How Golden are Americans’ Golden Years?

Authored by: Isabella Flutak

Art by: Rachel Jacob

My grandparents from Milan still climb mountains. At almost ninety years old, they have an active social life and bike to the farmer’s market for fresh food. My grandmother still cooks for the whole family whenever we stay with her. Still, when I think of aging, I think of a stagnant, almost vegetative state—the opposite of my grandparents’ lifestyle. Perhaps this discrepancy is because the United States has the largest healthspan-lifespan gap and greatest noncommunicable disease burden among WHO member states [1]. 

The issue is not that American adults are dying younger— in fact, the United States has a higher survival rate after age 75 than countries of similar income. Advances in medicine and health, such as high rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income compared to peer nations have dramatically increased our lifespan. Yet, the quality of life of elderly people in the U.S. is surprisingly low across all demographics, even among highly advantaged Americans. There are many factors that explain this trend. For example, the United States has limited public health and primary care resources, along with a large uninsured population. As a result, Americans are more likely than their counterparts to find care inaccessible or unaffordable, and less likely to report lapses in the quality and safety of care outside of hospitals. While serious illnesses may be prevalent in any elderly population regardless of nationality, they can be exacerbated and thus more likely to turn deadly without the appropriate care. Furthermore, older American adults face greater morbidity and mortality from chronic diseases whose risk factors are often established earlier in life. For example, Americans consume more calories per capita than their counterparts in peer countries, contributing to obesity and diabetes later on. This pattern of food consumption is shaped by environmental factors, such as the actions of agriculture industries, grocery stores, and restaurants. Furthermore, the built environment in the United States discourages physical activity, being designed for cars rather than pedestrians [2]. 

What, then, does healthy aging look like? In a study conducted by Dan Buettner, the five Blue Zones— that is, geographic areas across the globe where people consistently live over 100 years old— were analyzed for their shared characteristics. Researchers found that in all five zones, elderly people moved naturally because their environments constantly and unconsciously encouraged movement. They all practiced routines that shed stress, something that can lead to chronic inflammation and is associated with major age-related diseases. They all recognized the threshold between feeling satisfied and feeling too full, eating their smallest meal in the late afternoon or early evening, and then not eating any more for the rest of the day. They drank alcohol regularly, but in moderation, and they all belonged to a community of long-living people that favorably shaped their health behaviors. Their lives were centered around putting their families first— parents and grandparents often lived nearby or in the home, lowering their disease and mortality for them as well as for their children and grandchildren. Interestingly, they all also had a strong sense of purpose [3]. Besides the timing of eating, another study found that choosing low-carb diets or diets rich in vegetables, fruits, nuts, cereals, fish, and unsaturated fats decreased cardiovascular diseases and obesity risk, protected the brain from aging and promoted an overall healthier life [4]. 

Could such a lifestyle be established across the United States? Could we reduce our dependence on cars, structure our lives around activity, eat better, form a close community of like-minded people, prioritize our families, drink moderately, and find purpose? How much of these factors are really in our control, or is the structure of our society utterly incompatible with aging well?  

Perhaps we could start with our public health systems. If public health systems were redesigned to coordinate existing support and services for older adults, families, and caregivers, and if they collected and analyzed data to identify community needs and assets, then cost-effective interventions could be implemented to improve quality of life. A pilot program in Florida tried just that, working with 37 of Florida’s county health departments. It resulted in the creation of a new data system to identify older adult health priorities, the establishment of new collaborations to leverage existing programs and services, greater consideration of older adults in community health assessments and planning, and the expansion of existing programs to include older adults. During the height of the pandemic, older adults in these communities were better served— those who needed at-home vaccinations were given them, food deliveries were expanded, and steps were taken to address social isolation. The project has since expanded to 50 counties in Florida, as well as to Mississippi and Washington [5]. 

It may not address all of the upstream effects of unhealthy aging, but implementing such a program nationwide would begin to address the immediate lifestyle factors that contribute to quality of life in our twilight years. They might start to look like those of my grandparents, who, as I hope to do when I am older, remain active members in the lives of their loved ones. After all, science and technology have given us extra years— they should be lived to the fullest. 

References:

1. Garmany, A., & Terzic, A. (2024). Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States. JAMA Network Open, 7(12), e2450241–e2450241. https://doi.org/10.1001/jamanetworkopen.2024.50241

2. U.S. Health in International Perspective. (2013). National Academies Press. https://doi.org/10.17226/13497

3.  Buettner, D., & Skemp, S. (2016). Blue Zones: Lessons from the World’s Longest Lived. American Journal of Lifestyle Medicine, 10(5), 318–321. https://doi.org/10.1177/1559827616637066

4.  Wolfe, M., & Gracia, J. N. (2023). The Value of Age-Friendly Public Health Systems in the Age-Friendly Ecosystem. Geriatrics, 8(3), 63. https://doi.org/10.3390/geriatrics8030063

5. Leitão, C., Mignano, A., Estrela, M., Fardilha, M., Figueiras, A., Roque, F., & Herdeiro, M. T. (2022). The Effect of Nutrition on Aging—A Systematic Review Focusing on Aging-Related Biomarkers. Nutrients, 14(3), 554. https://doi.org/10.3390/nu14030554