POV: Let’s slow the downward trajectory of life expectancy in the United States
For the last century, Americans had been conditioned to see increases in life expectancy—or how long a person in the United States could expect to live, on average, at different timepoints—e.g., at birth, at age 65, at age 85, or even at age 100. Like other gerontologists, I included oft-cited statistics in my talks emphasizing gains in life expectancy at birth over the century—from 1900, when it was less than 50 years to 2000, when it was almost 80 years, and forecasting that life expectancies would likely continue to inch upward in the 21st century.
Popular commentaries abounded about what would happen if we all lived to 100. With life expectancy increasing, attention turned from longevity to active life expectancy. These gross statistics have belied the fact that there were always marked disparities between men and women and people from different racial, ethnic and socioeconomic backgrounds.
What happened in 2020 to life expectancy?
Provisional data from newly released vital statistics for the first half of 2020 are concerning, with the largest drop since World War II when U.S. men’s life expectancy in 1940 dropped slightly more than one year. While notable for its reversal of a long upward trend in longevity, this recent one-year drop had been foreshadowed by a plateauing of life expectancy gains around 2010.
At first these flattened gains were attributed to rising obesity rates, especially severe obesity, which reduces life expectancy dramatically, and then they were attributed to the opioid epidemic, which was killing more than 100 Americans daily.
What do these statistics mean for middle-age and older adults who have been hit especially hard by the opioid epidemic in terms of increased risks for death? Or what do the disproportionate death rates among the older population for COVID-19–related complications mean? It is shocking that 80 percent of COVID-19 deaths are reported in older adults.
It is important to look carefully at the national vital statistics. Just taking the average 65 year old as an example, in 2020 an older person in this age group could expect to live 19.1 more years, versus in 2015 when it was 19.3 more years. However, there have been small gains in longevity at the oldest ages. In 2020 with those age 85 expected to live 6.8 more years versus in 2015, when the number was 6.6 years.
Social determinants of health cannot be ignored. Greater declines are seen in minority populations, particularly Hispanic elders, who have been hit especially hard by the obesity epidemic and the COVID-19 pandemic (from 2015 when it was 21.4 additional years to 2020 when it was 20.6). This drop has actually erased some of the mortality advantage previously experienced by Hispanics.
It is important to note that life expectancy rates are dropping, but by small amounts, so at this time, the additional life years lost in 2020 are minimal. But what also should be noted is the quality of life experienced by older adults during those last years, especially elders in nursing home or assisted living facilities, which mandated reduced visitation and social gatherings. While these life expectancy numbers are statistically small, they represent a life lost or lost meaningful relationships at an age where each year counts.
Policy makers must step up
The decline in life expectancy and associated quality of life among older adults should be a wake-up call to American policy makers and other key stakeholders. There are a lot of uncertainties about the future. Hopefully, the most direct effects of the COVID-19 pandemic will pass in the next year or so.
On the one hand, even prior to the pandemic, there had been a steady drumbeat to combat ageism in American society and to reframe what it means to grow old, and to recognize the contribution of older adults. There were many positive signs on the horizon, with older adults better able to define their own destiny—and to age in place, as well as benefit from the growing availability of home- and community-based services. But on the other hand, the economy has been shaken to its core, and there is an outpouring of groups needing and calling for government resources.
To maintain the gains in healthy aging that older adults have enjoyed over the past decade, it is critical to put policies and programs in place that optimize older adult’s lives, especially elders from disadvantaged backgrounds, who have the fewest resources with which to cope with public health epidemics or pandemics.
Moving forward we need policies that recognize the interconnectedness of people of all ages, and appreciate how families already are being strained by increased care demands from the growing cohort of older adults. Instead of viewing older adults as the problem, we should see them as the bellwether for new ways of building healthier communities and resilient families to support Americans who are young and old—and to turn the tide on the plateauing/declining life expectancy in our nation.
This story originally appeared in Generations Now, a publication of the American Society on Aging.
Marcia G. Ory, PhD, MPH, is Regents and Distinguished Professor in the Department of Environmental and Occupational Health at Texas A&M School of Public Health in College Station, Texas. With a long-standing interest in aging and public health, she is the founding director of the university-wide Center for Population Health and Aging. Her primary administrative role is serving as associate vice president for strategic partnerships and initiatives at the Health Science Center.