Ask a 50-something if he's looking forward to retirement, and the answer is likely to be, "What's not to look forward to? Lots of leisure-time activities. A little travel. No major health issues as I sail effortlessly into my 90s."


Does that last expectation sound a little too rosy? Consider this: A poll released in September by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health found that just 13 percent of working Americans over 50 expect their health to get worse in retirement. As futurist Jeff Goldsmith told NPR, "Hello. That's what getting older is eventually about. We're all going to have serious health problems in retirement, and eventually really serious health problems."

Not that we ought to sit around and fret about it. But if our glasses are so rose-colored they're distorting our outlook, we might fail to do all we can to stay fit as long as possible and to make sure we're ready financially and otherwise when medical care does become necessary. Moreover, Robert Wood Johnson Foundation CEO Risa Lavizzo-Mourey, M.D., says, "Insights from the poll can help policymakers and others think about how to meet the needs of aging Americans. There are changes we can make to our health care system, finances and communities that might help ensure that our retirement years will be as fulfilling as we hope."

To some degree, these "pre-retirees" are justified in their optimism. The poll found that 68 percent of Americans over 50 who still work have changed to more healthful diets while only 58 percent of retirees have done so. And 72 percent of pre-retirees have increased the amount of physical activity they get compared with just 44 percent of retirees. "We really have a generational change recognizing that exercise is one major thing you can do to reduce your health risk in the future, and that's really caught on among the pre-retiree generation," Harvard's Robert Blendon said in another NPR interview.

When it comes to finances, just 22 percent of pre-retirees say their financial situation will be worse in retirement. Still, a hefty minority of pre-retirees — in the 30 to 40 percent range — do anticipate trouble paying their health insurance premiums or paying for long-term care and are not confident that Medicare will provide benefits equal in value to current benefits.

Pre-retirees and retirees agree on what makes communities healthier for retired people: clean air and water, low crime rates, access to affordable fruits and vegetables, and access to high-quality doctors and hospitals. Pre-retirees are more likely to say access to outdoor space for walking, jogging and sports is important, while retirees are more likely to say access to pharmacies and drug stores is important.

As many boomers surge toward retirement without a firm grasp of what lies ahead, the consequences on individuals and on the health care system could be severe. Policymakers, hospital leaders, other providers, and communities should consider the implications and do what they can to soften the impact.

Bill Santamour is managing editor of Hospitals & Health Networks. Follow his tweets at