Spring 2008

Q & A With Robert N. Butler, MD
Aging Well
Vol. 1 No. 2 P. 42

Gerontologist and Pulitzer Prize winner Robert N. Butler, MD, author of the recently released The Longevity Revolution: The Benefits and Challenges of Living a Long Life, has dedicated significant time and research to the study of longevity in the United States. Aging Well had the privilege of interviewing Butler and on the following pages he offers his specialized insight into longevity, its causes, and its implications.

AW: Is ageism likely to increase or decrease with extended longevity and continuing increases in the elder population?

Butler: At the International Longevity Center, we continue to monitor, to the degree possible, the extent of ageism or age discrimination. It is difficult to determine and define increases or decreases in ageism. If extended longevity is associated with improved health, I would anticipate a reduction in ageism. If, however, we fail to provide proper care for older adults, subsequently increasing the incidence of disease and disability, this may result in increased ageism.

Ageism will be tested in the forthcoming presidential campaign with Sen. John McCain (R-AZ), the presumed Republican presidential nominee. He has campaigned vigorously. Ronald Reagan was effective in his negotiations with the Soviet Union during his second term when he was older than McCain is now. Older leaders often play extraordinary roles in stabilizing countries in crises. We witnessed such stabilizing forces during the tenure of Konrad Adenauer in Germany and Charles de Gaulle in France following World War II.

AW: Is one’s longevity a function of genetics or environment?

Butler: It has been estimated on the basis of the Danish Twin Study that perhaps 25% of our longevity is a function of genetics. We are in a powerful position, holding the key to 75% of our life expectancy in our own hands, which highlights the importance of teaching children from the beginning to not smoke, to eat moderately, and to exercise regularly. It is tragic indeed to see type 2 diabetes in 10-year-old children in America. For the first time in American history, the frightening possibility is raised that these children will not live as long as their parents.

AW: Is the perception of older adults changing? How can we effect a positive change in this regard?

Butler: We conducted a study in collaboration with the National Council on Aging and Harris Interactive. From both the public perspective and older people’s personal perspective, respondents view older persons as younger than they did only 25 years ago. Perception does appear to be changing in a positive direction. This is associated with a decline in both physical and mental disability rates. It has resulted in a famous cartoon in The New Yorker whose caption reads, “Good news, honey—seventy is the new fifty.” The sentiment is now commonly expressed in the media and daily conversation.

AW: What part does the family unit (e.g., married/single parents) play in longevity?

Butler: The family is the true cradle of longevity. If the family is healthy and provides for the healthy growth of the child, it will likely contribute to his or her longevity. It is interesting, too, that married people live longer than unmarried people. This is probably based on practical considerations of availability of someone to assist another when ill. It also undoubtedly reflects the importance to longevity of an intimate relationship. Genes do, however, play a role in longevity. Long-lived families do exist. A significant number of centenarians are from families with other centenarians.

AW: What changes will be required in the U.S. healthcare system to accommodate the increasing number of older adults?

Butler: I believe it’s essential to end the great expense incurred through the private health insurance industry in order to accommodate the increasing number of older adults. We must also restructure the healthcare system to include health promotion, disease prevention, chronic disease management, electronic recordkeeping, long-term care, and end-of-life care.

America spends 16% of its gross domestic product [GDP] on healthcare, whereas the European so-called welfare states require only 10% of their GDP to be devoted to healthcare. These countries are able to cover all citizens and, in general, enjoy a longer life expectancy than the current U.S. life expectancy. Over the last two decades, for example, the United States has dropped among nations from 11th place to 42nd place in life expectancy. It is estimated that up to 20% of our healthcare dollars are spent on matters unrelated to health, that is, marketing and advertising of health insurance, claims adjustment, and profits.

AW: Are employers starting to recognize the need to adapt to accommodate older workers who want or need to work well into their 70s?

Butler: Considerable anxiety in corporate America focuses on the impending retirement of the baby boomers. There is concern not only about the loss of managerial and executive talent but also about the retirement of nurses from the healthcare arena. Additional concern surrounds the impending retirement of air controllers and atomic energy personnel. Thus, industry, government, and employers have necessarily changed their views and attitudes with regard to older workers.
Studies show that it is possible to alter the workplace and work requirements in order to create an environment in which employers can accommodate older workers. Older adults are known to be loyal and productive employees. Continuing to be successful in the workplace is more a matter of function than of age.

AW: What kinds of professions will need to expand significantly to support the burgeoning aging population?

Butler: Both the legal and medical professions will need to expand significantly to support the growing aging population. The medical profession urgently needs more doctors who are better trained to care for older adults. Primary care physicians with the requisite training can provide the necessary care for older adults. Unfortunately, we are confronted with a decline in the number of primary care physicians. This, in turn, necessitates a larger cadre of outstanding academic geriatricians, the teachers who will ensure that graduation from medical school and completion of residency training, regardless of the specialty, necessarily include an understanding of the special issues of aging.

The burgeoning population of older adults, of course, will require increases across the entire range of nursing professions, from paid in-home caregivers to registered nurses to nurse practitioners. We are currently confronted with a major shortage of nurses, including instructors of nursing, creating a serious concern. Clearly, we are going to need more physician assistants, Medicare coordinators, social workers, psychologists, and other healthcare professions.

AW: How can Americans effectively structure their finances to extend over the additional years they’ll likely live?

Butler: Americans are not good savers. It’s essential for them to be taught early in life to become more effective savers. Americans must do better in investing and will have to work longer in order to not outlive their resources.

In short, people are going to have to be more thoughtful in preparing financially for longevity. It is estimated that, on average, baby boomers have only about $40,000 in their 401(k) [accounts] for retirement of two decades or more. Without significant planning and calculated savings, it will be impossible for them to support themselves during two decades of retirement or possibly even longer. People will need to work longer and take much more responsibility in order to finance an increased life expectancy. This is likely to mean that people will have to reinvent themselves throughout their life span, developing new competencies and embarking on new careers.