Americans Are Living Longer, But Not Better

Americans are living longer than ever, the government reported last week. But that seemingly good news (who wants to die young?) is more of a mixed blessing than might be apparent at first. That's because it does not address the quality of life during those added months and years of existence. In particular, it does not address our nation's ongoing failure to generate novel solutions to the problem of what to do with the quickly growing population of elders who cannot live independently and are in need of varying levels of long-term care.

Current estimates are that the number of Americans older than 85 will quadruple by 2050, to 18 million from today's four million. A huge proportion of these people will require some kind of ongoing help with the tasks of daily living. Yet as spelled out last year in a Center for American Progress report by Lisa Eckenwiler, "Caring About Long-Term Care," the vast majority of our elderly will not get the benefit of professional long-term caregivers because of the lack of resources or lack of available programs in their communities.

The worst thing that could happen is for people to gain extra years of life and wish, for lack of decent care, that they'd had an earlier exit.

In fact, 80 percent of the nation's long-term care is provided by unpaid caregivers, mostly family and friends. There are many obvious benefits of keeping at least a portion of long-term care in the family, but it is not practical in many cases to expect family members to be able to carry the entire burden. At least 60 percent of those unpaid caregivers are already busy with their own jobs.

Meanwhile, few employers offer assurances of help for employees who need to care for aging relatives. And the Family and Medical Leave Act, which assures up to 12 weeks of unpaid leave for such purposes, still applies to only a fraction of employers and, if anything, has lately come under threat of being weakened by business lobbyists.

As last week's report showed, the need is only going to grow. In 2006, the latest year for which data are available, U.S. life expectancy grew to a record high of 78.1 years, up from 77.8 a year earlier. Death rates from all the major killers dropped, including cancer, heart disease, stroke, high blood pressure and diabetes. In fact, diabetes dropped from the No. 6 leading killer to No. 7, overtaken by Alzheimer's disease.

In large part this reflects a payoff of years of basic research by federally funded researchers, especially those supported by the National Institutes of Health, according to Robert Palazzo, president of the Federation of American Societies for Experimental Biology. "Thanks to NIH research, millions of deaths from heart disease have been averted, millions more people have survived cancer, and deaths from diabetes have decreased dramatically," he said in a statement. Yet as Palazzo and others have noted with increasing alarm, the $27 billion agency -- considered the crown jewel of U.S. biomedical research -- has been flat-funded for five years now.

Clearly we need to renew our nation's commitment to high-quality research aimed at understanding the mechanisms of the major diseases. But at the same time, we need to develop a comprehensive approach to caring for all the people who will benefit from those discoveries. Eckenwiler notes that among the problems contributing to the long-term care crisis is an overemphasis on research relating to acute medical problems, and an inadequate research focus on medical and social management of the chronic conditions that lower the quality of life for long-term survivors.

This fragmented approach to medicine, which emphasizes specialists focused on their part of a patient's problems instead of taking a holistic approach to patients' needs, is out of step with the rising longevity of the American people. And this fragmentation is mirrored in the conflicting payment structures for different kinds of care.