
Dateline – Seattle, Washington
It’s check out how things are going with the nonagenarian father and the family weekend which occurs every four to six months depending on work and performance schedules, the balance in the travel fund coffer, and phases of the moon. I’m delighted to say that all appears to be well within the family circle and my father continues to stump around relatively independently and is not wreaking too much havoc on the functioning of his senior living facility. Now I can relax for a day or so before facing the trip home. The trip here was uneventful, just long. It usually takes me about 10 and a half hours door to door but this one was thirteen as I changed in Detroit rather than Atlanta in order to save a few hundred bucks on airfare (which has more or less doubled between BHM and SEA since the end of the pandemic).
Haven’t seen much of Seattle outside of the Aljoya Northgate senior living community but what I have seen is gray and dreary and a good deal colder than Alabama. But, as a child of this climate, I do know how to dress for the weather and I don’t have much issue with mist or gloom. When I come up here, I do a talk for the assembled multitudes in the community conference center which was scheduled for earlier this afternoon. I have perfected by Q and A schtick over the years and a good time was had by all as I fielded soft ball questions about arthritis, incontinence, various medications, sleep patterns, and all of the other things I usually get from elder audiences. Nothing too far in left field this time and a request that I delve more into the politics of health care next time I do one. Happy to get up on that soap box if people will submit questions that lead me down that path.
I’ve been toying with a bunch of ideas which kind of come together under the heading of what I call ‘The Uncertain 80s’ so I’m going to take a few paragraphs to explore that rather than discuss the latest temper tantrums emenating from the toddlers in the executive branch as I think it’s a bit more germane to most of my regular readers, if not due to personal experiences, than due to their participation in family life and society where these issues are very much raising their head.

When I refer to the uncertain 80s, I am not referring to the decade of shoulder pads and excessively moussed hair, but rather to a particular decade of human existence which we experience between our 80th and our 90th birthdays. For most of human existence, humans of the privileged classes who lived to age could expect to reach roughly 70 or so in good health but very few would celebrate an 80th birthday as a robust independent individual. This was codified in Western thought by a phrase of Psalm 90 “The days of our years are threescore years and ten’ (KJV). It’s part of the reckoning that led us to set retirement age in the mid 60s. There was common acknowledgement that after sixty or so things began to physiologically change and that bodies and brains began to slow as the chronic dieases of aging began to take hold and make themselves known.
But life expectancy in the US started to rise fairly rapidly starting in the 1970s – from 70.8 years in 1970 to 72.6 years in 1975 to 73.8 years in 1980. Some of this was the great strides made in medical care. Some of this was the opening up medical care to those of older age through Medicare which began in 1965. Some of this was better understanding of environmental and industrial hazards which caused premature death and new laws and rules to reduce accumulated health risks over time. In the 1970s, your chance of making it to your 80th birthday was a little under 30%. Today, the chance of making it to your 80th birthday is about double that or 60%. However, your chance of making it to your 90th birthday is only about 20%. The 80s, therefore, is the decade which, for most of us, where everything changes.

The Baby Boom officially began celebrating their 80th birthdays about seven weeks ago (as the official demographic start is January 1, 1946 – roughly nine months after the first troops returned from the European theatre). We’re going to have roughly 7,000 new octogenarians daily every day in this country for the next twenty years. Famous names from the first year or so of the boom who have already passed the eighty mark include Goldie Hawn, Bette Midler, and Dolly Parton. Other first year boomers who turn eighty this year are Sally Field, Susan Sarandon, Tim Curry, Sylvester Stallone, Donald Trump, Bill Clinton, George W. Bush, and Cher. They remain a vital cohort still active and contributing and still, as many Silent and World War II generation individuals remain living, considering themselves a youth generation even though thre are three adult generations below them (Gen X, Millennials, and Gen Z).
What is going to happen over the next ten years? It will be different for every one of these newly minted eighty somethings. Some will sail through the decade in robuts good health (likely a minority), others are going to face significant challenges which will cause them to question all sorts of life choices. And we, as a culture, have done little to prepare ourselves either to answer these questions or to ready ourselves for the demands these individuals will make on healthcare and on society as a whole. Thus the uncertain 80s.
Some of the issues are going to be biologic and physiologic in nature as vital organ systems begin to malfunction or wear out. Those with active minds are going to want to keep going leading to strains on systems such as hemodialysis, chemotherapeusis, radiation therapy, and other technologies that can get a few more years out of failing organs. We are already seeing this with the uptick in chronically ill individuals created by the pandemic. Many of these need the services of specialists in long term management of disease such as physiatrists, neurologists and rheumatologists. Getting appointments for establishment in these specialties is now a slow and laborious process. Expect to wait a minimum of six months. Even a small increase in chronic disease burden can have huge ripple effects as these individuals require careful monitoring and multiple appointments over an indefinite future.

No matter what is done, a large chunk of the population will die between their 80th and 90th birthdays. And roughly 10-15% of total health care costs and 30% of total Medicare costs come in the last year of life. This population will send health costs in this country, alrady the highest in the world, ballooning by hundreds of billions, if not trillions of dollars without mechanisms in place to raise these funds.
Some will maintain robust physical health but enter the twilight world of dementia. Dementia appears to be part of the human condition. Most studies suggest that all humans will develop a variant on Alzheimer’s should they continue living indefinitely. The brain wasn’t designed to last for a century or more. It’s not going to add a lot of dollars to the general health bill as our health culture considers dementia, a chronic illness without much of an acute phase, not worthy of medical treatment and pushes the costs of long term care back on individuals, families, and, for those without resources, states under the Medicaid program. Long term care medicaid enrollees are just over 5% of benificiaries but are 40% of the cost of the program. In some states, long term care is already taking 15-20% of state budget allocations and that the demand is about to mushroom.
I am being called for dinner. I’ll try to get back to this tomorrow and complete these thoughts. Feel free to ask questions that need to be answered with part II.





























