Wake-Up Call
The 10 Physical, Social, Spiritual, Economic and Political Crises the Boomers Will Face as They Age in the 21st Century
by Ken Dychtwald 
Two powerful forces are building that will transform every aspect of life as we know it. The first, the mass aging of our society (and others throughout the world) may very well be the most extraordinary evolutionary event of all time. Throughout 99 percent of all time humans have walked this planet, average life expectancy was under 18 years. We have never before had a mass population of older people. Until very recently, most people did not age; instead, they died relatively young.
During this past century something tsunamis has begun. As a result of dramatic advances in sanitation, public health, food science, pharmacology, surgery, medicine and, lately, wellness-oriented lifestyle management, most of us will age. We are witnessing the birth of a 21st century "gerontocracy."
When this gero-revolution is joined by the second major force that will dominate the decades to come, the 76 million baby boomers barreling toward maturity, an "age wave" emerges that will soon have the strength and power to create vibrant new social forms and functions and an equally compelling potential for social, financial, political and personal catastrophe. Maturity is about to undergo a revolution like nothing the world has ever seen.
As we envision these two forces colliding, it would be comforting to be able to assume that our society is prepared and that everything will be fine down the road. We could then believe that all of the social and political issues worthy of debate and discussion have already been at least engaged if not resolved and that the future is in good shape: We have got the right healthcare system, the right political priorities, the right Social Security program, the right roles for retirees, the right approach to intergenerational equity and the right marketplace orientation.
But this is not really the case, and it is increasingly keeping me awake at night; things are not pointed in the right direction at all, and we may be heading for disaster.
When I look toward the future, I can clearly see a variety of train wrecks about to happen-- all of which are preventable, but only if we fully understand the relationship between our current decisions and their future outcomes and only if we initiate corrective action now.
What follows is an attempt to characterize the 10 physical, social, spiritual, economic and political crises we will face as we age in the 21st century.
1. A Pandemic of Chronic Disease
We are heading toward a future in which chronic disease, frailty and a variety of long-term health problems will be pervasive. If there is going to be a healthy old age for our generation and our children's, we have got to make several dramatic changes in our approach to healthcare.
First, we must substantially upgrade the amount of support directed toward producing scientific breakthroughs that could eliminate or mitigate the diseases of aging.
Second, we should be ashamed of the fact that although we have 128 medical schools in this country, there is only one department of geriatrics. Standards for basic levels of geriatric competency for the average physician, nurse, pharmacist and physical therapist must be set.
Third, since we now know that many of the conditions of the later years can be prevented, postponed or eliminated through proper lifestyle management and self-care, we must make prevention a core component of our healthcare system.
2. Mass Dementia
In this century, we have increased our effectiveness at keeping people alive for decades more than our ancestors ever dreamed of living. We already have 3 million people over the age of 85, and this is the fastest-growing segment of the population. However, we have not done that good a job of seeing to it that these long-lived men and women are functioning with full physical and mental faculties. Today, the dementia rate for the 85+ population is a staggering 47 percent.
We must realize that unless much-needed scientific breakthroughs occur, Alzheimer's will be the scourge of the future--and a costly one at that. For us to inherit a future old age without Alzheimer's, we must take a lesson in political activism from the AIDS and breast cancer crusaders who have dramatically upgraded the amount of attention to and funding for their causes. A revolution in interest, attention and funding for brain dysfunction is needed now. Our future is in the balance.
3. The Caregiving Crunch
The average American now has more parents than children (including in-laws and even grandparents), and 10 percent of the elderly population in our country have children who are also elders over 65. We are driving toward a future in which four- and five-generation families will be the norm. As a result, more and more of us will have to provide time, money, respite, housing, transportation, love and nourishment to our parents and our children--and possibly grandchildren and grandparents--simultaneously, for decades.
In response, we need a more effective means of supporting the tens of millions of families who are currently providing care for older family members or friends, a number that is certain to grow. Our health and social services systems will need to include convenient adult daycare, effective homecare and accessible respite care or else millions of caregivers will probably break under the strain. In addition, our work/family benefits and our insurance policies will need to better link and more effectively cover the emerging needs of multiple adult generations.
4. Coping with Death and Dying
The contemporary approach to old age and dying emphasizes keeping people alive as long as possible, regardless of their quality of life and regardless of their wishes. Whereas in the past nearly all deaths in America occurred at home, today about 80 percent take place in institutions. Yet, except for a smattering of wonderful hospice programs, we do not have institutions that are sufficiently comforting, nurturing or supportive of the dying and their families. It is essential that we create a palliative-care model and make certain it is reimbursed and properly staffed to do an excellent job of respectfully guiding people through this final stage of life.
We will also need a new medical/social/religious ethic within which to allow individuals to feel that their final days are progressing in a fashion that respects their dignity and right to self-determination. Since all recent public polls indicate that the general public and medical professionals are becoming increasingly comfortable with living wills, suicide and passive euthanasia (although assisted suicide and active euthanasia are not viewed positively, for many good reasons), we need enhanced public discussion of these topics to set acceptable policies.
5. "Gerassic Park"
All future-oriented public policy in America, including policy regarding Social Security and Medicare, is based on the assumption that there will be no meaningful breakthroughs that will affect longevity or biological aging. So what happens if we wake up tomorrow morning and there is a breakthrough?
Might it be a "Gerassic Park" in which, instead of cloning entire humans, we find a way to clone organs? What if we learn to manipulate the body's immune system to increase longevity? Can we imagine a future without cancer, a world without Alzheimer's or heart disease? It is possible. As biotechnological breakthroughs occur that could radically alter late-life disease and even human aging as we now know it, battles could erupt over who will decide how these mind-boggling technologies will be controlled and who will have access to them.
And if, all of a sudden, people start living to the age of 100 or 120, should they retire and start receiving pensions at 65? What becomes of traditional life-stage activities--work, retirement and old age entitlements? We need public discussion and debate now about the ethical and social repercussions of possible biological and gerontological breakthroughs. The biotechnology century is coming; we should expect the unexpected.
6. An Inhospitable Marketplace
Within the U.S. marketplace there still persists an overwhelming obsession with youth. From the perspective of a 60-, 70- or 80-year-old, the world is a long way from being aging-friendly. The typeface in our newspapers and magazines is too small, signage in public buildings and on street corners is too hard to read, doorknobs are too difficult to grasp and turn, traffic lights change too quickly, auditory levels of telephones and televisions are not geared to older ears, lighting in offices creates too much glare, food is not formulated or prepared with older taste buds in mind, car seats are uncomfortable for older backs, bathtubs are too slippery and dangerous, medications are likely to create pharmacological problems for elders, store personnel are often rude and insensitive to older shoppers, and this list could go on.
Most product developers, marketers and advertisers still give only lip service to the needs of the aging population despite the fact that, during the past decade, mature men and women have become the most affluent and active consumers in the history of the American marketplace. We continue to be entranced by the myth that being young is better than being old. If we want a world that fits our needs as we grow older, we must encourage the development of new aging-friendly products in all sectors and match that with much better trans generational marketing. And, we must take a firm stand to eliminate all ageism in advertising.
7. Changing Markers of Old Age
When Otto von Bismarck picked 65 as the marker of old age in the 1880s, in preparation for Germany's first pension plan, the average life expectancy was only 45. Our current markers of aging have no place in the new millennium. Increasing longevity will not only postpone the arrival of old age, but will also cause all of the stages of life to stretch and shift significantly:
* Youth will become the period from 18-25.
* Young adulthood will expand to include the period from 25-40.
* A new adult life stage, middlescence, will characterize the period from 40-60.
* Late adulthood will be postponed and extended to occupy the period from 60-75.
* Old age will be postponed and extended to begin at 75 and end around 90.
* Very old age will encompass the 90+ life stage.
In addition, the traditional "linear life" paradigm in which people migrate first through education, then work, then leisure/retirement will become transformed into a new "cyclic life" paradigm in which education, work and leisure are interspersed repeatedly throughout the lifespan. Social and public policy that correspond to life-stage development will have to change to match these more flexible work and retirement styles; at the very least, benefits will need to become more flexible and portable.
8. Financial Insecurity
Many of today's elders are the beneficiaries of generous entitlements, radically elevated property values (caused by the boomers) and a responsible savings mentality. In contrast, many boomers have accumulated dangerously high levels of debt and minimal savings and will not be the beneficiaries of a demographically driven home equity boost. Pensions are becoming less reliable as guaranteed benefits are swiftly being replaced by defined-contribution pension plans. The futures of Medicare and Social Security are, at best, shaky. Because of demographic forces, future financial support for boomers in old age is destined to diminish. Eighty percent of boomers do not believe that they will receive a Social Security check.
Many boomers are caught in a dangerous state of "financial paralysis." They are not prepared for the future. Therefore, government needs to play an active role in encouraging debate on these issues among all generations, mandating savings and creating flexible, portable pensions. If we do not take action now, we could face a future with massive elder poverty.
9. Age Wars
There are profound differences among the old and the young in terms of values, interests, needs and attitudes toward government. Sixty-five-year-olds are reasonably well organized, have a great deal of free time, and have the largest affinity organization in the history of America, outside of religion, to battle their battles, while 25-year-olds have no political voice and are scrambling to make ends meet.
The boomers will not have much of an impact on modifying today's elders' entitlements. There is too much respect and guilt on the part of boomers and too much power and unity on the part of elders. However, when the boomers amble their way into their 60s, totally disorganized and with financial paralysis, they will become a disproportionately powerful 21st century "gerontocracy" and, with it, will inherent all of the pentup anger and backlash of the young.
We need to establish a nonpartisan, multigenerational panel so that all age groups have a chance to express the concerns of their stage of life with equal weight and power. Future elders should have a large say in future aging issues.
10. Elder Wasteland
We haven't yet figured out the modern purpose of a healthier old age. To what use do we put the incredible resource of elder hood?
We desperately need a heroic model of old age for our coming maturity. If elders want to have the support of younger generations, those generations have also got to feel that elders are giving something back.
We need to establish an elder corps: an army of tens of millions of elder men and women who can become co-teachers in our grade schools, mediators in our churches, mentors in the workplace, surrogate grandparents to our young families, and leaders in our communities. If we had 70-year-olds helping to educate and nourish our children, not only might they be helping them improve their arithmetic skills, but they would also be imparting a powerful base of values that we are about to lose.
Fueled by long sought-after breakthroughs in longevity, we are witnessing the emergence of a gerontocracy, a powerful new old age. And we have the largest generation in American history barreling toward it. How we respond to the demands of this enormous "age wave" and whether or not we are able to avert the catastrophes that might occur in its wake may turn out to be the most important challenge we will face at the dawn of the new millennium.