The Aging “Forgotten Middle” Are Declining in Well-Being

We often talk about the financial struggles of America’s “forgotten middle,” the group of older adults who earn too much to qualify for public benefits but not enough to comfortably afford long-term care. This time, we look at another side of the story: their health. Research shows that the forgotten middle are not only financially vulnerable but also experiencing significant decline in well-being as they approach retirement age.

Well-Being Study Researchers from Stanford Health Policy and the Research Network on an Aging Society analyzed twenty years of data from the Behavioral Risk Factor Surveillance System (BRFSS).

BRFSS is a nationally representative Centers for Disease Control and Prevention-run survey that gathers information on health and well-being from all 50 states and includes more than 5.3 million participants from 2003 to 2022. The researchers examined trends in three key areas:

• Physical well-being

• Mental well-being

• Functional well-being (such as difficulty with daily tasks)
  

They looked at these trends across different income groups, paying particular attention to households between the 15th and 45th percentiles of income or the group known as the “forgotten middle.” They found that well-being has declined across all income levels over the past two decades BUT the largest declines occurred among the poorest and the lower-middle-income households with declining trends being greatest for lower-middle-income households.

These lower-middle-class older adults ages 50 to 59 pre-retirees have worse well-being than adults ages 60 to 74.

In contrast, adults who are well off or financially comfortable are aging with better physical and mental health.

Why This Matters

The decline in health and well-being among the forgotten middle has serious implications for individuals, families, and the systems that support older adults.

Right now, the forgotten middle have less financial cushion, more chronic stress, and fewer support systems.

This means they will likely need medical care sooner and more often, including treatment for chronic conditions, hospital visits, and ongoing management of physical or cognitive decline.

Impact on Medicare Expenditures Because adults in the forgotten middle will eventually enter Medicare at age 65, the system will inherit a population that is already in poor health. Many will need medical care sooner and more frequently. Entering Medicare sicker means higher utilization, greater spending, and more complex care needs. Impact on Social Security When people cannot continue working due to worsening health, they may claim Social Security early, which reduces their lifetime benefits but increases the number of individuals drawing from the program sooner.

Impact on Labor Force Participation

Poor health limits the ability to work full time or maintain jobs. A growing number of older adults may exit the workforce earlier than planned, leading to fewer earnings, reduced savings, and lower contributions to retirement accounts. This early exit not only harms individual financial security but also impacts the broader economy. A smaller number of people working may reduce tax contributions that help fund programs like Medicare and Social Security, which could create additional pressure on these systems as demand for benefits continues to grow.

The Opposite of What We Desire The researchers noted a concept called “compression of morbidity". It is the idea that as people live longer, they will spend fewer years being sick or disabled. In other words, people would enjoy more healthy years and only experience illness toward the very end of life.

But this new research shows the opposite is happening for the forgotten middle.

Instead of staying healthier for longer, they are entering older age with more health problems and fewer financial resources.

Without addressing the health and financial gaps affecting this group, the path forward may move us further away from the ideal of healthy, productive aging.

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This article was made by  Elder Love USA.

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