Junkfood Science: Baby Boomer blues

April 24, 2007

Baby Boomer blues

“Could Baby Boomers Be Approaching Retirement in Worse Shape Than Their Predecessors?” Last month, the National Institutes of Health issued a press release posing this question. The answer was supposedly found in a survey it was promoting that had been published by the National Bureau of Economic Research, a private, nonprofit, economic research organization.

It was a gloomy paper, indeed. Its dire findings “portended poorly for the future health of Boomers as they age...and possibly increasing health care costs for society.” But like most reports bearing scary bad news anymore, those darn facts keep getting in the way of the fears.

The flaws in the paper were so obvious and its conclusions so clearly contradicted the evidence, that few healthcare professionals took the survey seriously. But clearly some people had. On Friday, ABC television reported this study as evidence that Baby Boomers may be the first generation to enter their golden years in worse health than their parents. A syndicated Washington Post article, picked up by papers across the country this weekend, proved to be the source of the story.

Baby Boomers Appear to Be Less Healthy Than Parents

While not definitive, the data sketch a startlingly different picture than the popular image of health-obsessed workout fanatics who know their antioxidants from their trans fats and look 10 years younger than their age.

Boomers are healthier in some important ways — they are much less likely to smoke, for example — but large surveys are consistently finding that they tend to describe themselves as less hale and hearty than their forebears did at the same age. They are more likely to report difficulty climbing stairs, getting up from a chair and doing other routine activities, as well as more chronic problems such as high cholesterol, blood pressure and diabetes. Baby boomers interviewed in 2004 reported being in poorer health than people of the same age interviewed 12 years previously, according to a study by University of Pennsylvania researchers....

Of no surprise, the obesity epidemic, poor diets and sedentary behaviors, were pointed to as the reason for these unhealthy trends and rising disability rates. According to the article, despite all of those gym memberships, even those trying to take care of themselves aren’t being entirely successful. The article portrayed a 57-year old who walks and swims regularly, “watches what he eats, and fights to keep his weight down.”

He takes medication to keep [his blood pressure] under control. His cholesterol jumped, too, requiring another pill to keep that in check. Then his blood sugar started going up, prompting his doctor to remind him that he really should drop at least 10 pounds if he wants to avoid diabetes. “There are the creeping aches and pains. I dislocated my shoulder once, and that continues to bug me. I have knees that decide to be wobbly on occasion. I know that as you get older things tend to begin to fall apart," Kirkland said, adding that he gets fever blisters and that his psoriasis flares up when he is stressed....

To the story’s credit, the lead author of the survey, Beth J. Soldo, Ph.D., at the Pension Research Council at the University of Pennsylvania, was quoted as saying it was unclear if babyboomers were really sicker or simply more health conscious and had higher expectations of what good health means, making them more likely to notice and complain about symptoms that earlier generations would have accepted as part of getting older. But while it made a brief mention that some were skeptical of the findings, noting life expectancies have been steadily decreasing for decades, along with a drop in disability rates, the article was predominated by sensationalized concerns:

“the findings so far are ominous” [Kenneth Manton]

“it doesn’t bode well for society, it’s quite worrying” [Richard M. Suzman]

“it’s very disturbing” [Mark D. Hayward]

“it’s worrisome” [Robert Hummer]

“it’s pretty scary” [John Mirowsky]

No it isn’t.

The need for good, unbiased health information — not insupportable alarm— runs deep no matter what age we are. Because this study is both worrying people and an indication of what worry can do to us, it’s worth taking a brief look at its primary flaws. It can help us put concerns into perspective and recognize what’s really going on.

There were two significant problems with this study: it was a survey and based on subjective perceptions. Since it didn’t use any actual health measures, it shouldn’t surprise us that its findings didn't concur with actual real-life evidence, either.

Being an opinion survey differentiates it from more dependable medical studies. As we’ve repeatedly covered here, surveys are easily-manipulated marketing creations. The results of this survey happen to support the government’s ongoing scare campaign to convince us that we are all unhealthy and disease-ridden, getting sicker, and in need of their programs and oversight to prevent us from dropping dead. It is essentially marketing through fear of death and disability.

Think about most everything we hear from government agencies and the media anymore: alarming predictions to create anxiety about ill-health in our future, inflated prevalence claims and expanded definitions of diseases, medicalizing normal conditions of human existence (heartache, heartburn to headaches), warnings that we all must be under constant diligence to monitor our healthy bodies for signs of potential ill-health and seek interventions at earlier stages to prevent death.

We’ve been inundated over the past decade by intense health promotion — which is really disease promotion. And it’s increasingly shaping our perceptions of what it means to be healthy and our own perceptions of how we feel, sick or well. Given the climate of fear surrounding us, more of us are finding it hard to feel especially well. In actuality, only a small minority of us are sick at any one time, and most of us are healthy, meaning there’s a lot more money to be made targeting healthy people.

If we tallied up the numbers of Americans we’re told have some ailment, it would be 1.5 billion sick people, five times the population! Add to those all of the “pre-diseases” and it gets really over the top.

Are we all really that diseased? Of course not, but it sells a lot of preventive health programs, screenings, pills and research to make us think we’re sick, or soon will be, or scared about the possibility. And if we’re not quite sure there’s anything wrong with us, they’ll find something. For good or bad, all of the screening, fancy diagnostic scans and blood tests also pick up health issues that our parents’ generation wouldn’t have even been aware of or concerned themselves with.

Healthcare professionals are increasingly questioning if today’s escalating focus on preventive health messages are harming people’s well-being. In a critical examination in the British Medical Journal, Dr. Iona Heath of Caversham Group Practice in London, wrote that “the more people are exposed to doctors and contemporary health care, including the rhetoric of preventive care, the sicker they feel.... [As a result] achievement of longer and, by all objective measures, healthier lives, may result in those lives being increasingly dominated by feelings of illness and fear.” Simply being labelled at risk or surrounded by risk information also “casts shadows of doubt and insecurity over people's lives and undermines their experience of integrity and health,” said Dr. Heath. As we’ve looked at, even being told their blood pressure is too high results in people feeling sick and calling in sick more.

Anxiety, stress and social problems can lead people to feel unwell in the absence of any disease, cause symptoms, and lead to the ready adoption of the sick role, where they feel less confident about their health and their ability to care for themselves, and become more dependent on doctors and medicine.

As Anita Evangelista, a nurse practitioner in Aurora, Missouri, wrote in response to Dr. Heath’s article:

[I]n my clinical practice, there is also no doubt that most of my day is spent attending to patients who are not “truly” sick — their condition is self-limiting, the type of illness which our mothers and grandmothers would have treated with epsom salts or cod liver oil or mustard plaster ....to just as good effect as our costly sprays & pills. I find it hard to accept the truth that we have bred a generation of adults who don't know the most simple self-care during transient illness...Not only that, they fully expect to be cared for and medicated for all conditions large and small through the lifespan.

Which brings us to the second problem with this study — its basis on subjective perceptions. The authors used a survey questionnaire developed in 1992 and all health measures were from self-reports of perceptions of health, and the participants’ answers to questions about if they’ve ever had various aches and pains or been told by a healthcare provider that they have certain conditions. The researchers reported that fewer of today’s early Baby Boomers than earlier generations rated their health as excellent to very good — down to about 50%. While slightly fewer surveyed said they were free from chronic conditions, the percentage reporting psychiatric problems had tripled.

Perceptions, while very real to us personally, are inaccurate measures of clinical reality. Using subjective measures (energy, fatigue, aches, quality of sleep, etc.) is a technique also frequently found in faulty research used to support alternative modalities. Our perceptions can be so easily manipulated, in part through the nocebo and placebo effects. As we’ve talked about here, fear, anxiety and beliefs that we might be sick can make us feel simply awful. We can be led to attribute even normal aches and pains as being abnormal and indicative of something seriously wrong with us. These effects are well-recognized and so profound that to account for them, the most careful clinical trials are double-blinded with a placebo or control group.

Discrepancies between patients’ perceptions of their health and their doctor’s evaluation or objective reality are quite common. This phenomenon has been explored in the medical literature for decades. Countless classic medical studies have shown that perception of health and whether people feel well or ill, has little relationship to the severity of clinical symptoms or disease.

Many with chronic diseases or disabilities rightly see themselves as generally healthy, just as elderly people do, and they have good quality of lives because they have realistic ideas of what being healthy means and take their individual health challenges in stride as part of life.

How people view their health is very much influenced by their situation, culture, expectations and social experience. As Nobel prize winner, Amartya Sen, explained in a recent issue of the British Medical Journal, self-reported health problems are best viewed as part of social studies, not objective medical research, because they can “thoroughly mislead public policy on health care and medicine.” He compared destitute and better-off populations in India and those in America and found the highest self-reported instances of poor health among those who were the healthiest and living the longest. Looking just at self reports of health problems could mistakenly lead us to believe Americans were in poorer health than starving peoples in Bihar, India, where average life expectancies are decades less than ours:’

So reporting more health problems is not the same as actually having more health problems.

Today, our pampered culture is coming to define health in narrow terms to mean eternal youthfulness, free from any aches and pains, unpleasant symptoms or the natural changes and limitations that come to our bodies as we grow older — things our parents and grandparents calmly accepted as a natural part of aging. We’ve come to see aging as a preventable disease that can be forever forestalled by living a healthy life and we believe that if we don’t have the same body we had at 20 then something must be wrong with us. We’ve come to fear aging like never before.

Whenever we find ourselves feeling fearful, it’s time to look for the most impartial evidence we can find. By all objective evaluations of our health, we’re living longer, healthier lives than ever before and there’s no evidence that these positive trends are going to suddenly go into reverse. We can’t ignore the actual government health statistics that continue to demonstrate good news in increasing life expectancies and lowering rates of chronic diseases, such as heart disease and cancers.

Even as surveys go, this one’s conclusions were far more pessimistic than the National Health Interview Survey that has been conducted by the CDC's National Center for Health Statistics regularly since 1957. Their latest report, issued last December, found that about 85% of adults aged 45 to 64 years of age rated their health as excellent to good.

And claims that our health is deteriorating and that aging is leading to disability so serious it threatens our economic future were contradicted in a recent study funded by the National Science Foundation. Published by the NBER last fall, it examined “The Growth in the Social Security Disability Insurance Rolls.” It reported that while the numbers of U.S. adults collecting disability benefits has risen over the past twenty years to 4.1 percent, disability rolls are still well below most other developed countries. What was most enlightening, was what the researchers found when they looked at why our disability rolls have grown:

The most important factor is the liberalization of the DI screening process that occurred due to a 1984 law. This law directed the Social Security Administration to place more weight on applicants' reported pain and discomfort, relax its screening of mental illness, consider applicants with multiple non-severe ailments, and give more credence to medical evidence provided by the applicant's doctor.

These changes had the effect of both increasing the number of new DI awards and For example, the share of awards for a primary shifting their composition towards claimants with low-mortality disorders.impairment of mental illness rose from 16 percent in 1983 to 25 percent in 2003, while the share for a primary impairment of musculoskeletal disorders (primarily back pain) rose from 13 per-cent in 1983 to 26 percent in 2003.

And specifically looking at if disability can be blamed on aging and worsening health, they concluded:

[T]he aging of the U.S. population has made only a modest contribution to the growth of the DI program, accounting for 6 percent of the increase. Changes in the health of the population are also deemed to have had a small effect at most.

But the best evidence of all to defuse distress about old age was a large study of Medicare enrollees and actual medical expenditures published in the December issue of Proceedings of the National Academy of Sciences. It received practically no media attention, perhaps because the news was good!

The study was conducted by Kenneth G. Manton, Ph.D., and colleagues at Duke University and looked at chronic disability among older Americans. They found that not only had disability dropped dramatically over the past two decades (from 26.5% in 1982 to 19% in 2004/5), but the rate of decline is accelerating. Notably, this is also while “obesity rates” have increased. They reported that the health and function of older Americans is continually improving.

In other words, not only is life expectancy dramatically getting better, so is our quality of life. A few of their uplifting findings were:

· Rates of all types of chronic disability had decreased among those over 65, with the greatest improvements seen among the most severely impaired.

· The proportion of people without disabilities increased the most in the oldest age group, rising by 32.6 percent among those 85 years and older.

· The percentage of Medicare enrollees age 65 and older who lived in long-term care institutions such as nursing homes dropped dramatically from 7.5 percent to 4.0 percent.

According to the researchers, “the combined effects of declines in Medicare per capita costs in the nondisabled elderly population aged 65–84 and the increase in the size of the nondisabled population reduced Medicare expenditures in 1999 by $26 billion.” If this continues as anticipated, the researchers said, it would help bolster the outlook for Medicare program’s fiscal health.

What did they attribute these positive findings to? They suggested various contributing factors, including improved medical care, increasing levels of education, better nutrition and physical activity, and smoking cessation.

“This continuing decline in disability among older people is one of the most encouraging and important trends in the aging of the American population,” said the director of the National Institute on Aging, Richard J. Hodes, M.D.

Fears have a sad way of getting the better of us and have led so many to live in fear of aging and getting sick sometime down the road. Sadly, those fears and the constant dire claims about aging may be why we’ve come to believe older age is not a time of our life to cherish or value, and why as a society we fail to treasure the seniors in our life as do other cultures.

Aging gracefully may best be achieved by keeping our critical thinking skills sharp, objectively questioning scary things we hear, and recognizing that our fears may just be the biggest thing keeping us from feeling our best at whatever age we are.

© 2007 Sandy Szwarc

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