Even if scientific advancesprove extraordinary, "we are going to have to deal with the costs,workforce and service delivery arrangements for large numbers ofelders living for at least a year or two with seriousdisabilities." (Photo: Shutterstock)

Within 10 years, all of the nation's 74 million baby boomerswill be 65 or older. The most senior among them will be on the cuspof 85.

Even sooner, by 2025, the number of seniors (65 million) isexpected to surpass that of children age 13 and under (58 million)for the first time, according to Census Bureau projections.

"In the history of the human species, there's never been a timelike [this]," said Dr. Richard Hodes, director of the NationalInstitute on Aging, referring to the changing balance between youngpeople and old.

Related: The baby boomer generation is starting to retire –and no one is prepared

What lies ahead in the 2020s, as society copes with thisunprecedented demographic shift?

I asked a dozen experts to identify important trends. Someresponses were aspirational, reflecting what they'd like to seehappen. Some were sobering, reflecting a harsh reality: Our nationisn't prepared for this vast demographic shift and its far-reachingconsequences.

Here's what the experts said:

A crisis of care. Never have so many peoplelived so long, entering the furthest reaches of old age andbecoming at risk of illness, frailty, disability, cognitive declineand the need for personal assistance.

Even if scientific advances prove extraordinary, "we are goingto have to deal with the costs, workforce and service deliveryarrangements for large numbers of elders living for at least a yearor two with serious disabilities," said Dr. Joanne Lynn, alegislative aide on health and aging policy for Rep. Thomas Suozzi(D-N.Y.).

Experts caution we're not ready.

"The cost of long-term care [help in the home or care inassisted-living facilities or nursing homes] is unaffordable formost families," said Jean Accius, senior vice president of thoughtleadership at AARP. She cited data from the Genworth Cost of Care Study: While the median household incomefor older adults was just $43,696 in 2019, the annual median costfor a private room in a nursing home was $102,204; $48,612 forassisted living; and $35,880 for 30 hours of home care a week.

Workforce issues are a pressing concern. The need for healthaides at home and in medical settings is soaring, even as low wagesand poor working conditions discourage workers from applying for orstaying in these jobs. By 2026, 7.8 million workers of this kind will be required and hundredsof thousands of jobs may go unfilled.

"Boomers have smaller families and are more likely to enter oldage single, so families cannot be expected to pick up the slack,"said Karl Pillemer, a professor of human development at CornellUniversity. "We have only a few years to plan different ways ofproviding care for frail older people to avoid disastrousconsequences."

Living better, longer. Could extending "healthspan," the time during which older adults arehealthy and able to function independently, ease some of thesepressures?

The World Health Organization calls this "healthy lifeexpectancy" and publishes this information by country. Japan wasthe world's leader, with a healthy life expectancy at birth of 74.8years in 2016, the most recent year for which data is available. Inthe U.S., healthy life expectancy was 68.5years out of a total average life expectancy of 78.7years.

Laura Carstensen, director of Stanford University's Center onLongevity, sees some cause for optimism. "Americans are beginningto exercise more" and eat more healthful diets, she said. Andscientific studies published in recent years have shown thatbehavior and living environments can alter the trajectory ofaging.

"With this recognition, conversations about aging societies andlonger lives are shifting to the potential to improve quality oflife throughout," Carstensen said.

Other trends are concerning. Notably, more than one-third ofolder adults are obese, while 28percent are physically inactive, putting them at higher risk of physicalimpairments and chronic medical conditions.

Rather than concentrate on treating disease, "our focus shouldshift to health promotion and prevention, beginning in early life,"said Dr. Sharon Inouye, a professor at Harvard Medical School and amember of the planning committee for the National Academy ofSciences' HealthyLongevity Global Grand Challenge.

Altering social infrastructure. Recognizing therole that social and physical environments play in healthy aging,experts are calling for significant investments in this area overthe next decade.

Their wish list: make transportation more readily available,build more affordable housing, modify homes and apartments to helpseniors age in place, and create programs to bring young and oldpeople together.

Helping older adults remain connected to other people is acommon theme. "There is a growing understanding of the need todesign our environments and social infrastructure in a way thatdesigns out loneliness" and social isolation, said Dr. Linda Fried,dean of Columbia University's Mailman School of Public Health.

On a positive note, a worldwide movement to create "age-friendlycommunities" is taking hold in America, with 430 communitiesand six states joining an effort to identify and better respond tothe needs of older adults. A companion effort to create "age-friendlyhealth systems" is likely to gain momentum.

Technology will be increasingly important as well, withaging-in-place likely made easier by virtual assistants like Alexa,video chat platforms like Skype or FaceTime, telemedicine, roboticcaregivers and wearable devices that monitor indicators such asfalls, according to Deborah Carr, chair of the sociology departmentat Boston University.

Changing attitudes. Altering negative attitudesabout aging — such as a widespread view that this stage of life isall about decline, loss and irrelevance — needs to be a highpriority as these efforts proceed, experts say.

"I believe ageism is perhaps the biggest threat to improvingquality of life for [older] people in America today," Harvard'sInouye said. She called for a national conversation about "how tomake the last act of life productive, meaningful andfulfilling."

Although the "OKBoomer" barbs that gained steam last year testify to persistentintergenerational tension, there are signs of progress. The WorldHealth Organization has launched a global campaign to combatageism. Last year, San Francisco became one of the first U.S. cities to tacklethis issue via a public awareness campaign. And a "reframing aging"toolkit developed by the FrameWorks Institute is in use incommunities across the country.

"On the bright side, as the younger Baby Boom cohort finallyenters old age during this decade, the sheer numbers of olderadults may help to shift public attitudes," said Robyn Stone,co-director of LeadingAge's LTSS (long-term services and supports)Center @UMass Boston.

Advancing science. On the scientific front, Dr.Pinchas Cohen, dean of the Leonard Davis School of Gerontology atthe University of Southern California, points to a growingrecognition that "we can't just apply one-size-fits-all guidancefor healthy aging."

During the next 10 years, "advances in genetic research and bigdata analytics will enable more personalized — and effective —prescriptions" for both prevention and medical treatments, hesaid.

"My prediction is that the biggest impact of this is going to befelt around predicting dementia and Alzheimer's disease asbiomarker tests [that allow the early identification of people atheightened risk] become more available," Cohen continued.

Although dementia has proved exceptionally difficult to address,"we are now able to identify many more potential targets fortreatment than before," said Hodes, of the National Institute onAging, and this will result in a "dramatic translation of discoveryinto a new diversity of promising approaches."

Another potential development: the search for therapies thatmight slow aging by targeting underlying molecular, cellular andbiological processes — a field known as "geroscience."Human trials will occur over the next decade, Hodes said, whilenoting "this is still far-reaching and very speculative."

Addressing inequality. New therapies spawned bycutting-edge science may be extraordinarily expensive, raisingethical issues. "Will the miracles of bioscience be available toall in the next decade — or only to those with the resources andconnections to access special treatment?" asked Paul Irving,chairman of the Milken Institute's Center for the Future ofAging.

Several experts voiced concern about growing inequality in later life. Itsmost dramatic manifestation: The rich are living longer, while thepoor are dying sooner. And the gap in their life expectancies iswidening.

Carr noted that if the current poverty rate of9 percent in the older population holds over the nextdecade, "more than 7 million older persons will live withoutsufficient income to pay for their food, medications andutilities." Most vulnerable will be black and Latina women, shenoted.

"We now know that health and illness are affected by income,race, education and other social factors" and that inequalities inthese areas affect access to care and health outcomes, Pillemersaid. "Over the coming decade, we must aggressively address theseinequities to ensure a healthier later life for everyone."

Working longer. How will economicallyvulnerable seniors survive? Many will see no choice but to try towork "past age 65, not necessarily because they prefer to, butbecause they need to," Stone said.

Dr. John Rowe, a professor of health policy and aging atColumbia University, observed that "low savings rates, increasingout-of-pocket health expenditures and continued increases in lifeexpectancy" put 41 percent of Americans at risk of running out ofmoney in retirement.

Will working longer be a realistic alternative for seniors?Trends point in the opposite direction. On the one hand, theU.S. Bureau of Labor Statistics suggests that by 2026 about30 percent of adults ages 65 to 74 and 11 percentof those 75 and older will be working.

On the other hand, age discrimination makes it difficult forlarge numbers of older adults to keep or find jobs. According to a2018 AARP survey, 61 percent of older workers reportedwitnessing or experiencing age discrimination.

"We must address ageism and ageist attitudes within theworkplace," said Accius of AARP. "A new understanding of lifelonglearning and training, as well as targeted public and privatesector investments to help certain groups transition [from old jobsto new ones], will be essential."

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

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