Boomer health decline reported

Are they less well than earlier group? Or is it imagined?

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University of Pennsylvania sociologist Beth Soldo, an early-wave baby boomer, wasn't seeking potentially ominous news about the health of her generation, but it was staring her in the face.

Studying data from the U.S. Health and Retirement Study, she and her colleagues found that people in their early to mid-50s were reporting more health problems than people that age had described previously.

Significantly, fewer such middle-aged people in 2004 than in 1992 rated their health highly. More of them rated pain as a regular problem. And a higher percentage had trouble climbing stairs or walking a few blocks.

The findings for the 51-56 age group ran counter to assumptions about the nation's health, especially that disability among the elderly was declining.

What's not clear in the wake of the report is whether there's an actual health decline among boomers born between 1948 and 1953 or just a decline in perceptions. The federal data are not correlated with any actual health evaluations.

"Boomers indicate they have relatively more difficulty with a range of everyday physical tasks, but they also report having more pain, more chronic conditions, more drinking and psychiatric problems, than their ... earlier counterparts," said Dr. Soldo's study, which was done for the National Bureau of Economic Research.

If any increased physical hardships among baby boomers prove long-lasting, it could be crippling for the future of Medicare costs, government financing of nursing home care, the nation's workforce needs and the caregiving burdens placed on their children.

No one's saying there's evidence yet of any such doomsday scenario, but findings like Dr. Soldo's intrude upon consistently optimistic news about reductions in heart disease, better maintenance of chronic conditions and longer life expectancy.

"I spent a good bit of time trying to prove to myself that these [negative findings] were incorrect," said Dr. Soldo, the 58-year-old director of Penn's Population Aging Research Center, whose own health benefited from knee replacement surgery last year. "I will not swear on a Bible this is the gospel truth, but I will say these are credible and reasonable."

Of 5,000 people, age 51-56, answering the national health and retirement survey in 2004, exactly half the age group rated their health as either "excellent" or "very good." In 1992, 57 percent of people the same age rated their health that way. In 1998, 53 percent did so. The survey is done every six years.

Since publication two weeks ago of Dr. Soldo's report, called "Cross-Cohort Differences in Health on the Verge of Retirement," people who study health issues have suggested a number of theories to explain why those new to the age group might report more physical problems than their predecessors:

The nation's increased obesity rates, which affect various health issues, are just now showing up as a factor in such data.

Baby boomers may be less stoic than their predecessors, with higher standards for their health and more likelihood ofo complaining about maladies.

Improvements in medical diagnoses and more widespread use of medications make people more aware of their own health issues and less likely to pronounce themselves in top shape.

Increased stress is burdening the newer members of the age group, rendering them less likely to report vigorous health overall.

Dr. Richard Suzman, director of the National Institute on Aging Behavioral and Social Research Program, said most news about today's older adults has bred optimism that the 78 million baby boomers approaching old age won't overwhelm the health care system. He wants to see more research before making any assumption that such a huge population is either worse now, or will be worse in the future, than projected.

"If it's true, it's pretty important," he said.

He and others speculated that if there's actual health decline, obesity is a top suspect. Carrying excess weight contributes to the likelihood of diabetes and other disease, as well as to creating lethargy that can affect how people rate their health.

The usual suspect: obesity

Obesity was cited by another survey as one prominent factor in increased rates of disability among the non-elderly population. According to Darius Lakdawalla, a senior economist at RAND in Santa Monica, Calif., a review of the 2004 National Health Interview Survey found obesity especially prevalent for people ages 50-59 who reported disability. He viewed the findings by Dr. Soldo's research group as more potential evidence of obesity's impact on the age group.

"What happens with obesity is unique," he said, "because unlike other functional limitations, obesity in older people has a bigger impact on health and not on longevity. It makes them sicker, but doesn't cause them to die."

That's the nightmare scenario that some health analysts and economists have feared for years: the possibility that people who live longer because of medical advances will spend too many of those twilight years sick, bankrupting the system for everyone else.

One of the nation's leading analysts of aging health trends, Duke University research professor Dr. Kenneth Manton, sees no basis for such fears and nothing in Dr. Soldo's study to change his mind. His data from yet another source, the National Long-Term Care Survey, finds persistent drops in disability rates among the elderly since 1982.

The prevalence of chronic disability for people over age 65 stood at 19 percent in 2004-05, compared to 26.5 percent in 1982, and the improvement came at a higher rate in recent years than a decade or two ago, according to Dr. Manton's analysis. Because that data is connected to Medicare enrollees' medical records as well as their responses in interviews, Dr. Manton sees it as a more reliable indicator of how people are doing than self-reporting.

He also said it's possible that the negative effects of obesity are exaggerated, because Americans have been getting bigger in body size as a long-term trend at the same time their life expectancy and other indicators have improved. Also, adding pounds is one common side effect of stopping smoking, which, he said, is "still a net [health] gain."

"If there is a real increase in health problems, that's negative, but we have to be careful about it just being that medical care is better at detecting these things," Dr. Manton said. "I would have to have another five to 10 years of data to feel comfortable saying things are falling apart for people in the U.S. in their 50s."

One complication is that different types of surveys don't necessarily reach the same conclusions. AARP, for example, has focused generally on positive news about baby boomers' health, using respondents' own descriptions in the National Health Interview Survey. A higher percentage of those ages 50-64 in 2004 reported health as "very good" or "excellent" than in 1994, the opposite of what Dr. Soldo found over roughly the same period for the smaller group of ages 51-56.

In the same survey, a lower percentage of people ages 75 and over reported very good or better health in 2004 than in 1994, which sounds inconsistent with Dr. Manton's findings about the broader elderly population.

"I don't understand why the data would be different," Lynda Flowers, strategic policy advisor for the AARP Public Policy Institute, said of the different surveys' results. "Whether or not these people are actually in bad health is another question in terms of making dire predictions for the future."

One local physician who has been treating patients since 1983 is willing to believe that his patients today feel worse, even if they're not any more ill than people previously. People in their 50s are feeling more stress than their predecessors, from a combination of work duties, financial responsibilities, child-rearing concerns and burdens of care-giving for older relatives, suggested Dr. James Reilly, a general internist at Allegheny General Hospital and Drexel University College of Medicine assistant professor.

"I think life is more complicated for someone in their 50s today than someone who was in their 50s six or 12 years ago," he said. "There is greater stress, less time to rest, more fatigue, more sleep deprivation."

Such stresses will directly affect a person's sense of physical well-being, Dr. Reilly said, as well as how to answer a survey. The other intangible with any comparison of self-reporting over time is the cultural shift in how generations behave or perceive themselves.

The boomers whose answers caused concern for Dr. Soldo are being compared to people born 12 years earlier, between 1936-41, whose earliest imprints were in the Depression and World War II era. They grew up in households where life was tougher, and expectations were less, than for those born after World War II.

That attitude shift is a factor that analysts of the new report said could affect the negative findings.

"I think it's likely there's a different threshold for what good health looks like to a baby boomer, and therefore, if they don't meet those standards, they might be likely to report they're a notch down in health," Dr. Soldo acknowledged.

One optimistic note offered by Dr. Soldo and others is that baby boomers are more conscious of health, more educated about it and more familiar with role models showing the benefits of exercise, nutrition and other healthy living.

Such factors have motivated Patti Bird, 57, of South Franklin, Washington County, who doubled her weight during depression after the death of her husband in 1995. She lost more than 150 pounds after joining a meeting program called Take Off Pounds Sensibly where she estimates nearly half of her group's participants are in their 50s.

While still obese today, a condition that became more challenging after a stroke slowed her last year, the former chef is focused on daily exercise and low-fat dinners such as baked, skinless chicken with broccoli and cauliflower. She knows what good health is supposed to be, and aims to get there.

"I don't want to go into a nursing home, you know what I'm saying?" she said. "I'm trying to do what I can to take care of myself, because I'm too young."

  
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Baby boomers in decline   
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Gary Rotstein can be reached at grotstein@post-gazette.com or 412-263-1255.


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