2008). But the key distinguishing feature of the next generation of older Americans will be their vast numbers.

According to the most recent census numbers, there are now 78 million Americans who were born between 1946 and 1964 (U.S. Census Bureau, 2006). By 2030 the youngest members of the baby boom generation will be at least 65, and the number of older adults (defined in this report as ages 65 and older) in the United States is expected to be more than 70 million—or almost double the nearly 37 million older adults alive in 2005. The number of the “oldest old,” those who are 80 and over, is also expected to nearly double, from 11 million to 20 million. In percentage terms, the portion of the U.S. population that is 65 or older is expected to rise from 12 percent to almost 20 percent.

The major reason for the growing number of older adults in the United States will be the aging of the baby boom generation, but increased longevity will also contribute. During the lifetime of the baby boomers, there has been a variety of improvements in personal health behaviors (e.g., smoking cessation) and advances in medical technologies (e.g., diagnostic imaging technologies and prescription drugs) (Cutler et al., 2007), and these changes have helped to increase life expectancy. For example, the widespread use of cholesterol- and hypertension-lowering medications contributed to a decline in the rate of deaths from cardiovascular disease (NCHS, 2006).

Although advances in longevity are to be applauded, increased life expectancy coupled with new treatments that convert once-fatal disease to lifelong conditions is giving rise to what some observers call “an epidemic of chronic disease” (Anderson and Horvath, 2004). The vast majority of older adults (80 percent) suffer from at least one chronic condition (e.g., dementia, diabetes, hypertension, heart disease) (Anderson, 2003), and chronic diseases are the leading causes of death for older adults in the United States (Kramarow et al., 2007). Chronic disease also brings an increased risk of major depression, which is associated with substantial disability (Moussavi et al., 2007) along with non-adherence to treatment of co-existing medical illness and increased utilization of health care resources (Ciechanowski et al., 2000). Unlike most infectious diseases or acute illnesses, chronic conditions may last for years, place limits on the activities of older adults, and require ongoing care (Anderson and Horvath, 2002). As a result, individuals with chronic conditions tend to use far more health services than others, and care of chronic conditions has fueled much of the increase in Medicare spending over the past two decades (MedPAC, 2007).

The nation needs to prepare to meet the social and health care needs of an older adult population of an unprecedented size. Additionally, as Americans live longer, the composition of the population that is 65 or older will also become more complex with varying characteristics and demands due to the inclusion of multiple generations of older adults (i.e., the 65-year-old

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