THE SHARE IMPERATIVE

!

Richard SuzmanDirector, Behavioral and Social Research

National Institute on Aging, NIH, HHS

DELFT

April 2008

United Nations Projected Percentages of Global Population

Source: World Population Prospects: The 1996 Revision, Annex 2 (low-variant projection). UN Population Division.

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Year

0

5

10

15

20%

of G

loba

l Pop

ulat

ion

Age <5

Age 65+

Projected Actual

1

Aging Reshaping our WorldAging Reshaping our World1.1. Speed of population aging –Incl. Third WorldSpeed of population aging –Incl. Third World

2.2. Simultaneous population aging & pop. decline Simultaneous population aging & pop. decline

3.3. Prospects for human longevity Prospects for human longevity

4.4. Changing 65+ burden of disease Changing 65+ burden of disease

5.5. Prospects of huge increases in dementiaProspects of huge increases in dementia

6.6. Technology pressure on health system costsTechnology pressure on health system costs

7.7. Impact of evolving family structures 65+ Impact of evolving family structures 65+ supportsupport

8.8. Worker-Dependant ratio and old-age securityWorker-Dependant ratio and old-age security

9.9. Global capital flows and macroeconomics of Global capital flows and macroeconomics of agingaging

• We discussed how our nations can promote active aging of our older citizens with due regard to their individual choices and circumstances, including removing disincentives to labor force participation and lowering barriers to flexible and part- time employment that exist in some countries.

• In addition, we discussed the transition from work to retirement, life-long learning and ways to encourage volunteerism and to support family care-giving.

• We considered new evidence suggesting that disability rates among seniors have declined in some countries while recognizing the wide variation in the health of older people.

Communiqué: Denver G-8 Summit

– It is important to learn from one another how our policies and programs can promote active aging and advance structural reforms to preserve and strengthen our pension, health and long-term care systems.

– Our governments will work together to promote active aging through information exchanges and cross-national research.

– We encourage collaborative biomedical and behavioral research to improve active life expectancy and reduce disability, and have directed our officials to identify gaps in knowledge and explore developing comparable data in our nations to improve our capacity to address the challenges of population aging.

Communiqué: Denver G-8 Summit

US National Academy of Science (NAS) Report: Preparing for an Aging World

• Expert recommendations for:

• International research agenda

• Comparable Data needed to implement that agenda

National Research Council (2001), “Preparing for an Aging World: the Case for Cross-National National Research Council (2001), “Preparing for an Aging World: the Case for Cross-National Research.”Research.”

NAS Panel Recommendations

• Creation of measures that are conceptually comparable across societies (harmonization)

• Database development that can support critical multidisciplinary research

National Research Council (2001), “Preparing for an Aging World: the Case for Cross-National National Research Council (2001), “Preparing for an Aging World: the Case for Cross-National Research.”Research.”

The Demographic The Demographic Imperative May be Worse Imperative May be Worse

than we Thinkthan we Think

!!

Projections of Older Population Projections of Older Population Very UncertainVery Uncertain

Uncertain Future of:Uncertain Future of: Fertility Mortality MigrationFertility Mortality Migration

UN’s Usual High-Medium-Low VariantUN’s Usual High-Medium-Low Variant Projections only reflect fertility uncertainty.Projections only reflect fertility uncertainty.

The future path of old age mortality is very The future path of old age mortality is very uncertain and heavily influences the uncertain and heavily influences the projected proportions of elderly.projected proportions of elderly.

Lutz IIASALutz IIASA

1840 1860 1880 1900 1920 1940 1960 1980 2000

45

50

55

60

65

70

75

80

85

90

95

Life

-exp

ecta

ncy

in y

ears

Best practiceEstimate of MaximumJapan extrapolationicelandswedenffirstbjapannethswitzaustral

Year

ffirstbnorwaynzicelandswedenffirstbjapannethswitzaustral

Norway

New Zealand

Iceland

Sweden

Japan

The Netherlands

Switzerland

Australia

Female life expectancy in the record-holding

country from 1840 to 2000

Record Female LE --Another 6 years

Life Expectancy in G-7 Industrialized Nations, 2050

75 80 85 90 95

Canada

France

Germany

Italy

Japan

UK

US

Median Life Expectancy, 2050

TuljapurkarGovt Estimate

Source: Shripad Tuljapurkar, Nan Li and Carl Boe. A UNIVERSAL PATTERN OF MORTALITY DECLINE

IN THE G-7 COUNTRIES. Nature 405: 789-792 (15 June 2000).

Western Europe, Uncertainty Distribution of Proportion above Age 80 (2000-2100)

Western Europe, Proportion above age 80

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

20

00

20

05

20

10

20

15

20

20

20

25

20

30

20

35

20

40

20

45

20

50

20

55

20

60

20

65

20

70

20

75

20

80

20

85

20

90

20

95

21

00

Year

Pro

po

rtio

n a

bo

ve

ag

e 8

0

0.8

0.4

0.2

0.025

0.975

Median

0.6

Fractiles

Sergei's DELL PIII, file: E:\Current\Run\2000\NewTechique\Simul\[pop_new21_4_del1_sing5_c1.xls],06-Jun-01 07:36

UN “low”

UN “high”

0.0 1.0 2.0 3.0 4.0

2050204520402035203020252020201520102005200019951990198519801975197019651960195519501945

females

0.01.02.03.04.0

05

101520253035404550556065707580859095

100105

European Union, 2050

Population (millions)

males

Age Period of Birth

Sergei's DELL PIII, file: C:\Sergei\Current\Run\2002\EU\[make_pyramid_to_file2_EU2.xls],21-May-02 14:36

European Union, Support ratio

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

2000

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

Year

Supp

ort r

atio

0.8

0.40.2

0.025

0.975

Median0.6

Fractiles

Sergei's DELL PIII, file: C:\Sergei\Share\EU\[presentation02.xls],21-May-02 13:56

European Union, Demographic Support Ratio (20-64/65+)

PUBLIC PENSION INCENTIVES TO LEAVE THE LABOR FORCE FOR MEN IN 11 COUNTRIESPercent of men age 55 and 65 not working

Source: Gruber J, Wise DA, eds. Social Security and Retirement around the World. Chicago, IL: University of Chicago Press, 1999.

Trends in Late-Life Disability

0

10

20

30

40

50

NHIS 70+ NLTCS 65+ HRS 65+ MCBS 65+

Per

cent

Sources: NLTCS, Manton et al. (2006); NHIS, Schoeni, Freedman, Martin (2006); MCBS, Trends in Health and Aging (2007); and HRS, unpublished tabulations by Freedman,Martin, and Schoeni (2007). All estimates age-adjusted.

1982, 1984, 1989, 1994, 1999, 2004

1983-2005

1998, 2000,2002, 2004

1992-2004

Projections of Number of Disabled Americans Age 65 & Over(in millions)

Source: National Long Term Care Survey 1982-1994 (Kenneth Manton, Ph.D.) Revised November 1999

1996 2004 2012 2020 2028 2036 2044 20520.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

22.0

24.0

1.5% decline per annum (1989-1994)

20.2

7.38.6

7.0

10.4

22

Increasing Disability

Sweden

BelgiumJapanPercentage of those over 65 who qualify

for Long Term Care Services

Great Britain –LE and HLE1981-2001 (ONS)

Expansion of disabled life expectancy

Decline in Disability RatesDenmark Finland

Italy Netherlands

Prevalence of Cognitive Impairment and Dementia, by Age (HRS-ADAMS)

0%

20%

40%

60%

80%

100%

70 75 80 85 90 95

CIND

Demented

Hours of Family Care, by Severity of Cognitive Limitation (HRS data)

05

1015202530354045

NormalCognition

Mild Moderate Severe

Severity of Cognitive Limitation

Ho

urs

of

Car

e

Langa K, Kabeto M, Herzog AR, Chernew M, Ofstedal MB, Willis R, Wallace R, Mucha L, Straus W, Fendrick AM. “The quantity and cost of informal caregiving for the elderly with dementia: Estimates from a nationally representative sample,” Journal of General Internal Medicine 2000; 15 (

Langa K, Kabeto M, Herzog AR, Chernew M, Ofstedal MB, Willis R, Wallace R, Mucha L, Straus W, Fendrick AM. “The quantity and cost of informal caregiving for the elderly with dementia: Estimates from a nationally representative sample,” Journal of General Internal Medicine 2000; 15 (

HRS

Additional Annual Cost of Informal Caregiving per Person

$1,700 $2,000

$5,000

$17,000

$0

$18,000

Diabetes Incont. Stroke Dementia

Cos

t ($)

Chronic Condition

Some observations on social and behavioral research on aging

• Acceleration of interdisciplinary and multilevel integrative research

• Newly hyphenated-fields – neuro-economics, behavioral-economics, social-neuroscience, macro-economic-demography becoming prominent

• Increasingly, Giga-scale team-science, using large-scale costly infrastructure – longitudinal surveys collecting behavioral data, clinical data !

• Regular interval Longitudinal Studies, essential

• Growing interest in x-national comparative studies

• More thought being given to developing large-scale multilevel randomized interventions.

National Institute on Aging (NIA) investments in large scale

research and resources• Centers: Demography; Roybal; RCMAR; NACDA

Archive

• Interventions: REACH, ACTIVE, Experience Corps and more

• Data collection: 40+ Public-use longitudinal studies including HRS, NLTCS, WLS, MIDUS II, NSHAP, ELSA, SHARE, SAGE, INDEPTH

• Multi-level vertically-integrated Program Projects

Does the EU Need a National Institute on Ageing (NIA) ?

• NIA’s annual budget is over $1 billion – even with the Euro strength that is quite a lot

• Enormous improvements in EU research capacity on ageing, but still fragmented and lacking in infrastructure for data collection and analyses

• SHARE is a leader but under-funded

HRS Reporthttp://www.nia.nih.gov/ResearchInformation/ExtramuralPrograms/BehavioralAndSocialResearch/HRS.htm

The Health and Retirement Study1992-2008+

a cooperative agreement between the National Institute on Aging

and the Survey Research Centerof the Institute for Social Research

at the University of Michigan

HRS

Motivation for HRS

• Concern over the impact of population aging on Social Security and Medicare– and their private counterparts, pensions and retiree

health insurance

• Concern about impact on older people and their families from reforms of Social Security and Medicare– And changes in private pensions and insurance

The HRS is:

• A study of aging in the US (population over age 50)• Multi-disciplinary in content• A longitudinal study with replenishment • A public-use dataset: collects data for distribution to

other researchers, does not control analysis• A foundation for smaller, more focused studies• A leader in administrative linkages• An example and support for similar studies in other

countries

How Big is the HRS?

• From 1992 through 2004:

– 30,000 people were interviewed at least once

– 135,000 interviews were completed

– 7,000 people died

– 5,000 workers retired

HRS Designed to Understand Decisions, Choices, and Behaviors As People Age, and in Response to Change in Policies, the Economy,

and Public Health

• Study families rather than individuals• Gather integrated multidisciplinary information about

all aspects of life• Follow people over time as events happen and their

choices get made• Make the data available to researchers and policy-

makers as quickly as possible• Let the full power and creativity of America’s scientific

community address the challenges of an aging population

Fundamental Objects of Measurement

• Resources for successful aging– Economic, public, familial, physical, psychological

• Behaviors and choices– Work, health, residence, transfers, use of programs

• Events and transitions– Health, widowhood, institutionalization

A multidisciplinary effort

A large and diverse community of researchers actively participated in the study design and implementation

• Economics

• Sociology

• Demography

•Medicine

•Public Health

•Psychology

Core Content Areas in HRS• HealthPhysical/psychological self-report, conditions, disabilities;Cognitive testingBehaviors (smoking, drinking, exercise)

• Health ServicesUtilization, expenditure, insurance, out-of-pocket spending

Labor ForceEmployment status/history, earnings, disability, retirement, type of work

• Economic StatusIncome by source, wealth by asset type, capital gains/debt, consumptionLinkage to pensions, Social Security earnings/benefit histories

• Family StructureExtended family, proximity, transfers to/from of money, time, housing.

Biomarkers and Performance Tests

– Measures of cardiovascular risk, metabolic syndrome Cholesterol, A1c, CRP

– Blood Pressure

– DNA

– Physical performance measures

– Anthropometry

– Psychosocial questionnaire

HRS is a foundation for many smaller, innovative studies:

• Dementia study (ADAMS)– First nationally representative study of dementia

• Consumption and Activities Study (CAMS)– Longitudinal data on consumption and time-use

• Diabetes study – Use of mail survey to collect clinical measure (HbA1c)

• Internet interviewing– Mode comparisons

• Prescription Drug Study (PDS)– To evaluate new Medicare drug benefit begun in 2006

The HRS Commitment to Rapid Public Release

• Interviews every even-numbered year

• Complete at end of year or early the next year

• Early release 3-4 months later – Nearly complete data

• Final release 12-18 months later

HRS Scientific ProductivityCreation of a Scientific Community

HRS is used by multiple US Government Departments

And has become the premier data source in

many areas

HRS: A Public Use Data Set with an Impact on Research

• 6,000 registered users

• 32,097 downloads in past 2 years

• 600+ scientific papers published using HRS 1,000 total papers

• 1,000 unique authors

• 4 special issues of journals

• 75 Ph.D. dissertations

International standard for similar studies in other countries

• MHAS: Mexican Health and Ageing Study• ELSA: English Longitudinal Study of Ageing• SHARE: Survey of Health, Ageing and

Retirement in Europe• KloSA: Korean Longitudinal Study of Aging• CHARLS: China HRS• LASI: India HRS

HRS has created powerful new scientific communities and new science

• It is a powerful engine for creating new fusions in science :– psychology and economics

– Cognitive neuroscience and economics

– Epidemiology and economics

– Bio-demography and social neuroscience

– Development of new methodologies

– International scientific cooperation

47

HRS Studies’ Global Coverage

Health and Retirement Study (HRS)

English Longitudinal Study of Ageing (ELSA)

Survey of Health, Ageing and Retirement in Europe (SHARE)Planned Asian HRS studies

Mexican HRS (MHAS)

???

HRS in Argentina

Evidence and Information for Policy - Global Study on Ageing

SAGE and INDEPTHSAGE and INDEPTH

•Mexico•South Africa•Ghana

•China•India•Russia

•Kenya•Tanzania•Bangladesh

•Viet Nam•Indonesia

Essential Harmonization Essential Harmonization !!• Cross-national comparisons demand Cross-national comparisons demand

harmonizationharmonization

• Without harmonization very difficult if Without harmonization very difficult if not impossiblenot impossible

• Requires strong Central coordinationRequires strong Central coordination

• SHARE’s harmonization must rank as SHARE’s harmonization must rank as one of the great feats of social science one of the great feats of social science in the last 100 years!in the last 100 years!

Harmonization of Longitudinal Cross-Harmonization of Longitudinal Cross-National Surveys of AgingNational Surveys of Aging

This must be a critical area for the EU and This must be a critical area for the EU and SHARE is a world leader in this areaSHARE is a world leader in this area

Longitudinal Studies Longitudinal Studies !!

• Longitudinal Studies essential for Longitudinal Studies essential for understanding causal dynamics of agingunderstanding causal dynamics of aging

• Without longitudinal studies easy to Without longitudinal studies easy to make incorrect causal inferences e.g. make incorrect causal inferences e.g. on wealth health relationshipon wealth health relationship

• Requires equal interval wavesRequires equal interval waves• Our experience -- unequal interval Our experience -- unequal interval

surveys much more difficult to analyzesurveys much more difficult to analyze

Are Americans Really Sicker than the English?

• Disease and Disadvantage in the United States and in England

– Banks, Marmot, Oldfield, and Smith (JAMA May 2006

• Non-Hispanic Whites ages 55-64

– HSE 2003 (clinical measures)

– NHANES–1999-2002 (clinical measures)

DATA

England

– ELSA–2002

USA

– HRS–2002

6.1

12.5

4.0

5.4

2.3

3.8

6.3

8.1

5.5

9.5

0

2

4

6

8

10

12

14

Diabetes HeartAttack

Stroke LungDisease

Cancer

England Unadjusted United States

Disease Prevalence in England and the United States (ages 55-64)

Source: Banks, Marmot, Oldfield, and Smith, 2006.

21.6

24.0

40.1

34.5

6.4

8.0

10.0

30.4

32.2

3.8

0 10 20 30 40 50

Low HDL cholesterol

Fibrinogen high risk

CRP high risk

BP>140/90

HbA1c > 6.5%

Prevalence (%)

England

US

Biological Markers Exhibit Differences Too

Source: Banks et al., JAMA, 2006.

14.4

38.8

31.1

61.9

20.1

30.0

40.9

23.0

66.1

21.9

0 10 20 30 40 50 60 70

Heavy drinker

Overweight

Obese

Ever smoked

Current smoker

Prevalence (%)

England

US

Some differences in risk factors 55-64 year olds

Source: Banks, Marmot, Oldfield, and Smith, JAMA 2006.

The Americans are Sicker than the English

55-64 year olds; controlling for differences in risk factors

Source: Banks et al., JAMA, 2006

9.5

8.1

3.8

5.4

15.1

42.4

12.5

5.4

6.2

2.3

4.2

10.1

35.1

7.2

0 10 20 30 40 50

Cancer

Lung Disease

Stroke

Heart Attack

Heart Disease

Hypertension

Diabetes

Prevalence (%)

England

US

6

13

8

6

109

6

9

7

13

7

5

9

0

2

4

6

8

10

12

14

England United States Austria Denmark France

Germany Greece Italy Netherlands Spain

Sweden Switzerland Total

Diabetes Prevalence

Smith (2008)

What We Said

• Middle-aged Americans are a sickly lot

– Both self-reports and biomarkers confirm it

• Standard risk factors (smoking, excess drinking, obesity, minority groups, health insurance) do not fully explain it

END

HRS Longitudinal Sample DesignAGE

92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10

YEAR

70

65

60

AHEAD

CODA

HRS

90

85

80

75

55

50

War Babies

Early Boomers

Mid Boomers

C. J. L. Murray, et al., Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States. PLoS Medicine: Sept. 2006. Vol. 3, Issue 1513 9, e260 www.plosmedicine.org

County life expectancy 1997-2001

Males Females

$ 3,922$ 4,439$ 4,940$ 5,444$ 6,304

1996 Per-capitaMedicare Spending

Average age-sex race adjusted per-capita Medicare spending

Ratio: High to Low: 1.61

23 new applications submitted to Retirement Economics PA

• P01 Economic Decision Making: The Role of Expectations, Information and Cognition• R01 Financial Planning for Retirement: A Psychological Model• R01 Premium Support and Risk Segmentation• R01 The First Decade of Retirement: A Two-Cohort Comparison of Wealth, Health, & Work• R01 Social Influences and Retirement Decisions• R01 Financial Planning for Retirement: How and Why Minorities Differ from the Majority• R01 Unemployment Insurance and Retirement Transitions• R01 Obesity and Work Across the Life Course• R01 Retirement in Pay-as-You-Go versus Personal Accounts Systems - Evidence from Chile• R01 New Directions for Disability Insurance• R01 An Investigation of the Experiences of Early Adopters of Health Savings Accounts• R01 Retirement Contrast: Canada and the United States• R01 Determinants of Pre-Retirees' Decision-Making Competence• R01 The Impact of Labor Markets on Retirement: Evidence from the US Census• R01 Building Retirement Wealth: Evidence from Large Randomized Field Experiments• R01 Modeling the Effect of Health on Retirement• R03 Are Individuals Prepared for Retirement? Five Decades of Retirement Surveys• R03 The Economic Consequences of Disability Onset Near Retirement• R03 The Health and Economic Consequences of Retirement: Longitudinal Trends• R03 A Longitudinal Study of Health, Retirement and Long-Term Care Insurance• R03 International Comparisons of Retiree Well-being• R03 Unemployment Insurance and Retirement Transitions• R21 Comprehensive and Integrated Investment Models for Retirement Planning

Part of the social network from the Framingham Heart Study with information about BMI in 1975 compared to the year 2000

The Increasing Burden of Chronic Non-Communicable Diseases: 2002-2030

Source: P01 AG 017625 (PI Murray) Lopez, et al. Global Burden of Disease by Risk Factors. (2006)

The Smoking Gun?

• SMOKING?

• OBESITY?

• STRESS?

• LOW SOCIAL INTEGRATION?

Changes in smoking behavior and the impact on mortality

Birth Year

Yea

rs s

mo

ked

bef

ore

ag

e 40

Source: Preston and Wang. 2006. Demography 43(43): 631-46.

0

5

10

15

20

1885 1890 1895 1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950

Men

Women

Cancer Rates, US 1930-2003Women Men

Source: US Mortality Public Use Data Tapes 1960 to 2003, US Mortality Volumes 1930 to 1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2006. American Cancer Society, Surveillance Research, 2007

'Per 100,000, age-adjusted to the 2000 US standard population

Trends in Late-Life Disability

0

10

20

30

40

50

Per

cent

MCBS 65+

NHIS 70+

NLTCS 65+

Sources: NLTCS, Manton et al. (2006); NHIS, Schoeni, Freedman, Martin (2006); MCBS, Trends in Health and Aging (2007); and HRS, unpublished tabulations by Freedman,Martin, and Schoeni (2007). All estimates age-adjusted.

HRS 75+

Trends in Late-Life Disability

0

10

20

30

40

50

NHIS 70+ NLTCS 65+ HRS 65+ MCBS 65+

Per

cent

Sources: NLTCS, Manton et al. (2006); NHIS, Schoeni, Freedman, Martin (2006); MCBS, Trends in Health and Aging (2007); and HRS, unpublished tabulations by Freedman,Martin, and Schoeni (2007). All estimates age-adjusted.

1982, 1984, 1989, 1994, 1999, 2004

1983-2005

1998, 2000,2002, 2004

1992-2004

Figure 1. Number of Disabled Japanese if Disability Prevalence Had Not Improved

5.9

6.9

5.6

5.7

4.7

5.4

6.1

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

'93 '94 '95 '96 '97 '98 '99 '00 '01 '02

Millions of Disabled 65 and Older

Actual

If disability rate had not changed since 1993

Total Population 65 and Older in Each Year (in Millions) 16.9 19.0 21.2 23.6

Source: Schoeni, Liang, and Bennett, 2004.

Declining Disability Trend in Japan?

Projections of Functional Status of Future Elderly

“As the number and share of the population aged 65 and over will continue to grow steadily in OECD countries, improvements in the functional status of elderly people could help mitigate the rise in the demand for, and hence expenditures on, long-term care… One of the main policy implications that can be drawn from the findings of this study is that it would not be prudent for policymakers to count on future reductions in the prevalence of future disability to offset completely the rising demand for long-term care that will result from population aging…”

Stable Rates

Australia Canada

Increasing Disability

Sweden

BelgiumJapanPercentage of those over 65 who qualify

for Long Term Care Services

Great Britain –LE and HLE1981-2001 (ONS)

Expansion of disabled life expectancy

But Will the Decline Continue?COMPETING VECTORS:• Increased Education and better TX for CVD are

major factors that account for the disability decline, but their push ending

• But three+ analyses of cohorts find disability for adults under age 65, either increased or showed no improvement, and some predict end of trend

• Today obesity appears to influence disability more than mortality

Table 1: Cross-Cohort Comparisons of Health Measures for Male Respondents Aged 51-56 in Different HRS Cohorts

Birth Year Self-rated Health (5=poor, 1= excellent)

Fair or Poor Health

Subjective Probability of Survival to Age 75

Health Limits Work

Number of Limitations

Number of Health Conditions

1936-41 2.39 16.7% 62.3% 17.5% 2.12 0.70

1942-47 2.51 19.3% 61.8% 17.8% 2.12 0.68

1948-53 2.59 22.1% 60.7% 19.2% 2.06 0.71

t-statistic 4.82 3.83 -1.42 1.22 -0.69 0.42

Source: Weir, David R. Are Baby Boomers Living Well Longer? in Bridget Madrian, Bridget, Mitchell, Olivia S. and Soldo, Beth J. (eds.), Redefining Retirement How will Boomers Fare?

Notes: The t-statistic tests the hypothesis of no change between the birth cohort of 1936-41 (assessed in 1992) and the cohort of 1948-53 (assessed in 2004).

Obese Are More DisabledObese Are More Disabled

0 200 400 600 800 1000 1200

60-69

50-59

40-49

30-39

18-29

AgeObese

Not Obese

Rate per 10,000Source: Lakdawalla, Bhattacharya, Goldman, Health Affairs, 2004.

Where in the World are the DATA?

RFA: “National Study of Disability Trends and Dynamics” • U.S. 65+ population in community and

institutional settings

• link to Medicare records

• New survey, or supplement existing survey, or new wave or successor NLTCS

• December 20/January 18, 2008

The shift from Defined Benefit Pensions to 401(K) Plans, Shifts Risk to Individuals

• Source: Poterba, Venti, and Wise (2007), “The shift from defined benefit pensions to 401(k) plans and the pension assets of the baby boom cohort,” PNAS 104(3).

Procrastination in retirement savingsChoi, Laibson, Madrian, Metrick (2002)

Survey– Mailed to a random sample of employees– Matched to administrative data on actual savings

behavior Consider a typical population of 100 employees

– 68% report saving too little– 24 of 68 planned to raise 401(k) contribution in

next 2 months– Only 3 of the 24 actually did so in the next 4 months

Clever Use of Behavioral Economics

Madrian and Shea (2001) Choi, Laibson, Madrian, Metrick (2004)

401(k) participation by tenure at firm

0%

20%

40%

60%

80%

100%

0 6 12 18 24 30 36 42 48

Tenure at company (months)

Automaticenrollment

Standard enrollment

HRS

The HRS Data System: Counts for Y17-22

• 59,718 interviews– 25,000 with biomarkers and other added content, – 4,222 exits

• 32,138 mail surveys– 12,138 CAMS panel

• 21,228 Social Security linkages• 18,688 Medicare linkages (1800 MDS)• 1,430 in-home neuropsychological assessments

– On 850 ADAMS respondents

Outline

• Institutional Aspects for Aging Research in Europe and Asia

• Dealing with Uncertainty in

Future Aging Trends

• Adding Education to Age and Sex in the Study of Population Aging

Institutional Challenges in Asia

• Need for skill upgrading among professionals and integration into cutting age research (not just bi-lateral collaboration)

• More comparative analysis of joint challenges• Asian MetaCentre (NUS, Chula, IIASA) – Wellcome Trust

Regional Centre of Excellence. Funding greatly reduced.

• Good new Journal “Asian Population Studies”• Currently establishment of Asian Population Association

• Challenge of communication of demographic knowledge to policy making audiences and public at large (Panic in Korea)

Institutional Challenges in Europe

• Fragmented research landscape. Not enough collaboration between national demographic centers.

• Need for skill upgrading among professionals and integration in cutting age research.

• More comparative analysis of joint challenges

• Increasing collaboration of scientists across border (EU-Framework Programs).

• Intensifying collaboration among major research centers (INED, NIDI, MPIDR, VID/IIASA)

• Increasingly active European Population Association (Barcelona)

• Challenge of communication of demographic knowledge to policy making audiences and public at large (Panic in the East)

Future Aging

• For projecting the population by age and sex we need the current population by age and sex and make assumptions about the three components of change:

Fertility - Mortality - Migration

The future paths of all three components are uncertain.

• The usual High-Medium-Low Variants Approach (UN Population projections) only reflects fertility uncertainty.

• The future path of old age mortality is highly uncertain and greatly influences the projected proportions of elderly.

• Hence the High-Medium-Low Approach is misleading.

Figure 1. Percentage of simulations when proportion 60+ is greater of equal to 1/3

Sub Saharan Africa

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YearSergei's FREECOM, file: L:\IIASA2007\World_Projections\res\[probability_peaking1_graph.xls],21-Feb-08 15:45