Grand Challenges of Our Aging Society

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Amy Smith, Rapporteur Center for Economic, Governance, and International Studies Division of Behavioral and Social Sciences and Education

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Gov- erning Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engi- neering, and the Institute of Medicine. The members of the Steering Committee for the workshop were chosen for their special competences and with regard for appropriate balance. This study was supported with internal funds from the National Academy of Sci - ences. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number-13: 978-0-309-15010-1 International Standard Book Number-10: 0-309-15010-8 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Copyright 2010 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council. (2010). Grand Challenges of Our Aging Society: Workshop Summary. Amy Smith, Rapporteur. Center for Economic, Governance, and International Studies, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal govern - ment on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its mem - bers, sharing with the National Academy of Sciences the responsibility for advis - ing the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in pro - viding services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR THE ACADEMIES-WIDE INITIATIVE ON THE GRAND CHALLENGES OF OuR AGING SOCIETY Ronald lee (Chair), Center for the Demography and Economics of Aging, University of California, Berkeley RobeRt H. binstock, School of Medicine, Case Western Reserve University RobeRt n. butleR, International Longevity Center, New York JuditH campisi, E.O. Lawrence Berkeley National Laboratory, Berkeley, California lauRa l. caRstensen, Department of Psychology, Stanford University JosepH F. cougHlin, Engineering Systems Division, Massachusetts Institute of Technology eileen m. cRimmins, Davis School of Gerontology, University of Southern California RobeRt m. HauseR, Center for Demography of Health and Aging, University of Wisconsin–Madison James s. Jackson, Institute for Social Research, University of Michigan cHaRles m. lucas, Osprey Point Consulting, Deer Isle, Maine david b. Reuben, Multicampus Program in Geriatric Medicine and Gerontology, University of California, Los Angeles david R. WeiR, Institute for Social Research, University of Michigan Jane l. Ross, Study Director tRacy HaRRis, Senior Program Officer connie citRo, Center Director baRney coHen, Board Director RogeR HeRdman, Board Director susan van Hemel, Senior Program Officer baRbaRa WancHisen, Board Director scott Weidman, Board Director gooloo WundeRlicH, Senior Program Officer baRbaRa boyd, Administratie Coordinator katHleen saslaW, Assistant Director, Finance 

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Acknowledgments T his report summarizes the proceedings of a workshop that focused on the development of high-priority topics in aging research. Over a year ago the presidents of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine launched an initiative focused on the challenge of shaping policies and programs that exploit the benefits of increased longevity and enhanced health for individuals and for society. The intent of the initiative was to develop a broad portfolio of studies and related activities that would contribute to an evidence-based dialogue on population aging. The initiative was also designed to contribute to the development of sound program and policy options related to an aging society. The two-day workshop on which these proceedings are based included presentations by experts in many aspects of aging and discussion with a broad range of invited guests. The substance of the workshop was developed by the Planning Committee for the Academies-Wide Initiative on the Grand Challenges of Our Aging Society. The workshop was supported by the Presidents’ Fund. This workshop summary was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accor- dance with procedures approved by the Report Review Committee of the National Research Council (NRC). The purpose of this independent review is to provide candid and critical comments that assist the institu- tion in making its report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness ii

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iii ACKNOWLEDGMENTS to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. The panel thanks the following individuals for their review of this report: Andrea Louise Campbell, Department of Political Science, Massachusetts Institute of Technology; Laura L. Carstensen, Department of Psychology, Stanford Center on Longevity, Stanford University; Joshua R. Goldstein, Office of the Executive Director, Max Planck Institute for Demographic Research, Rostock, Germany; and Barbara Boyle Torrey, Population Reference Bureau. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the content of the report, nor did they see the final draft of the report before its release. The review of this report was overseen by Beth J. Soldo, Population Aging Research Center, University of Pennsylvania. Appointed by the NRC, she was responsible for making certain that the independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the report rests entirely with the author and the NRC.

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Contents 1 INTRODUCTION 1 Grand Challenges of Our Aging Society, 1 Introductory Remarks, 2 Ronald Lee 2 BIOLOGICAL RESEARCH, MEDICAL ADVANCES, AND ETHICAL CONSIDERATIONS 5 Extending the Life Span, 5 Richard A. Miller The Biology of Frailty, 7 Linda P. Fried Allocating Scarce Health Care Resources, 10 Daid B. Reuben 3 ENHANCING HEALTHY AGING 15 Strategies for Health Promotion, 15 Robert N. Butler Obesity Among Older People, 16 Gordon L. Jensen Exercise and Cognition, 18 Arthur Kramer Racial Disparities and Communication, 19 M. Chris Gibbons ix

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x CONTENTS 4 MACROECONOMIC AND FINANCIAL IMPACTS 23 General Macroeconomic Overview, 23 Axel H. Börsch-Supan Macroeconomic and Financial Impacts of Aging, 25 Robin Brooks An International Perspective, 27 Daid Canning 5 INCOME SECURITY AND HEALTH CARE FINANCING PROGRAMS 31 Income Security for an Aging Population, 31 Alicia Munnell Health Care Financing, 34 Kenneth M. Langa An International Perspective, 37 Andrew Mason 6 SOCIAL INSTITUTIONS AND POLICIES 41 Will Institutions and Policies Permit Sufficient Flexibility?, 41 Phyllis Moen The Growing Imperative for Structural Change, 43 Richard V. Burkhauser 7 COMMUNITY RESPONSES 47 Transportation, 47 Sandra Rosenbloom Technology, Aging, and Innovation, 50 Joseph F. Coughlin 8 SUMMARY DISCUSSION 55 Reaction of Discussants, 55 General Audience Discussion, 58 APPENDIxES A Agenda 61 B Selected Recent National Academies Publications on Aging Issues 65 C Biographical Sketches of Planning Committee Members and Presenters 69