SAN MARCOS – New research conducted in part at Texas State University has revealed that later-born generations of older adults in the United States are more likely to have a greater number of chronic health conditions than the generations that preceded them.
The increasing frequency of reporting multiple chronic health conditions—multimorbidity in research terms—represents a substantial threat to the health of aging populations. As the number of U.S. adults aged 65-plus is projected to grow by more than 50% by 2050, the fact that multimorbidity may be increasing in generations of adults just beginning to enter older adulthood may place unprecedented strain on the well-being of older adults and the medical and federal insurance systems they depend on.
The research was conducted by Texas State’s Nick Bishop, assistant professor of human development and family sciences in the School of Family and Consumer Sciences, along with Steven Haas, associate professor of sociology and demography at The Pennsylvania State University and Ana Quiñones, associate professor in the Department of Family Medicine and OHSU-PSU School of Public Health, Oregon Health and Science University. Their research, “Cohort Trends in the Burden of Multiple Chronic Conditions Among Aging US Adults,” is published in The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences (https://academic.oup.com/psychsocgerontology/advance-article/doi/10.1093/geronb/gbac070/6591182).
The research focuses on the differences in multimorbidity between cohorts—more commonly thought of as generations—showing that more recently born generations of older adults are more likely to report a greater number of chronic conditions and experience the onset of multimorbidity earlier in life. For example, when comparing Baby Boomers (in this study, those born between 1948-1965) to those born during the later years of the Great Depression (1931-1941) at similar ages, Baby Boomers exhibited a greater number of chronic health conditions. Baby Boomers also reported two or more chronic health conditions at younger ages.
“The way I like to describe it to my parents, who were born to the Baby Boom generation, is that you’re more likely to have multimorbidity than your parents were when they were your age,” Bishop said.
The researchers examined data from adults aged 51 years and older using 20 years of repeated assessment drawn from the Health and Retirement Study, a nationally representative survey of aging Americans. The study measured multimorbidity using a count of nine chronic conditions: heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer (excluding skin cancer), high depressive symptoms and cognitive impairment. The researchers also explored variation in the specific conditions driving generational differences in multimorbidity. Analysis of the data showed that later-born generations had a greater risk of multimorbidity and developed multimorbidity at earlier ages than those born to prior generations.
Importantly, sociodemographic factors such as race and ethnicity, whether the person was born in the United States, childhood socioeconomic circumstances and childhood health influenced the risk of multimorbidity for all cohorts. Among adults with multimorbidity, arthritis and hypertension were the most prevalent conditions for all generations, and there was evidence that high depressive symptoms and diabetes contributed to the observed generational differences in multimorbidity risk.
On the surface, the results may seem counterintuitive. Later-born generations have had access to more advanced modern medicine for a greater period of their lives, therefore may be expected to enjoy better health than those born to prior generations. Though this is partially true, advanced medical treatments may enable individuals to live with multiple chronic conditions that once would have proven fatal, increasing the likelihood that any one person experiences multimorbidity.
Older adults in more recently born generations have also had greater exposure to health risk factors such as obesity, which increases the likelihood of experiencing chronic disease. In terms of other possible explanations for their findings, Bishop said that medical advances have also been accompanied by better surveillance and measurement of disease, leading to the identification of chronic conditions which once may have gone undiagnosed. Though the researchers tried to account for this through statistical modeling, this process may increase the number of chronic diseases reported by generations such as Baby Boomers compared to earlier generations.
Future research led by Bishop will dig deeper into explanations of these emerging cohort trends in multimorbidity.
“The goal of this study was to establish whether there were cohort differences in multimorbidity,” Bishop explained. “The next step is to examine why there were cohort differences in multimorbidity.”
Bishop said he hoped the results of this study will help inform policy to address the potentially diminishing health of our expanding population of older adults.