People in the developed world are not only living longer than ever, they are also staying healthier well into their later years. Once considered a time of disease and frailty, the years after age 65 can often be a vital and active part of life, a time when many people discover new interests, realize lifelong dreams or change careers.

Merck is helping to play a role advancing healthy aging by:

1. Seeking new medicines that may help maintain and enhance physical and mental function,
2. Studying its drugs in the elderly to learn more about their use in older adults,
3. Supporting training of geriatric experts, and
4. Providing health care professionals as well as consumers with information on approaches to healthy aging.

At the end of this interview with two of the world's foremost experts on aging and health—Patricia Barry, M.D., and Mark Beers, M.D.—readers will find links to helpful Web sites on aging and health.

PB: Today's older adults make up a larger proportion of the population than ever before. Since 1900, the United States population has tripled, but the number of adults aged 65 and older has increased 11-fold, from 3 million in 1900 to about 36 million currently. A huge increase in the number and percentage of older adults will occur between 2010 and 2030 as the baby boom generation crosses the 65-year threshold.

MB: In many ways older adults are remaining more functional as they age. Among Americans aged 65 to 74, nearly 90 percent report no significant disability whatsoever. Thanks to awareness and better tolerated medications, high blood pressure and high cholesterol levels are being treated, with an accompanying reduction in the prevalence of arteriosclerosis, stroke and other cardiovascular disorders. Among people over age 65, death rates from heart disease declined by more than 30 percent and rates from stroke by more than 36 percent between 1980 and 1997. Developments in drug and non-drug treatments are helping older people remain functional, despite diabetes, arthritis, incontinence and many other conditions. Because of improvements in the health status of older adults, researchers estimate that in 1999 there were 2.3 million fewer disabled older adults than would have been predicted in 1982.

MB: Because the "oldest old"—those aged 85 and older—are proportionally the most rapidly growing age group. Between 1960 and 1994, their numbers rose 274 percent, while the entire U.S. population grew only 45 percent. The majority of those 85 and older are, and will continue to be, women. In addition, today's older adults have more diseases than ever, in large part because medical care allows people with chronic disease to live. Approximately 80 percent of all today's older adults have at least one chronic condition and 50 percent have two or more. Chronically disabled older adults incur health care costs at a rate 7 times that of their healthier peers. In addition, more attention could be given to prevention of disease. If the baby boom generation comes to late life with as much chronic disease as the current older generation, the cost of their health care may prove unaffordable.

MB: Yes. An analysis of Medicare data shows that the United States spends an additional $26 billion each year for older people who can no longer live independently. The average annual cost of care for a person who remains independent is about $4,800. That figure rises to about $18,000 if the individual requires help with daily activities and to $36,000 if the person lives in a nursing home. An Alliance for Aging Research report concludes that the United States would save at least $5 billion in health care and custodial costs for every month that physical dependency could be postponed for older Americans.

PB: It is also imperative that the medical profession start to provide training and education in geriatrics so that older Americans will receive the best possible care. Today, less than half of medical schools have geriatrics programs, and less than half of baccalaureate nursing programs have full-time faculty certified in geriatrics training. A mandatory geriatrics rotation in all medical schools would be welcomed, but it would not solve the problem. There are about 650,000 physicians in the United States. About 16,000 new doctors graduate from medical schools each year. If geriatrics training were required in every medical school today, it would still take more than 40 years for all practicing physicians to be replaced by those with geriatrics training. We especially need to ensure that community-based practicing physicians have the knowledge and skills they need to provide the best care for the older adults they see in their offices every day. The Merck Institute of Aging and Health has a major focus in this area.

PB: We all must recognize the great need to ensure that we remain healthy as we age. Our success will be based on how well we:

• Reshape our view of aging from that of inevitable decline to that of a new life stage.
• Promote individual responsibility for healthy lifestyle choices, including diet and exercise, disease prevention and screening and use of drug therapies and vaccines that can help prevent, slow the progression and reduce the complications of disease.
• Support the discovery of new medications and technologies that help prevent disease and preserve and enhance function.
• Educate ourselves about the best ways to remain healthy.

MB: The pharmaceutical industry is dedicated to improving care for older adults. Today, pharmaceutical companies have more than 800 new medicines under development that will help treat older adults. At Merck, our scientists are studying the diseases that affect aging and the aged and attempting to discover the best medicines to prevent diseases and treat them. Beyond our research focus, Merck has developed special initiatives, such as the Merck Institute of Aging and Health to serve the needs of older adults and health professionals, and has been involved with many of the organizations that support geriatrics research and care to help assure that in the future America is rich with geriatrics experience. Merck has developed an internal staff with considerable expertise in geriatric medicine and publishes The Merck Manual of Geriatrics. The company also has dedicated teams to the appropriate marketing of medicines in nursing homes and other long-term care settings. We have made special efforts to support the geriatric care needs of managed care organizations.