Complete credit for this interesting and timely article is directed to Bill Santamour.  It is used as a basis for discussion in graduate classess.  REH

A Good Word About Old Age: 'Compression'
By Bill Santamour H&HN Managing Editor	September 03, 2013
Living more years with chronic illness, but fewer with disabilities.

Every time I passed my neighbor Otto walking down the block in that tentative, arthritic gait of his, he would shake his head, smile ruefully and feed me that old chestnut: "I'm warning you, Bill, getting old ain't for sissies." Otto was in his 70s by then, and he had a number of infirmities beyond arthritis, including heart and circulation troubles. But he was no sissy. He was the primary caregiver for his wife, Marcy, who suffered from Alzheimer's. Into his 80s, he kept his own house, ran his own errands and carried on with the photography that was his life's work, producing striking, black-and-white images in his own tiny darkroom.

Every day, 10,000-plus baby boomers reach age 65 and the proportions of Americans older than 70, older than 80 and older than 90 are ballooning; health care policymakers worry how in the heck we as a society are going to cope economically and otherwise. Providers foresee a tidal wave of patients with multiple chronic conditions and other needs that will require a support system built around IT and staffing models that are still evolving.

But a recent report from Harvard and the National Bureau of Economic Researchcontained a bit of hopeful news on the aging front. The report challenges the assumption that old age necessarily means diminished quality of life. The study discovered "a compression of morbidity" among older Americans, which means that while more people are living longer and have multiple chronic illnesses, they are, as the National Journal puts it, "both living more years disability-free and fewer years disabled." In other words, the period in which quality of life is diminished occurs in a more compact time frame, closer to death.

"People have more diseases than they used to, but the severe disablement that disease used to imply has been reduced," the researchers said. My neighbor Otto was an example of that phenomenon. He became unable to care for himself only near the end of his life.

Optimism about old age is reflected in the second annual United States of Aging Surveyreleased in late July. Among respondents older than 65, 84 percent said it is not very or not at all difficult to perform regular activities independently. More than half (58 percent) with one or more chronic conditions are very confident they can manage their health so as to reduce their need to see a doctor, up from 44 percent of senior respondents in 2012.

The survey does contain some alarming findings. While 65 percent of seniors report having at least two chronic conditions, fewer than one in five has received guidance in the past year to develop an action plan to manage their health. Twenty-six percent of seniors exercise less than once a week for 30 minutes or more.

"Maintaining good health as we age requires being proactive, especially for people with chronic health conditions," said Richard Birkel, senior vice president, healthy aging, and director of the National Council on Aging. "We must seize opportunities across local communities to empower seniors with the skills they need to stay healthy." The NCOA conducted the survey with UnitedHealthcare and USA Today.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.