Aging Well in America Has Gotten Harder

What is causing the drop in America's life expectancy?

Posted Oct 19, 2018

Although statistics don’t always tell the full story, it’s hard not to feel a little bit of anxiety about the shrinking life expectancy in the United States. For two straight years, life expectancy has fallen here while it’s concurrently lengthening in other countries.

“Old Age is Not for Sissies”

I remember seeing a cartoon depicting an older man bench pressing weights wearing a t-shirt that stated, “Old age is not for sissies.’ This is maybe truer now than it was 20 years ago when the cartoon appeared in print. The more advanced medicine has gotten and the more advanced the treatments available have become, the longer a person who is “near death” can stay alive -- especially compared to 20 or 40 years ago. Being willing to undergo “extraordinary measures” when life is nearing its end takes a lot of courage today. As the cost of growing old has also gotten steeper, living longer is not synonymous with aging well.

What’s Wrong with Old Age and Death?

In a Huffington Post article from a few years ago, the ways in which contemporary cultures treated their aging citizens painted some stark contrasts between the Western countries and other regions of the globe. In the United States, we place such a high value on youthfulness that we have seen exponential growth of some amazingly lucrative businesses that prey on the “age fearful” folk. From anti-aging health and beauty products to medical procedures that reverse the signs of aging, our culture is doing everything it can to help the "age fearful" hide their true appearances from the mirror. Just as “menopause” was turned into a medical problem, the natural progression of age-related appearance changes has become a problem to be solved. Not only that,  Americans' fear of death creates an anxiety that generations pass on to the next. In our culture, the person who admits that he has lived a good life and is accepting of death, whenever it is to come, is increasingly the “exception to the rule.” Fear of death, on the other hand, has become increasingly normal as even our elders seem to now struggle with the pandemic FOMO, fear of missing out. The great psychotherapist, Irvin Yalom, suggested that the people who fear death the most are often those who have the greatest regrets about the way they chose to live their lives. This certainly makes good sense. You don't want to leave until you "get it right" or at least have time to try.

Around the Globe, Aging is Pretty Much an Okay Development

Some of the countries that truly embrace the developmental process that a long life allows include Greece. Here, the branches at the top of the family tree still warrant respect from the younger members of the family tree.  Native Americans respect their elders as do younger generations in Korea, China, India, among other countries. In Korea, there are big parties to celebrate the attainment of a 60th birthday and then, a decade later, turning 70 is cause for celebrations. In the US, we’ve been celebrating major birthday milestones with black roses, tombstones, and “over the hill” banners for decades.

In dream symbolism, automobiles are considered to be symbols of the self. Using that metaphor, it’s clear that depreciation of the value of the human life begins falling once we hit our thirties – which is similar to the way that a new car’s value depreciates the moment you drive it off the lot. Human life, though, is not a material commodity, although that’s often the way that we and our institutions treat our elders. We see the elderly as material commodities of little value that need to be “stored” until a final "storage facility" is required.

Is a Shortened Life Expectancy a Self-Fulfilling Prophecy?

Sadly, the raging levels of addiction and substance abuse have contributed significantly to the lowered life expectancy according to Woolf et al. (2018). The number of lives lost – usually in their adult prime or before youth have even reached adulthood – to substance abuse including opioid-related deaths is beyond sobering. Between 2000 and 2014, there was a 137% increase in opioid deaths alone.

Outright despair is also cited as a major contributor to the shrinking lifespan. In addition to the sweeping level of addiction, the suicide rate has exploded. In a country which was founded on the pursuit of happiness, it turns out that the reality of despair has taken hold and Americans fall victim to what have been termed the diseases of despair, drug abuse, alcoholism, and suicide.  Not only have the diseases of despair stolen years from our life expectancy, they also cost hundreds of billions of dollars. The Surgeon General put a $442 billion price tag on drug and alcohol abuse, a $500 billion price tag on the opioid crisis, and a $90 billion price tag on suicide attempts and suicide.

Diseases of Despair Speak to Dark Truths

In a country that's been perceived for hundreds of years as a mecca for people who came here seeking a country with roads paved with gold and opportunities to overcome the most poverty-stricken of early beginnings, it seems that the road to success is a lot rockier and longer than a lot of Americans expected. It’s not surprising that a country obsessed with “fixing” health problems with procedures, regimens, and "magic bullet" pills would give rise to a population using drugs (legal and illegal) and alcohol to “fix” the pain of despair and sense of hopelessness that too many of us face.

How Do You Beat the Decreasing Longevity Odds?

Aging well is all about multiple domains of functioning. It certainly makes sense that physical well-being is a key to aging well and living longer. However, social connections and emotional well-being are also key to a long life. Those who try to travel the road alone are going to be a lot more likely to turn to self-medicating effects of alcohol and drugs that numb us to the real-world pain of isolation, despair, and struggles to keep ahead of existential anxiety or pain and illness. Suicide’s uptick in younger people certainly paints a picture of entrenched disrespect and heartless cruelty between kids today along with a lack of mental health awareness and perhaps a tragic lack of parental presence and connections between parents and children too tenuous for awareness of the emotional pain a child suffers to be acknowledged or comprehended. The increase among older adults suggest that the cost of being old – from housing expenses, medical care, food scarcity, and basic living assistance – are just too much for too many people on limited incomes to bear.

The fear of aging may actually reflect a truth much deeper than a vanity-based fear might suggest. In our country, aging is synonymous with anonymity, uselessness, expense, and purposelessness in a world obsessed with living hard and living fast and staying young. Old age is not for sissies and it appears that Americans are doing everything they can to ensure that they are increasingly protected from having to face the specter of old age and a long life.

The real question is not how to help the elderly live longer, but how we help the young to survive to reach older adulthood. It is not infant mortality that is the problem, it is young and midlife adult frailty that is becoming a medical emergency. Despair takes hold when hope is weak.


Woolf, S. H., Chapman, D. A.,  Buchanich, J. M., Bobby, K. J.,  Zimmerman, E. B., Blackburn, S. M. et al. (2018). Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics BMJ 362 :k3096