Living longer with chronic diseases carries economic and medical burdens.
Hollywood icon Betty White is a prime example of how extreme old age can be a time of health, productivity, and even fun. She’s energetic, in demand as an actress, winning awards, and seems to be having a ball at age 93.
Although living into our 90s like Betty White isn’t the norm yet for most Americans, we’re headed in that direction. Life expectancy in the U.S. has hit a record high, according to a report from the Centers for Disease Control and Prevention (CDC). Females born in 2010 will likely make it to their 81st birthdays, while males born in 2010 are projected to live 76.4 years. On average, American women who were 65 in 2012 had two additional decades ahead of them; their male counterparts had about 18 more years of expected life left.
The increase in life expectancy is mostly due to reductions in deaths from cancer, heart disease, and stroke. That’s good news — to a point.
For some people, like Betty White, longer life comes with enjoyment. However, for many senior citizens, extra years bring financial hardship and little quality of life due to chronic and other health problems.
In fact, the rise in life expectancy among those who are already elderly is slowing. The burden of multiple chronic conditions is likely the cause, according to an analysis of 1.4 million Medicare enrollees age 67 and over by Johns Hopkins Bloomberg School of Public Health researchers. They found that both the kind and number of chronic diseases a person has influences their lifespan.
“The balancing act needed to care for all of those conditions is complicated, more organ systems become involved as do more physicians prescribing more medications,” said Gerard F. Anderson, PhD, a professor in the Department of Health Policy and Management at Johns Hopkins. “Our system is not set up to care for people with so many different illnesses. Each one adds up and makes the burden of disease greater than the sum of its parts.”
For example, if you have heart disease at age 67, you will likely live another two decades or more, unless you have other health woes. Four out of five older Americans live with several ongoing ailments, and their life expectancy is reduced by almost two years for each additional chronic condition, the research showed.
“We already knew that living with multiple chronic conditions affects an individual’s quality of life, now we know the impact on quantity of life,” said Eva H. DuGoff, PhD, lead author of the report. “Living with multiple chronic diseases such as diabetes, kidney disease and heart failure is now the norm and not the exception in the United States. The medical advances that have allowed sick people to live longer may not be able to keep up with the growing burden of chronic disease. It is becoming very clear that preventing the development of additional chronic conditions in the elderly could be the only way to continue to improve life expectancy.”
While simply growing older raises the risk for many ills, the good news is that most chronic diseases that impair the quality of life as we age can be prevented or delayed. Heart disease, stroke, many cancers, type 2 diabetes, obesity, and arthritis are not only among the most common and costly of all health problems — they are among the most preventable, according to the CDC.
One way Americans can lower the risk of chronic health problems in old age, and also reduce healthcare expenditures throughout their lifetime, is to get weight under control. Medical costs linked to obesity are estimated at around $147 billion annually in the U.S., CDC statistics show.
An international report found that type 2 diabetes, largely exacerbated by being overweight and sedentary, costs individual Americans with the condition about $283,000 each in healthcare costs over their life time. “Our findings underline the fact that diabetes not only has strong adverse effects on people's health but also presents a large — and at least partly avoidable — economic burden,” said University of East Anglia health economist Till Seuring, who headed the global survey. Keeping weight under control can also reduce your risk of arthritis.
In addition to people taking personal responsibility for their health by lowering risk factors such as obesity, what else can we do to make our increased years of life healthier?
In a series of reports on aging and health, World Health Organization (WHO) researchers outlined both societal and medical strategies that may help. Emphasizing that increased life expectancy is a global phenomenon, WHO experts in aging called for policies that encourage older adults to remain active in the workforce longer. To reduce the economic and medical burden of chronic diseases in elders, they advised low-cost disease prevention (such as reducing salt intake, smoking cessation, and regular exercise) and placing emphasis on early detection of disease when treatment can be most effective and less expensive.
"Collectively, we need to look beyond the costs commonly associated with aging to think about the benefits that an older, healthier, happier, and more productive older population can bring to society as a whole,“ said Somnath Chatterji, MD, of the Department of Health Statistics and Information Systems at WHO.
April 07, 2020
Christopher Nystuen, MD, MBA