Living longer, living sicker

Does the fact that Americans are living longer mean they’re also healthier? Not necessarily, according to a new study that appears in the upcoming issue of the Journal of Gerontology.

In fact the researchers identified a rather depressing trend: Average morbidity, or the years of life spent with serious disease or declining functional mobility, has actually gone up. In other words, we may have gained quantity but we’re coming up short when it comes to quality.

The study more or less turns upside down the belief that life expectancy and better health go hand in hand. Among some of its findings:

- From 1998 to 2008, the average number of healthy years has decreased.

- A 20-year-old man in 1998 could expect to live another 45 years without encountering cardiovascular disease, cancer or diabetes. By 2006 this had dropped to 43.8 years. For women, the expectancy of remaining disease-free dropped during this same period from 49.2 years to 48 years.

- The number of people reporting a lack of functional mobility has grown. Functional mobility was defined in the study as the ability to walk up 10 steps, walk a quarter-mile, stand or sit for two hours, and stand, bend or kneel without needing special equipment. The study found that a 20-year-old man today can expect to spend 5.8 years of the rest of his life without functional mobility, compared to 3.8 years a decade. The average 20-year-old woman will likely spend 9.8 years without mobility vs. 7.3 years a decade ago.

- The disease burden appears to be rising. The researchers found an increase in cardiovascular disease among older men, a significant increase in the incidence of diabetes among all adult age groups over 30, and a rising proportion of Americans with multiple diseases.

Some of this may reflect the fact that health care in the U.S. has evolved toward more aggressive identification and labeling of chronic disease. But in an accompanying news release, one of the study’s authors, Eileen Crimmins, said what it “most clearly reflects is increasing survival of people with disease.”

Crimmins, who holds the AARP Chair in Gerontology at the University of Southern California, said the evidence indicates we haven’t been anywhere near as successful in preventing or delaying the onset of disease as we have in preventing death from disease.

“The growing problem of lifelong obesity and increases in hypertension and high cholesterol are a sign that health may not be improving with each generation,” she said. “We do not appear to be moving toward a world where we die without experiencing significant periods of disease, functioning loss and disability.”

For many years, saving lives and extending life expectancy have been the markers of success for everything from heart attacks to cancer. There has been less focus on the hidden cost of longer life spans burdened by disease and what this means in the actual experience of the patient.

In an ideal world, we’d be able to prevent everything. Everyone would live long, healthy lives and die quickly at the end. The more realistic view is that we try to prevent or delay disease as much as possible, and look for ways to help people live as well as possible. On some level, disease and decline are inevitable. This doesn’t have to mean they’re inevitably a burden.

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