“When I’m 64”

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Getting By with a Little Help

Despite indications that American baby boomers will have longer careers and potentially sharper memories than members of the preceding generation, their greater need for help with personal care activities is troubling. At a minimum, this increasing need among Americans aged 50 to 64 poses challenges related to future health spending, demand for health care and other support workers, prospects for continued labor force participation, and thus access to employer-sponsored health insurance.

Figure 7 — Almost 2 Percent of Middle-Aged Americans “Need Help” with at Least One Personal Care Activity

Figure 8 — Forty-Two Percent of Middle-Aged Americans “Have Difficulty” with at Least One Common Physical Function

SOURCE FOR FIGURES ABOVE: “Trends in Disability and Related Chronic Conditions Among People Ages Fifty to Sixty-Four,” Health Affairs, Vol. 29, No. 4, April 2010, pp. 725–731, Linda G. Martin, Vicki A. Freedman, Robert F. Schoeni, Patricia M. Andreski.

NOTES FOR FIGURES ABOVE: Asterisks denote statistically significant increases from 1997 to 2007. Data are from the National Health Interview Survey.

Data from the National Health Interview Survey from 1997 to 2007 indicate that there was a statistically significant increase in the proportion of Americans aged 50 to 64 who reported the need for help with two activities of daily living: getting into or out of bed or a chair, and getting around inside the home (see Figure 7). The overall rate of needing help with any such personal care activity remained quite low within this age group, having risen from 1.3 percent in 1997–1999 to 1.8 percent in 2005–2007. But given the substantial personal and societal costs of caring for those with such limitations, the upward trend bodes ill for the future.

Beyond the nearly 2 percent of baby boomers between the ages of 50 and 64 who reported “needing help” with personal care activities in 2005–2007, about 42 percent of them reported “having difficulty” with at least one of nine common physical functions, and many reported having difficulty with more than one function (see Figure 8). There was no statistically significant trend overall, but difficulty with four functions related to mobility and the lower body did increase significantly between 1997 and 2007 for Americans in this age group. These functions included standing for two hours, walking a quarter mile, climbing ten steps without resting, and any combination of stooping, bending, or kneeling. There was also a significant increase in reports of using special equipment, such as a cane, wheelchair, special bed, or special telephone.

The two most frequently cited causes of having difficulty with any physical function in 1997–1999 and 2005–2007 were arthritis or rheumatism and back or neck problems. Likewise, these two were the most commonly cited causes of needing help with any personal care or routine household activity at both the beginning and end of the study period. In the case of needing help, though, the top two causes switched places from one decade to the next. There was a significant decrease in the reporting of arthritis or rheumatism as a reason for needing help, while there was a significant increase in back or neck problems.

AP IMAGES/BOB EDME

Strikers in Paris on May 27, 2010, joined those across France who protested government plans to raise the retirement age past 60, one of the lowest even in Europe.The placard in foreground reads, “I want the same retirement as Juppe, Woerth,” referring to former French Prime Minister Alain Juppe and current Labor Minister Eric Woerth.

There was also a prominent and growing role for diabetes as a cause of needing help among those aged 50 to 64, as there was for depression, anxiety, or emotional problems; nervous system conditions; and other musculoskeletal conditions, such as tendinitis and bursitis. Nervous system conditions include many and varied ailments, such as paralysis, migraine, epilepsy, multiple sclerosis, Parkinson’s disease, and amyotrophic lateral sclerosis, or Lou Gehrig’s disease.

The self-reports of causes suggest that weight problems did not play an important role in the increase in need for help with personal care activities. Indeed, most obese people did not need help with personal care. However, some respondents might have been reluctant to cite weight problems, even though they were invited to cite as many as five causal conditions. The increased reports of back or neck problems, other musculoskeletal conditions, and diabetes may have been related to the growth in obesity.

For seven of the top ten conditions reported as causing people to need help in 2005–2007 (the ones named above plus hypertension), the most common age at onset was between 30 and 49. For the three other conditions (heart problems, lung or breathing problems, and vision problems), the onset was most common at age 50 and older. It is possible, as suggested in a recent report from the Institute of Medicine, that children and young adults with once fatal injuries or conditions are surviving to midlife and contributing to the growing need for help at these ages. If so, a lowering of the age of onset of the causal conditions would have been expected during the study period. There were no statistically significant changes in age of onset between 1997 and 2007, but the analysis was limited by the small numbers of people reporting any particular cause.

The fact that the most important causes of disability at ages 50 to 64 are conditions that tend to appear before age 50 indicates possible opportunities for prevention and early intervention. Such efforts might well pay off in reversing the growing disability rates among those in their 50s and early 60s. If successful, such efforts might also help more middle-aged Americans reach the age of Medicare eligibility in relatively better health, contributing to the continuation of a decades-long decline in potentially very costly disability among those over the age of 65. In the shorter term, delaying the onset and reducing the prevalence of disability would facilitate participation in life activities, including employment in the formal workforce, and thus further enhance the predicted longer work lives of baby boomers.

Related Reading

“How Longer Work Lives Ease the Crunch of Population Aging,” Journal of Economic Perspectives, Vol. 24, No. 1, Winter 2010, pp. 139–160, Nicole Maestas, Julie Zissimopoulos.

“Mental Retirement,” Journal of Economic Perspectives, Vol. 24, No. 1, Winter 2010, pp. 119–138, Susann Rohwedder, Robert J. Willis.

“Trends in Disability and Related Chronic Conditions Among People Ages Fifty to Sixty-Four,” Health Affairs, Vol. 29, No. 4, April 2010, pp. 725–731, Linda G. Martin, Vicki A. Freedman, Robert F. Schoeni, Patricia M. Andreski.

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