Mental Health: Another Dimension of Health and Ageing

1. Introduction

Life expectancy in the United States continues to rise, reaching another all-time high of 77.6 years. While long life is almost always celebrated, it is merely the quantitative aspect of one’s existence. How the quality of life of a long-lived individual is affected by a prolonged period of living is a question not posed often enough. One of the major concerns of a long life is the possibility of ill health since the chances of frailty and dependency tend to rise with age. This paper discusses issues concerning quantity of life and quality of life in the context of health and ageing. Although the frame of reference is that of the United States, some of the observations and implications may have relevance for other countries as well1.

2. Background

The past few decades have witnessed profound changes in the population structure and family patterns in the United States and in many other parts of the world. These changes raise concerns for individuals, families, and society over many issues, both financial and non-financial, all of which bear on the quality of life in its many dimensions.
Many older persons and their families are already coping with the consequences of changes and losses associated with growing older. The magnitude of this type of challenge will multiply in future years with the ageing of those born during 1946 and 1964, the ‘baby boomers’. One reason is the sheer size of this cohort, some 76 million strong. Another reason is the changes in family patterns. Still another is the increase in the proportion of older people in the total population due to lower fertility rates in recent decades. A compounding factor is that of increasing longevity.
At the societal level, there is growing awareness that increasing life expectancy, which has led, among other factors, to more years spent in retirement, generates enormous funding pressures for social security, healthcare, and long-term care.
With respect to long-term care, the new challenge in the next decades is the juxtaposition of the growing number of individuals in advanced older ages (‘ageing of the elderly’) against the diminished availability of family caregivers. By 2040, the number of Americans aged 65 to 84 will more than double from the current 30.5 million to 62.9 million, but the number of those 85 or older, now about 4.3 million, will more than triple (to 14.3 million). The 85+ population raises policy concerns because many more among them are prone to disability than those in younger groups such as the age 65 to 84 population.
Traditionally, informal caregivers (unpaid family members and friends) have met the bulk of long-term care needs. However, such care is becoming less and less available due to fewer children in the family, more childless families, higher divorce rates, more single-parent families, increased labour-force participation by women, geographical dispersion of family members, and the rising incidence of family members being unable to care for their older relatives due to their own health impairments.
The last-mentioned factor invites a closer examination when greater longevity becomes a significant factor. When people live to their 80s and 90s or beyond, it should be recognized that their children would be in their 60s and 70s or older, and their grandchildren would be in their 40s and 50s or older. It is not difficult, therefore, to appreciate the logistical, physical, emotional, and financial issues faced by younger members of the family in rendering assistance to their older relatives. While informal care is and will remain very important, greater longevity brings more urgency to the need for reforming the way we fund and deliver long-term care.
At the micro level, however, attention is lagging when it comes to the question of how individuals and families may protect their financial security and health status under conditions of extended periods of living that come with improved longevity. Even less attention has been paid to the effects a long life may have on the quality of life of the individual and his or her family. Quality of life may be adversely affected by financial concerns, as well as by conditions of physical and mental health that may accompany greater quantity of life.
While physical health issues are more generally recognized, mental or emotional difficulties are much less understood as issues exacerbated by ageing. For example, while those aged 65 or older represent some 13% of the total population, they account for nearly 20% of all successful suicides. Anxiety and depression are more prevalent among older people, but they often go unrecognized and hence under-treated. With changes in social conventions experienced by the modern family, relational issues among members of the extended family tend to become more complex, often contentious, and sometimes conflicted. Consequently, mental health issues may grow in frequency and intensity, with emotional burdens on all concerned but more so on older members of the family. Consequently, it appears important to emphasize the interactions between physical health and mental health.
To summarise, during the coming decades, retirement of the 76 million baby boomers will pose significant challenges for society as well as for boomers themselves and their families. These challenges stem partly from the fact that the younger segments of population have far fewer numbers of persons available to work and pay taxes to defray the costs of public and private retirement benefits, healthcare, and long-term care. At the same time, changing family patterns and increasing longevity compound the problem. In other words, lower fertility, greater longevity, and family pattern changes present new challenges — making it more difficult for society as well as for individuals and their families to prepare for old age, financially and otherwise, which has a notable impact on the quality of life. In short, quality of life issues tend to intensify as quantity of life increases.

Yung-Ping Chen: holds the Frank J. Manning Eminent Scholar’s Chair in Gerontology, University of Massachusetts Boston, MA 02125, U.S.A. A delegate to the 2005 White House Conference on Aging, he has attended, either as a delegate or consultant or both, the 1971, 1981, and 1995 White House Conferences on Aging and the 1998 White House Conference on Social Security. A founding member of the National Academy of Social Insurance, he served on the panel of the 1979 Advisory Council on Social Security. He may be reached via e-mail at .
1 Part of this statement is based on the author’s testimony on ‘research in ageing and quality of life’ at a hearing before the Subcommittee on Aging, Committee on Labor and Public Welfare, U.S. Senate, March 4, 1972.

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