Older Adults Today More Likely to Have Multiple Chronic Conditions than Prior Generations

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, according to a study conducted by Penn State and Texas State University.

For example, researchers found that Baby Boomers, born between 1948 and 1965, compared to persons born during the later years of the Great Depression (1931-1941) exhibited a greater number of chronic conditions and also reported 2 or more chronic health conditions at younger ages, according to a press statement from Penn State.

Multimorbidity, an increasingly prevalent state of heatlh, represents a substantial threat to the health of aging populations, according to the authors. Moreover, the strain on older adults and on the health care and federal insurance systems only stands to increase as the number of US adults older than age 65 years is estimated to grow by more than 50% by 2050.

"Even before the COVID-19 pandemic, we were beginning to see declines in life expectancy among middle-aged Americans, a reversal of more than a century long trend," said first author Steven Haas, PhD, associate professor of sociology and demography at Penn State, in the statement. He added that population health in the US has steadily fallen behind other high-income countries for the last 3 decades. Their findings, said Haas, suggest that the US “is likely to continue to fall further behind our peers."

The paper was recently published in The Journals of Gerontology: Series B.

20 years of data, 9 chronic conditions

For the study, the researchers examined intercohort variation in multimorbidity in adults aged 51 years and older using data from 20 years of repeated assessments drawn from the Health and Retirement Study (n=33 598; 1998-2018). According to the study abstract, 9 chronic conditions were included in the index: 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.

Haas and colleagues found that generations of older adults born more recently are more likely to report a greater number of chronic conditions and experience the onset of those conditions earlier in life.

A range of sociodemographic factors also affected the risk of multimorbidity across the generations, teh authros found, including race and ethnicity, being born in the US, childhood socioeconomic circumstances, and childhood health. The most prevalent conditions identified in adults with multiple chronic conditions, also for all generations, were arthritis and hypertension. The investigators also found evidence that high depressive symptoms and diabetes contributed to the observed generational differences in multimorbidity risk.

Coauthor Nicholas Bishop, PhD, assistant professor at Texas State University, said there could be multiple explanations for the findings.

"Later-born generations have had access to more advanced modern medicine for a greater period of their lives, therefore we may expect them to enjoy better health than those born to prior generations," Bishop said.

"Though this is partially true, advanced medical treatments may enable individuals to live with multiple chronic conditions that once would have proven fatal, potentially 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, he added. 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.

The researchers said future studies could try to find explanations for these differences in multimorbidity between generations.

Reference: Bishop NJ, Haas SA, Quinones AR. Cohort trends in the burden of multiple chronic conditions among aging US adults. J Gerentol: Series B. Published online June 1, 2022. https://doi.org/10.1093/geronb/gbac070