June 2010

This year’s Age Boom Academy – the takeaway

The heart of the matter, concisely put by the ILC-USA’s Executive Director Everette Dennis in his opening remarks at this annual journalism seminar, is the “perception of aging as a social problem versus as a great human achievement.”

There seems to be a lot more hand-wringing than back-patting going on. This is despite growing evidence that:
•    longevity generates wealth.
•    a new middle age is emerging, a cohort with the health, education, and potential to remain productively engaged decades past age 65 (a dividing line borrowed from German Chancellor Otto von Bismarck and maintained by an array of staggeringly obsolete policies).
•    the vast majority of older people enjoy their active lives. A quick data hit here from demographer Greg O’ Neill, the director of the National Academy on an Aging Society: 80%  of people over 65 are functionally independent.  Only four percent — down from 5% over the last decade — lives in nursing homes. Ninety percent of the remainder is cognitively fit.

Here’s another paradox:  if so many people are so damn worried about the coming tsunami of the demented and decrepit, why aren’t they doing anything about it? An opening litany delivered by Bob Butler, the President and CEO of ILC, reflected alarms he’s been sounding for decades: Why the drastic shortage of geriatricians? Who’s going to take care of older people if immigration laws toughen? How come 9 out of 10 nursing homes don’t meet basic federal standards? Why is the poverty index totally outmoded? Why is there no requirement to include older patients in drug trials? Why the lack of progress against elder abuse — or Alzheimer’s disease, whose incidence and prevalence will double every 20 years at unthinkable personal and economic cost?  

This is what happens when the personal denial that I’ve been focusing on plays out on the sociocultural level.  As I wrote in my manifesto, “If we’re squeamish about facing our own prejudices, our own aging and death, how can we expect more of our government?” It’s the collective price we’re going to pay for pretending that the most universal aspect of the human condition, with all its pains and pleasures, will somehow not apply to us. The costs will swamp millions of boomer boats, which contain far too little to fund any kind of conventional retirement.

While lots of octogenarians resemble Bob Butler (healthy, vital, engaged — as well as well-educated and optimistic by temperament, advantages he’s quick point out), many of the old old are poor, frail, and dependent. This contributes to the challenge of advocating for aging policy, as Stephen McConnell of the Atlantic Philanthropies pointed out. “We tend to look at things in a single direction, black or white,” said McConnell. “We do that with aging, and it’s a problem, because we have difficulty in dealing with [these contradictory images] in our policies.”

A major controversy swirls around the workforce.  One of McConnell’s first campaigns was to get rid of mandatory retirement, but the victory was largely symbolic. Although people over age 60 can now anticipate 20 to 30 more active years, by age 65 only 15% of the male population remains in the workforce. (Since the turn of the century, this has begun to trend upwards.) Only about 1% volunteer, although those who do contribute twice the hours of other age groups. TV-watching dominates what people over 55 and out of the workforce do with their leisure time.  Needless to say, lots of television — especially if you’re watching alone, or with a drink or cigarette in hand — isn’t likely to land you in the “productive aging”/Bob Butler camp. Work of some sort, on the other hand, promotes physical, social, and psychological well-being.

“Civil engagement is the answer,” declared Rick Moody, the Director of AARP’s Office of Academic Affairs, and many agreed, including O’ Neill. “How do we promote meaningful engagements on the part of older adults?” he asked. These guys see this as the catalyst for what O’Neill, dubbed “a new vision of aging,” in which age is perceived as an asset, society exploits the human capital of the “experience dividend,” and “seniors are about production and contribution, not just consumption and need.” Butler, who invented the term “ageism” in the 60s, has coined a new term that subverts conventional thinking. He uses “shortgevity” to describe countries where people don’t live long and healthily enough to be productive The policy challenge in our dumb country is to support those who want to keep working, encourage those on the fence, and protect those who cannot.


Geriatrics: "an incredibly satisfying life"

At an afternoon session of this year’s Age Boom Academy for journalists there was a critical mass of geriatricians at the table: Robert Butler and Harrison Bloom, both of the International Longevity Institute (which co-sponsors the Academy along with the New York Times), and Rosanne Leipzig of the Mt. Sinai School of Medicine.  I took advantage of this to pop a question I’d written about a few weeks earlier: what makes geriatrics so satisfying?

Dr. Leipzig pulled no punches in her terrific response.  Describing herself as a “clinician and educator in the trenches,” she’d briskly dismissed the preceding topic (the potential for “resetting” cells to slow degeneration) as “sexy aging” that deserved no spot on the national agenda. “The type of person who goes into geriatrics has decided to do it anyway” — despite the low pay and reimbursement hassles — “and it’s an incredibly satisfying life,” she responded. Especially if you’re salaried, and most geriatricians work at universities or big healthcare facilities. “Why did I go into it, besides a grandmother?” she continued, adding as an aside, “Everyone goes in because of a grandmother. The other is that it’s probably the most intellectually challenging work I could have found. You have to be the best doctor in the world and then figure out how to apply your knowledge to the older patient. There’s much more heterogeneity than across younger patients. Every patient is a major challenge, with between three and eight chronic conditions, on multiple medications, with different social constructs, and I have to put all this together.  I can’t write a prescription and expect them to go home and fill it and deal with it all.”  She paused, smiling. “It’s holistic medicine. I go to weddings, I go to funerals, and it’s incredibly satisfying to be that kind of doctor in this day and age.”

“something very deep and quite human”: happiness in late life

A large Gallup poll of more than has found that “by almost any measure, people get happier as they get older.” The tone is skeptical: “[Getting old] sounds miserable, but apparently it is not.” The methodology is impeccable: researchers surveyed 340,000 Americans aged 18 to 85. The conclusion is clear: “good news for old people, and for those who are getting old.”  In other words, for everyone.

The Gallup poll joins a growing body of research, including studies conducted at the University of Chicago and the University of Warwick and Dartmouth College, that confirms this  “U-shaped happiness pattern.” Researchers aren’t sure why old age brings happiness. “It could be that there are environmental changes,” said Arthur A. Stone, the lead author of a new study based on the survey, “or it could be psychological changes about the way we view the world, or it could even be biological — for example brain chemistry or endocrine changes.”  It seems universal, though. And perhaps one day the fact itself will no longer surprise.