yeah. All right. Yeah.
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Mhm mm hmm. Mhm. Yeah. Mhm.