Longevity, Ageism, and Cognitive Decline

Journal of Financial Planning: September 2024

By Chris Heye, Ph.D. Chris Heye, Ph.D., is founder and CEO of Whealthcare Planning (https://whealthcareplan.com) and Whealthcare Solutions.
 

Most of us will live longer than our parents and grandparents. A healthy 65-year-old man can expect to live another 17 years, and a healthy 65-year-old woman another 20 years.¹ Many Gen Xers and millennials are expected to make it to age 90 and beyond.

But living a long life (lifespan) and living a physically and behaviorally healthy life (healthspan) are often two very different things. Advances in medicine are likely to help close the healthspan versus lifespan gap in the coming years, but at least two major obstacles to a happy and healthy longevity are likely to persist for the foreseeable future.

Cognitive Decline

The first is cognitive decline. While significant progress has been made in treating cancer, heart disease, and many other serious illnesses, a cure for dementia remains elusive. Alzheimer’s is the only illness in the top 10 causes of death that cannot be cured or even meaningfully slowed. And there are no drugs in the developmental pipeline that promise major advancements in the treatment of dementia. Given the long lags between drug discovery, clinical testing, and government approval, we are at least several years, and perhaps decades, away from a cure for Alzheimer’s.

For most older adults, some cognitive decline is inevitable, and serious cognitive impairment is probable. An average 75-year-old in the United States has a 10 percent chance of having Alzheimer’s or another variant of dementia, and a 12.5 percent chance of suffering from mild cognitive impairment (MCI), i.e., cognitive decline that goes beyond “normal aging” (and which often eventually progresses to dementia). By the time a person reaches age 82, they have a greater-than-50-percent chance of having either dementia or MCI.² By age 90, the likelihood of serious cognitive impairment is greater than 80 percent.

While most people are living longer, cognitive impairment can have serious consequences for their everyday quality of life. Dementia sufferers are not able to manage the activities of daily living or make any kind of meaningful decisions on their own. Few people look forward to living this kind of life. Even for those adults who are not (yet) experiencing cognitive issues, just the fear of dementia may be negatively affecting their emotional lives and lifestyles. Adults in the United States fear Alzheimer’s (79 percent) more than any other disease except cancer (84 percent), even though each year roughly five times more people die of cancer than Alzheimer’s.³ 

Ageism 

The second major impediment to a successful longevity is ageism. A study by AARP found that roughly two-thirds of adults ages 50-plus believe that older workers face age discrimination at work, and nearly all (90 percent) believe that age discrimination is common in the workplace.⁴ Ageism makes it more difficult for older adults to stay in their current jobs, as well as find new ones. A study by ProPublica and the Urban Institute concluded that more than half of all workers over 50 (56 percent) reported being pushed out of their jobs before they wanted to retire. The same study found that only about 10 percent of workers who were let go earned as much in their subsequent jobs.⁵ And most older workers believe that their age is making it harder for them to get a new job.⁶ Workplace ageism is a major threat to a successful longevity for adults who want to continue working, and is especially detrimental to those who need to keep getting paychecks in order to pay their bills.

In addition to the workplace, there is extensive evidence of ageism within the healthcare industry. Roughly one in five older Americans report they experienced age-related discrimination when receiving healthcare services.⁷ Ageism in healthcare delivery is believed to not only lower the quality of care received by older adults, but according to a Yale University study, it can actually provoke new illnesses. The researchers found evidence that ageism produced worse outcomes in a number of conditions, including depression, and resulted in reduced life expectancy.⁸

Cognitive decline and ageism can interact in ways that further limit opportunities and choices for older adults. Ageism is often expressed in condescending attitudes toward, or negative statements about, an older person’s cognitive capabilities. Older adults are referred to as “crazy,” “nuts,” or having “lost their marbles” more often than “frail” or “sick.” Too often, ageism and cognitive decline appear as two sides of the same coin.

Solutions for Successful Longevity

Let’s start with ageism. It is important to understand that everybody ages differently. I have known older adults in their mid-80s who are energetic and incredibly lucid. I have also known people in their 60s who are already experiencing significant cognitive decline. So, it is hard to pick a particular age and say after that date, that’s it.

Using an example that is top of most people’s mind—the current United States presidential election—many people think Donald Trump and Joe Biden are too old to be president. Concerns about Joe Biden’s age and cognitive capacity were so great that he decided to drop out of the race. 

But are they “too old”? 

Using the same approach to estimating cognitive capacity as mentioned above, a person Biden’s age has a 22 percent chance of having Alzheimer’s or another form of dementia and a 23 percent chance of having mild cognitive impairment. Not insignificant numbers.

But let’s take a look at a few other older politicians. While you may not agree with their political views and feel like they are “out of touch” with younger voters, Nancy Pelosi (age 84), Mitt Romney (77), and Bernie Sanders (82) all appear to be as sharp and articulate as ever.

This is why I would hesitate to impose age limits on politicians or members of any other profession. A vital part of combatting ageism is to stop assuming that all older adults are the same. It is also important to recognize that older adults possess experience and knowledge that younger adults don’t have, and that there is something to be learned from all of them.

Reducing the risks that cognitive decline poses to a successful longevity is not easy, especially given the dearth of treatment options, but there are still meaningful steps you can take.

Live a healthy lifestyle. There is no magic bullet for maintaining cognitive health, but research has shown there are many things we can do to delay the onset of cognitive decline. Exercise regularly. Eat a healthy diet of mostly vegetables, fruits, and nuts. Watch your weight. Get enough sleep. Maintain strong social relationships. These may not be sexy options, but they have been clinically proven to work.

Build a team. As we get older, it is especially important to surround ourselves with people we trust who can support us emotionally and help us make good decisions. At a certain point, none of us should be making major medical, financial, or other decisions solely on our own. The team should include trusted family members, friends, and medical and financial specialists. Consult with team members before making a major financial, medical, or legal decision.

Practice self-awareness. The third piece of advice might be the hardest one for many of us to follow, but it might be the most important. We all need to look at ourselves in the mirror and ask if we are still capable of making good decisions. If the answer is “no,” then get help. It is also important to recognize that if the answer is “no,” then that’s OK. We all need help at some point, especially later in life. Accept where you are, make plans to ensure you stay physically, emotionally, and financially safe, and continue with the rest of your life.

As the old saying goes, Father Time is undefeated. We all need to learn to accept the inevitable changes to our physical and cognitive capabilities and also recognize that other older adults are experiencing similar changes, though at different rates of speed. In the end, empathy and compassion will go a long way toward lowering the barriers imposed by ageism and cognitive decline. 

Endnotes

1. Social Security Administration. n.d. “Actuarial Life Table.” www.ssa.gov/oact/STATS/table4c6.html
2. Heye, Chris. 2022. “Examining the Prevalence of Diminished Capacity.” Journal of Financial Planning 35 (8): 62–65. www.financialplanningassociation.org/learning/publications/journal/AUG22-examining-prevalence-diminished-capacity.
3. Worstell, Christian. 2021, June 1. “What Health Conditions and Diseases Do Americans Fear the Most? | 2021 Health Study.” Medicare Advantage. www.medicareadvantage.com/news/most-feared-heath-conditions-report. 
4. Choi-Allum, Lona. 2022. “Age Discrimination Among the 50+: Annotated Questionnaire.” AARP. www.aarp.org/research/topics/economics/info-2022/workforce-trends-older-adults-age-discrimination.html.
5. Gosselin, Peter. 2020, March 2. “If You’re Over 50, Chances Are the Decision to Leave a Job Won’t Be Yours.” ProPublica. www.propublica.org/article/older-workers-united-states-pushed-out-of-work-forced-retirement.
6. Perron, Rebecca. 2021. “Ageism Could Hurt Job Prospects, Say Job-Insecure Older Workers.” AARP. www.aarp.org/pri/topics/work-finances-retirement/employers-workforce/ageism-job-security-older-workers/.
7. Pecci, Alexandra Wilson. 2015, April 10. “1 In 5 Adults Report Age Discrimination in Healthcare Settings.” HealthLeaders Media. www.healthleadersmedia.com/clinical-care/1-5-adults-report-age-discrimination-healthcare-settings.
8. Greenwood, Michael. 2020, January 16. “Harmful Effects of Ageism on Older Persons’ Health Found in 45 Countries.” Yale School of Medicine. https://medicine.yale.edu/news-article/harmful-effects-of-ageism-on-older-persons-health-found-in-45-countries/.