Consider Britain's Queen Elizabeth, still gadding about on horseback at age 90. "Ninety just isn't what it used to be," a friend of mine commented.
The Express calls the queen "the remarkably sprightly monarch," but a new paper, co-authored by Harvard health economists, suggests her nonagenarian activity may not be quite as remarkable as it once was. It quantifies what many of us have observed: Not just 90, but 70 and 80, aren't what they used to be. You can see enviable quality of life among more older people than ever these days. And the new research pinpoints two significant contributors: healthier hearts and sharper eyes.
There’s been some bad news lately about life expectancy: After decades of improving longevity, death rates have risen a bit among middle-aged white Americans. But in the higher age brackets — people over 65 — the new study offers some better news: Americans are living not just longer but healthier, less disabled lives. The findings serve as a counter-weight to concerns that extending longevity may mean mainly more years of low-quality — and medically expensive — life.
I spoke with Harvard economics professor David Cutler, who co-authored the study looking at national data on mortality and health status from the early '90s through the late 2000s. He distilled the math to this: If you're a typical person who reaches age 65, you can expect 11 years of disability-free life and about eight years of disabled life. The health shift over the last couple of decades has given you two more disability-free years, and a half-year less of disability. The upshot: We're living longer, on average, but spending less time disabled.
Our conversation, lightly edited:
DC: What we were doing in this study was looking at the question: As people were living longer, to what extent were they living healthier? Are the years that we’re adding good years or less good years? The interesting thing is that not only are people living longer, but the amount of time that they’re living healthy is going up by even more. The time people are spending disabled is falling, even though they’re living more total years.
From the early 1990s through the late 2000s, people lived an additional 1.3 years on average. Disability- free life went up by 1.8 years and disabled years went down by half a year.
So this is good news?
It is good news. It’s good news both personally — that is, people want to live and enjoy life — and it’s also good news for society, in the sense that being healthy, people don’t use a lot of medical resources. The fear many people had is that what we were doing with medical interventions was extending life but not particularly high-quality life, and it was extremely expensive life, and that’s not what we’re finding.
And what's making the difference?
If you look at why people say they’re healthier, what conditions they don’t have, or still have but they're not as disabling, two things pop up. The first one is reduced mortality and morbidity from cardiovascular disease: heart disease and strokes. We don’t know exactly why, but at least a good part of that is likely to be the revolution in statin drug availability and use that came about over this time period. There are many fewer cardiac events, many fewer heart attacks, many fewer recurrent episodes, and people who’ve had an episode seem to be much healthier.
And the second?
It's really very interesting and not something people have focused on at great length: It's vision problems. The biggest change over the period of time we looked at was the very widespread diffusion of cataract surgery, to more people at an earlier stage of vision impairment. Cataract surgery has become much easier, much less expensive, much more available — and it seems to have had quite a marked impact, certainly on the quality of life. Many fewer people report disability associated with vision problems than used to.
This is an example of the smaller things that influence disability — many of which we don’t normally think of. One of them that's improving a lot is vision, but there are other things you see and say, 'If only we could make progress against X.' In this case, X might be something like arthritis, which is very disabling and for which we've not made anywhere near as much progress.
So if people are living longer with less disability, does this raise the question of whether we should raise the age of Medicare or Social Security?
If it were happening uniformly in the population, you could imagine that would be a reasonable policy; that is, if people are living longer, healthier, then it’s natural to say people should work until later ages. But I would’t reach that conclusion without doing the analysis by socio-economic status.
One of the things we've seen in other work is that life expectancy at age 40 is increasing much more in higher-income groups than lower-income groups. One wants to be really, really careful not to make policy that affects everyone based only on the average, if there are systematic differences between some groups and the average.
What we'd like to do next is to extend our results and look at how disabled life expectancy and disability-free life expectancy is changing by socio-economic status. We don't know that yet.
Readers, thoughts? Questions? Read the full paper here.