| Less Dementia, More Physical Disability

| Harry Margolis

| Reposted with permission from Risking Old Age in America on Substack

| I’ve been ringing the alarm about the coming elder care crisis with the aging of the baby boom generation. It’s simply a numbers game: the risk of dementia and other disabilities increases dramatically with age — more older old folk means more people needing assistance.

But what if that’s not true, if increased age doesn’t lead inevitably to a greater risk of disability or if the rates of disability are declining? That’s what The Economist reports is happening with respect to dementia.

Dementia

Studies find that the rates of dementia in a number of developed nations including the United States, the Netherlands and Finland have been declining at rates of 13% to 20% per decade. As this Economist chart shows, while one in three adults born at the end of the 19th century who made it to their late 80s had dementia by then, for those born in the late 1930s, only a bit more than one in ten exhibited dementia at the same age.

This could have a huge impact on the need for care in the future. That need will still grow since there are so many baby boomers, but at a much slower rate. A Dutch study projected that the number of people with dementia in the Netherlands will increase 43% between now and 2050 instead of doubling as it would without the new more optimistic findings.

The reasons for lower rates of dementia appear to be related to better cardiovascular health in general, especially fewer people smoking, and better control of high blood pressure and cholesterol. Better education also appears to increase cognitive health during the entire life course.

More recently, The Economist reports, scientists have found that the shingles vaccine has reduced the risk of suffering dementia by 20%. On the other hand, efforts to find a cure for Alzheimer’s disease have so far proven ineffective.

But What about the Baby Boomers?

Now the bad news: I was surprised to learn about a new study published in Health Affairs finding evidence that more younger seniors, between the ages of 65 and 74, are suffering from disabilities than in the past.

The study, titled “Trends In Care Needs Among Older US Adults Diverged By Age, 2011–22,” compared the status of older adults in 2011 with those in 2022. In 2011, the oldest baby boomers were turning 65. By 2022, the oldest were 76 years old and most were at least 65. So for the youngest cohort, those between ages 65 and 74, this is a comparison of baby boomers with older generations.

The report found two trends going in opposite directions. Between 2011 and 2022, the number of adults aged 75 or older either receiving care or reporting some difficulty but not receiving care declined. At the same time, more of those aged 65 to 74 were receiving care or reported some difficulty but were not receiving care.

In other words, the so-called “silent” generation is doing better than the older adults who preceded them, which is consistent with The Economist report on dementia, while the baby boomers are faring worse than the silent generation.

Looking at the 65 to 74-year-old age cohort, between 2011 and 2022 it became somewhat more diverse ethnically, better educated, and had a lower history of heart disease and heart attacks. As mentioned above, more education has been associated with lower rates of dementia, yet the study finds that “this countervailing trend was not strong enough to offset increases in disability and care among the younger age group.” Apparently, at the same time rates of dementia are declining, rates of physical disability are increasing.

Obesity?

While the study doesn’t explain why baby boomers are faring worse than their elders, my guess is the reason is greater rates of obesity. This has been long predicted.

Decades ago, I had the opportunity to interview Dr. Robert Butler, often called the father of gerontology. I asked him about the prospects for baby boomers, fully expecting them to be great given my impression that we were eating healthier foods and all either jogging or doing aerobics with Jane Fonda. I was surprised by his response that he was not sanguine about our generation due to the increasing rates of obesity.

If this is true, perhaps the advent of GLP-1 drugs will reverse the trends.

A longtime elder law attorney, Harry Margolis founded ElderLawAnswers.com, answers consumer estate planning questions at AskHarry.info, and hosts the podcast Risking Old Age in America.