The Senior Mentor Home Visit Program: The Story behind the Grant

A project shows how to head off ageism in tomorrow’s young doctors

Maggie, 82, sits on a metal chair across from her new family doctor.

“I’ve just been feeling tired lately,” she tells the young MD.

“Well, no wonder!” the doc responds. “You’re 82!”

Actually, Maggie—who does tai chi, volunteers at an animal shelter and is sporting a sea glass necklace from her latest beach vacation—has developed a persistent bout of depression. But her newly minted doctor, who has mostly only ever seen older people in the hospital, thinks she’s doing great, “considering.”

This hypothetical situation is the kind that medical schools have been working to prevent. If med students only see older people in the hospital with pneumonia and broken hips, they can get a skewed impression of what their lives are like.

So in 2011, the Silver Century Foundation stepped in to help combat this challenge, funding the Senior Mentor/Home Visit Program at the Robert Wood Johnson Medical School in New Brunswick, NJ.

By the end of two grant cycles, 48 medical students had learned, as one put it, “never, ever, ever judge a book by its cover.” And the medical school had a solid foundation for what would become an ongoing mentor program.

Ageism Prophylactics

In 2011, Kay Klotzburger, founder and president of the Silver Century Foundation, was looking to fund a promising ageism-prevention project. She just hadn’t found it yet.

Until that point, the foundation had mostly funded programs that served older adults. But Klotzburger was frustrated; she kept encountering hardwired ageism—in both older and younger people. She wanted to pivot to prevention, to stop ageism before it began.

Grace Egan, whom she’d worked with on the New Jersey Elder Index grant, told her about a project that might fit the bill. The Robert Wood Johnson Medical School (now a part of Rutgers University) was looking to launch something called a senior-mentors program. The purpose was, in large part, to combat ageism in medicine.

“As students go through medical school—particularly as they get to the clinical years—they’re actually spending most of their clinical time in a hospital setting,” explains Joyce Afran, MD, co-director of Patient Centered Medicine at the medical school. “So they really don’t have the opportunity to develop an understanding of what’s actually happening when patients leave the hospital—how they’re managing their chronic medical problems at home, how well they’re functioning.”

This can lead to a tendency to dismiss treatable medical problems as just part of old age. “They’re seeing patients when they have problems and they’re in a gown and they’re not really moving,” says Afran. “You [as a student] don’t see what they can do—to understand what you can get them back to.”

Doctors in every specialty need to know more about aging. For example, orthopedic surgeons—who see patients at their physical worst—need to understand that people of all ages have lives to get back to (and to do intensive physical therapy for).

So, in the early 2000s, medical schools were testing out solutions. One promising option was the senior-mentors model.  

In senior-mentors programs, healthy older people living independently in the community served as “mentors” to medical students. The students visited their homes and practiced essential skills, such as taking medical histories and checking for fall hazards. Over the course of a few visits, the students also got to know these older people as human beings.

The Robert Wood Johnson Medical School had tried such a program a few years before but needed a grant to start one up again. So the Silver Century Foundation provided it.

The new program—which Afran helped run, along with Fred Kobylarz, MD—launched in 2011 with 18 medical students. The following school year, enrollees jumped to 30.

One student wrote in a course evaluation after the first year, “We learned that some people can maintain their good physical and mental health long into their ‘old age’ so be sure to understand how well your Senior patient is able to function and treat them like adults & not needy incapable children—as our mentor told us.”

Prevention Prescription

The Senior Mentor Home Visit Program was an elective track for second-year medical students in the Patient Centered Medicine course. Students don’t choose their specialty until the third or fourth year, but “I don’t care what specialty you’re going to go into, you will encounter older adults,” points out Kobylarz, director of the school’s Center for Healthy Aging. “So even if you’re a pediatrician, Grandma might be bringing in little Johnny for whatever, and you better be able to think about what Grandma might be saying.”

“I think especially the students who are not going into primary care—we hope that they’re the ones who are taking with them a better understanding of what it’s like to be an older adult and be functional,” says Afran. For example, orthopedic surgeons—who see patients at their physical worst—need to know that people of all ages have lives to get back to (and to do intensive physical therapy for).

In the school’s mentor program, the students visited their mentors three times. Each visit had a specific focus. The first covered functional abilities, the second, medication management and the third, home environment. Students were given lists of topics to ask their mentors about. Being only second years, they were barred from giving medical advice.

Over the course of the three visits, students learned details about such personal but medically relevant topics as:

  • Social support level and whether it met the mentor’s emotional needs
  • Financials, such as whether the mentor had enough money for food
  • Hobbies
  • Any functional limitations and how the mentor dealt with them
  • Personal life problems and how the mentor was handling them

“It was kind of a little puzzle for the students to find out, how do these people do it?” says Klotzburger. “What they found out rather quickly is that a lot of these people had liabilities. They couldn’t see too well, they couldn’t drive, they limped, they had to use a cane, their balance wasn’t great, but there they were, living in the middle of their community, and they weren’t depressed, and they weren’t saying that they had all kinds of health problems. They had figured out how to cope with aging. And the students found that astonishing.”

At the end of the first year, students completed evaluations of the program. One of the questions was, “What did you learn from your senior mentor about aging and growing older?” Responses (as written) included:

  • That not all aging people are sick!
  • The aging process is different for every individual and can still be a fun, rewarding and lively experience.
  • My senior mentor was great. She showed a lot of appreciation for the life that she had, but also lamented that growing old was not exactly a walk in the park.
  • It’s not easy, and sometimes the best way to deal with it is to try to focus on other things.
  • That I should learn to play bridge.

Students also said they found new appreciation and respect for older people. One wrote, “Elderly folks have numerous ways to retain control over their lives even as their health degenerates. I gained respect for older individuals who suffer from numerous ailments but are able to functionally cope with them.”

The original nine mentors—who had been recruited from senior centers—expressed appreciation for the program in their evaluations. “I enjoyed having [the students] here,” one wrote. “I don’t get many visitors.”

“Our sessions were interesting and fun and enjoyable in every way,” another commented.

Many mentors talked about the importance of helping train these medical students. “Those are young, intelligent, future doctors who need to know what aging is all about because seniors have different needs,” one wrote.

“The program provided the mentors with a $50 credit card when they got through with this,” says Klotzburger. “Initially they were all excited—‘Ooh, I can go shopping with $50!’ By the end of it, they said, ‘I don’t need any money for this; this is such fun.’”

In year two, 23 mentors signed up—almost three times the number from the first year.

Klotzburger believes the increased interest among both students and mentors is clear evidence of the program’s success. “The students scrambled to enroll in the elective program and clearly had a change of mind about treating older people,” she says. And as for the mentors, “It allowed them to participate in a teaching role, to interact with young people and thus to feel that they were still important, contributing members of society.”

This success of the senior-mentors program solidified a new focus for the Silver Century Foundation: combating ageism in younger people. For example, since the senior-mentors grant ended, Klotzburger says, “we have funded programs that work to train journalists in how to be aware of their own ageism and write articles about midlife and older people that do not incorporate ageist perspectives.”

Prognosis

“We’re all going to age,” says Kobylarz. “We’re all going to develop certain diseases. But despite these diseases, this aging process—it’s not all negative.”

The Rutgers Robert Wood Johnson Medical School continues to offer a senior-mentors program to students. After the initial two years of working with healthy older people, the school transitioned to working with people who had chronic diseases. Now the program is a cross between the two models, Afran says.

More medical schools have joined the trend now too. Senior-mentor programs have become more common. “And different variations on the scene as well,” she says. “I would say now the focus is on chronic disease management.”

Afran explains that’s because, as people are living longer, they’re also developing more chronic diseases and managing them at home. “I think part of it is also the economics of health care,” she says. “We are trying to keep people out of the hospital.”

But when they end up there, at least doctors will know that they have lives to get back to—no matter their age.

Many Women Are Defying the Bully: the Antiaging Industry

They’re keeping the gray and tuning out the antiaging hype

At age 57, Victoria Marie sports a full head of long, lustrous gray hair—in the city of Los Angeles, as an actress, in an industry where youth is life. “This is who I am,” she says. “Take it or leave it.”

Across the country, in North Carolina, Martha Truslow Smith embraces her premature gray—at age 26. “I never want to pick up a bottle of dye again,” says the graphic designer.

With its ubiquitous hair dyes, creams, injectables and surgeries, the antiaging industry is a multibillion-dollar field. Yet more and more women are declaring they’re done with it. They’re done with being told aging is shameful. They’re done with spending money, time and effort to hide signs of aging—particularly gray hair. And some of them insist this anti-antiaging trend is here to stay, despite a bevy of naysayers.

The Visible Rebellion

Truslow Smith found her first gray hair at age 14. By the time she was in college, she was dyeing her hair and feeling embarrassed by her gray roots.

The cycle of dye-and-shame was “a slow, quiet monster that developed in my life that I didn’t allow myself to really acknowledge,” she says.

At age 24, she decided to face it. She was in a relationship and realized she wasn’t truly being herself. She was hiding a ball of stress from a man she wanted to marry. So in the summer of 2016, Truslow Smith stopped dyeing her hair—and started an Instagram account called Grombre to chart her growing-out process and to build a supportive community. She invited people who celebrated silver to message her and be featured on the account.

In July 2018, the account had about 7,000 followers. Then Refinery29, a women-focused online outlet, wrote an article about it, followed by BBC News and other media organizations (unsolicited). Now, Grombre has about 46,000 followers and almost 1,000 posts featuring women of all ages. And Truslow Smith (now married to the aforementioned gent, who “loves” her hair) gets so many emails from women wanting to tell their stories that she can’t possibly feature them all.

Women who decide to go gray naturally say they’re tired of dyeing. And then there’s the double standard: on men, gray hair is considered distinguished.

She’s found the massive interest surprising and wonderful. “It’s a change I would like to see in the world—to have women feel like, if they don’t want to dye their hair, then they shouldn’t be obligated to do so.”

For her part, Victoria Marie feels no such obligation. In the summer of 2013, when she was in her early 50s, she uploaded a video to YouTube about her gray roots. She was recovering from a series of bad dye jobs and had decided to let her gray hair grow in fully, like she used to have it. She titled the video, “Gray Is the New Blonde!”

Women started emailing her—excited to tell her how much they related to what she was saying. “I thought, ‘This is interesting. People care about gray hair? How bizarre.’ I had no idea,” she says. Many told her they were letting their gray hair grow in too.

Now, in 2018, Marie is preparing to release her first documentary, Gray Is the New Blonde, which profiles women who have decided to go gray. The film’s Facebook page has about 13,000 followers.

“Women are saying, ‘I’m here, and this is my path, and take it or leave it. I’m not going to shrink to societal pressures anymore and feel like I’m not worth anything unless I do. I’m very worth something, with gray hair and all.’”

Who Goes Gray

Both Truslow Smith and Marie say the most common reason women decide to gray naturally is they’re tired of the dye process. “They are just fed up with this every two to three weeks of having to go get their hair done,” says Marie. “And it’s no longer fun like it was when we were in our 20s and 30s. It’s a requirement now.”

Many cite the double standard—that gray hair on men is usually considered distinguished. They decide, “What’s wrong with my gray hair? It looks good!” she says.

Some women also stop dyeing their hair for health reasons—for example, if they’ve had cancer and want to avoid the chemicals.

One woman told Truslow Smith, “I lost my son, and he will never have the chance to go gray.”

“It’s a combination of women kind of being fed up with being bullied [by antiaging marketing messages] and realizing that there is so much more to life—that we only have so much energy; why are we spending it on things that at the end of the day don’t totally matter?” Truslow Smith says.

But another common theme among these women is fear. In a culture that values women for their looks and equates beauty with youth, women who are considering going gray are often afraid they’ll be rejected—for work, by potential romantic partners, by family members, even by strangers. And many times, those fears are realized.

“A lot of people get a lot of negative comments and feedback and pushback,” Marie says. She knows of one woman in her 30s who was in a training class for administrative work. “She’s got great features, and she looks so chic, but that male instructor shamed her verbally in front of everyone in the class and said, ‘You’re not going to get hired if you don’t go and dye your hair,’ and brought her to tears.”

When Marie started growing her gray out, one of her friends pressured her to dye it, to the point that he offered to cover the cost. Later, she realized his protests were actually related to how he viewed his own aging. “Typically that’s what it’s about,” she says. “It’s not about the person who’s decided to go gray. It’s about the person who’s saying to them, ‘You should go dye your hair.’ It’s because of their own fears and their own insecurities about the aging process.”

Women who do go gray despite any negative pressures tell Marie they have one regret: they wish they’d done it sooner. “Women say over and over again, they did not expect to feel so empowered, so authentic,” Marie says. “They feel fierce, they feel strong, they feel powerful. And they’re rockin’ it.” For that reason, she believes, this trend is no fad. “It is a movement, and it’s not going away.”

Wrinkles: to Fight or Not to Fight

Gray hair is one thing. Wrinkles? That’s another matter. If a woman goes gray and doesn’t like it, it’s easy enough to dye her hair back. Wrinkles are harder to get rid of.

Even women who go naturally gray aren’t always so gung-ho about ditching antiwrinkle creams—despite the fact that scientists and dermatologists say most such creams don’t work.

Often, it boils down to fear of regret, says Abigail Brooks, author of The Ways Women Age: Using and Refusing Cosmetic Intervention (2017). They’re afraid they’ll end up looking older than their friends who use antiaging creams and procedures. And they also face some guilt.

Per pervasive marketing messages, “to age well, particularly as a woman, means that you should be fighting aging every step of the way,” Brooks says. The idea is, “this product gives you the power to fight back, and therefore you should say yes to that fight.”

The antiaging industry itself is ready to embrace aging at least partially—or it wants to sound as if it is.

For her book, Brooks did find women who were refusing antiaging creams and procedures. And she discovered a main commonality: they accepted aging as a natural process that didn’t need fixing.

“They actually talked about being able to understand the wrinkles and the sags and the bags and the gray hair as beautiful, just in different ways from how a young, wrinkle-free female face might look,” she says. They saw these signs of aging as “reflective of lived experience and actions taken and thoughts had and emotions felt. And they thought that that was a really interesting kind of beauty.”

Many women also said they were less focused on attracting male attention. “It’s like they’ve moved beyond that cultural expectation of the reproductive-vessel-slash-sex object, and that allows them this whole new, exciting phase of life,” Brooks says. “They feel like, I’m going to feel empowered to focus more on my mind now or more on other aspects of what I always have wanted to do.”

On the other hand, when Brooks interviewed women who did use antiaging creams and procedures, she found that they equated beauty with youth. Age-related changes “made them feel like their bodies were outside of their control,” Brooks says. Some “talked about needing to look younger to continue to be viable in their workplaces.” Others wanted to find a new male partner.

These women told Brooks that unlike men, they had to look younger to be taken seriously. “I think we have to say, but is that really OK?” Brooks says. “Is that where we want to be?”

The Antiaging Market

As the number of older Americans has increased, so has rebellion against antiaging marketing, with people asking why signs of aging must be hidden or “fixed” or “treated.”

In the summer of 2017, the beauty magazine, Allure, declared it would stop using the term antiaging altogether. “I hope we can all get to a point where we recognize that beauty is not something just for the young,” wrote editor-in-chief Michelle Lee in a letter from the editor—while also clarifying, “no one is suggesting giving up retinol” (probably the best-studied antiaging ingredient).

The antiaging industry itself is on board with this embrace-aging-to-some-extent idea too. Or, at least, it wants to sound like it is.

“We’re not anti-aging, we’re anti-wrinkles,” declares Neutrogena (whose Healthy Skin Anti-Wrinkle cream is marketed to “treat” wrinkles “and other signs of aging”).

In a CoverGirl television ad, model Maye Musk muses, “They say at a certain age, you just stop caring. I wonder what age that is” (as she applies a foundation that “reduces the look of wrinkles” and a graphic notes she’s “70 years young”).

Antiaging marketing has largely evolved from “aging is a problem” to the supposedly more empowering, “you are the solution.” Take charge, the ads declare. Fight! Nurture yourself!

In some ways, the revised messaging is a welcome change, says Brooks, who is director of the women’s studies program at Providence College in Rhode Island. But in other ways, it continues to reinforce the mindset that looking your best means looking as young as possible.

Nonetheless—and despite the fact that many women are shunning these products—the marketing seems to be working pretty well. Statistics about the size of the antiaging market vary widely, in part because they don’t all include the same sectors (such as cosmetics, cosmeceuticals, pharmaceuticals, exercise equipment, surgeries, even perfumes touted to make women smell younger). Estimates range from under $100 billion to more than $300 billion. But the general consensus is, the market is huge, and it’s growing.

Some of that growth is due to the fact that the industry has diversified its target audience, points out Toni Calasanti, a sociology professor at Virginia Tech who specializes in gender and aging. “More and more people are getting pulled in and at younger and younger ages,” she says. Women in their 20s are now key antiaging targets—as are men. “There are some gender differences, but the similarity across all groups is, we need to not look old.”

Aging with Freedom

Women who eschew antiaging products and procedures “talk to me in so many interesting and exciting ways about new room for growth, for freedom, for exploration and even liberation with age,” Brooks says. “They feel like now they can move into new avenues where they have more room for self-development or self-expression.”

Truslow Smith has a similar take. “I’m getting the sense that women who are embracing their gray hair are entering a new chapter of life that is unexpected, and they’re finding a new sort of love and contentment with themselves.”

Both Truslow Smith and Marie emphasize that they’re not suggesting it’s bad for a woman to dye her hair. They just want women to have a viable choice.

“We operate within beauty standards that have been a big bully,” Truslow Smith says. At 26, she recognizes that as the years go by, she’ll develop a lot more wrinkles, gray strands and other signs of aging. “Am I going to choose to believe that my value is decreasing as I’m getting older? Or am I going to choose to absolutely love myself and my full potential—and walk my path the way that I feel called to walk?” Self-acceptance, Truslow Smith says, “is a revelation that is not expressed within any sort of beauty advertisement—that women are claiming for themselves.”

Bucking Ageism in Philanthropy

Five Organizations That Make Older People’s Lives Easier

This is part 2 in our series on aging-related philanthropy. Read part 1 here.

There are a lot of problems in the United States.

Take the fact that our country is aging. By 2035, Americans 65 and older will outnumber kids for the first time in our history, according to the US Census Bureau.

The fact that we see that as a problem, not an opportunity, is a problem.

The fact that we haven’t made adjustments to this reality—in health care, government programs, cultural mind-set and practical accessibility—is a problem.

There are lots of problems.

But there are also charitable organizations standing in the gap right now, as our country—and our world—scramble to catch up with the new demographic reality. They’re helping older people, creating innovative solutions and leveraging the benefits of an aging America.

Yet, despite the fact that 15 percent (and growing) of Americans are 65 or older, only a small amount of money from grant-making foundations—perhaps less than 1 percent—goes to aging-focused initiatives.

Nonetheless, some aging-related charities are raising money and making significant impacts across the nation. Here are five of them—and what their leaders think about the philanthropic landscape.

Encore.org

“While many see our aging society as a problem, we view it as a solution,” says Encore.org’s website. “For the first time in history, many of us have an extra 20 or 30 ‘bonus’ years of active, healthy life, after having developed extensive skills, knowledge and life experience.”

Through specialized programs, Encore.org connects such people with volunteer and work opportunities that address social issues—especially those related to young people and their futures.

The Encore campaign that’s generated the most interest from grant-making foundations is Generation to Generation, which connects people over 50 with nonprofits that help kids.

“The campaign, which now includes 140 nonprofits, can help young people thrive in all kinds of ways, from literacy to job training,” Encore.org’s founder and CEO, Marc Freedman, wrote in an email interview. The program can also help fight loneliness at both ends of the age spectrum.

But why has it, in particular, drawn such keen interest? “Perhaps the potential of cross-generational unity in these divisive, kids-versus-canes times is an appealing tonic,” Freedman theorized.

Through another of Encore.org’s programs, Encore Fellowships, skilled people who want to transition to a career in the nonprofit sector are placed in short-term assignments with charitable organizations. These fellows are paid for their work, though relatively little.

“The organizations benefit unbelievably,” says Paul Irving, chairman of the board for Encore.org. “You can imagine having somebody who was a chief financial officer, or a general counsel, of a major company, who now goes into a small nonprofit and helps that nonprofit survive and sustain and elevate. And the people who do it find incredible joy in the work, and a new sense of meaning, and a sense of the possibilities of their longer lives.”

Over the years, Encore.org has managed to land grants for various projects from a number of foundations.

“I would hardly say it’s been easy,” Freedman wrote, acknowledging that there’s ageism in philanthropy just like everywhere else. “We have to make older generations standing up for and with younger ones the norm in later life—and that’s going to take innovation, investment, an army of activists and years of hard work. It’s the only way to make this more-old-than-young world work for all generations.”

The Green House Project

Most anyone who works in long term care today knows about the Green House Project—a person-centered, nursing home model with around 250 member homes in 33 states. But in 2005, there was just one Green House in one Mississippi town.

That’s when the Robert Wood Johnson Foundation stepped in with a five-year, $10 million, replication grant to launch such homes across the country.

“I don’t know what we would have ever done without their support,” says Susan Ryan, senior director of the Green House Project. “Robert Wood Johnson recognized that if ever there was a field that needed this transformation, it was this field. And the model certainly offered promise.”

The Green House Project helps organizations, which pay a technical-assistance fee, develop home-like, family-centered nursing homes, in lieu of traditional hospital-like facilities. Green House homes are small—with just 10 to 12 people living in their own private rooms. These homes have open-access kitchens and living rooms. And respectful care is prioritized: each resident is to be treated as a unique human and afforded appropriate autonomy.

Ryan came to Green House after spending years working to keep people out of nursing homes. She’d seen firsthand how they worked. When she was director of nursing at one in the ’80s, tying people to their beds and chairs to prevent falls was considered best practice, she explains. “I knew in my heart of hearts, this is wrong; this is dreadfully wrong.” (Today, such liberal use of restraints is illegal.)

So in 2001, she transitioned to home care and worked in her community to come up with creative solutions. But by 2008, she saw promise in the Green House Project, and she joined the company as senior director.

On TV, you don’t see anybody raising money who’s the poster child for problems that affect older people.

“Green House is not just a small-house movement, but it is a movement to deinstitutionalize, destigmatize and humanize care for elders,” Ryan says.

With its $10 million grant, the Robert Wood Johnson Foundation mandated that the Green House Project become a viable, sustainable business, Ryan says.

They’re getting there. Right now, about 75 percent of the general operating budget comes from partner fees. “We don’t want [the] cost to work with us to be a barrier to implementation and adoption of the model,” Ryan says. “So we try to keep our fees at a pretty decent rate.”

Yet even if fees eventually cover 100 percent of the budget, Ryan believes she’ll still seek out grants to help Green House continue to innovate.

Like many other leaders who work with older people, she’d like to see aging-related issues in general supported more—and maybe get a little publicity. “Look at TV. You’re not seeing people raising money for aging issues,” she points out. “Nobody that is aging becomes the poster child for raising money.”

“What we do with every engagement that we have with the Green House partners is to try to create those champions and those advocates,” she says. “Hopefully it starts changing the landscape and foundations could maybe stand up and take notice.”

Health Affairs

While the Green House Project helps shape long term care, home by home, Health Affairs helps shape health care, article by article.

A respected, health-policy journal founded by the nonprofit Project HOPE (Health Opportunities for People Everywhere), Health Affairs publishes papers about ways to improve health care.

And the John A. Hartford Foundation has helped ensure that since 2015, a good portion of those papers highlights innovative care models for older adults.

The grant makers at Hartford chose to support Health Affairs because they knew it had influence, explains George Suttles, Hartford’s program officer for the grant.

Health Affairs has a long track record of being able to get stories into the hands of practitioners and policy makers on both the state and federal level,” he says. “So when we were thinking about disseminating models of care and best-practice models, Health Affairs seemed to be one of the logical partners,”

It’s very important to us … that we’re not just advancing knowledge but that we’re changing practice and that we’re improving public policies.

–Alan Weil, Editor in Chief, Health Affairs

The two-year grant renewal for 2018 and 2019 calls for at least 10 to 14 articles about geriatric care—plus publicity for the articles and a briefing in Washington, DC, about them.

The John A. Hartford Foundation specializes in “improving the care of older adults,” so its mission happens to match Health Affairs’ well anyway, explains Alan Weil, the journal’s editor in chief.

Health Affairs is an empirical journal. People are looking for results from experiments or innovations,” he says. “They’re trying to figure out what works and ‘what can we try to do.’ And so [Hartford’s] interest in innovative care-delivery models fits very well with the kind of papers we like to publish—and the kind of papers our readers like to read.”

Over the years, the Hartford-funded series has had influence, says Weil. For example, a 2017 article about an initiative to reduce avoidable, expensive hospitalizations among nursing home residents became the journal’s 10th most read article of the year. It got a lot of publicity, Weil says, which helped make it more likely that the reported efforts would continue—and that more facilities would adopt similar measures.

Health Affairs has also received grants from other foundations to publish aging-related articles. “What’s interesting about aging is that it’s multifaceted,” Weil says, though some facets are easier to get funded than others. It all depends on what a foundation is interested in. “For example, John A. Hartford is very interested in age-friendly hospitals. I don’t know anyone else who’s working in that area,” says Weil.

“It’s very important to us—and it’s very important to the foundations that support us—that we’re not just advancing knowledge but that we’re changing practice and that we’re improving public policies,” Weil says.

ElderHelp of San Diego

Eighty-seven percent of people 65 and older want to remain in their own homes as they age, according to a 2014 AARP report.

ElderHelp of San Diego is working to make that desire a reality.

ElderHelp offers a menu of solutions, including rides and nonmedical in-home aid (such as grocery shopping and safety-bar installation)—all provided by volunteers.

There’s also a home-share program in which people are matched for mutual benefit. For example, a younger person might live with an older person in exchange for doing household chores. The older person gets help and companionship, and the younger person gets a financial leg up in one of the most expensive cities in the United States.

In 2018, California State Senator Toni Atkins named ElderHelp nonprofit of the year in her district.

Because there are no fees for ElderHelp’s services, individual donations and grants keep the organization running. Ninety percent of ElderHelp’s clients are living on low income, says Gretchen Veihl, the organization’s director of philanthropy. “Grant funding is really the backbone of the agency.”

She finds it challenging to locate funders whose priority is older people. “When you’re applying for a grant, seniors are never on a drop-down menu,” she notes. Health, illnesses, education, children may all be there, but rarely older people.

To entice and keep funders, ElderHelp maintains careful documentation of its impact. “For example, we know that ElderHelp clients have 10 percent fewer falls in the home than the average San Diego senior, and 92 percent of our clients feel more safe in their home because they have ElderHelp services,” Veihl says. With this evidence, “people see the value in investing in your agency and feel confident that you’re doing what you say you do and using your dollars well.”

Adopt-a-Native-Elder

Adopt-a-Native-Elder also helps older people remain in their own homes—or, rather, survive there.

The organization provides life-sustaining aid to Navajo elders who have traditionally lived off the land and can no longer do so effectively.

“These elders were self sufficient. They had sheep, they wove their rugs, they were silversmiths,” explains Linda Myers, founder of Adopt-a-Native-Elder. “The problem being what happens when you’re too old to leave, you have to sell your sheep because you can’t take care of them anymore, and you can no longer do silversmithing.”

And you live with no running water or electricity—where, in some areas, of the 27,000-square-mile reservation, temperatures can plunge well below zero. “It’s a third-world country within our own United States,” Myers says.

Adopt-a-Native-Elder provides essentials such as food, medical supplies and firewood to about 570 elders who live on the Navajo Nation reservation in Utah and Arizona. The elders are 75 and older—sometimes much older. “I had a 116- and a 114-year-old elder,” Myers says. They have no pensions and don’t receive enough Social Security to survive on.

Their families, the reservation and state governments try to help, but there’s not enough money to go around. “Many of their children, because they take care of the elders, live a very impoverished lifestyle,” Myers says.

Providing something as simple as firewood can save lives. “If you’re elderly and you don’t have electricity, it can be pretty cold,” Myers explains. “If they don’t have wood, then they freeze to death.”

In March 2017, CNN profiled Myers as a “CNN Hero” for the difference she’s making. But even heroes struggle. In particular, Myers has had trouble getting interest from foundations.

We found children [cared for by] elders quite often—and very old elders who didn’t have vehicles and didn’t drive.

Linda Myers

She used to incorporate children’s programs into Adopt-a-Native-Elder—providing Christmas stockings, backpacks and shoes. “I could get more funding for those programs than I could for the elders,” she says. “That was very unfortunate, because the only reason we started those programs is because so many young children were left with the elders.”

The children’s parents would leave the reservation to find work, only coming home on weekends. “So we found children with elders quite often—and very old elders who didn’t have vehicles and didn’t drive.”

Myers believes more foundations are willing to donate money for children than elders because “they see a future in children”: with a little leg up, kids might move out of poverty.

One challenge in getting grants for the Navajo elders is that people just can’t fully grasp their predicament, Myers says. “They can envision homeless, but they can’t envision people who actually live off the land and have survived to be in their 100s.”

And modern, online grant writing doesn’t allow for much education. “Today when you write a grant, it’s usually, ‘In 10 words or 30 words, describe what you do,’” Myers says. “They’ve cut it down to just the pure basics.”

Myers has the best luck getting grants from people who have volunteered or traveled with her and happen to have family foundations. “They see a need, they tell family, they adopt an elder.”

Local foundations that give small grants are also important sources of support, as is the American Express Foundation. “American Express in Utah has done a lot of work out on the reservation, and so they actually understand what our organization does,” says Myers. “They see what we do.”

“Caring for these elders is kind of a window of time. The traditional ones are now in their late 80s, 90s and 100s,” Myers says, explaining that unlike their children and grandchildren, these elders never learned English, never went to school and always lived a traditional lifestyle. “Caring for them is a huge need.”

Working Together for the Future

These five charities are changing the world in their own unique ways—with the help of foundations that see the value in investing in older people.

But there is much more to be done.

“Changing fatalistic attitudes toward aging is the best way to increase philanthropic funding of aging issues,” says Katherine Klotzburger, founder and president of the Silver Century Foundation, which commissioned this article.

Silver Century’s most recent grants have focused on journalism projects—both articles and documentaries—that Klotzburger hopes will challenge such attitudes and combat ageism across a wide sphere.

Nathaniel McParland, who served on the board of the Retirement Research Foundation for almost 30 years before retiring in 2018, is already seeing promising trends.

“I think the elderly have finally gotten a voice of their own,” he says. “The politicians are paying more attention to them than ever. And I think this trend will probably continue.”

Ultimately, such a trend will benefit people of all ages. “Unlike gender and race and religion and other things, aging really is a common bond that should bring us together,” says Paul Irving, who’s chairman of the Milken Institute for the Future of Aging, in addition to being chairman of the board for Encore.org.

“Every single one of us has a stake in ensuring that older people have a healthier future, have a more productive and engaged future, have an opportunity to realize their dreams and aspirations, have an opportunity to connect and learn, and an opportunity to contribute,” he says. “And we should all be working together to make sure that is possible.”

What’s Missing in Philanthropy?

Enough funding for efforts to help older people. Could that be ageism?

This is part 1 in our series on aging-related philanthropy. Read part 2 here.

There’s an odd dichotomy in the philanthropic world.

Every year, American grantmakers donate tens of billions of dollars to nonprofits, to help make the world a better place. Yet only 1 percent of those dollars goes to aging-related projects, according to the Foundation Center, which analyzed grants of over $10,000 made in 2015 by 1,000 of the largest US foundations. By contrast, 28 percent goes to projects for children and youth.

This is nothing new. Other studies have found similar results over the years. But as the percentage of older people increases (16 percent in the United States and rising), the need to ensure that people of all ages are supported gains more and more urgency.

There are a few main reasons aging-related funding is so low. On the grantmakers’ side, there’s an attitude of negativity and hopelessness. On the side of the charities receiving the grants, there’s a lack of focus on fundraising.

So for charities, the key to change is focus: focus on fundraising and focus on a new message—one of positivity and opportunity.

For grantmakers, the key may be openness to new ideas, because this new messaging is counter to what our society has led them to believe.

A Hard Sell

“Children are an investment. Old people are an expense.” This is the attitude John Feather, chief executive officer of the industry organization Grantmakers in Aging, says he faces often when encouraging philanthropies to donate more to aging-related initiatives.

Katherine Klotzburger agrees that ageism is a key problem. “We applaud people for getting to be 90, but we don’t want to support that,” says Klotzburger, founder and president of the Silver Century Foundation, the organization that commissioned this article—and one of the few foundations that focus solely on aging-related grantmaking.

“Aging is just a hard sell across the board,” Feather says. “It’s hard to get people to focus on it. It’s hard to get people to identify with it. People want to avoid the topic.”

And it’s easy to avoid, because society doesn’t focus on it either, says Klotzburger. “There’s just not as much emphasis, not as much information, not as much discussion about the problems for older people,” she says. “People just don’t know about it.”

Funders tend to donate to causes that get a lot of airplay, according to Klotzburger. For example, behind religion, education receives the highest percentage of privately donated dollars, per the Giving USA Foundation.

As the huge boomer generation ages, philanthropy will play an increasingly significant role.

Charitable grantmakers also tend to assume the government has older people covered.

Yet “all of the federal aging programs put together that are not health care are less than what Medicare spends in a day,” Feather says. “Medicare is an essential piece. But there are lots of other programs—social services, congregate meals—that have gotten squeezed and squeezed and squeezed until there’s just not a whole lot left.”

And some, such as nursing homes and assisted living communities, tend to focus on earned fees rather than private grants.

As the large boomer population ages, “earned revenue and public funding [will] go only so far,” cautions Giving and the Golden Years, a 2017 report from the Giving USA Foundation, which regularly publishes data about charitable giving. “Philanthropy will play an increasingly significant role.”

So grantmakers have a growing opportunity to jump in and make a difference. But first, they need to understand that they really can help change things.

Overwhelming Need

Determining exactly how many dollars from philanthropic foundations go toward aging-related issues is tricky. Generally, only grants that have something like “aging” or “seniors” in the title are counted, Feather says. So lung-cancer research, for example, isn’t necessarily included, even though most people with lung cancer are 65 or older.

But Feather argues that the important thing is, the percentage is small—whatever the exact number. “And it hasn’t changed in 25 years—even as the population of older people continues to grow.”

In fact, that population growth actually may be working against the push to increase funding. Trustees of grantmaking foundations continually tell Feather that a main reason they don’t want to get into aging-related philanthropy is that it’s overwhelming: the problems are too big; they don’t know where to start; their money won’t make a dent.

Katie Midgley confronted this feeling at her own organization. She’s the director of research and evaluation at the Plough Foundation in Memphis, TN. Its mission is to do the greatest good for the greatest number of people in its city and county. The foundation hired Midgley in 2011 to research whether it should delve more into the aging realm.

So Midgley set out to assess Memphis’ needs. She interviewed dozens of leaders around town and found that not only was the community in need but the leaders themselves were too. “I don’t know where to turn. I don’t know what to do,” they would tell her. “When my mom needs help, who do I call?”

“So it was just astonishing, really, to see the level of need,” she says.

Through her research, Midgley identified seven areas that required attention: caregiver support and respite, transportation, elder abuse, aging in place, basic needs (such as medicine and food), end-of-life planning, and the need for social engagement and purpose.

But when she presented her findings to the board, “They said, ‘Katie, you’ve done a great job. But here’s the thing. That’s everything.’ And it was,” she says. “It’s tons of stuff. So how do we narrow?”

Just One Thing

To counter that overwhelmed feeling, when Feather talks with grantmaking foundations, he doesn’t immediately advise them to create an entire funding initiative around aging. “That gets nowhere,” he says.

Instead, he encourages them to look at the work they already do through an “aging lens.”

For example, when talking to grantmakers with a focus on rural economic development, Feather may point out that a third of the community they’re serving is 65 or older. He can then encourage the funders to think about expanding the work they’re already doing simply by paying closer attention to these people’s needs.

If the foundation is working on improving transportation, for instance, that’s already an important issue for older people. Finding ways to help them get around better would fit smoothly into the foundation’s mission.

Society is looking for solutions to the problems of an aging population, and there is vast opportunity for innovation.

Feather points out that grantmakers also need to understand that one small project can make a big impact. And it can get the ball rolling on grander innovations.

Efforts to make cities more age friendly often start small, he says—for example, with a community garden. A garden can launch relationships, bring generations together and improve the neighborhood—all the while, strategically building public support and political will for further projects.

For its part, the Plough Foundation ended up conducting a citywide survey to determine where to focus its efforts.

“We realized we’d made a fundamental error, and it was that we had not involved seniors in some way in our process for input,” Midgley says. “Too often, I think folks—very well-intentioned, thoughtful, smart people—sit in rooms and make decisions about serving people and never ask them what they think or what they need.”

As a result of hearing from citizens, one project the Plough Foundation homed in on was home modifications for aging in place. “Memphis has a huge housing stock that’s poor quality,” Midgley says. “We did not have a group at that time [that] was doing home repair and modifications.” So in 2014, they gave Habitat for Humanity of Greater Memphis a grant to get started on that. The project is still active.

Innovation

In addition to lamenting that the problems are too overwhelming, philanthropists also often tell Feather the aging sector is depressing.

This belief may be partly due to how people view their own aging. “Ironically, people’s fatalism and anxiety about the aging process also mute their ability to think about efforts and interventions to improve the experience of adult aging,” says Gauging Aging, a 2015 report from the FrameWorks Institute, an organization that helps nonprofits communicate effectively. “Assuming that deterioration is inevitable, people are less able to think productively about solutions and the pragmatic actions that could be taken to improve life for older adults, and society more generally.”

But if people can look past that internalized negativity, experts say, they might find that rather than depressing, the aging arena is exciting. There is vast opportunity for innovation. Society is looking for solutions. Grantmaking philanthropists can help develop them.

“In our country, innovation drives success,” says a FrameWorks Institute report from 2017. “We need to apply our tradition of innovation to an important social problem: a culture that prevents older people from living full, productive lives.… To fully capture the massive energy of our ever-aging population, we need to think differently—and innovatively.”

As an example, the study cites a program that “brings older people and preschool children together in local community centers.” The older people’s well-being is enhanced, and the children improve their social and emotional skills. “Innovative programs benefit the old and young alike—and they prove that we can use our tradition of innovation to tackle new challenges.”

One of the sectors Klotzburger finds most innovative right now is so-called senior living. Experimental congregate housing models and care models are being developed. Communities for older citizens are being built in walkable downtown areas, so residents can participate in town life.

Two sectors she finds particularly ripe for more innovation are disaster preparedness and think tanks. Grantmakers could make an immediate impact in disaster preparedness—helping cities and older people mitigate problems such as being stuck in a high rise with no electricity, being stranded at a house without a car, and being unable to afford air conditioning or heat. And think tanks could help solve the societal issues that lead to such situations.

Aging Philanthropists

As America ages, some of its grantmaking philanthropists are also getting older. Time will tell whether donations to aging-related projects will increase because of that. But at least one sign points to maybe: studies show that as a whole, when it comes to making charitable donations, boomers are more self-interested than their parents and grandparents, says Cedric Richner, cofounder and president of Richner + Richner, a fund-raising-consulting firm that specializes in aging-services organizations.

Boomers tend to donate to charities not just because it’s a good thing to do but because it’s a good thing for them, Richner says. They want to know what impact their contribution will make and how they’ll benefit.

Because of their age, boomers may directly benefit from aging-related initiatives. But another plus for a donor of any age can simply be feeling appreciated. So Richner advises charities to develop strong donor-recognition programs and ensure good stewardship—continually explaining gifts’ impacts.

If charities can adjust their messaging to help grantmakers get past ageism and negativity, the aging-philanthropy landscape may change for the better.

“The truth is that seniors are a great asset, and we don’t celebrate and look at that enough.” And that is a message that needs to get out there, Midgley says. “They’re caregiving for folks, they’re volunteering, they’re giving to charitable organizations regardless of income.”

Besides, society must not simply abandon a huge segment of the population, says Klotzburger. “We’re modern, 21st-century people. We don’t get rid of people just because they turn 50 or 65.”

Investing in older people means investing in the community. Everyone benefits for years to come—including the grantmakers, who could possibly make all the difference.

Coming of Age in Aging America: The Story behind the Grant

The film that’s igniting discussions of a new and different future for aging

Brace yourself. Devastation is nigh. The “silver tsunami” roars.

As the large boomer generation ages, the percentage of older people in America will increase. This will bankrupt government programs, overwhelm health care systems and run adult children into the ground, according to media reports. America is doomed.

Unless it’s not.

The thing is, aren’t there at least a few good things about older people—like experience, and sometimes wisdom, and maybe even other stuff? And if that’s true, could we view societal aging as an opportunity rather than a disaster?

It’s a radical idea these days, but Coming of Age in Aging America argues that it’s the more reasonable one. This documentary, which the Silver Century Foundation helped fund, takes a fresh look at the so-called silver tsunami and finds that there is, in fact, a strong upside to it. But it’s an upside that does require change—“change we have to design, legislate and wrap our heads around.”

Coming of Age in Aging America is being used across the country to start conversations about such change. It’s available for screenings—in communities, workplaces, city halls and on college campuses.

The film points out that there’s something almost everyone can do to kick-start change, even if it’s just altering our own outdated preconceptions.

Starting the Conversation

Despite the fact that the aging of America is often attributed to boomers, that generation comprises only the first wave of what’s going to become a silver tsunami. The demographic change is permanent, Coming of Age in Aging America points out. So it’s not that society needs to weather a boomer storm and then go back to “normal.” Society needs to be altered for good.

That’s a fact that even the film’s producer and director, Christine Herbes-Sommers, didn’t realize until she was working on her 2013 documentary What Time Is Left, about how one man’s two grandmothers were aging differently.

“Once you start scratching the surface of aging—I was very curious to probe a little bit further the idea of an aging society,” she says. “It’s startling. You kind of go, ‘Oh my god!’ Most people don’t know this.”

By the time What Time Is Left was released, Herbes-Sommers had been making socially conscious documentaries for 40 years—since a few years after she graduated college in 1970. “The women’s movement was in full throttle, and I suspected that films could move that agenda,” she says. Her filmography has spanned a range of societal issues, including racism and income inequality. She’s won two Alfred I. duPont-Columbia University Awards.

It was What Time Is Left that piqued the Silver Century Foundation’s interest. Katherine Klotzburger, PhD, the organization’s founder and president, had been struggling to find the perfect grant-making path. Since its launch in 2002, the foundation had supported a variety of projects, including local film screenings and a transportation program for older people. But Klotzburger wanted to make a wider impact—to combat ageism’s effects from the inside out. She wanted to change how people across America viewed their own aging.

When her grants consultant, Lois Favier, brought her the proposal for Coming of Age in Aging America, something clicked. For one thing, the film’s nonageist message would speak to a key demographic Klotzburger wanted to reach: people in their 40s and 50s, who, per the cultural narrative, were anticipating a future of long decline.

This film would present a different, positive view of aging. It would show how people in middle age “could continue to work and be a part of mainstream society—and how society could change itself to deal with this rapidly changing demographic,” Klotzburger explains. Plus, the film would be aired nationally, providing the wider platform Klotzburger had been looking for.

With Coming of Age in Aging America, the Silver Century Foundation began a new grant-making direction—one that matched the organizational theme already in the works: planning for a longer life.

Spreading the Conversation

Coming of Age in Aging America, which premiered in 2016, has aired on PBS, but its larger purpose is to prompt ongoing conversations in private and public screenings across the country.

The DVD is available for purchase at www.theagingamericaproject.com. The website, which the Silver Century Foundation also helped fund, has a wealth of free resources, including a toolkit to help people organize screenings for policy makers, students, communities and workplaces.

Herbes-Sommers, 69, who is now semiretired and studying classical drawing and painting, helps organize large workshops focused around the documentary. We caught up with her for an update on the film—and on the societal changes it proposes.

Q&A with the Filmmaker

SCF: In the screenings you’ve attended, what idea from the documentary has resonated most with people?

CHS: The idea that this [aging of America] is a permanent phenomenon—and, interestingly, this whole idea of rethinking the life course. There have been so many people who have come up after the screenings and said, “Yeah, why didn’t we think about it this way?”

SCF: The film proposes a new life course: instead of jamming intense work into middle age, people could work less then, but work longer into their older years, extending retirement age, since we’re living longer. People could even be allowed to collect a year of Social Security in midlife and delay it later.

CHS: Remember that whole piece in the film about the squeezed demographic—that people are least happy between the ages of 37 and 54, because they’re really, really, really squeezed? They’re taking care of older people, raising a family, saving for retirement, saving for their children’s education, trying to make ends meet, etc., etc. And this is with two jobs, and it’s an impossible task. So that’s the idea that resonates most—“Why do we choke our lives up like this—and then have 20 years of doing nothing?”

And 20 years of being regarded as doing nothing or as fit for doing nothing. Ageism is certainly a huge factor in all of that. I recently talked to people who have been the victims of ageism, particularly around the 2007 meltdown. Actually, when the economy recovered, they did not recover their jobs. Their jobs ended up being taken by younger, cheaper labor.

SCF: That brings up one of the challenges of taking time off in middle age. It can be hard to get rehired, because of ageism, technology changes and other factors. How do you propose tackling that?

CHS: [By having] a universal expectation that you could leave the workforce and there would be no stigma attached to it.

SCF: Some employers do value the experience of older workers, as the film’s segment on WellStar Health System in Georgia points out—a segment the Silver Century Foundation helped fund. What led you to that company?

CHS: [In preproduction] we learned that one of the areas in which there was going to be the greatest shortage of skill, because of the aging population and ageism, was in the area of nursing.

We interviewed a really great guy who was a retired nurse who had to retire because it was too much on his body. But he kept on working with WellStar, and one thing led to another, and we learned that WellStar had instituted all of these changes in order to retain all of these nurses.

But in the meantime, we found that what was good for older workers was good for younger workers. And that’s a big theme in the film—that there is a brain drain in some industries, and older people are capable of working—not only capable but add to a work environment—but certain changes need to be made in order for them to function better physically. So what WellStar did is, they redesigned the nurses’ station. The nurses walk so much, [so] they changed the flooring. They redid the patients’ rooms so that nurses could face the patients rather than have their backs to them while they updated their charts.

And they also did very small things. I wish I had gotten it into the film, but they changed all of the chairs in patients’ rooms so that the seating was much shallower. If you have a deep cushion, you’re way back in the chair. So they brought in chairs that had a much shallower seating area, and the nurses could help pick up and move the patients much more easily because they didn’t have that extra four inches of body weight to move.

Another important thing about this is that all these changes were done with the active involvement of the nurses themselves, and the medical personnel themselves—older and younger.

SCF: What are some benefits to having older people in the workforce?

CHS: As the film points out, younger brains and older brains have different strengths. They also have different weaknesses.

The younger brains acquire new information faster. They don’t necessarily process it faster in a problem-solving way, however.

Older brains don’t acquire information as quickly, and occasionally their memory is not what it used to be—but my theory about that is that we’ve just got a lot more to remember than we used to. [Laughs.]

SCF: True!

CHS: But their experiences have honed their brain chemistry in such a way that it kind of can short-cut their problem solving: “Oh, I remember something like this in the past,” or, “Wait a minute, let’s take a holistic view of this.”

So in that way, the two sets of cognitive faculties are different and compatible. Very compatible. They end up creating greater efficiencies.

On the emotional side, which always surprises kids when they see the film—Laura Carstensen at Stanford said [to college students], older people are much happier than you are, and the data bears it out. And, in fact, older people have greater what she called equanimity. They can balance the good and the bad with greater facility.

Younger people are anxious, in part because their prefrontal cortex—that part of the brain that sort of organizes emotion and hard content—is not fully developed until the late 20s. So older people tend to be less impulsive. They are more careful and emotionally more grounded.

So the way you combine those two things—I mean, sometimes impulsivity and the kind of “let’s do it!” young energy is great. Well, the brakes that come on from older people are also great and also useful.

The other thing that employers report is that the work ethic among older people is much better than the work ethic of younger people. There are lots of reasons for that. It has to do with the structure of the economy, our experience growing up with different kinds of jobs, the expectations that we had when my generation was younger—that you’d have one job and you would climb the corporate ladder. Kids don’t do that anymore, nor should they, because the economy has changed.

SCF: As you said earlier, another of the film’s main themes is that the “aging of America” isn’t just a boomer thing; it’s permanent. People are living longer. Are people starting to realize that? 

CHS: Anecdotally, I will say that it’s very difficult for this idea to take hold. But more and more, there’s less of a sense that all these older people are a big problem and more of a sense that, yeah, all these old people are going to be a big problem, but why should they be? There’s a small shift there.

SCF: Overall, are you pessimistic or optimistic that the societal changes the documentary proposes will happen? 

CHS: I’m very optimistic, and I think the people who are going to be doing it are older people themselves. I don’t think the federal government is—except for Social Security—an important trigger for this. I do think states are, when they look at their Medicaid and other dollars. Certainly individual small communities, as they build new structures, are beginning to think about the older populations.

SCF: You’ve moved recently yourself—from Boston to North Carolina.

CHS: I’m 69, and you can read me as kind of a poster child for the Aging project. As I approached my 68th birthday, I thought, “Can you physically do this really taxing physical and anxiety-producing work through your 70s?” And the answer was no.

SCF: So, even though you’re still involved in screenings for Coming of Age in Aging America, you effectively retired from filmmaking and joined an atelier—a small, intensive art class—to study classical drawing and painting.

CHS: There are 12 of us [in this atelier]. And I’m the oldest by a lot—five, 10 years. I’m older than the director by five years. I was in class the other day, and we started talking, and I said, “Boy, this is very funny to be in the role of the old lady, you know, with the elder wisdom.” And one student said, “You are the youngest spirit here. You’re the funniest, you’re the most interesting and you put things in perspective.”

So I think the more that we as older people get out there and off the golf courses and take a leap of faith—more than once a day, I say, “What have you done, Christine?” I’ve left Boston, I’ve left friends, I’m not making films anymore. And I’m doing it alone.

But it’s not so hard in some ways—emotionally. I don’t know how quite to explain it. The worst part of it is actually moving your goods and working out the finances. But the easier part is just saying to yourself, “I have about 15 good years ahead of me, and I want to be useful in this way, or I want to learn to do this in this time,” and to really believe that you can do it.

This interview has been edited for clarity and length.

The New Jersey Elder Index: The Story behind the Grant

S​tudy reveals that over a third of ​a state’s elders can’t afford basic essentials

Experts have been rolling their eyes at the federal poverty guidelines for years. The numbers are unrealistic; the formula they come from is outdated. But government is government.

So, despite official calls for change since the Nixon administration, the guidelines remain based on mid-20th-century spending patterns, and for the most part, they don’t even adjust for location.

In 2011, the Silver Century Foundation (SCF) jumped into the fight to change things. By funding a strategic study on older people in its home state, New Jersey, the foundation ended up helping to educate policymakers, increase the impact of safety-net programs and ultimately change state law.

Today, New Jersey is considered a leader in accurately recognizing poverty among older citizens. But getting here took the persistent work of private nonprofits that were determined to help older people who were in need live independently, with dignity. First step: find them.

Stepping over the Poverty Line

Officially, in 2010, about 8 percent of New Jersey’s citizens 65 and older were living in poverty. But “poverty” for a single-person household meant an income of only $10,830 per year or less. For a two-person household, it was $14,570.

These numbers came from the federal poverty guidelines, which are based on this formula: three times the cost of a minimal food plan in 1963, adjusted for modern pricing.

That made sense in the mid-20th century when, it was estimated, people spent a third of their money on food. But today, nourishment eats up more like 13 percent of the budget. (Housing and transportation take bigger chunks.) So the guidelines substantially underestimate the amount of money people need to stay afloat.

Yet the decision-makers for many federal, state and private safety-net programs—such as ones that help pay for electricity, medications and food—use the poverty guidelines to determine need and set eligibility levels. (For example, program participants may have to have an income below, say, 135 or 150 percent of the poverty line.) And in the contiguous United States, the guidelines don’t even take cost of living into account. Manhattan has the same poverty line as small-town Mississippi.

So various organizations have developed alternate guidelines. One in particular quickly shot to the forefront: the Elder Economic Security Standard Index—Elder Index for short. According to it, more like 43 percent of older New Jerseyans lived in poverty in 2010. We know this—and much more—because of a trailblazing study.

The Age Difference

Most alternate poverty guidelines don’t sufficiently adjust for a key factor—age—even though spending patterns change with it. Health care expenses tend to increase, while assets decrease.

So in the mid-2000s, researchers at the University of Massachusetts Boston developed the Elder Index in partnership with the nonprofit Wider Opportunities for Women (now inoperative).

The Index’s focus was on aging in place: how much money, minimum, did people 65 and older need to live independently, in their own homes?

“There were other policy research and advocacy organizations that were looking at the real cost of living for families,” said Melissa Chalker, deputy director for the New Jersey Foundation for Aging (NJFA). “But nobody was saying, ‘It’s different for older adults.’”

Now maintained by the National Council on Aging and the Gerontology Institute at the University of Massachusetts Boston, the Elder Index takes into account the cost of not only food but housing, health care, transportation and other essentials to living in place with dignity. There is economic security data for each state as a whole, as well as every county in the nation. And it varies according to household size (one or two people) and type (rental, owned with a mortgage, owned without a mortgage).

She believed the study was worthwhile—but she felt the government should pay for it.

“There had never been a tool developed like that previously,” said Grace Egan, executive director of the New Jersey Foundation for Aging. Yet she wanted more.

In 2009, NJFA—under the guidance of Wider Opportunities for Women—published one of the first state-based studies using the Elder Index. Its usefulness was limited, though. It showed how much income older New Jerseyans needed to live on but didn’t specify how many fell under the threshold or who they were. How many were women? Men? What were their ethnicities? Did findings differ by age?

So Egan approached Katherine Klotzburger, PhD, president of the Silver Century Foundation, with an idea: would SCF fund a more in-depth Elder Index study that delved into demographics?

“This is really a gong ringer for me,” said Klotzburger about poverty among older adults. It’s an issue she feels passionately about and works to fight. So she believed the study was worthwhile—but she felt the government should pay for it.

When it became apparent that that wasn’t an option, she decided to move forward with the grant, hoping the study would at least help the state better understand the importance of robust safety-net programs—and understand who, exactly, needed them.

So, funded by the SCF, the demographic study was conducted by the Legal Services of New Jersey Poverty Research Institute under the guidance of NJFA, which then published the results in 2012.

Surprising Results

The study, based on data from 2010, found that more than one-third of older New Jerseyans had enough income to put them over the federal poverty line but not enough to cover basic, essential, living expenses. (The Index ranged from $25,320 per year, for a homeowner living alone with no mortgage, to $48,204, for a two-person household with a mortgage. Altogether, 252,470 people 65 and older—42.6 percent—lived below that range.)

Further, the study revealed specific demographics. People living alone, women, renters and people 75 and older were more likely than their counterparts to live below the Index. Among people living alone, about 84 percent of Latinos, 72 percent of blacks, 56 percent of Asians and 55 percent of whites fell below the Index. And those are just the state averages. The data was further broken down by county.

The 2012 study “allowed us to provide information to the state, to the local policymakers, to local planners, that wasn’t before available to them,” Egan said. “It also gave us the opportunity to work with antipoverty programs, antihunger programs and affordable housing programs” to try to increase access to services.

And, when presenting the study to decision-makers, Egan was able to educate them about what life was like for many older people. “We wanted to highlight the fact that seniors did have a different set of conditions that might make them more vulnerable,” Egan said. For example, per the study, one in four older New Jerseyans relied solely on Social Security. In 2010, the average monthly draw for a retiree was $1,176 nationally—less than $15,000 a year. Living on a fixed income like this can make sudden financial hardship, such as the cost of moving from a flooded house or being financially exploited, especially devastating.

Egan has also been able to correct misconceptions. Once, in a meeting with gubernatorial candidates about the Index, someone on a policy team asked why a person over 65 would have a second mortgage. “And I was, like, they had a second mortgage because their furnace blew up, they needed a roof, they put their kids through college,” Egan said. “There are so many reasons why somebody after 65 would still have a mortgage.” At other times, she’s confronted the common belief that health care is free for older people.

Policy Impacts

The goal of doing the study wasn’t just to educate. It was to prompt meaningful change.

“The important thing is to make sure that we’re connecting people with services, not just describing the plight,” Egan said. “We didn’t do the study just to look at the numbers.”

And change has come.

For one thing, safety-net programs in New Jersey used to be disconnected. For example, people accepted into the pharmaceutical assistance program might not be told they may also qualify for the Supplemental Nutrition Assistance Program (SNAP). The Elder Index data helped leaders of such programs realize that many of their target enrollees overlapped—so perhaps they could reach more people by working together.

In 2016, the state’s Division of Aging Services launched a universal application form that screens people for eight programs at once. In addition, compared to 10 years ago, enrollment in SNAP has doubled, Egan said. “In some respects, what the study did was highlight and hopefully target outreach from county programs a little bit better.”

As for Klotzburger’s wish: the state did see the benefits of the study—so much so that in 2015 government funding for future Elder Index studies was signed into law.

“The legislators in New Jersey thought the study was a significant tool and that it should be incorporated into the state planning process,” Egan said.

The next step is to increase affordable housing in New Jersey That would be the biggest help for many people with incomes below the Elder Index.

The law also requires the Department of Human Services to use future studies’ findings in the planning, coordination and delivery of safety-net programs.

“To my knowledge, New Jersey is the only state to incorporate language that is this strong into law,” Jan Mutchler, PhD, said via email. Mutchler is the director of the Center for Social and Demographic Research on Aging at the University of Massachusetts Boston, which publishes reports on the national Elder Index. “New Jersey is a leader with respect to using the Elder Index.”

The state has funded two studies so far, both published in 2017.

“I think that because of the requirements of the New Jersey legislation, and the persistence of advocates like the New Jersey Foundation for Aging, the frequency of developing and issuing these types of materials has been better than in most other states and locations,” Mutchler said.

But Egan isn’t finished yet. The next step is to increase affordable housing in New Jersey, she said, explaining that this would be the biggest help for many people with incomes below the Elder Index.

“And so we have continued to use the study—the Elder Index and its data—to continue to push. We are working with housing advocates and managed-care providers to help them understand the meaningful role of affordable housing—and how we can work with developers to continue to expand the housing options.

Basic Elder Index data for counties nationwide is available through this interactive tool.

“We would not have had the ability to do the demographic profile for the 2012 report without additional dollars. And the Silver Century Foundation provided those dollars. I think that’s an important piece to recognize,” Egan said. “It really made it such a better tool to illustrate how seniors are struggling in New Jersey. Not only were we able to say who these people were but how many. And for some people, it gave them a better sense that [poverty] was affecting a greater number than they had ever imagined.”

Margaret Morganroth Gullette: Revolutionist against Ageism

A scholar takes on ageist violence in all its guises

This article is the next in our series on the future of aging: interviews with people who are experts in their fields and are also visionaries. We’re asking them to talk about what they believe will happen in the years ahead to change the experience of aging.

Margaret Morganroth Gullette, PhD, is a leading scholar in age studies—especially ageism’s effects on the midlife years. For more than 35 years, through books, essays and teaching, Gullette has educated people about ageism and provided thoughtful commentary on the changing American culture.

Ageism did not end with the 20th century. But there were hopes.

Feminism had brought changes for women, rights movements had brought changes for black people and disabled people, and the—well, there was no widespread, organized movement for older people. But surely things were looking up.

Margaret Morganroth Gullette, PhD, for one, was optimistic. In 1988, the midlife-studies scholar published a book called Safe at Last in the Middle Years about how middle age wasn’t always depicted as such a downer in fiction anymore. And in 1989, at 47 years old, she wrote an essay for the New York Times called “Midlife Exhilaration.”

“As the largest age group in the country, our tastes, our opinions, our dollars can make changes,” she wrote in the essay. The oldest boomers were in their early 40s. The revolution was coming. 

Ageism is growing stronger and affects people at younger ages than ever.

Unfortunately, it got stalled somewhere along the way. In fact, since she began studying it, ageism has strengthened, Gullette, now 75, contends—and it’s hitting people younger than ever.

“Lacking its own passionate movement, ageism remains the most stubbornly, perplexing naturalized of the isms,” Gullette points out in her latest book, Ending Ageism, or How Not to Shoot Old People (2017).

So, through her book, she’s hoisting the revolutionary flag again, calling for people of all ages to join the cause. But to put much-needed passion into the movement, first things first: like the American Revolution, this one, she says, must begin with a detailed, pointed declaration.

The Declaration of Grievances

Gullette is one of only a few American scholars to have long specialized in middle-ageism—a term she coined. She now studies ageism across the age spectrum. She’s written a number of award-winning essays and books and has taught at Harvard, Radcliffe and Berkeley.

Now a resident scholar at the Women’s Studies Research Center at Brandeis University in Massachusetts, Gullette fights what’s called the “decline narrative”—the idea that youth is the best time to be alive, and then it all goes downhill.

“The narrative gets reproduced by the people who live in the culture,” Gullette says. “They’ll have black-balloon parties at age 30, or they’ll start sending jocular cards to friends. There’s one—it’s a Valentine’s Day card, actually—it goes, ‘Grow old and disgusting with me.’”

When you’re made to feel ashamed that you’re old, that’s a form of violence.

These types of jokes may seem harmless, but they support an ageist culture, which causes palpable harms, Gullette argues. Yet those harms are often unrecognized, minimized or ignored. So in Ending Ageism, she lays them out—going so far as to include “A Declaration of Grievances,” whose style is reminiscent of the Declaration of Independence.

“Through shameless age-shaming, they silence us,” reads the first of 13 grievances. (“They” refers to people causing or benefiting from the “subjugation” of older people.) “They destroy confidence in our own powers, lessen our autonomy, and make many accept, willingly or not, an unnecessarily dependent or abject life.”

To begin to reduce ageism, Gullette calls for “a revolution in perception and empathy” across all ages and throughout society. We spoke with her about this vision and how she’d like to achieve it.

SCF: You’ve pointed out that ageism has gotten worse at the same time American society has been celebrating increased longevity. Why do you think that is?

MMG: One of the reasons is that there are more people who need to capitalize on ageism. You could start with the people who get money out of frightening people about getting older. I call them the dysfunction and the uglification industries.

The dysfunction industry tells you that your sexuality is impaired, starting as early as they can get you to believe it. The uglification industries include the fashion magazines and a lot of the portrait photography, and so on, that try to get people to believe that they need help with their appearance as they get older, which could be anything from hair dye to Botox to surgery.

There’s a kind of rule in critical age studies, and that is, look for the money. So those are the businesses that actually make money out of aging. But they have to convince you that you are becoming a needier person.

Then there are the people who want to cut out the social safety net—the entire Republican Congress right now. They want to cut Social Security, Medicare—what I call the first-generation solutions to ageism. So again, you’re looking for the money.

SCF: You want to start a revolution against ageism. Who do you need to join it?

MMG: Children should be where families start in anti-ageism. In other words, you just be real careful what you’re saying about grandparents and older people in general.

And then, once they get old enough—I think certainly in high school—you can have anti-ageism as part of the curriculum, just the way you [can] have antiracism or antisexism part of the curriculum.

Education—while it can’t do everything in this ageist ideology, it can do a lot. So I focus in the book [Ending Ageism, or How Not to Shoot Old People] on the college years, and I actually have a chapter that’s about teaching anti-ageism in a freshman composition course. I think that’s a good place in college to begin. You want students to not just think about ageism. You want them to discover it for themselves.

One of the things I did is to have the age barometer. The first 10 minutes of every class—it could be longer—I asked students to come in with anything that was about age or ageism. Some of them might want to do a Google search for ageism, and they would find the material. And I would be encouraging them to look at their own circles—listen for ageist comments from their roommates.

Teachers—once you give them the concepts, they can run with it themselves.

SCF: The 13 items in your “Declaration of Grievances” are varied and inclusive. For example, you mention distorted depictions of older people in the arts, discriminatory laws and hiring practices, and the treatment of older people as burdens. How did you devise this list?

MMG: The “Declaration of Grievances” covers the grievances that the book covers. It is a two-page summation of the concerns.

Now when I started writing the book, I did not think that I was going to write the “Declaration of Grievances.” In fact, quite the contrary. I said to myself, “This is for a decade hence—or maybe two decades hence—when we really understand ageism. That’s when somebody will write, in wonderful language, a declaration. I didn’t think it would be me. It was almost serendipitous that by the end of the book, I could write it.

SCF: What are some of the effects of all these different types of ageism on older people?

MMG: That you are both invisible and hypervisible. That younger people, but also ourselves—we are intolerant about our appearance. We lack an audience for our subjectivities and our grievances. People underestimate our suffering and the violence that’s turned against us. And they’re unwilling to look us in the eye or spend time in our company. These emotions are the experience of the book.

SCF: You mentioned violence against older people. What’s an example of that?

MMG: When being invisible means that you are likely to be knocked down—that public spaces are not safe for you—I think that’s violent.

Hate speech is violent. There are examples in the book of Internet hate speech. But there are also other kinds of violence. People who think they know, better than you do, what you want—I think their attitude toward you is violent. I think being made to feel ashamed of being old is a form of violence.

Many people feel ashamed of being old. And I say, “This is not intrinsic to you. You are suffering from the affect that somebody else is imposing on you. It is their disdain. It is their contempt that is the violence that is causing you to feel shame.”

SCF: Why do you call things that don’t physically hurt you violent?

MMG: Because the effects are so violent—to turn a whole group of people into self-conscious individuals who may be ashamed of aging, which is a natural phenomenon—just as natural as being a woman or a person of color. To be an age shamer is a disgraceful form of being.

SCF: Part of the book’s title is “How Not to Shoot Old People.” That’s a play on words. You use it to mean both shooting with a gun and shooting with a camera—referring to the way older people are depicted in the arts—correct?

MMG: Yeah. But I also mean “shooting” as a metaphor for these other forms of violence. And let me give you one other instance: medical violence, which is denying not-so-very-old people who have lung, colorectal and breast cancers and lymphoma the life-saving treatments [doctors] would offer younger people. I give instances of that in the book.

SCF: Is the idea that older people are undertreated debatable, though?

MMG: I wouldn’t say that it’s debatable. I would just say that it’s not well enough known.

I could give you an exact example, which is new; it’s not in the book. It’s from Wales. And it’s about cardiac resuscitation. They studied the time [EMTs] spent giving cardiac resuscitation to people over 70 and under 70. Well, it was 13 minutes for people under 70, and it was 6 minutes for people over 70.

Now that’s not controversial. It’s a study. When people want to deny ageism, they’ll say to me, “It’s only one study, and it’s in Wales.” There are ways of denying ageism the way there are ways of denying sexism and racism. This happens all the time.

One particular study is not expositive. But the weight of the evidence in my book means you cannot deny that there is a range of ageisms—that many of them are experienced in violence.

SCF: Have boomers reduced ageism? Will they as they get older?

MMG: Allegedly, they’ve done it. You know, “Boomers will change aging the way they changed every other phase of life.” They were born, and they needed more schools, and so the schools got built. But actually they didn’t make that happen; their parents made that happen. So I think a lot of things that the boomers were said to have done they didn’t really do.

If they could have changed the situation that I’m describing, they should have done it [years ago]. The problem is, of course, that there is no such thing as the boomers. Everybody born in one cohort is not like everybody else in that cohort. That’s the basic, sociological truth. In fact, they have every difference that you can imagine under the sun. If you take the homeless vet and the one-percenter, what do they have politically in common?

SCF: Do you think ageism will get worse or better in the near future?

MMG: A lot depends on politics. In other words, we have not had a president who took the White House as a bully pulpit for anti-ageism. Might we have such a president? Well, maybe we could. One of the things the movement needs is leaders who are willing to declare the grievances, speak for the humiliated and the dehumanized, speak on behalf of their causes.

There are countries that are doing pretty well. I think Europe is doing better than the United States. I … was at [the 2016 Social Innovation for Active and Healthy Ageing international conference]. It was in Barcelona last fall, and I was a keynote speaker. There were hundreds of people, in all fields, thinking about social innovations for age: how to bring computers to old people, how to have universal design for old people. And this was all paid for by the European Union.

We have a lot of agencies in the United States that are pro-aging. All our [Area Agencies on Aging], for example, are pro-aging. But they’re not anti-ageist. That’s the crucial link that needs to be made.

SCF: You say that to fight ageism, we need a “revolution in perception and empathy.” How so?

MMG: This goes back to the families. I take my family as a certain kind of model, but many, many families are like this: we’re protective and empathic. Our elders get a lot of respect and understanding, and their own children—midlife children—spread it through the rest of the family.

But how do you reactivate that kind of familial loving-kindness and protectiveness at the national social level or international social level when a lot of people think ageism is done with? Because we have all these first-generation solutions [such as Social Security and Medicare]—it’s all taken care of, right?

I mean, you may get a request to help save Social Security, and you’ll sign a petition or something like that, and then that’s the end of it. But no, the second-generation stuff is still floating around in the atmosphere and distorting our perceptions and making us feel that old people—particularly if they have cognitive impairments—are not quite us; they’re not quite human anymore.

So yes, I think reactivating loving-kindness and protectiveness at the social level is an immensely important task. But it’s not just going, “I’m pro-aging.” If you don’t name the bad guys—if you don’t say, “These industries do us dirt, do us down”—if you don’t go on the attack, then you’re not going to be able to generate new perceptions and new kinds of empathy.

[Younger people] don’t know yet the harms that ageism does—don’t understand how deeply wounding ageism is to individuals and to society. So the first level is sort of like a cognitive and an emotional process: recognize the suffering, recognize the hidden injuries of age, and then you’ll be able to have new perceptions and empathy. Otherwise, it just strikes on deaf ears.

You can say a thousand times to people—gerontologists have said this for decades: “Nobody can live on a $1,000 a month; [many] old people are poor.” That doesn’t take somehow. It’s like slinging arrows into the air. They fall you know not where.

SCF: You mentioned “second-generation stuff” that’s floating around. What did you mean by that?

MMG: The first generation was making sure that there was a safety net. That was the 1960s, and then [George W.] Bush added a pharmaceutical benefit [in 2003]—which benefited the pharmaceutical companies also—but that’s the stuff that we believed solved all the issues: the elder services, Social Security, Medicaid, Medicare.

The second generation is all this other stuff—the stuff that’s in the “Declaration of Grievances.” It has nothing to do with the first-generation solutions. It’s over and above. It’s the burden language. It’s the decline language. It’s the belief that it’s worse—I mean, but the belief is true; it is worse to get older in the United States. You are likelier to lose a job if you’re older than if you’re younger.

SCF: Getting older is strongly associated with death. Does aversion to mortality factor into ageism? If so, how do you combat that?

MMG: People forget that old age goes on for a long time. Young people are very vulnerable to this mistake about old age. They think that your business is to die, so go on, get on with it. I’m not saying all young people. There are pages with Internet trolls talking about old age. “Once were people” is what one troll called old people.

I say this with a little more experience about how long old age goes on—and I anticipate that my own old age, which has already begun, will go on a very long time too.

So hold your horses, guys. We’re not dying. We’re here. It could be a slogan: we’re here to stay. We are still human. And we want to be treated in a humane way. And we’re going to make our demands known. And we hope you’ll listen.

This interview was edited for clarity and length.

Martha Holstein: Feminism and the Future of Aging

She argues that there’s no ‘new old age’ and 70 is not the new 50

This article is the next in our series on the future of aging: interviews with people who are experts in their fields and are also visionaries. We’re asking them to talk about what they believe will happen in the years ahead to change the experience of aging.

Martha Holstein, PhD, is a leading voice in the field of feminism and aging. Thoughtful and outspoken, Holstein challenges assumptions about what later life should be—and what it is—particularly for older women.

Conventional wisdom doesn’t mean much to Martha Holstein, PhD. “I never set out to be a devil’s advocate,” she says. She just happened to be one. “I always saw the opposite of what other people saw.”

So when she stumbled into a career in the field of aging, Holstein did not go along to get along. Instead, she became a dogged groundbreaker—and ultimately one of America’s preeminent scholars on feminist gerontology.

Holstein has spent more than 40 years as—at various times—professor, researcher, speaker, author and consultant. She’s taught at Loyola and Northwestern universities. She’s worked at a think tank and as an activist. And that just scratches the surface.

Now semiretired, Holstein continues to challenge assumptions about getting older. One difference is, she’s now older herself. This adds a richness to her expertise that makes conversing with her fascinating and thought-provoking, whether you agree with her or not. She is passionately liberal; a self-described pessimist; and, she insists, a product of great luck.

Out of the In Crowd

As a speaker and writer, one of Holstein’s main goals today is to get women to embrace being old—the good, the bad and the in-between. But the ways she wants them to embrace it go against the cultural tide—and often against leading, fellow gerontologists.

Tell Holstein 70 is the new 50, and she’ll say 50 isn’t all roses, and what’s wrong with 70 anyway? Call her “not old” at 76 and she’ll insist that she is too. (Tip: don’t argue.)

Many of her views are unpopular in the academic world and even prompt teasing from her friends, she admits. She preaches “own your old” so much that people call her a broken record. But unpopularity is old hat to Holstein. She’s spent most of her entire academic career not being agreed with.

She actually never planned to go into the field of aging. In 1973, Holstein, in her early 30s, was teaching the history of Western civilization at a community college in largely conservative Orange County, CA. She’d just finished working on the presidential campaign of George McGovern, the anti-Vietnam War Democrat who lost to Richard Nixon, when she happened across a job listing for someone to coordinate “senior volunteers.” She applied and, to her surprise, was hired.

As it turned out, this was the same year that the federal government created Area Agencies on Aging, local organizations that connect older people with services to help them live independently. Out of curiosity, Holstein got involved with those. “One thing led to another, and that is the beginning of this career in the field of aging,” she says. “It would have been totally impossible to do it now, where people get degrees in gerontology. But in 1973, it was possible.” She got her own PhD, in medical humanities, in her mid-50s.

During the early years of her scholarly work, “Martha was going upstream against at least two currents,” Mark Waymack, PhD, said via email. He’s the chair of philosophy at Loyola University Chicago and has worked with Holstein on various projects. First, aging just wasn’t a popular topic. “Second, Martha is a woman and expressing a feminist voice. And in those earlier years, the feminist voice was also very much a scorned and devalued voice in academia.”

“She has shown courage in standing up to some of the most traditional influential scholars on aging and ethics,” emailed Jennifer Parks, PhD, a professor of philosophy at Loyola University Chicago who’s also worked with Holstein. Even today, Holstein “is one of maybe a small handful of scholars working on aging from a feminist perspective. I take her work in this regard to be unique and to be a major contribution to ethics and aging.”

While she is still speaking, writing and teaching one quarter a year at the University of Chicago School of Social Service Administration, Holstein is also learning what it’s like to be an older woman, not from an academic standpoint but from a real-life one. Some things are challenging. The former runner (who now does yoga and Pilates) has lost some physical agility and lives with chronic lower-back pain. But many other things are rewarding—like having leisure time. “I love my life now,” she says. “I was a workaholic. I always had an endless to-do list.”

We talked with Holstein—whose most recent book is Women in Late Life: Critical Perspectives on Gender and Age (2015)—about the issues that most concern her today and where she sees the future of aging headed, particularly for women.

SCF: Though you’ve focused on aging for over 40 years, has anything about the experience of getting older surprised you?

MH: What interests me is how, despite all these efforts to change images of aging—all this great push of what I call the rah, rah version of aging—“70 is the new 50” and “you’re only as old as you feel”—I encounter ageism all the time. I encounter salespeople calling me young lady. And when I say I’m an old lady, they say, “No, you’re not.” They don’t even let me be old.

SCF: You embrace that word, “old.” You want other older women to call themselves that too—and to resist the effort to see old age as an extension of midlife. Why?

MH: If we adopt this notion that young or middle age is universally good and old is universally bad—therefore we have to deny that we’re old—I think we just reinforce the kind of ageist notions that dominate in our society today.

And you hear people regularly say, “Oh, I’m not really old,” or, “I’m so busy I don’t have time to do anything; my children say I’m busier than they are.” We’re always emphasizing the things that make us like a young person instead of emphasizing the things that make us special and different, which is a certain amount of freedom to get up every day and say, what do I want to do today? We may not pay sufficient attention to the opportunities and the possibilities of old age and may even feel guilty that we’re slowing down.

SCF: Along those same lines, you reject the “70 is the new 50” idea and the so-called new old age. Why?

MH: If I say that at 76 I’m just like I was at 56, then I have to accept all the things that I did at 56—work late into the night, work every weekend. You can’t just have the good parts. You must accept the bad things that go along with it.

And again, it doesn’t break the power relationships between young and old. It still says young is better than being old.

SCF: In your book Women in Late Life, you’ve pointed to many social inequalities older women face. What are the most critical ones?

MH: The social inequalities are in part economic issues, because women have worked in a gendered workplace. We don’t have family leave policies. Women have more dropout years or reduced earnings when they take care of family members, so they have lower Social Security benefits—as well as increased out-of-pocket costs. In our system—particularly now in the neoliberal state—caregiving is viewed entirely as an individual responsibility. There’s no place for the public sector. So playing the kind of gendered role [of caregiver] that’s expected of women in our society often leaves us financially much more insecure than men when we are old.

The other place that there’s a lot of social inequality is—we’ve just seen all these reports about how often women are silenced, that women are interrupted far more often than men, that when women make a point it’s ignored, and then when a man makes a similar point, it’s applauded. So when you combine gender and age, women have far less role to play in public life. There is that kind of persistent ageism that discounts women as we get old.

SCF: You mentioned the neoliberal state. What do you mean by that?

MH: It’s a revival of sort of 19th century classical liberalism, which is not political liberalism as we think about it today. That’s why it’s called neoliberalism. It is basically the dominance of the market—that the private sector can do everything better than the public sector. So whatever you can commodify, translate into a good that could be sold for a profit, is really the desirable end. The people who fit into this kind of society are entrepreneurs, are consumers, are workers, are all the things that many of us who are old are not.

SCF: How should society fix the social inequalities you talked about?

MH: If I knew that, I probably would win a Nobel Prize. I think part of it is for us to be proudly old. And I think we need more and more intergenerational groups where we are with people who can see [that] just because we have gray hair doesn’t mean our brains are fried or that we have no cognitive capacity at all.

And the other thing—for women, it is that dual intersectionality between gender and age. So you have to break gender norms since our life is framed by gender.

But there’s no single answer. The way the gerontological community tried to do it with this “new aging”—you know, with “productive aging” and “successful aging”—just kind of played into it and said, in order to be a successful old person, it means you just don’t have to grow old at all. You can age without aging. And that’s a myth. None of us are going to get old without aging.

And the more we talk about all these positive developments, we leave out the mass sadnesses that people feel. It’s like it’s not OK to mourn the loss of capacity, to recognize that you can’t play tennis anymore or you can’t play golf anymore. It’s not OK to have these losses associated with aging.

SCF: You just mentioned successful aging—the idea that you’re aging “successfully” if you’re healthy, happy and active. Elsewhere, you’ve said that this concept has amounted to a moral judgment. Instead of “successful” aging, what should the emphasis be on?

MH: There should be no adjective. We don’t have successful middle age. We don’t have successful childhood. Successful aging is a concept that says there’s a bad way to age, and there’s a good way to age. So I don’t want any adjective except to recognize that being old is as diverse and as interesting or boring as any age.

SCF: You’ve also spoken against emphasizing productivity as a measure of an older person’s value. What other values should be emphasized more, especially when it comes to older women?

MH: It’s hard because finally when we’re old—if we are not impoverished and not worrying about where our next meal comes from, which almost half of women are—but if we’re lucky, we finally have the chance to make choices about our life. We finally have to decide how we want to live. And the last thing I want is somebody to tell me that to be a good old person, I have to be productive, that I have to keep on working or that I have to volunteer or I have to do something.

Does ever a time in our life come where we can assess our own lives and decide how to live? Have we not paid—most of us—paid our dues, either working full time, taking care of our family, working in our community? Don’t we ever get a chance to—let’s say I just want to write poetry all day?

SCF: You’ve said you don’t think we can eliminate ageism in society. Why not?

MH: In some ways, it’s because it’s everywhere and nowhere. It’s everywhere in that when I go to the cosmetic counter, she wants to tell me that I’m not an old lady even though I insist that I am. Well, that’s ageist. That’s saying to me that it’s not OK to be old. So it’s everywhere.

And you go look at images of old women in greeting cards. If you just change it and make that a black person or brown person, with all the negative imagery, there would be hell to raise.

So that’s what I mean that it’s sort of everywhere and nowhere, because it happens, and people are not held accountable for it.

SCF: There’s been much talk in the media about how boomers will change the experience of aging. Is there truth in this?

MH: I’m not a student of boomers. But the first observation I’ll make: boomers are not all white, middle class people who are spending a lot of time defying that they’re old. There are a lot of impoverished boomers. There are a lot of people living in terrible conditions who are boomers.

You want to generalize the things that make you feel good: everybody’s doing great, everybody’s really affluent, we’re healthier than usual. If you break that down by race, class, gender, ethnicity, the picture isn’t all that rosy. But that serves a critical political agenda that says, oh, we can cut Social Security because people are rich; they’re affluent.

So I don’t know that the boomers are going to change everything like a lot of sociologists tell us they should.

Obviously, I’m not a very optimistic person, and I’m very political, and I see the grip of neoliberal politics, which want to undermine the fact that most of us need public assistance. The average woman’s Social Security is $1,200 a month. Most women don’t have pensions; 401(k)s primarily serve people earning over $100,000 a year.

So my optimism about the future is bleak as long as this neoliberal ideology that undermines the role of government in providing the necessary supports for us to then build our lives—as long as that’s the dominant ideology, it’s kind of hard to change things.

SCF: What does the term “old woman” mean to you?

MH: Being an old woman, to me, means trying to live as consciously as I possibly can, knowing that I don’t have an endless amount of time left. There’s an element for me of urgency about, how do I live every day?

Some people wisely call it conscious aging, that we live with this kind of awareness. My friend [radio journalist] Connie Goldman said, “Who am I when I’m not who I used to be?” So who am I now? So that’s, for me, really important.

This interview was edited for clarity and length.

Marc Agronin: There’s Power in Growing Old

A psychiatrist believes aging brings ‘an unfurling of untapped potential’

This article is the next in our series on the future of aging: interviews with people who are experts in their fields and are also visionaries. We’re asking them to talk about what they believe will happen in the years ahead to change the experience of aging.

A geriatric psychiatrist, Alzheimer’s researcher and writer Marc Agronin, MD, has written or cowritten eight books, been published in the New York Times and Scientific American, and blogged for the Wall Street Journal. Agronin is a leading voice in transforming how Americans view old age.

Marc Agronin, MD, knows old age—as much as a 51-year-old could anyway. In particular, he knows difficult old age.

As vice president of behavioral health and clinical research, Agronin oversees the mental health services at Miami Jewish Health Systems, whose 25-plus-acre campus includes a hospital, assisted living community and large nursing home.

On average, his patients are about 90 and have dementia, which is his clinical and research focus. So every day, he witnesses common ravages of aging at their worst. Yet to Agronin, getting older is not depressing. On the contrary, it’s powerful.

Agronin is helping lead the charge to improve the experience of aging—particularly for people who have dementia. “In my work as a geriatric psychiatrist I have learned that aging equals vitality, wisdom, creativity, spirit, and, ultimately, hope” (emphasis his), he wrote in his book How We Age (2011). “And for an increasing number of aged individuals, these vital forces are growing by the day.”

The Calling

The seeds for Agronin’s positive, often reverent, views about aging were planted early on, when he was growing up in Appleton, WI, surrounded by warm, colorful, older relatives. His great-grandfather ran a dairy and bakery; his grandmother frequented Green Bay Packers’ games and was “probably the craziest fan of everyone there,” he says. An older aunt was a weight lifter, and his grandfather was the town doctor in nearby Kaukauna.

“When I decided to go into medicine, to me it was just a natural fit that I would work with older people,” he says. “I always loved to hear stories of older people’s lives—always, since I was young, fascinated by the intersections of their stories and history.”

“I never really sat down and thought, I want to do this,” he says about geriatric psychiatry. “It felt like a calling for me.”

In their early 90s … they want to have psychotherapy about relationship issues and sexual problems …

–Marc Agronin

Half of a typical workday for Agronin is spent seeing patients, through either the memory center or the Alzheimer’s clinical trials program. The other half is spent more on managerial tasks or on writing. When he can, he roams the halls of the nursing home, assisted living center or hospital, visiting with patients informally, on their own turf. “I almost feel like one of the residents here,” says Agronin, who’s worked at Miami Jewish Health Systems for 18 years. “I know people and their families and their grandchildren.”

He takes issue with the notion that nursing homes are “God’s waiting rooms,” as they’re often derisively called. His patients aren’t folks just waiting to die, he says. In How We Age, he wrote, “We imagine the pains of late-life ailments but not the joys of new pursuits; we recoil at the losses and loneliness and fail to embrace the wisdom and meaning that only age can bring.”

To Agronin, who’s working on a sequel to How We Age and helping to plan what will likely be the first dementia village in the United States, getting older is not a depressing roll down a gravestone-lined slope but an unfurling of untapped power and potential—an important life stage in its own right, bringing essential roles to fill and influences to make.

SCF: What is changing right now in geriatric psychiatry? Is there an important trend that you could see coming to larger fruition?

MA: There are two opposing trends here. On the one hand, people are living longer, healthier lifespans. I’m seeing more and more patients in their 80s and 90s who are in generally good physical health, are vigorous, are involved in life more so than ever before. It’s not uncommon to have someone to come in in their early 90s, and they want to have psychotherapy about relationship issues and sexual problems and family discord that we might not have even imagined 10 and 20 years ago.

What I see for this group of individuals is an incredible expansion of lifestyle choices well into one’s 90s. We will not think twice about psychotherapy, about being aggressive with other medications and other treatments. And the focus is not easing the pathway into the grave, but the focus is on enriching their lives.

I have one older friend of mine who’s in his 90s, and he loves to come in and talk about all his relationship issues and what he’s doing with his girlfriend and what’s happening at work. If I close my eyes for a moment, I could be talking to someone in their 50s and 60s.

On the other hand, the trend that is disrupting all of this is the fact that Alzheimer’s disease is at epidemic proportions. At the age of 85 and above, nearly 50 percent of the population has Alzheimer’s disease, not to mention all the other forms of dementia that people can have. And this is creating a growing community of people who are suffering from cognitive impairment, which is robbing them of their independence—which is requiring significant caregiving.

Many older individuals who would otherwise like to be engaging in many different life activities are really overwhelmed with being caregivers for a spouse or a parent—sometimes even a child—because we do not yet have, and do not have on the horizon, a cure for Alzheimer’s disease. So it’s these two very different trends that are pulling at one another.

I’m involved in the latest clinical trials, trying to find more effective treatments and ultimately a cure for Alzheimer’s disease. At the same time, we’re really looking at what’s the best care model for these individuals. How can we create communities outside of institutions, or care models within institutions, to provide for optimal lifestyles for people?

My focus is getting away from a deficit model that looks at people as diseases, full of decline, decrepitude. My focus really is on assessing and balancing things out with what are people’s strengths and trying to create models that can really leverage these strengths.

SCF: The World War II generation tended not to seek psychiatric therapy. Are you seeing that same pattern with boomers, as they get older, or do you think it’s changing?

MA: It’s changing. I think what really catalyzed a change towards mental health was two things. The first Persian Gulf War was right around the time that we were hitting the 50th anniversaries of World War II events. A lot of World War II veterans who were in full retirement and were starting to feel the effects of aging were suddenly seeing a reemergence of posttraumatic symptoms—also more age-related issues, which triggered mental health issues.

So the Greatest Generation, as I think they are aptly called, really began to see mental health as a critical part of overall health. I was being trained at the time in part of the VA system, and I was able to work with so many veterans and see this change and help do an enormous amount for them.

Baby boomers are a very different generation because they’re very open to mental health treatment. They are more activists. They might not be as trusting of their physicians, but they want to work in partnership with them. Older boomers form really close partnerships with me in my practice.

SCF: Despite seeing positive changes, you’ve also said that some older people still wait a surprisingly long time before seeking help for relatively uncomplicated mental-health issues. Could you give us some examples of those issues?

MA: Number one would be memory changes. A lot of people have memory changes not because of Alzheimer’s disease but because of treatable, reversible conditions. It’s medications or depression or substance abuse. But the longer they wait, the more damage there can be, and the more hopeless they get—and it’s more difficult to treat.

Number two, anxiety disorders are actually the most common psychiatric diagnoses in late life, but they’re often hidden. And people will try all sorts of home remedies—supplements and sleeping pills and alcohol, and [for] more and more people, cannabis. It’s just it’s not doing the trick because it’s not real treatment.

SCF: You specialize in memory disorders. One thing that’s caught the media’s attention in recent years is the concept of “dementia villages”—secure neighborhoods for people living with dementia. They have shops and restaurants and caregivers dressed in street clothes. In fact, at Miami Jewish Health Systems you’re working on creating the first dementia village in the United States. Do you see such villages as an ideal potential future for dementia care?

MA: Yes and no. It’s a really alluring model, but it has to be paired up with the right model of care. It’s easy to design and build a beautiful, cool-looking place, but the care within it has to be commensurate with that.

SCF: To your point, even the design for the village you’re working on isn’t only about looking good. It takes into account practical things like Miami’s hot weather, incorporating shade to keep residents safe and comfortable.

MA: We want a design that’s beautiful and functional and that incorporates nature into it, but also one that contains elements that draw people into them and get the families involved—elements like an indoor/outdoor café, a store, a wellness center with a type of spa, a theater, a creative arts program, all purposed to the level of people involved—designed for individuals who have moderate to severe physical and cognitive disabilities.

We want a safe, enclosed community but that’s full of life, not only because of the programs and activities but also because it draws into it family and kids and pets and staff that love working there.

SCF: Do you see these types of villages in the future becoming more common in the United States?

MA: I see a lot of somewhat gimmicky places coming up that look the part—that have really cool design features. I don’t disagree with those features. But the complexity of working with individuals with moderate to severe cognitive impairment requires more than just a façade. It’s a big challenge. It’s very complex, and it’s expensive, and it’s time consuming. And I don’t think there’s enough of a consistent model to replicate yet.

I’m not even sure that village is the right word for [what we’re designing]. We’re using that term now more as a placeholder, but this is more than just a village per se. It’s really meant to be an evolution in terms of how people with these impairments are able to live and still be involved in the community.

SCF: In a blog post for the Wall Street Journal, you wrote about bringing to your 50th birthday party a booklet of gratitude to your elders, to put a positive spin on getting older. Do you see aging in a different way from most people?

MA: In my earlier years, I did a lot of cartooning. So I made a comic book that talks about all the things I’m grateful for, being 50. It talks about all the people in my life that have made a difference—going all the way back to even some of my great-great-grandparents—and focuses on how I want to approach the next 50 years.

At the same time, another friend had a 50th birthday, and they presented him with this gag gift that poked fun at aging. Everyone was looking and laughing. What struck me is that if someone had a similar gag gift that poked fun at their gender or their religion or race, we’d be horrified over it. We’d reject it. So why is aging still a target? We need to change that.

My take on aging is as follows: I would love to live to 100 or above. I hope I do, and I hope I live to that age in good form. But I realize that that’s an uncertain formula.

I know that if I take good care of my body and my mind that I’ll increase the odds of that. But I also realize that there’s a lot more preparation that needs to be done to live a good old age. And that’s recognizing the strengths that we gain as we get older and using those strengths to deepen relationships with family and friends. It’s thinking about what my purpose in life will be, what I want my legacy to be. These things are aided by years, but they don’t absolutely depend on it.

And to me, that is the most gut-satisfying aspect of aging. You’re going to face losses. I dread them. [You’re] going to have physical challenges. I’m afraid of them. I also know that a lot of strengths are coming my way that can help me and all my loved ones to cope with those as we get older.

SCF: Strengths like what?

MA: One strength is that we build up a reserve of experiences and knowledge that we can turn into wisdom. And by wisdom, I just don’t mean coming up with good decisions as you get older but something much deeper. Whether you look at intelligence, emotional state, spirituality, we can continue to learn and to grow and to develop.

I don’t really have a sense of retirement for what I do because I know that the mission I have is going to take a lot longer than the next 15 years, when I’ll be 65. I need many decades to realize this vision and this dream. I think everyone can do that, in a certain way. But what happens is people lose the confidence; they lose the sense that they can make a change—that they can inspire themselves and others to do that.

People get too caught up in wanting to live out their bucket list, forgetting the fact that it’s a lot more than just that as you get older. You have enormous power as a grandparent or a grand uncle, as a community leader, as a spiritual leader, as a docent, whatever—so much power to influence younger generations. We cannot cede that as we get kind of lost in still trying to be like teenagers.

I think this notion of trying to make old brains like young brains is misguided. I think young brains have a lot to learn from old brains. We need to realize that aging itself is the solution, not the problem, to so much of what we face as we get older.

So it’s a different perspective. But when I look at the older people in my life who have had the greatest impact on me: regardless of their mental and physical condition, I think they really understood the power of aging, and they harnessed it. They took it seriously. And it made a difference in their own life and had a profound impact on me and on other younger people. So if I can capture that, that’s my goal.

This interview has been edited for length and clarity.

What’s a New Word for ‘Old’?

Is there a warm, fuzzy one? Maybe not

Warren Wood is old. He’s proud he’s old. He advertises the fact that he is old by wearing a cap that says UFO in red letters. “What’s UFO?” people ask. “United Flying Octogenarians,” Wood, 86, of Carmel, CA, happily responds.

All members of UFO—an international organization that Wood is president of— had a pilot’s license on or after their 80th birthday. “We still have our wits about us. We can still carry on a conversation,” he says. “We take pride in the fact that we grew old but we didn’t grow old.”

And there’s the crux. You can call them old, but don’t call them old. Because old is bad—even when you’re proudly old. Right?

Well, Pat McGill, 71, isn’t old. She’s seasoned. “Anybody that’s old is just somebody that’s older than me,” says the South Dakota speaker, trainer and consultant.

Ashton Applewhite, 64, is an older—a term she coined in 2012. “It is short. Everyone understands what it means. It is value-neutral,” says the anti-ageism activist, blogger and author of This Chair Rocks: A Manifesto Against Ageism (2016). Besides, “I got tired of typing ‘older Americans.’”

Seniors, older adults, mature Americans—all sorts of terms and euphemisms have been proposed to describe people of a certain age. Nothing has been universally accepted, despite quite a bit of debate, especially over the last decade or so.

“This is a discussion that’s going on in the aging community,” says Karyne Jones, president and CEO of the National Caucus and Center on Black Aging. “Everybody wants a different title, but they don’t want people to label them so that it makes them old.” Her organization most often uses the terms seniors, senior citizens and older workers.

“The question of what should we call this group has been bubbling up more frequently,” says Susan Donley, publisher and managing director of Next Avenue, a PBS-associated website for older people. “I think it’s because people are starting to pay more attention to this group, and this group is starting to get larger.”

By that, she means the boomers have arrived. Now ages 53 to 71, people in the massive boomer generation are getting to be what some might call old, though certainly not old.

In boomers’ lifetimes, old has connoted declining, decrepit and irrelevant. So too, to varying extents, have related words, like senior and—shudder—elderly.

And one thing nobody but nobody wants to do is offend the boomers. These 75 million older adults bring money, power and influence. Newspapers and magazines depend on them as subscribers; local governments woo them for tourism and retirement relocation; independent-living communities (no longer “retirement homes”) need them to move in; manufacturers need them to buy.

But not one of these groups has yet figured out what to call them. All they know is boomers are not their parents, and nobody had better imply otherwise.

The ‘Senior’ Problem

For a number of years, senior and senior citizen were among the most commonly used terms for older people. But “calling Sting [at age 65] a senior citizen just seems wrong,” says Donley, summing up how a lot of boomers feel on the subject. For them, senior implies rocking chairs and golf. And that doesn’t fit how they see themselves.

“Many seniors—especially the younger seniors—don’t like to be called seniors because it reminds them of older people like their own parents or grandparents,” says Manoj Pardasani, PhD, an associate professor at the Fordham University Graduate School of Social Service. “Someone who’s 60, 65 today looks and feels and acts very differently than someone [of the same age] 30, 40 years ago.”

The perceived revulsion against senior is so strong that some service providers, in an effort to connect with these young-olds, have changed their names to omit the term.

Starting about 10 or 15 years ago, many “senior centers” in particular were seeing enrollment rates drop, says Pardasani, who has spent much of his academic life studying these meal-and-activity providers and who’s on the board of directors for Bronx House, which runs such a facility in New York. So some centers decided to change their names and omit the word senior altogether, becoming, for example, “community centers.”

“If society wasn’t ageist, we’d be totally fine with being old.

–Ashton Applewhite

But a funny thing happened. The name changes alone didn’t bring in the seniors, Pardasani says. What did work were major overhauls: centers that changed their programming and updated their facilities, along with changing their names, have been the ones to see noticeable enrollment increases.

As senior centers found, it’s not just the traditional labels that boomers are rejecting but the lifestyle that stereotypically comes with them.

“I’m not my mother’s 70,” says McGill, the speaker in South Dakota. “The baby boomers are going to be the generation wearing the blue jeans. We’re not going to be playing bingo; we’re going to be dancing—and, if possible,” she adds, laughing, “smoking a little marijuana.”

“The longevity boom has created a new stage of life for a lot of people,” Donley says. “If you’re lucky, you’ve got 20 or 30 healthy and productive years that fall after traditional retirement. I think that we’re figuring out as a society what that means and how we take advantage of that—and, as individuals, how are we going to live with purpose? Those are giant questions. I don’t think it’s that surprising that we don’t quite have the vocabulary for it yet.”

Finding the Right Words

There’s no consensus on when these so-called senior years begin. But say they start at 50, the age at which people can join AARP and start getting some “senior discounts.” That would mean society is looking for a term that encompasses at least five decades, from age 50 to 100. “It’s a huge group of people,” says Applewhite, who blogs at This Chair Rocks. (The Silver Century Foundation re-posts selected blogs from Applewhite.) “It’s incredibly diverse.”

So it’s understandable that finding one term that pleases everyone is challenging. But complicating the challenge is the fact that aging is often viewed in a negative light—as a state of decline. “If society wasn’t ageist, we’d be totally fine with being old,” Applewhite says.

For boomers and their parents and their parents before them, “old age has simply been looked upon as another stage of life but, unlike previous stages, it was viewed as a reversal of earlier growth stages,” wrote Herbert C. Covey, PhD, in a 1988 article about words used for older people that was published in The Gerontologist, the journal of the Gerontological Society of America. “[O]ld age is often associated with decline in attractiveness, vigor, health, and sexual prowess.”

“Once you start to think about aging differently, older adult or other terms stop sounding quite so offensive,” Donley says. “But the problem is the negative perception that those words carry already in our culture. I think that’s why people are looking for something new. What we’ve got is laden with baggage.”

Senior is one of the most-used terms right now. But “no one likes senior, honestly,” Applewhite says. “Senior implies that young people are junior.”

Elders is another option, but it has specific cultural meanings that complicate its use. In some Christian churches, elder is an official designation for certain leaders. In many Native American communities, elder refers to respected older tribe members. “And elder, like senior, implies a higher status than younger people,” Applewhite says.

Elderly is out unless it’s used in reference to frail older people.

Older people has emerged as a top choice in recent years. It’s the term the Silver Century Foundation uses most. It’s value-neutral and doesn’t carry as much baggage as some of the other terms. Besides, “people who won’t cop to being old will more readily cop to being older,” says Applewhite, who opts for her shortened version, olders.

“Perhaps no term will be acceptable until boomers get a little older and start embracing, or at least accepting, their advancing age.

Yet older people is too nonspecific to be the perfect solution for everyone. It leaves open the question, older than what?

The generally accepted best practice is to opt for specificity when possible: people 65 and older, women in their 80s, and so on. But here, another problematic term enters: boomers.

Boomers is specific but to some people, nonsensical. It’s a shortened form of baby boomers, a name for the generation of people born after World War II soldiers came home, between mid-1946 and mid-1964. The infantilizing “baby” is often dropped now—leaving many to wonder what a boomer even is.

“Some people hate ‘boomers,’” says Jones, of the National Caucus and Center on Black Aging. Boomers themselves tell her they don’t understand what the word means—and besides, their parents were deemed the Greatest Generation. “That’s a wonderful example of a term for people who have lived through a great, important time. You don’t want to then be called a boomer,” she says, laughing. “What’s that?”

For the most part, journalists, governments, service providers and manufacturers are left still scratching their heads, trying to come up with the perfect term for their ideal audience. Perhaps it’s out there, in some creative person’s mind, just waiting to be discovered.

Or perhaps no term will be acceptable until boomers get a little older and start embracing, or at least accepting, their advancing age. Maybe it’s normal for people to resist being called old, no matter the word you use—at least for a little while.

“It’s hard to get old,” McGill says. At a coffee shop, a cashier asked one of her family members whether he wanted the senior discount. “He was furious,” she says. “He’s a very kind human being, and he just lost it. For some people, it’s just going to be harder for them to get older.”

That feeling is not exclusive to boomers. “[C]ontemporary older people do not like to use the word old in describing themselves or their membership groups. Many of today’s elderly do not think of themselves as old.” Covey wrote that in 1988.

Wood, the UFO president, was 58 that year. “If somebody had called me old then, I probably would have taken umbrage,” he admits. But now he’s proud to be his age—as long as you realize he’s not old. He’s just old. And that makes all the difference.

Henry Cisneros: Homes—and Neighborhoods—Should Work for All Ages

Former HUD secretary envisions a future designed for aging well

This article is the third in our series on the future of aging: interviews with people who are experts in their fields and are also visionaries. We’re asking them to talk about what they believe will happen in the years ahead to change the experience of aging.

Henry Cisneros, former US secretary of housing and urban development, believes that in the future, our homes, neighborhoods and cities will be easier for older people to navigate. People will be able to remain in their homes longer—healthier and happier than generations before.

For years, Henry Cisneros watched his father, George, live an active life with limited mobility. A stroke at the age of 59 had left the elder Cisneros without the use of his left arm and left leg. But parts of his house were modified to accommodate his limited mobility. He was able to live there, with his wife, Elvira, in the home and close-knit neighborhood where they’d raised their children, until two years before he died in 2006 at age 89.

We’re living ever longer, but today’s houses, neighborhoods and cities haven’t caught up with that.

Elvira Cisneros continued living by herself in that home until a few months before she died in 2014 at the age of 90.

Cisneros had witnessed his parents attain a modern American dream: living independently in your own home as you grow older—even with reduced mobility. It’s called aging in place. Like most dreams, however, this one often doesn’t come true.

Though life expectancy has increased, today’s houses, neighborhoods and cities haven’t caught up with the times. Even when older homeowners can remodel their houses for changing mobility needs, as Cisneros’ parents did, they still need age-friendly neighborhoods, transportation and services to make aging in place work well. Much of today’s world just isn’t built for the modern old age. So, many people have to move to a retirement or assisted living community.

Cisneros believes this can change—in fact, it must if we want to avoid “disaster” as the percentage of older people in our country continues to grow. That’s because home means more than memories. It means independence, and it fosters mental and physical health.

Cisneros has some specific ideas on how neighborhoods must be different in the future to accommodate all ages. And he feels optimistic that they will. In fact, he says, change has already begun.

The New Dream for a New Old Age

Cisneros, a grandson of immigrants from Mexico, has long been passionate about helping immigrants and people with modest incomes achieve traditional American dreams—things like economic success and home ownership. He served as the US secretary of housing and urban development from 1993 to 1997 under President Bill Clinton. He’s the founder of CityView, a real estate investment firm that focuses on helping build homes for the workforce. And he created the Cisneros Center for New Americans, which trains young people so that they can help immigrants integrate and gain economic achievement in the United States.

But it was as the mayor of San Antonio (1981 to 1989) that he started to become keenly aware of the challenges older Americans in particular faced in modern America. In Independent for Life (2012), a book he coedited that proposes ideas for creating age-friendly homes and neighborhoods, he wrote:

During the years that I served as the mayor of San Antonio and spent many evenings listening to residents in neighborhood meetings across the city, I noticed repeated development patterns related to aging. In the same neighborhoods in which the population was aging, the housing stock was deteriorating and social needs were intensifying. As I listened to the older residents of those neighborhoods, I did not know then that those patterns were local manifestations of what we now know to be the national forces of aging demographics, of physical isolation experienced by many older people, of unaffordable housing, and of diminishing social services funding. Over all these years, the frightened faces and plaintive voices of those older residents have stayed with me and spurred this search for public and private answers.

Three Components of an Age-Friendly Society

Eighty-seven percent of people 65 and older want to stay in their current homes as they age, according to a 2014 AARP Public Policy Institute survey of 4,500 people.

There are some challenges to accomplishing this dream though. After all, old age often brings with it mobility issues. So first, you need a home that’s easy to navigate no matter your abilities. Most aren’t. There are stairs, high cabinets, deep tubs to step over and narrow doorways to maneuver walkers and wheelchairs through.

“… if we can keep people in their homes for longer, they’re happier, and the society saves money.”

–Henry Cisneros

Aging in place also requires a safe, walkable neighborhood or door-to-door services that make up for the lack thereof. Somehow you have to buy groceries, get to doctor appointments and make social connections—even if you can no longer drive. 

Beyond the neighborhood, certain other services and amenities can help facilitate independent living. These include nutrition, activity and exercise centers (though you must be able to get to them).

Older people can sometimes address these needs themselves—if they have enough money. Houses can be retrofitted. Drivers and delivery services can be hired. But often elders don’t have the money, or there are other practical concerns, so they must move from the home and the neighborhood they love.

On the Cusp of Triumph (or Disaster)

Federal and city governments (along with businesses and nonprofits) could knock down many barriers to aging in place, and they needn’t do so out of purely altruistic motives. Cisneros argues that by helping older people remain independent longer, the government would save money in the long run. Medicare and Medicaid expenditures on emergency services, medical interventions, facility care and long end-of-life care would decrease, because aging in place would result in a concept called compression of morbidity: staying healthy for a longer portion of your life and then having a briefer period of sharp decline.

“It is my strong conviction,” Cisneros wrote in Independent for Life, “that the physical environment in which older people live—with the security, stability, comfort and psychological nurturing it offers—has a lot to do with staying healthy and independent longer.”

We talked with Cisneros about the changes he believes need to happen to make his vision of an age-friendly society come true.

SCF: When did aging in place become a passion for you, and why? Or is that your passion?

HC: What makes me most personally passionate is the thought of people being able to live with a good quality of life for as long as they can. That’s one thing that moves me a great deal.

The other is the importance of all this to our country. We have the opportunity to create a society in which people, as they age, are treated with dignity. They have a place in the society. They’re rewarded for the contributions they made in their time. And [creating this society] will be hugely important. Otherwise, I see a chaotic world out there where everybody suffers because of the costs associated with aging to the general society, and because the failure to have a robust economy will make certain that elderly people do not have the resources they need to live in dignity. It’s a formula for disaster.

SCF: Already, there are some neighborhoods full of people who are aging in place. Can you tell us about them?

HC: There are a couple of concepts. One of them is what are called existing communities. In the urban planning field, they’re referred to as NORCs—naturally occurring retirement communities—which means neighborhoods where everyone is getting older at the same time.

We see entire communities in the Midwest—in farming communities, in Kansas and Nebraska and Iowa—where the population is aging quite dramatically. We also see it in the core cities across the country as the young people move out—seek a different kind of housing—and the people who are left behind tend to be older.

So that is an absolutely implacable reality for city officials. They have to figure out ways to address that with better policing services and with different approaches to health care outreach—and with aging specialists from the city looking in on people, and nutrition centers, and parks-and-recreation offerings that relate to advancing age. So that’s one reality.

What we need to do, really, is articulate a conception of the city as a city for people of all ages, so we’re thinking not only of children and adolescents and creating a city that is safe and uplifting for them, but a city for older populations as well.

And I’m pleased to say that I see the evidence that cities across the country are thinking about this—foresighted places like Chattanooga and New York City, for example, and multiple cities in the Midwest like Des Moines.

SCF: What do you believe the government needs to do to help your vision of an age-friendly society come to pass?

HC: I’ve done some town hall meetings with older Americans, in neighborhoods and cities across the country, and I’ve heard what they say themselves. They feel that they are disconnected and lonely as they give up the car and can’t travel as easily, and they’re relying on other people to pick them up. And people are busy and don’t come by. People then become a little disoriented, and then they make mistakes about medicines or about forgetting food or just become depressed.

So the kinds of things that local governments can do relate to transportation access—good transportation systems. And not just buses but vans and shared rides and so forth. We can foster the development of things like virtual villages that connect people so they can trade services and help each other out.

[Also, we should be] working on retrofitting some of our neighborhoods so that we have sidewalks that are walkable and parks that have some amenities for older people like exercise equipment. [We should make sure older people are] safe—they don’t get knocked over or assaulted.

We need to be thinking about things like policing that relate to the special needs of older populations, where policemen walking the block will stop and help older people, looking in on them. Cincinnati undertook an initiative like that related to some senior complexes that were the targets of assaults. New York City has some special districts that they’re actually zoning as districts with specialized senior services.

I think, in due course, city governments will have to think about things like retrofitting existing homes so that they are more user friendly, eliminating stairs, and putting in security lighting, and zero-[step] entrances, and lower kitchen cabinets, and more accessible bathroom fixtures, and security communications equipment that seniors can use to access police or ambulance help if they need it.

SCF: When the next generation starts to age in place, do you think these retrofitted houses will be more readily available?

HC: I’m hopeful that we, as a country, will do for senior housing what we did to respond to the energy crisis a few years ago, when we weatherized millions of homes across the country—caulking and sealing and window work and basically making them more energy efficient. I hope we do the same with a package of renovations that will create what [my colleagues and I] have called the life-span home—the home that’s accessible to people for an entire lifetime.

So this is a way the government can help—and, by the way, probably save money for the country in the long run, because the most expensive care is institutional care, and if we can keep people in their homes for longer, they’re happier, and the society saves money.

SCF: What is so important about a house?

HC: Well, that’s a profound question. I think people are surrounded by the memories of the best years of their lives. Literally, the walls are repositories of memories: their children growing up, social events that have been held there, the family gatherings, the good days—baptism and Mother’s Day—the sad days—wakes and sickness. But it’s home. There’s deeply rooted psychological value in being home.

SCF: Looking forward, say, 20 years in the future, will your ideal vision for an age-friendly society be a reality?

HC: As Americans, we tend to be, on the whole, a compassionate people, who are going to understand sooner or later that people do slow down a step as they age. They do become more frail as they age. They may have less income as they age. And we can’t leave people destitute and helpless. We can’t leave people lonely and unconnected. So I do see that many cities across the country will understand this and take appropriate steps.

SCF: It’s interesting that when you talk about creating an age-friendly society, you seem to talk more about entire cities rather than focusing on individual neighborhoods. Is that correct? Is that how you think of it?

HC: No, I think the unit that we relate to most after our own home is the neighborhood. The immediate block, the next-door neighbor, the people across the street, the people who looked in on you, the people who you can trust to keep an eye on your house, the people who you would call if they needed immediate help. The neighborhood is very, very important.

SCF: So, to build this future, do you picture going neighborhood by neighborhood?

HC: When they talk about naturally occurring retirement communities, they’re really talking about a smaller subset than even a region of the city. We’re talking about the neighborhood level.

Nowadays with GPS and statistical methods, you can identify where the groupings of people who are older and need help are. Instead of talking about some artificial neighborhood boundaries on a map that were drawn there a hundred years ago, let’s reconfigure our services around naturally occurring pockets where we see concentrations of population that need help.

SCF: What’s the biggest challenge faced when trying to get cities and towns to do things like allocate monies to retrofit homes, build accessible parks or provide transportation services for older people? Do cities accommodate young families and children more than older people? Does ageism play a role here?

HC: I think there’s two barriers. The first is all cities are strapped for revenue. So budgets are tight, and it’s very difficult to do all of the things that are desirable and necessary. There’s a constant battle of priorities.

Number two, the field of preparing public facilities for an aging population is relatively new. The concept of “cities for all ages,” which I think is going to be a very viable concept going forward, is relatively new in terms of its practical application. So at this point no one is really advancing the concepts. It’s not that there is a tilt toward younger. It’s just that nobody has really acknowledged the possibility, the technology, the creativity, the designs that would allow older people to enjoy parks, walking trails, walkable sidewalks, transit systems that have them in mind.

Now that’s going to become much more common going forward. I think we’re right at the point where people are beginning to think creatively about that, and this concept that I mentioned, cities for all ages, is gaining traction.

SCF: We’ve talked about government’s role. Are you looking forward to or hoping for any innovations from the private sector?

HC: Oh, yeah. When you talk about the private sector, that normally is intended to mean business, but I would mean it to include nonprofits and newly formed virtual organizations like [the villages] that I referred to earlier. [They] started in Beacon Hill [Massachusetts]; there’s now more than 200 across the country—people who are coming together to offer rides, to help with needs in the home, run errands, pick up groceries, pharmaceuticals, etc. All that is private.

Church-based organizations are hugely important. There’s nutrition centers as focal points for gathering. Those are private.

And then, of course, the private sector as we think of it—business—as well: the local grocery store becoming more age appropriate, the pharmacy, the bank and other services—everything from cosmetics and hair styling to workout facilities, understanding the demographics are changing.

SCF: Once you get an aging-in-place community going, what are the biggest challenges to sustaining it?

HC: Well, as with everything else in life, people have to be involved and help keep it going, but I would say that, if we do this in partnership with the local government, we can institutionalize some of these things, and then someone is responsible for them, like the parks or the transportation systems, and they cannot be withdrawn easily. Partnerships will make that possible. Permanent funding streams will make that possible. Local government involvement will make that possible.

SCF: What’s the likelihood that cities will do the things you believe they need to do?

HC: I think there’s going to be some cities that set the pace for the country. And by the way, I want to compliment the Milken Institute. They did a report [last] year on best cities to age [in]. I was a member of the advisory committee to that. And there’s some wonderful examples in there of places that are taking steps in every one of these realms that we’ve talked about.

So I think the odds are very good. I’m very positive about the ability of Americans to respond when they see the need, and the need here is becoming every day more clear.

SCF: You’ve seen that in your own life.

HC: My mother—we lost her in November [2014] at 90 years of age, and she lived in her home by herself until end of July of last year. She had a relatively short span of August, September, October and November in various hospitals and nursing homes after she had fallen. But she was in command of her destiny, fully aware, engaged in her community—loved her home, loved her yard, loved her plants, loved her neighbors. And I think it added immensely to her quality of life.

This interview was edited for clarity and length.

Grieving Has Changed: Today People Do It Publicly—Online

Will that transform mourning for better or worse?

These days when a loved one dies, we don’t stop clocks and don black for months. There is no sackcloth. Often, we can’t even make it to the funeral.

Death, it seems, has been stuffed into the shadows. In a society where people live long and die in facilities, we are relatively cleansed of morbidity.

Yet there is one place where death has come into the light. There, death intermingles with everyday life as it did in generations past—boldly, as if it (gasp) never went away.

Death is alive online.

Social media has ushered in a renewed era of public mourning. There are new mourning traditions—and new clashes over mores.

Stoicism has ruled for generations. And that hasn’t necessarily been good.

As we sort through what is allowable, healthy and helpful in this new world, one unchanging truth lies beneath the surface: everything we’re doing now—all the rituals and debates—has exact parallels in digital-free yesterdays. Grief, it turns out, provides a fascinating connection to our forebears—and even a glimpse into the likely future.

When Mourning Walked among Us

The Victorian era was a heyday for mourning. Strict rules of etiquette affected every part of life, and grief guidelines were extensive. Widows, for example, wore mourning garb for months or years. For Victorians, mourning wasn’t just not hidden; it walked around in everyday society, visible and tangible.

“And this was the 19th century, so people experienced deaths a lot more often,” Kate Sweeney, author of American Afterlife (2014), said in an email interview. “There was a LOT of mourning and mourning behavior going around.”

In the 20th century, with hospitals, nursing homes, and young people just plain not dying as often, death receded from view and public mourning grew passé. “Grief was tacky; it was outdated. Now, having control over your grief was honored and respected,” Sweeney said.

Stoicism has thus ruled for generations. And that hasn’t necessarily been good.

When researching her book, which is about American mourning traditions, Sweeney found that many mourners today feel alienated. People act awkwardly around them, not knowing what to do. “Death is just not expected to happen to us—to you and me,” she said. “It’s not part of the American narrative of life, which is so focused on youth and success and triumph and winning.”

But that denial is beginning to wane.

Mourning Goes Public Again

Americans’ bottled-up grief was bound to start seeping out sometime. And in the last few years, it has finally found a crack—not in social rules but in social media.

Many people today do their public mourning online. They do it in whatever way feels right to them. And what feels right just so happens to echo the past.

Victorians wore jewelry with dead loved ones’ pictures. Facebook mourners change their profile photos to depict the deceased.

Victorians took photos of corpses to remember their loved ones. Search the hashtag #RIP on Twitter, and believe it or not, you might find a dead body or two in hospital beds.

Even traditionally private grieving activities have been made public. Dead people’s Facebook profile pages have become virtual gravesites, where mourners speak to the dead publicly, writing messages on their walls.

A deceased friend’s Facebook page can make it seem like he’s still alive. Or like he’s frozen or trapped in a virtual world.

Such personal expressions—messages both to the deceased and about them—incite the biggest disagreements about online mourning: Should grief be displayed in such a public way in such casual media? Should devastated declarations appear in the midst of celebrity news and what your friends ate for dinner?

“Some people who aren’t social media users just truly can’t wrap their brain around why somebody would find those things helpful,” said Carla Sofka, PhD, MSW, a professor of social work at Siena College in New York who studies social media mourning. That may be due to both personality and lack of familiarity with these outlets.

Some people who share personal grief online find this easier than expressing it face-to-face, Sofka said. Plus, they can get immediate support through kind responses from friends—day and night.

And these days, there’s not always a funeral service where they’re able to share stories in person.

“Our society is one of the few places where there are a number of people that would, for example, have cremation and no services,” said Ashley Cozine, director of a funeral home and treasurer for the National Funeral Directors Association. “Most every other society in the world has some kind of ritual or service or ceremony to recognize the fact that a loved one has died.”

“As we share the memories, it helps us mourn,” said Kenneth J. Doka, a professor of gerontology at the Graduate School of The College of New Rochelle and senior consultant to the Hospice Foundation of America. “It’s a way of saying this person mattered, this person counted, this person was part of our lives.”

The Disenfranchised Welcome Here

One important aspect of mourning is celebrating and honoring the dead person’s life. Pre-Internet, this was partly accomplished through newspapers. But unless you were well known, you probably only got a short obituary—or nothing.

“Mainstream newspapers appeared not to notice the deaths of the vast majority of African Americans,” wrote Janice Hume in Obituaries in American Culture (2000). “Children, the poor, socially outcast, or disabled Americans also failed to fit a social ideal that would allow them to be part of public memory.”

The Internet has changed that. Now, anyone’s story can be published. And anyone can publish a story—including previously disenfranchised mourners, such as friends (traditionally pushed aside for family members) and people grieving due to a taboo form of death, like suicide.

“If there is a piece of the loss that’s ostracizing or hard for people to publicly talk about, sometimes cyberspace can provide a more comfortable place for people to be open about that,” said Sofka, who’s co-editor of Dying, Death, and Grief in an Online Universe (2012).

The Internet even allows previously out-of-luck out-of-towners, overseas soldiers and homebound family members to be brought into the mourning fold—not only through social media but also sometimes through webcast funerals.

The Immortal, Digital Self

One of the most fascinating aspects of online mourning is the concept of the digital afterlife. Society has finally found a form of immortality: social media profiles.

After death, unless a designated loved one takes down your accounts, you remain present, in a sense, online.

To complicate things, Facebook is often a main way—or the only way—people keep in touch. So not much seems to change when the person dies (except that the deceased no longer types back). This can create confused feelings.

In a 2014 study about online mourning, one participant said a deceased friend’s Facebook page made it seem like he was still alive. Others said their friends seemed “frozen or trapped in a virtual world.”

“I feel like it’s made him a ghost,” said another. The study, by Kelly R. Rossetto and colleagues, was published in the Journal of Social and Personal Relationships.

How will mourning evolve as today’s young people age? And how will they view our treatment of grief?

Yet many people find the continued presence comforting. Still being able to talk to the person allows you to say goodbye, I miss you, and even happy birthday year after year. One participant called this “a more new-aged way of praying.”

In other cultures, in fact, feeling the continued physical presence of someone who died is encouraged. In many Asian and African countries, “the deceased are remembered and included in the daily activities of the ongoing lives of their survivors,” wrote Brian Carroll and Katie Landry in a 2010 study published in the Bulletin of Science, Technology & Society. In some cultures at Christmastime, an extra place is set at the dinner table for a dead loved one.

As long as you understand the person is dead, talking to them is normal. “In the olden days, we used to think you kind of accept and acknowledge and move on,” Sofka said. “We know now that people find ways to keep that connection ongoing.”

The Selfie Generation

In late 2013, the funeral selfie hit. Teenagers, it was discovered, were taking pictures of themselves—occasionally with a casket in view—before and after funerals.

The kids were shamed heartily in the national media for apparent irreverence and narcissism. Yet Sofka points out that maybe they were just never told that what they were doing was inappropriate. “Selfies are a way of keeping an electronic journal, right? ‘This is where I was. This is what I was doing.’ Well, on that particular day, that’s where they were, and that’s what they were doing.”

For today’s teenagers, digital media has always been part of their lives. Expressing themselves that way is as normal as wearing sackcloth or a black veil used to be.

So an interesting question is: How will mourning evolve as this generation ages? And how will they view our treatment of grief today?

We can’t know for sure, of course, in part because technology is changing so rapidly. In our lifetime, memorialized, social-media profiles may become old fashioned. Something that sounds as bizarre as interactive, digital avatars of the deceased, complete with personal memories, could become the new norm. (A company called Eternime is developing this right now. The avatars will be accessible through their website and, eventually, mobile apps. They say over 29,000 people have signed up.)

Yet if history proves true, some time-tested traditions will remain. Though a digital condolence message will be nice, a handwritten card will be nicer. Though attending a funeral online will be respectful, an in-person hug will bring more comfort.

And no matter how stoic or rules-driven or death-defying any era may become, grief will eventually find a way to break through, reminding us that in the end, we’re all the same. Dust to dust, generation after generation.

Membership Medicine: When the Doctor Is Always In

The pros and cons of joining a concierge practice

Adina Cook’s teenage son was skateboarding one evening. He tried to jump 10 concrete stairs and landed smack-dab on his shoulder.

Instead of rushing him to the emergency room, Cook, 52, called the family’s doctor, Tracy Ragland, who met them at her office—on her birthday, 45 minutes before her party.

Ragland got the shoulder back into place and dispensed muscle relaxants and pain medicines from her in-practice pharmacy. “She saved us probably at least a couple thousand dollars in medical costs” versus an ER visit, Cook says.

Hugh Stroth Jr., 69, another of Ragland’s patients, had been trying to lose weight for a while. So Ragland suggested he meet with her monthly for weigh-ins and lengthy consultations. Over the next year, he lost 16 pounds and improved his blood pressure enough to cut his medication back.

Many concierge physicians—and their patients—are in their 50s or older.

Insurance didn’t cover any of this. Ragland, who runs OneFamilyMD in Crestwood, KY, doesn’t accept it. She’s what’s called a direct primary care physician. People pay $50 to $100 a month, or $150 per family, to join her practice. In return, they receive unlimited office visits, 24/7 access to Ragland, wholesale lab and medication prices, and even house calls and work calls if needed.

Ragland is one of a growing number of doctors in the United States who runs a membership-based medical practice, a model of care that’s grown exponentially since it started two decades ago. In recent years, the growth has been driven by doctors and patients frustrated with modern health care delivery. Many of them—both the physicians and the people they treat—are in their 50s and older. They remember an era before mounting insurance regulations and shrinking appointment times. Nostalgia for those good ol’ days is part of what membership practices are banking on.

The membership trend worries some experts and thrills others. This model of care is poised to alleviate the United States’ primary care crisis—or send it reeling into the deep end, depending on whom you talk to.

How We Got Here

In 1996, Americans were struggling with skyrocketing health care costs and government attempts to stymie the growth. Much-derided HMOs were booming. These insurance plans were meant to help reduce health care costs, but they set strict guidelines for patients and doctors, including limitations on which doctors they’d cover. Old-fashioned health care, in which the doctor and patient were solely in charge, was going by the wayside.

When MD2 (pronounced “MD squared”) came along that year, the national reception was less than warm. Launched by two doctors in Washington state, this new type of practice, dubbed “concierge medicine,” charged an annual fee of about $13,200 per person, or $20,000 per couple, for exclusive, personalized care. Many people saw it as elitist and downright unfair.

But in 2000, MDVIP launched as a more affordable concierge model, and the industry started growing. MDVIP is now one of the largest concierge franchises in the country. Its average membership fee is $1,800 a year.

In a 2005 report, the Government Accountability Office identified just over 100 concierge practices. Estimates of current practice numbers range from 6,500 to 12,000—with thousands more doctors contracting with at least some of their patients.

How It Works

In membership medicine, patients pay a monthly, quarterly or yearly fee to join a medical practice. In return, they typically receive unlimited access to their physician—phone calls, texts, emails, video calls. They get long, often same-day doctor appointments and additional perks, such as thorough coordination of care with specialists and free or low-price tests and lab work.

There are two main practice models: concierge medicine and direct primary care. In general, concierge practices accept insurance, are more expensive and offer more services. Direct care practices, which are also called direct pay, don’t accept insurance. (“Concierge medicine” is also sometimes used as an umbrella term for both types of practice.)

Independent research on membership medicine is scant so far. The typical fee seems to be about $1,000 to $3,000 a year. Direct care models skew toward the cheaper end because they don’t accept insurance. These doctors have less paperwork and don’t have to hire staff members solely to help them comply with insurance rules.

Patient Praise

Membership medicine is often touted as a return to old-fashioned health care. Those were the days when doctors, instead of cost-focused third parties, owned their own practices. The days when physicians didn’t have to keep patient visits to 15 minutes or less because insurance would only pay so much, and they had to make time for all that paperwork anyway.

“In the old days, you really had the time to address every problem when the patient came in. You didn’t have to hurry them or skip things and make them come back,” says internist Steven Mickley, who started practicing medicine in the 1970s. Nowadays, “a lot of doctors just refer out to some other subspecialist because they don’t have time to deal with it.” Mickley, who practices with two other doctors at Glenville Medical Concierge Care in Greenwich, CT, transitioned to concierge medicine in 2015.

“We want people to think of us as having a doctor in the family.”
–Bruce Jung, MD

In membership medicine, doctors are reimbursed the same no matter how many problems they address at once. And appointments often last 30 to 40 minutes.

Such practices maintain about a fourth of the patient load of traditional primary care practices—around 200 to 500 patients, according to an informal poll conducted by Concierge Medicine Today (though these numbers may skew low because some respondents likely have young, still-growing practices).

Older patients dealing with multiple medical issues often especially appreciate the extra time, says Bruce Jung, a family physician who runs The Doc Shoppe, a direct primary care practice in Corbin, KY. For example, cutting yearly visits down from 12 to two, which he suggests is sometimes possible, saves people who use wheelchairs headache, time and expense. Plus, brief to nonexistent waiting-room times can cut down on germ exposure, which is good because the immune system weakens with age. Some practices offer house calls when necessary.

One of the most gushed-over perks patients cite is doctor accessibility. Nights, weekends, holidays—the doctor is always in, sometimes precluding the need for an urgent care center or expensive emergency room.

“We want people to think of us as having a doctor in the family,” Jung says. “They know they can call us when they feel they need to because we’d much rather take care of things sooner rather than later.”

While recovering from shoulder-replacement surgery in the hospital, Patricia Vitula Mundt’s 94-year-old mother was in excruciating pain. “We were just constantly pushing the button—it’s time for her pain meds—and she’s crying, and 20 minutes later we might get someone in there,” Mundt recalls.

But Mundt and her mom were patients of Ragland’s, at OneFamilyMD in Kentucky. Ragland texted Mundt to see how her mom was doing. When she learned what was going on, Ragland called the nurses’ desk to address the problem. The next day, she went to the hospital to check on things in person.

Ragland also provides occasional everyday caregiver support, in the form of advice-giving. “It’s just been wonderful that I can email her and text her right away, because Mom’s blood pressure goes up and down,” Mundt says. “I’m not an experienced caregiver. Sometimes I don’t understand—like if her blood pressure goes up very high—what I can do.”

If membership medicine continues to grow, will it exacerbate the doctor shortage?

Even with all this accessibility, doctors say they aren’t overwhelmed with calls. “I’ve been doing this now for almost three years, but I’ve only been called twice between midnight and 6:30 in the morning,” Jung says. He establishes mutual accountability and respect upfront. “My agreement with my patients states that they can drop me at any time for any reason, and I can dismiss them at any time for any reason,” though he notes that he gives them time to find a new physician.

“We have not had to have a conversation with any patients about ending the arrangement except for one patient who was rifling through our lab cabinets in a quest for narcotics,” he says, adding that his practice doesn’t store narcotics anyway. “We have dismissed a few patients for lack of payment, but that is a pretty standard and common situation in any medical practice.”

The Effect on the Doctor Shortage

By the year 2020, the United States will have a shortage of 20,400 primary care physicians, according to a 2013 report from the government’s National Center for Health Workforce Analysis. Causes include population aging, population growth and the fact that more people have health insurance because of the Affordable Care Act.

One partial remedy the government has come up with is to encourage the use of nurse practitioners and physician assistants as primary care providers. But that’s not good enough for many patients, who want to see their doctor. That’s another perk of membership medicine: patients usually get to see the physician they’re contracted with.

Yet some industry experts worry about those who can’t afford memberships. Membership doctors see fewer patients, after all, so if membership medicine continues to grow, will it exacerbate the doctor shortage?

Proponents say that’s unlikely. They argue that membership medicine could actually help alleviate the shortage by keeping doctors happier and in medicine longer.

At her busiest while practicing traditional medicine, Ragland had about 2,200 patients on her roster. She was burned out and constantly behind, an oft-repeated complaint from primary care physicians. “With each new law and regulation that was supposed to address problems with our health care system, it just created more and more layers of bureaucracy that just made it harder and harder,” she says.

“I was about to retire early from medicine and go to the family farm, and now I can honestly say, I could do this until I’m an old lady.”

The Cost

One obvious downside to membership medicine is the additional cost to patients. No matter the benefits and discounts, many people find they can’t afford to join a membership practice. So when a beloved doctor transitions, long-time patients are often hurt, angry and frustrated.

When Ragland transitioned in 2015, reactions from her then-1,400 regular patients were mostly positive, but some were “downright mean,” she says. Unhappy patients felt abandoned and said they couldn’t afford the fees. Her small town has a median household income of $80,000. She held meetings and helped people find other doctors. Fewer than 300 patients initially joined the practice. More joined later.

Jung’s town has a median household income of just $33,000. He feels a spiritual calling to practice in a community that isn’t rich, but it’s been challenging. “I’m [only] at 350 members, and I have been doing this for almost three years now,” he says. His monthly membership fee is $50 to $75 per person or $150 per family. Routine lab tests and some other common services are included.

Research has yet to prove whether membership medicine leads to better health outcomes.

It’s common for membership doctors to dedicate about 10 percent of their practices to discounted or free services. Even so, some traditional doctors and industry experts see membership models as unfair, elitist and potentially discriminatory.

But proponents argue that there’s the potential for patients to save more money than they spend. More frequent, personalized, prevention-focused doctor visits could mean reduced medications, hospital stays and visits to specialists. Easy access to the doctor may lead to fewer urgent care and emergency room visits. Even insurance premiums can go down if patients switch to high-deductible plans and use membership care to fill the gap. With the current dearth of independent research, most of these money-saving aspects are still speculation.

Where membership medicine really gets complicated is on the topic of insurance. In a nutshell, here are three things to keep in mind:

  • Maintaining insurance is still recommended. Even though direct care practices don’t accept insurance, experts recommend having a high-deductible policy for expensive things not covered in the membership, such as hospitalizations.
  • Medicare has its own rules. Many membership doctors treat patients who have Medicare. Some of these doctors—especially in direct care—have “opted out” of Medicare, a legal option that prohibits the use of benefits for most of the doctors’ services but still allows benefits to be used for outside services the doctor orders, such as labs and hospitalizations.
  • Membership fees are out-of-pocket. They don’t even apply to insurance deductibles and can’t usually be paid from a health savings account (HSA) or flexible savings account. (The proposed Primary Care Enhancement Act  could allow for paying direct care fees from an HSA if it ever gets out of committees.

Before joining a practice, ask how specialist referrals, hospital admissions and prescriptions will work with whatever type of insurance you have.

Who Benefits Most

At just 20 years old, membership medicine still carries a lot of controversy and questions.

There’s the long-expressed concern that it could lead to a two-tiered health system, in which poorer people are shut out of the premier slots. But not as often brought up is the question of favoritism. Might a membership system favor younger, healthier patients over older people or those with chronic illness? Even now, it’s common for practices to charge older people higher membership fees than younger ones.

And, while the traditional fee-for-service system can allegedly lead to overtreatment and rising costs, what happens when practices don’t make money on tests and procedures—or when they include them as-needed in the memberships? Could that incentivize some doctors to provide less care than warranted, swinging the pendulum too far back?

For these reasons and more, it’s a good idea to interview the doctor before joining a membership practice. Get a feel for the physician’s personality, bedside manner, expertise and trustworthiness before making the commitment.

Research has yet to prove whether membership medicine leads to better health outcomes. More time with the doctor may sound great in theory, but does it actually help? That said, Mickley, the concierge internist in Connecticut, where the median household income is $135,000, names two groups of people who he believes tend to benefit the most from membership medicine: younger people with bad health habits who need intensive preventive care and advisement, and people with chronic, complicated problems who need lots of follow-up.

But there are also plenty of membership patients who don’t fall into those categories. “I’m thinking long-term,” says one of Mickley’s patients, 76, who declined to be named. She joined the practice because she’d been a patient of Mickley’s for about 10 years when he transitioned to concierge care, so she already knew she “adored” him as a doctor. “We don’t know what our health care needs are going to be [going] forward. To have somebody that you can trust over the long term—it’s worth the cost, knowing that they’re going to be there for you.”

Mickley, like many membership-based doctors, now has a waiting list to get into his practice.

It’s Never Too Late to Exercise—but Starting by Midlife Is Best

How much Is enough?

Harrison Caldwell had a good excuse for not being athletic: one of his legs was about a quarter inch shorter than the other, thanks to a childhood bout with polio. Plus, his feet were so flat that the Army turned him down at the height of the Vietnam War.

He had a good excuse for smoking too. He came of age in the ‘60s, when about half of American men were smokers.

But at about age 40—with a 1-year-old daughter who would soon be watching her dad’s example something clicked. 

“I had gone from around 150 [pounds] to around 160, 165,” says Caldwell, who lives in Pontotoc, MS. “Nothing bad other than the suit size changed a little bit, but you could see the writing on the wall.” 

Caldwell had a choice. He could keep up unhealthy habits and therefore accept aging as a steep downward slope. Or he could kick some changes into gear.

His decision would end up impacting him for decades, changing his mind on what was possible and helping reshape his life and the way he lived it.

The Real Fountain of Youth?

In general, by around their mid-40s to early 50s, even active people start to lose muscle and bone if they don’t do something to counteract it, says Miriam E. Nelson, PhD, director of the John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention at Tufts University in Medford, MA. Other measures of health, like blood pressure and cardiovascular fitness, start to go downhill too. And increasing age brings a heightened risk for certain cancers and chronic diseases.

But there is something that can help you avoid or slow down all this deterioration—even reverse some of it. Some have compared this natural remedy to the fountain of youth. 

It’s plain old exercise.

Only 21 percent of American adults get the recommended amount of aerobic and strength-training exercise, according to the Centers for Disease Control and Prevention. 

How Much Is Enough?

The US Department of Health and Human Services lays out its exercise recommendations in the 2008 Physical Activity Guidelines for Americans. According to the report, adults without a condition precluding this much exercise should get a minimum of: 

  • Two-and-a-half hours a week of moderate-intensity activity (such as brisk walking), OR
  • An hour and 15 minutes of vigorous aerobic activity, OR
  • An equivalent combination.

Perform the exercise in at least 10-minute sessions each, spread throughout the week. Two days a week, also do strength training involving all major muscle groups.

For more health benefits, increase aerobic exercise to five hours of moderate-intensity or two-and-a-half hours of vigorous-intensity activity a week.

Start gradually to avoid injury. For more guidelines, including advice on when to consult a doctor before or after beginning exercise, see the report here.

David Nieman, DrPH, a professor in the Department of Health, Leisure, and Exercise Science at Appalachian State University in North Carolina, recommends moving throughout the day, in addition to exercising. 

“Prolonged sitting has been related to chronic disease now in a growing number of studies,” he says.

“Exercise is like medicine. You can’t get the immune system going without exercise. You can’t get your blood vessels more pliant without exercise. Your bones can’t be thicker without the weight lifting,” he says. “You’ve just got to keep doing it all your life.”

“Americans are so sedentary that the ramifications of the aging process are starting earlier and earlier,” says Nelson. If you’re approaching your 40s or 50s and haven’t been active, “you better start now.”

Exercise’s Effect on Disease

Most people 65 and older have at least one chronic condition. But exercise can knock out a lot of risk factors for many of those diseases.

Heart disease? Exercise can improve your cholesterol, blood pressure, blood-vessel health and heart health.

Type 2 diabetes? Being active improves your blood sugar and insulin usage.

Alzheimer’s disease? Exercise may help you prevent it or at least slow down its progression.

Certain cancers, such as breast, lung and colon? Not only can exercise help prevent them, but it can help you survive them.

“Whether it’s heart disease, diabetes, cancer, those that are active—once they are healthy enough to become active again—have much better outcomes and survivorship,” Nelson says.

Exercise may also help prevent colds and the flu, in part by revving up the immune system. (Though intense exercise, such as running a marathon, can have the opposite effect.)

And being fit can lengthen your lifespan—by about three years on average, says David Nieman, DrPH, a professor in the Department of Health, Leisure, and Exercise Science at Appalachian State University in North Carolina. 

For example, in a 2009 study published in the British medical journal BMJ, Swedish researchers administered questionnaires to 2,205 50-year-old men, then repeated this periodically for 32 years. They found that when inactive or somewhat active men became highly active in their 50s, they were half as likely to die after more than 10 years as they would have been otherwise. This put them on par with men who had already been highly active at 50. According to this study, you may need to keep up this high fitness level for five to 10 years before your mortality risk decreases. The researchers defined “highly active” as doing heavy gardening or recreational sports for at least three hours a week, or regularly engaging in hard physical training or competitive sports.

Certainly genes also have an effect on longevity and your likelihood of getting some diseases. 

“But for the most part, exercise—even with a poor genetic makeup—does really optimize your health,” Nelson says.

Exercise’s Effect on Mobility

When Sid Heller of Boulder, CO, turned 100, he said his three keys to a good, long life were music, love and walking.

Heller has always been active. In his 20s, on his way to work, he’d get off the bus a few stops early and walk. Later, while raising a family, he worked out at the gym, bicycled, hiked and swam.

Heller kept swimming into his 90s, stopping only because getting to the pool became difficult. These days, at 104 years old, he attends seated fitness classes at his independent living community. And every morning after breakfast, he takes his walker for a stroll outside.

“I do it because I just feel like doing it,” says Heller, who hasn’t visited a doctor in over a year. “I think it’s necessary for feeling good.” According to the experts, he’s right—in more ways than one.

It’s inactivity, not just aging, that causes many of the changes in muscles and bones that people tend to see as they get older, according to the American Academy of Orthopaedic Surgeons. Exercise can reduce your risk for falls and injury and keep you as independent and active as possible.

Though muscle and bone mass seem to peak around the mid- to late 20s, “the good news is you don’t necessarily have to just lose it after age 30,” says Stephen W. Farrell, PhD, science officer in the division of education with the Cooper Institute, a fitness-focused research and education organization in Dallas. “There’s a lot we can do to hang on to what we have and even increase bone density and muscle mass beyond the age of 30.”

One key to having strong muscles and bones is resistance exercise. That can include things like lifting weights, doing floor exercises such as sit-ups and push-ups, and engaging in manual labor—like digging or splitting wood—Nieman says. 

Changing Needs—and Motivation

Though exercise gives big benefits, aging does bring some unavoidable physical changes.

“As we get older, we can’t necessarily do the same quantity or quality of exercise that we once could,” says Farrell, a former competitive runner. For example, most people gain at least a little weight as they age. ”So if you’re doing a high-impact sport like long-distance running on concrete, you might be more susceptible to things like tendonitis and stress fractures.”

Repercussions from previous injuries can also take a toll. And your body may take longer to recover from both injury and heavy exercise.

All this can do a number on your motivation—perhaps even cause you to stop exercising. But changing your focus can combat that, Farrell suggests.

“I think as we age maybe we ought to think a little bit less about exercise as a means to athletic performance and focus a little bit more on exercise and health,” he says. Also, think beyond the exercises you’re used to, Farrell advises. “Be a little bit more open-minded about all the different activities out there.”

But what if your problem isn’t changing motivation, it’s never having been motivated in the first place? Well, perhaps you just haven’t found the right activity yet. 

“I think you’ve got to bring the fun back into being active,” says Nelson, who’s the founder and director of the StrongWomen Program, which organizes community exercise programs that bring women together for their health. Try dancing or playing with your children or grandchildren, for example.

“I just think of it as part of life and not as a duty,” says Heller, of Colorado. “I just enjoyed it.” 

Caldwell enjoys being active as well. “On a bicycle, you can see everything,” he says. “I found things in Pontotoc County I hadn’t seen in 40 years.” He also likes meeting people who have similar interests when he’s out and about.

“The number one reason people report for why they keep exercising on a regular basis is that they feel better mentally,” says Nieman, who’s also director of Appalachian State University’s Human Performance Lab. In fact, in addition to its physical benefits, exercise may also help prevent depression and anxiety and may make you sleep and think better.

Is It Ever Too Late?

When Caldwell confronted his unhealthy habits at around 40 years old, he decided to make some changes.

He quit smoking and started biking. Then, thanks to a relatively new product from Nike called running shoes—this was the mid-‘80s—he discovered that he could run without pain. The shoes provided cushioning and spring for his polio-affected leg and flat feet. This newfound ability, along with a talent for swimming, led to triathlons starting at age 42. 

Now 68, he no longer does marathons but remains quite active, with a resting pulse below 50 and healthy cholesterol levels.

Over the years, Caldwell has had some bicycle accidents, but “if you’re active, you’ve built some strong bones, you can avoid a lot of fractures. I sprained an ankle but didn’t break a bone.”

Soon, he’ll have hip replacement surgery. His shorter leg made for a bad footfall, leading to hip degeneration. But his doctors tell him he’ll have no problem with the surgery, due in part to his fitness. 

“The main thing was it turned out to be fun,” Caldwell says of his exercise habit. “I enjoy it because I know it’s good for me.”

Though it’s best to be active throughout life, it’s never too late to begin, says Nelson, who was vice-chair of a committee that helped develop the 2008 Physical Activity Guidelines for Americans. “It’s what you do now that matters.”

Nieman compares starting exercise to quitting smoking: benefits start quickly and increase as time goes on. Then again, “everything is so quickly reversed when you change the habits the wrong way,” he says. “You need to make exercise like eating and sleeping. It’s just something you have to do.” 

What to Do If You’re Not the Athlete You Once Were

Here are 6 tips for staying in the game

At 55 years old, Heidi Christensen relishes the chance to defy stereotypes. “You didn’t just get passed by an old person,” she says of the 20- and 30-somethings she zooms by on bike paths. “You got passed by an old lady.”

Almost three decades ago, chances didn’t look good that she’d be passing anyone while bicycling—or running or swimming—ever again. This, despite the fact that she was a professional triathlete who, at age 28, had just come in fifth at the Ironman World Championships. 

The problem was, not long after that triathlon triumph, the leg weakness and pain that Christensen had been experiencing for some time intensified to the point that her legs “basically stopped working,” at least at a competitive level. Yet doctors couldn’t figure out what was wrong.

So, at the peak of her career, Christensen faced the agonizing reality many professional and recreational athletes confront around their 30s, 40s or 50s: she could no longer compete in the sport she loved. “It was a hard adjustment,” she says, “a very hard adjustment.”

Christensen quit triathlons and went on with her life, but the pull of athletics never left. Before too long, she found a related sport—and excelled in a way she’d never expected.

The Inevitable Transition

For both professional athletes and weekend warriors, athletic performance declines with age. Stamina, power or simply the time to train lessens, or injury or illness makes competing impossible.

Since athletes often shape their lives and even identities around their sports, the what’s-next period can be depressing and confusing. Some quit physical activity altogether. But others are eventually able to find athletic fulfillment in new ways. They discover a different sport, change their level of competition or feed their soul through recreational exercise.

Older athletes and experts echo similar advice for making a transition like this: stay positive and think outside the box.

Tip 1: If You Have to Quit, Experiment

In some sports, older athletes can continue participating, just at lower levels of competition. But that’s usually not the case with explosive or high-impact sports like football, basketball and hockey.

As you get older, your jumping ability and explosive power decrease, says J. D. DeFreese, PhD, program manager of the Brain and Body Health Program at the University of North Carolina’s Center for the Study of Retired Athletes.

Decreasing bone density and flexibility make injuries more likely, and recovery becomes more difficult with age. In addition, your ability to compete could be impacted by old injuries that tend to linger from high-impact activities, DeFreese says. 

Most professional athletes in sports such as these retire young, but even recreational players must usually give up the game. 

When you have to quit a sport, “you lose a part of yourself,” says Doug Gardner, EdD, coordinator of mental training services with the NFL Players Association and founder of ThinkSport Consulting Services in California. 

“It’s not just a loss, it’s a loss of a sense of purpose”—including purpose for working out since that’s been tied to the sport, Gardner explains.

To regain excitement for physical activity, Gardner recommends brainstorming other activities you’ve enjoyed or want to try and training for those. Experiment to see if you can get the same level of satisfaction from them.

After all, as people grow older, we engage in sports not as much for external rewards like getting a scholarship or making it to the pros but “because we want to grow as a person and we want to challenge ourselves,” he says. “It’s about the participation; it’s about the work; it’s about improvement.”

Tip 2: Try a New Outlet for Your Skills

Former NFL player Steve Freeman of Oxford, MS, found his workout motivation in a new job.

In 1987, after playing in the NFL for 13 years, mostly with the Buffalo Bills, Freeman retired because his body was just worn out. “I knew it was time to walk away before something major happened,” he says.

But Freeman kept right on training because he knew what he wanted to do next: be an NFL referee.

In 2001, he got his chance. In 2014, 60-year-old Freeman was called on to ref the Super Bowl, “pretty much the pinnacle of anybody’s career.”

You can play some sports from the cradle to the grave. With others, you have to compromise.

During games, “you’re running anywhere from three to five miles,” Freeman says. “I’m running up and down the field with 20-year-olds, so I have to keep my body in shape.”

Freeman, who has torn biceps and rotator cuffs and has had a number of surgeries—all, after retiring from football—maintains a rigorous training regimen and stretches every day. “If you can’t keep up with [flexibility] it’ll leave you in a hurry,” he says.

He also uses his own hyperbaric oxygen chamber, a large machine that he notes many athletes use for recovery. It pumps pure oxygen into a pressurized environment. “I pretty much stay in it five to six hours a week,” he says. The increased oxygen helps tissues heal. “It’s taken away all the soreness that I ever had. All the joint pain—everything.”

Tip 3: Make Adjustments in the Same Sport

Some sports, such as tennis, swimming and golf, offer athletes a longer lifespan than others, allowing people to transition within the sport rather than leave. They might continue at a less competitive level or simply move up in age category.

Fencing is one of those “cradle-to-grave” sports, says Donald Anthony, a former Team USA fencer who’s now board president of the United States Fencing Association. 

Older athletes have some advantages. For one thing, they listen to their bodies.

Fencing has various age classifications—the highest being 70 and older. Anthony, who’s 56, won the US national championship in his category last year.

Though he hasn’t had to leave his sport, he has noticed his abilities change. Being a married, working professional leaves less time to train, so he’s learned to maximize his strength-and-conditioning time.

But then there’s the knee arthritis. “When I was younger I used to have an extremely long, very powerful lunge,” says Anthony, who’s also the founder of the fencing-promotion company SwordSport. Arthritis precludes such a lunge today. So he made adjustments. To attack an opponent, Anthony now uses other quick footwork to close the distance and finishes with a shorter lunge. 

“That’s where I think the advantage of being an older athlete is. We listen to our bodies more,” he says, “and we have that level of experience or wisdom where we can develop ways of still being highly effective without necessarily having to focus on one area of physicality.”

Tip 4: Avoid Injury

Whether you stick with your sport or find a new one, it’s all for naught if you get sidelined by a bad injury.

Many times, people do push themselves to that point, says Jim Thornton, president of the National Athletic Trainers’ Association. “They’re still 18, 19 in their minds, and their bodies aren’t.”

To prevent injury, Thornton recommends keeping up your “muscular prowess” (perhaps through something like Pilates), warming up before competing and engaging in a daily stretching and dynamic warm-up routine. “Maintain that range of motion in all of the joints, from your ankles all the way up to the top of your noggin,” he says.

And listen to your body. Pain that lasts more than two days or that doesn’t get better means “you’re hurting yourself, and you need to see your doctor,” he says. “Exercise and movement should improve your health, not affect it negatively.”

However, DeFreese, of the Center for the Study of Retired Athletes, notes that minor pain doesn’t always mean you have to stop your sport. In fact, being sedentary could make things worse. Your doctor may recommend physical or occupational therapy instead.

When seeking out therapists and doctors, Anthony says it’s helpful if you can find someone who knows the sport. He has access to the USA Fencing team’s physical therapists and works with an orthopedic physician who’s well versed in fencing. 

Finally, before starting a new sport, Thornton recommends seeing a doctor for a preparticipation physical exam, to make sure your body—including your joints and heart—is ready to go.

Tip 5: Take Care of Yourself Mentally

If, despite these tips, you’re having trouble mentally or emotionally during this time of change, you’re not alone. “Transitions are perfectly normal parts of life,” DeFreese says, “but it’s normal for them to cause stress.”

At age 45, Gardner, a sports psychology consultant, is facing such a transition himself. He plays hockey for fun as a goalie but isn’t sure how much longer he wants to put his body through those paces. 

He believes athletes who compete recreationally sometimes feel the loss even more profoundly than professionals. For them, “it isn’t about the termination of a career. It’s about the ability to do something that brings them pleasure and enjoyment as a lifelong activity,” he says. “They’re not doing this for all of those extrinsic rewards—money, fame, glory. They’re doing this for pure love.”

Plus, “for so many people participation is about being a part of a group,” Gardner says. Once the sport is gone, that social network may be lost as well.

So surround yourself with a supportive group of friends and family if you can. And don’t be afraid of seeing a mental health professional. “I would recommend that if it’s causing them to lose sleep, if they’re depressed, they need to see somebody,” Thornton says of transitioning athletes.

Some people who have a particularly hard time may even be dealing with an addiction, says Gardner. Runners, for example, may be worried about losing that runner’s high.

But, as with any loss, there is a light at the end of this grieving tunnel, as HeidiChristensen found after she first stopped competing.

Tip 6: Find the Fun Again

In 2011, 25 years after quitting triathlons, Christensen finally got a diagnosis for what was causing that leg pain and weakness: she had blockages in arteries that supplied blood to her legs.

Turns out, this is a common condition in triathletes and bicyclists. But it was barely known when Christensen developed it. 

Surgery repaired her arteries, but by that point, Christensen had missed a quarter of a century in her sport. However, she had gained achievements in a related sport: swimming.

About seven years after quitting triathlons, having kept fit, Christensen started competing in swimming. She won national masters championships in her age group, and in 2013, at age 54, she won a 10K world masters championship in the open water.

How? Christensen learned to swim without using her legs. “A lot of women long-distance swimmers don’t use a lot of kick because it doesn’t really propel you that much for the total oxygen cost,” she says. “I mastered a really fast stroke.”

At 55, Christensen can now bike again thanks to that surgery. But she’s finding that she’s become more laid back about exercise. “I think I get more joy just from doing the activity than I used to,” she says. “I may not be as fast as I was, but I’m out there, and I’m doing it.”

“You’ve got to find a way to have fun doing whatever you’re capable of doing,” she says, “even if it’s taking the dogs for a walk for a few miles. Enjoy that as much as you can.”

Christensen is starting to have some leg pain and weakness again. But she’s trying to accept it gracefully. “Legs or no legs, I can always swim,” she says, looking on the bright side. 

That’s a thread that runs through all these athletes’ tales: stay positive. Keep your head up. Keep moving. You never know where fulfillment might come from next.

When There’s Big News about Health, Should You Believe It?

A behind-the-scenes look at how the media report medical research

To be fair, at first glance, it did sound like a huge story.

“Metastatic Prostate Cancer Cases Skyrocket,” proclaimed the press-release headline in July of 2016. New cases of an incurable form of prostate cancer rose a whopping 72 percent from 2004 to 2013, according to a study from the prestigious Northwestern University.

The news headlines came fast and furious:

“Most Aggressive Form of Prostate Cancer on the Rise”

Newsweek

“Advanced Prostate Cancer Cases Soar”

—AARP

“Advanced Prostate Cancer on the Rise, Screening at Age 50 Key to Detection”

Huffington Post

The shocking increase could be due to “lax” screenings, the press release suggested. In recent years, various organizations, including the respected US Preventive Services Task Force (USPSTF), had relaxed their prostate-cancer screening guidelines, to some controversy. Was that the reason for the increase? Or perhaps prostate cancer, a disease that mostly affects men 50 and older, had become more aggressive.

Actually, what few reporters seemed to recognize was that there was a strong chance that neither factor was to blame—because there may have been no cancer increase at all.

This prostate-cancer frenzy was the perfect storm that experts in health and science journalism warn of. From the press release to the articles, it was a meld of sensationalism, misunderstanding and lack of due diligence.

But it wasn’t an anomaly. After all, news about research these days has become a running joke. Anything could kill you. Anything could be good for you. Think coffee is unhealthy? Just wait till tomorrow.

It’s funny, until it isn’t. Research on issues related to aging, in particular, helps shape our world. It affects medical guidelines, policy debates, social programs, even personal wellness decisions. To be accurately informed, people need to understand what the research really shows.

I’ve worked as a health journalist for over a decade, with a specialty in aging for much of that time. I started out with an unusual educational leg up: my father, James Hubbard, a family doctor and writer, taught me key points about understanding studies. Yet I still struggled at first. Research papers were gobbledygook—supposedly in English but impossible to make sense of.

Over the years, the studies haven’t gotten simpler, but I’ve gotten savvier—not only as a journalist but as a research news consumer. You can too. After all, in the midst of all that sensationalism, sometimes studies do come out that you’d actually benefit from knowing about. Deciphering which ones are likely worth a look just takes a little jargon know-how—and a deeper understanding of how research and journalism really work.

From Misled to Misleading

In the midst of the prostate-cancer frenzy, none other than Otis W. Brawley, MD, the American Cancer Society’s chief medical officer, stepped in to stem the tide.

It’s the rate that matters, not the raw numbers, he reminded the media through a statement on the ACS Pressroom Blog. “A rising number of cases can be due simply to a growing and aging population among other factors,” his statement read. If the number of new cases per 100,000 men ages 50 to 69 had risen by 72 percent, that would have been news. “In addition, in this study, the rise [the researchers] detected began before USPSTF guidelines for screening changed,” he wrote. 

Brawley continued:

The issue of whether and how screening may affect deaths from prostate cancer in the US is an incredibly important one. This study and its promotion get us no closer to the answer, and in fact cloud the waters. We hope reporters understand that and use this study to ask another important question: can we allow ourselves to be seriously misled by active promotion of flawed data on important health matters?”

His stinging question isn’t new. The problem has been discussed—by both researchers and journalists—for decades. There are remedies. But in many ways, society has only gotten further from them. 

Behind the Scenes in a Newsroom

The quality of research reporting varies. Some is fantastic. Some is abysmal. But here’s how such reporting is ideally done in my field, health journalism: a reporter reads the full study, paying particular attention to its limitations and weaknesses. She conducts interviews, including at least one with a researcher who isn’t affiliated with the study and who provides objective opinion and overall context. If part of her job is to suggest headlines for her stories, she writes one that’s not sensational or misleading.

But journalism doesn’t live in an ideal world. So here’s how health reporting is often done instead: the reporter interviews one of the lead researchers (maybe). She writes a compelling article based on that interview, the press release and the study abstract (summary). A click-worthy headline is added—either by her or an editor—and then it’s on to the next story.

What happened? No time, no education in reading studies and lots of pressure to drive clicks.

“The people who are dedicated health reporters at a lot of the major media outlets have really been dramatically cut. Where there used to be 10, 20 people, now there are two,” says Lisa Schwartz, MD, codirector of the Medicine in the Media program at the Dartmouth Institute for Health Policy and Clinical Practice.

Today’s reporters—on any beat—are notoriously overworked. In addition, “a lot of places have laid off staff like copy editors,” says Liz Seegert, a freelance health journalist who’s written for the Silver Century Foundation and is the topic leader on aging with the Association of Health Care Journalists. “So the checks and balances that used to be there have in many instances disappeared. In the rush to get published, you’ve got to be your own fact-checker, you’ve got to be your own editor.”

Yet reporters are often not even trained to do their main job. Specialty training for the health beat isn’t a big part of many university journalism programs, says Schwartz, who’s also a professor of medicine at the Dartmouth Institute. And because of the shrinking newsrooms, these reporters often don’t have so much as a mentor who’s been there longer to help them along, she points out.

Therefore, many health journalists have had no training that would, for example, help them read that prostate cancer article—whose second paragraph, by the way, begins as follows:

From the National Cancer Data Base (NCDB), all men diagnosed with adenocarcinoma of the prostate (International Classification of Diseases for Oncology histology codes 8550 and 8140) from 2004 through 2013 were included. Only patients with data available to risk stratify based on National Comprehensive Cancer Network (NCCN) guidelines were included (low risk: cT1cT2a, PSA <10 ng ml−1 and Gleason score < 6; intermediate risk: cT2b–T2c, PSA 10–20 ng ml−1 and Gleason score 7; high risk: cT3–4, PSA < 20 ng ml−1 and Gleason score 8–10; metastatic cN1 or cM1).5 

A press release is a lot easier to get through. So that’s often what journalists depend on (perhaps along with the study abstract, a brief summary of the study that’s published along with it). And some press releases do explain studies fairly. But many others exaggerate, misrepresent or worse. After all, publicists—not to mention researchers and universities—want those media hits.

“There are lots of self-interests that are served by getting great media coverage,” Schwartz says. “That’s part of how researchers advance their careers—by showing that their research is important. It’s also how institutions raise money. And part of that is to write a really exciting press release.”

Add to all this the intense pressure on the reporter to draw an audience.

“Journalists sometimes feel the need to play carnival barkers, hyping a story to draw attention to it,” health policy journalist Susan Dentzer wrote in 2009 in an article for the New England Journal of Medicine about the pitfalls of health care journalism. “This leads them to frame a story as new or different—depicting study results as counterintuitive or a break from the past—if they want it to be featured prominently or even accepted by an editor at all.”

Not all reporters fall into these traps. Paula Span, who writes the New York Times column The New Old Age, reads the studies even though she doesn’t have a science background. She calls the researchers for help translating.

“I find that most researchers are extremely glad to help out,” she says. “They want their information to get a broader audience.” If she’s reporting on a controversial issue, she’ll get opinions from researchers who weren’t involved in the study, as well.

Span also does something that many media watchers wish journalists would do more often: she reports on studies that have negative results—those that find no benefit to a treatment or supplement, for example.

Span, who’s also the author of When the Time Comes: Families with Aging Parents Share Their Struggles and Solutions (2009), believes that studies with negative findings should be covered more often. “We are coming to learn how much overtesting and overtreatment there is of older people and how detrimental this can be to them. I’ve written about a number of different studies that show no benefit to doing something.”

How to Analyze Research Stories

As the journalism, research and marketing worlds continue to sort all this out, the public still needs reliable information. So here’s how to get it: learn to be research-media savvy. The first step is to watch for three telling things in a story: association, size and risk.

First: association. One of the most common problems in research reporting is that the difference between association and causation is not made clear, says James Hubbard, MD, my father, who, full disclosure, publishes a website I edit, TheSurvivalDoctor.com.

For example, when an article says a particular fruit is “associated with” or “linked to” a reduced risk of developing some disease, that does not necessarily mean the fruit caused the reduced risk.

Usually, for association studies like this, “researchers take a big group of people and ask some questions and then try to associate different illnesses with the people’s habits,” Hubbard says. “This gives the investigators something to be suspicious of. Then more specific studies that are much more accurate and precise are done.”

For example, if a study finds that women who sip a nightly glass of red wine are less likely to get osteoporosis, maybe the wine reduced the risk. Or maybe the wine drinkers also tended to do yoga or eat dairy or do something else that was the true risk reducer. Further studies would be needed to find that out. Some studies that show association pan out; many don’t.

With association studies, there’s also often the question of which came first. For example, if older people with a positive attitude tend to be healthier, perhaps positivity improved their health. On the other hand, maybe they feel positive because they’re healthier.

Second: size. In general, bigger studies are better; smaller studies are preliminary. This is especially true of association studies, Hubbard says.

Stronger types of studies don’t have to be as large to be impactful. One of the strongest types is the randomized, double-blind, placebo-controlled study. All those terms are good to know:

  • Randomized: The participants are randomly divided into groups (commonly, two). Because neither researchers nor participants choose who gets into what group, the groups are likely to be similar. For example, neither has more severely sick people.
  • Double-blind: Neither the researchers nor the participants know who’s getting what treatment (for example, who’s getting what medication) until the study is over. This ensures that participants are objective about effects or the lack thereof, Hubbard explains. And researchers don’t, for instance, unknowingly give more positive reinforcement to one group than the other. (“It looks like you’re getting better.”)
  • Placebo-controlled: One group gets the treatment; the other gets a placebo, a “treatment” that’s secretly inactive. When analyzing study results, researchers evaluate whether the people who got the real treatment experienced stronger effects than those who got the placebo—in other words, whether the treatment has more than just a placebo effect (an actual or perceived effect caused by believing something is affecting you even though it really isn’t).

Third: risk. When a study finds that the risk for something has increased or decreased, consider what your risk was to begin with. The book Know Your Chances (2008), available for free at the PubMed Health website, which Schwartz co-wrote, explains it this way:

When someone tells you something like this—“42 percent fewer deaths”—the most important question to ask is “42 percent fewer than what?” Unless you know what number is being lowered by 42 percent, it’s impossible to judge how big the change is.

Thinking about risk reduction is like deciding when to use a coupon at a store. Imagine that you have a coupon for 50 percent off any one purchase. You go to the store to buy a pack of gum, which costs 50 cents, and a large Thanksgiving turkey, which costs $35.00. Will you use the coupon for the gum or for the turkey? Most people would use the coupon for the turkey.

So far, you’re watching out for association, size and risk. But there are a few other important things to consider:

  • Who were the subjects? Animal studies often don’t pan out in humans. For human studies, consider whether you fit into the researched category. Were the participants all one gender? Did they all have a certain disease or fall within a certain age range? For example, many studies don’t include people 65 and older even though medications commonly affect older people differently than younger ones.
  • Who funded the study? Does the funder—or the researcher—have a possible conflict of interest? For instance, was a study about the amazing benefits of oranges funded by a company that sells oranges? Does the lead researcher of a medication study have a relationship with the drug’s manufacturer? If the news story doesn’t include this information, the study should. Medical journals are now providing some studies in full, for free, online. Conflicts of interest are usually listed at the end.
  • Who’s quoted? Does the article include insight from someone other than the researchers involved with the study?
  • Has the study been published? Where? Ideally, it’s been published in a peer-reviewed journal, meaning experts in that study’s topic evaluated it before it was accepted. Well-known examples of such journals are the New England Journal of Medicine (JAMA) and BMJ, but there are many more.

These are some of the main points experts want you to understand when you’re reading news stories about medical research. But if you want to delve deeper, check out the review criteria from HealthNewsReview.org, which publishes critiques of health-news articles. They point out, for example, that the cost and possible harms of medical interventions are important to consider, not just the exciting positive possibilities.

HealthNewsReview.org also recommends a few websites to check out for reliable medical news, including a couple of my favorites, MedPageToday, which is written for health care professionals, and Kaiser Health News.

Overall, health news tends to be hit-and-miss, according to the experts I spoke with. No one outlet was mentioned by everyone as a go-to for great medical news. Schwartz believes newspapers with health sections and with reporters dedicated to those sections tend to do a better job. Both Hubbard and Seegert say that even when you find a good source, you shouldn’t trust them implicitly. “Even the best stories and the best done studies can be skewed,” Seegert says, “so look at multiple sources.”

Positively Percolating

Despite all the problems in research-related journalism, there are some positive signs for older people concerned about health.

For one thing, even though the aging beat is “not seen as a magnet for advertising or political or market support from the editorial suites upstairs, it has stayed alive because it percolates up from the bottom of the newsroom,” says Paul Kleyman, director of the Ethnic Elders Newsbeat at New America Media. Though corporate may not be pushing for stories on issues related to aging, reporters, editors and television producers continually encounter such issues in their own lives. “I’ve always felt that, like ‘all politics are local,’ ‘all journalism is personal,’” Kleyman says.

Also, these days, a number of fellowship and training programs support journalism that’s focused on aging or health. The Silver Century Foundation cosponsors one of them through a yearly grant to the Journalists in Aging Fellows Program, run by the Gerontological Society of America and New America Media. Seegert, the topic leader on aging with the Association of Health Care Journalists, was a fellow in 2015.

One of the most important things journalists learn from educational courses is when not to cover a study, says Schwartz, whose Medicine in the Media training program is, incidentally, on hold due to a halt in federal funding for it.

“There are lots of studies that help science to move forward but that are not ready for the public,” she says. Sometimes, she’ll get an email from a journalist who’s proud to have fought to keep a study out of the news. “That prostate cancer study is a great example,” she says, noting that, though many big outlets bit, a number of others didn’t. “When journalists take a stronger line about things that they feel aren’t in the public’s interest—and argue to get those things out of the news—they’re doing an incredible public service.”

When they don’t, though, the public needn’t be fooled. There are usually red flags galore; people just need to know how to recognize them.

Death Cafes Are All about Life

Why some people gather to talk about dying—and what happens during those conversations

Death comes to all. But heaven forbid it be mentioned.

Certainly not over tea and cake.

Yet people young and old are bucking social mores and having oh-so-morbid conversations about d-e-a-t-h—all while enjoying a civilized nosh.

They’re called Death Cafes—these meetings at coffee shops, cafes, libraries, even cemeteries, where philosophy, science, social responsibility and more merge under the umbrella topic: shuffling off this mortal coil.

For people who have never attended a Death Cafe, an obvious question is, “Why would I ever want to?” But for others, the response is more like, “When? Where? I’m on my way!”

In fact, since the 2011 launch in England of the organization Death Cafe, there have been almost 5,000 Death Cafes in 42 countries. About half of those have been held in the United States.

There is, it seems, a small but determined movement of sorts going on, made up of people who are eager to talk about death but feel isolated in this desire. They don’t necessarily have an agenda; they’re not urging people to sign advance directives or plan their funerals or write wills. They just want to discuss this profound thing that everyone will face but that’s largely hidden away in nursing homes and hospitals—that’s surely avoidable through modern medicine—that doesn’t at all jibe with the culture of youth—that’s oh, so easy to ignore.

“We don’t talk about death enough in our culture. We fear it. We deny it,” says Lauren Herzak-Bauman, a 34-year-old artist in Cleveland, OH, who has hosted two Death Cafes. “Death Cafe creates space for people to just explore death in a nonconfrontational way, in a nonjudgmental way.”

For people like Herzak-Bauman, who want to push past the cultural denial, talking about death isn’t morbid or depressing. In fact, they argue that having this taboo discussion has the power to improve not only how you die but how you live each day.

That’s one reason Death Cafes almost always include food. The act of eating is life-affirming—which is a large part of what these meetings are supposed to be about.

What Happens at a Death Cafe

It wasn’t a funeral or a grief therapy session. Nobody was actively dying. But on the evening of July 19, 2012, half a dozen people sat in Lizzy Miles’ basement in Columbus, OH, talking about death. It’s what they came to do. It is, in fact, what they very much wanted to do, as odd as their friends and family may have thought it.

This was the first Death Cafe in the United States, a concept Miles, a hospice social worker, brought over from England. (Death Cafe was started there in 2011 by Jon Underwood, a British man in his late 30s, who’s currently a web programmer and self-described “death entrepreneur.”)

To date, about 2,300 Death Cafes have been held across America.

At the typical Death Cafe, a dozen or so strangers gather at a designated location, likely having heard about the event through fliers, social media or word of mouth. The designated facilitator—often the host who organized the event—gets the conversation going, and attendees take it from there.

Some Death Cafes are one-offs. With those that meet regularly, many people come only once or occasionally. Anyone who wants to can organize a meeting, with general guidance from the central Death Cafe organization.

At Miles’ events, she often begins by posing this question: “What brought you out of your house to talk about death?” At the 30 Death Cafes she’s hosted, new topics have emerged every time.

Perhaps more than ever, Americans are seeking answers about death outside their religious upbringing—or outside religion altogether.

“People might bring up a book that they’ve read recently, or they might be talking about cremation versus burial,” she says. “One Death Cafe, they were talking about people that pull over for funeral processionals and how it’s different in different cities. There’s random topics like that.”

Also often delved into are deeper subjects such as fear of death and caring for dying loved ones. In fact, it’s the more profound topics like these that, in a way, inspired Miles to start these cafes.

In her work, Miles had found that even if a hospice patient had been sick for a long time, the family often hadn’t discussed death and dying and what it meant to them.

“It’s like they almost didn’t believe it would happen,” Miles says. “I originally thought, if I have these events, people will talk about it before it’s a real crisis situation. But what I found was you don’t come to a Death Cafe if you’re not comfortable talking.”

Instead, “people come for a variety of reasons. They may want to think about it existentially. They may have had loss experiences that they want to process. Some people are processing their own mortality.”

The Death Cafe guidelines specify that meetings are not therapy sessions. They’re also not supposed to be teaching sessions. The host is mandated to push no agenda. Event attendees are prohibited from trying to change each other’s views.

Who Attends Death Cafes—and Why

Though anyone can host a Death Cafe, most hosts work in the end-of-life arena like herself, Miles says. Attendees vary. There is a strong contingency of hospice workers, funeral directors and the like, but many people come who don’t work in death-related professions.

For the most part, whatever their day jobs, they’re people who want to talk about death but whose friends and family members don’t. They’ve been told they’re weird or morbid, or they’ve just been ignored or dismissed.

Most attendees are women. Ages vary widely depending on the location, host and advertising methods. At Miles’ events, the average age is 50-something—a time of life when women are often processing both their parents’ mortality and their own.

“There’s a general sense that we have that aging ought to teach us something,” says Brad DeFord, PhD, MDiv, an adjunct instructor for the master’s program in thanatology (the study of death) at Marian University in Fond du Lac, WI. “When you go to a Death Cafe and you’re a middle-aged woman, you’re going not just to learn something about death but to learn something about life—where your aging has brought you to.”

Death Cafes and Religion

In the United States, one community gathering place where the topic of death is traditionally broached is the church or synagogue or other place of worship. After all, religions tend to take strong stances on death—or at least on what happens afterward.

So it’s of note that the rise of Death Cafes comes at a time of religious change in the United States. A 2014 Pew Research Center survey of more than 35,000 Americans found that almost one-fourth were religiously unaffiliated, meaning they were atheist, agnostic or “nothing in particular.” That’s up 7 percent from the first survey in 2007. Most of the unaffiliated are millennials, but percentages have increased across the generational board.

Survey respondents were also more likely to identify as non-Christian than in 2007 and more likely to have switched from their previous religion.

These findings suggest that, perhaps more than ever, Americans are seeking answers about death outside their religious upbringing—or outside religion altogether.

At Death Cafes, atheists and agnostics mix with Christians and Buddhists. Miles’ attendees consistently say that their favorite part of a Death Cafe is meeting and hearing from different people. “Even when you have people who are the same ethnicity and religion, it can open your mind to different points of view,” Miles says.

DeFord, however, cautions that the cafes’ free-for-all approach can lead to pitfalls.

“With increasing secularization, we are really left much more on our own to establish our own rituals and our own beliefs, and we tend therefore to kind of smorgasbord it—we mish-mash it together,” he says. When it comes to rituals, “the nice thing is that there’s no sense very much of right or wrong. But there’s no sense either of whether it’s efficacious.”

The Abstract Versus the Practical

That no-agenda, nonpedagogical environment is one thing many hosts and attendees love about Death Cafe. But some end-of-life experts would prefer at least a little proffered guidance—especially when it comes to practical issues.

After all, Death Cafes have sprung up in the midst of not just religious change but scientific revolutions. Advanced medical interventions bring complicated, difficult, end-of-life decisions, such as which life-sustaining measures should be continued and for how long.

For years, Americans have been urged to think through these issues and to prepare living wills and other advance directives. Janet McCord, PhD, FT, who designed and runs the thanatology master’s degree program at Marian University in Wisconsin, “loves” Death Cafe but nonetheless wishes meetings addressed end-of-life care outright. “I think education is necessary, and Death Cafes [are] one way to get people going down that road,” she says.

In fact, another meetup organization has sprung up in recent years that does focus on end-of-life decisions: Death Over Dinner, which launched in 2013, encourages people to host dinner parties that prompt attendees to think and talk about how they want to die.

Before these dinners, guests are given a list of educational and inspirational resources that the organization has curated. They’re asked to choose five to read, watch or listen to. “I like that structured approach,” says McCord, who’s also president of the Association for Death Education and Counseling. Over 100,000 such meals have taken place in 30 countries, according to Death Over Dinner.

And then there are Death Salons. Organized by a group called the Order of the Good Death, Death Salons take place once or twice a year. They’re a meld of conference and festival, featuring academics, artists, writers and the like. The 250 to 300 attendees might learn about 19th century British death rituals, the ins and outs of a natural burial, or grieving traditions in other cultures, says Death Salon director Megan Rosenbloom.

On each occasion we hadn’t really been talking about death at all—we had really been talking about life.

Sophie Sandell

Rosenbloom notes that learning about death can even have financial benefits. For example, if people know more about funeral and burial options, they’re less likely to end up in debt out of guilt or ignorance. Like, maybe they won’t buy that $10,000 coffin purely out of guilt. Or maybe they won’t have their grandmother unnecessarily embalmed before cremation.

“People who don’t think about death at all don’t reckon with what might happen,” she says. So when a loved one dies, “you just want to do whatever you think is normal, and you don’t really ask questions.”

All that said, just because Death Cafes aren’t about teaching in the same way that Death Over Dinner and Death Salon are, that doesn’t mean the cafes aren’t about learning.

Before Bill Sipe started going to the Death Cafes hosted by his daughter in St. Joseph, MO, at age 61 or 62, he didn’t think about death much. But hearing attendees talk about their own end-of-life wishes and funeral plans “was very much an eye opener,” he says.

“After my first or second Death Cafe, I actually picked out the songs that I wanted to play at my funeral,” he recalls. This “floored” his daughter, Megan Mooney, who also runs Death Cafe’s Facebook page. “I said, ‘I’ve got my funeral all figured out.’ She said, ‘What? You’ve never talked about that!’”

Sipe, now 65, has been in the hospital a few times lately. During one stint, he realized he could die. “I really felt at peace,” he says. His religion (Sipe is Christian) and prayer helped with that, but also at Death Cafe, “I learned that dying is just the beginning of something else,” he says. “And I really don’t know if I would have felt at peace prior to going to a Death Cafe. I really think that had something to do with it.”

The Future of Death Cafe

Despite their critiques, the experts the Silver Century Foundation spoke to are glad Death Cafe exists because it’s at least opening the door to an important taboo topic.

And these days, the organization is not just doing that IRL (that’s “in real life” in Internet speak). At Death Cafe’s website, people can find local events; learn how to host a Death Cafe; and even submit blog posts, artwork, videos and quotes about death to be featured on the site.

When Mooney—Sipe’s daughter, who has a master’s in social work and works in end-of-life research—took over Death Cafe’s Facebook page in 2013, it had 655 likes, she said in an email interview. Now, it has over 33,000.

About once a month, she asks fans, “What is on your mind today as it relates to death and dying?”

“This discussion usually expands into weeks. There will be over 100 original comments, with other people replying to others’ comments,” she said. “Something new is brought up every time, just like at a Death Cafe.”

DeFord believes this digital expansion is essential for Death Cafe to make a measurable cultural impact. In-person meetups are “so 20th century—so 19thcentury,” he says with a laugh. “They don’t fit with the emerging paradigm of human  relationships in the 21st century.”

However people gather—whether online or in person—the point to organizers is, the topic is being broached.

People who go to Death Cafes often express relief that they can indulge their interest in death without reservation. Afterward, some report less fear of death or increased comfort in loss. Many say they have a heightened appreciation for the everyday.

After all, when you realize that something is finite or limited, you develop a deeper understanding of its value, Rosenbloom explains. Take water, for example. In Rosenbloom’s city, Los Angeles, after many years of drought, citizens now look at water in a different way. They’re more careful about using it, she says. “And when it rains, you want to do a dance.”

Sophie Sandell, who wrote about her Death Cafe experiences for the UK-based news outlet Guardian in 2015, agrees. “When I left that night I felt truly alive,” she wrote about her first of three meetings. “Talking about death, and thinking about the subject, has made me more aware of what’s important for me.”

“It compelled me to go on a songwriting course this summer to learn how to connect my words with music, and has made me feel both more humble about life and more determined to share my work, and to make good emotional connections,” she wrote.

“What became overwhelmingly clear after attending three death cafes was this,” she continued. “On each occasion we hadn’t really been talking about death at all—we had really been talking about life.”

For fans of Death Cafe, meetings aren’t morbid or depressing. At their core, they’re about getting the most out of life—and sometimes, getting a great piece of cake.

Want to Live in a Great Place? Find an Age-Friendly City—or Town

Walkable streets, affordable housing, transit options—the list is long but some communities are working to become age-friendly

It’s not that Princeton, NJ, had a master plan to become an age-friendly city. Not many towns did in 2012. But when Susan Hoskins read a magazine article about what made for such a community, she started checking things off.

“I thought, well, we [in Princeton] do that, and we do that, and we do that, and we’ve got some great things that meet that need. Holy cow! Why don’t we get acknowledged for what we do?” says Hoskins, who’s the executive director of the Princeton Senior Resource Center.

So, in 2014, thanks largely to Hoskins’ leadership, Princeton became the first community in New Jersey to receive certification from the World Health Organization (WHO) as a city that’s committed to becoming age-friendly. But that was just the beginning of the journey. Committing, after all, is one thing. Fulfilling is another.

Princeton is one of a number of towns all over the world that are working to become more accessible and attractive to older people. (The Silver Century Foundation is helping fund Princeton’s quest.) City leaders are recognizing that it’s not just young families and young professionals who sustain a town. Older people, too, are essential to making a community prosper. So the competition to reel them in is heating up.

No Country for Old Men (or Women)

When many of today’s new retirees were kids, cities were, in a way, built for them. It was the era of the baby boomers—of communities bursting at the seams with young families. Between 1945 and 1965, America’s population grew by 40 percent. That boom included over 76 million children. And those families needed somewhere to live.

It was during this time that urban sprawl began. Families moved outside the cities, where they could have their own houses with big yards to play in. At the same time, car ownership rates doubled. Parents had to get to their jobs in the cities somehow. Plus, there were all those road trips.

But fast-forward a few decades, and now all those millions of boomers are right around retirement age, with different needs than when they were kids. These days, many of them want to be near the action, not a long drive away from it. Curb cuts may trump playgrounds, and great health care can beat a large yard. So what’s an aging boomer to do?

Many cities are hoping they can entice retirees and other older people to relocate to their neck of the woods—or, if they already live there, to remain. These cities are working, step-by-step, on the years-long process of becoming age-friendly.

What Makes for an Age-Friendly City?

There are various models for age-friendly cities, but they all place a key focus on making communities more livable for older people. One of the most well-known—and most comprehensive—models is the one Princeton is following: the World Health Organization’s Global Network of Age-friendly Cities and Communities project. Launched in 2006, WHO’s extensive guidelines were developed with input from older people in 33 cities worldwide.

Among other things, an age-friendly community is walkable and safe, with opportunities for older people to find a job or volunteer, and to connect with others.

The guidelines, which are meant to be adapted by each city to its particular needs, cover the expected practical matters: transportation, safety and affordable housing. But they also address less obvious concerns, such as isolation and boredom. For example, in an ideal age-friendly city, older people are specifically invited out to a variety of events, says WHO. And both citizens and city government demonstrate respect for elders, who are consulted on key community decisions and included on boards and councils.

In the United States, AARP has partnered with WHO to promote the guidelines and manage cities’ participation. To be part of the initiative, a city must take three main steps:

  1. Submit a letter of commitment to AARP and join AARP’s Network of Age-Friendly Communities—a group in which cities problem-solve with each other. (The network included more than 70 communities by the end of 2015. It’s part of WHO’s larger global network, which launched in 2010.)
  2. Over the next couple of years, develop and submit an action plan to become more age-friendly.
  3. Accomplish a three-year implementation phase. Then participate in periodic evaluations.

Princeton is in the development phase right now, hosting focus groups with older residents and working with municipal departments and community members to identify problem areas.

Though WHO’s age-friendly initiative is relatively young, there are a few cities that provide a picture of where Princeton may be headed. New York City, for example, is one of the first American communities to join the WHO effort.

The WHO Plan

Princeton is one of only two cities in New Jersey to have joined the World Health Organization’s Global Network of Age-friendly Cities and Communities project. (Montclair, a town of about 38,000 residents, joined almost a year after Princeton, in early 2015.) The WHO guidelines cover eight main areas:

  • Outdoor spaces and buildings: Are they easily accessible? Safe and well lit? Are seating areas, public toilets and elevators available?
  • Transportation: How’s the public transport? Are alternate options available, such as free shuttles? Are roads well maintained?
  • Housing: Is enough affordable housing available? Is it integrated into the community rather than isolated from it? Are houses adapted for wheelchairs, or are modifications affordable? Are there affordable services to help people remain in their homes as they age?
  • Social participation: Is there a variety of affordable, conveniently located things to do? Does the community reach out to older people and invite them to these events?
  • Respect and social inclusion: Are older people sought out as advisors for community decision-making? Are they included in activities marketed as family events? Do school kids and older people interact?
  • Civic participation and employment: Are a variety of volunteer, training and employment options available for older people? Do advisory councils and boards include older people?
  • Communication and information: Is community information disseminated in a way older people can easily get it? Is there wide, affordable access to computers and the Internet?
  • Community support and health services: Are there conveniently located health services? Are residential-care facilities located within the community rather than isolated from it? 

Age-friendly NYC launched in 2008. The city’s plan included 59 initiatives. Lindsay Goldman, deputy director of healthy aging at the New York Academy of Medicine, which helps lead Age-friendly NYC, says the Department of Transportation’s Safe Streets for Seniors is one of her favorites. Because of this pedestrian-safety project, “annual senior pedestrian fatalities have decreased 9 percent citywide, from 58 senior fatalities in 2008 to 53 in 2014,” says Goldman. Pedestrian crashes [vehicles hitting pedestrians] have also decreased by 9 percent, and total injuries have fallen by 11 percent, she adds.

Other achievements Goldman highlights are:

  • 4,000 new bus shelters around the city
  • 1,500 new benches placed on the streets
  • 37 areas in which pedestrian and road safety were improved
  • 16 public swimming pools with hours just for seniors
  • 15 age-friendly neighborhoods
  • 50 colleges and universities promoting offerings for seniors
  • 400 age-friendly cultural institutions
  • More than 1,000 age-friendly businesses

The Incentive to Be Age-Friendly

The fact that any city cares about attracting older people is especially noteworthy, given the rhetoric about the coming “silver tsunami.” For years, the media and politicians have warned that, soon, health care services will be overrun; government resources will go bankrupt; the entire nation will suffer due to millions of newly minted senior boomers.

But elders are more than the services they use. It turns out, cities are realizing, older people are valuable—in more ways than one.

When Hoskins presented her idea of making Princeton age-friendly to the city council, she asked the members, “Who’s on your commissions? Who are the volunteers reading to the children in the schools? Who are the tutors? Who are the mentors? Who are the people keeping the safe communities going? They’re people over 50.”

Older people also contribute financially to their communities. “Boomers have money and no kids left at home,” says Hoskins. “They’re spending money; they’re traveling; they’re still self-indulgent.”

“There is some evidence that communities that have older adults aging in place are more stable and have less crime, and housing prices are more stable,” says Andrew Scharlach, co-author of Creating Aging-Friendly Communities (2015).

A couple of years ago, Scharlach, director of the Center for the Advanced Study of Aging Services at the University of California, Berkeley, was in a meeting with the mayor of a major western US city. The mayor wanted to make his city more age-friendly—to such an extent that it would become the nation’s retirement destination of choice. “And why is that?” Scharlach asks rhetorically. “Because he’s seeing people who have the resources to relocate for retirement as a real economic boost to the city.”

What Do Older Transplants Want Most from a City?

When Lynne and Ed Sullivan started thinking about retirement, they didn’t plan for the traditional time of rest and reflection. They planned for reinvention. “We didn’t want to just fade away,” says Lynne, age 71. “We wanted to do something more exciting with our lives.”

So when they started looking for a city to retire in, their minds were open. They visited Costa Rica and Spain. But those places weren’t quite right—too far from home for one thing. (They’d lived in Columbus, IN, for the last 35 years.)

So where does a couple who could retire about anywhere in the world end up? Durham, NC. Part of an area known as the Research Triangle, Durham attracts young techies. But it also has a lot to offer for retirees.

“With its three universities in the Triangle area, top-notch medical care, exploding downtown amenities and reasonably mild weather, we think we made a good choice,” says Ed, age 75. One of their sons also lives in North Carolina, but the Sullivans cite that as more of a fringe benefit than a deciding factor.

“Our new challenge is how we purposefully recreate ourselves to take advantage of these opportunities for the next 10 to 20 years,” Ed says.

This attitude isn’t unusual among retirees these days. “They volunteer for boards; they work in soup kitchens; they take care of their grandchildren; they run for political office,” says Phil Stafford, PhD, director of the Center on Aging and Community at Indiana University. “They’re just much more engaged—and not segregated from the rest of the community.”

At the same time, “One of the things that happens as we get older is that our world shrinks a bit,” Scharlach says. It can become more difficult, for example, to get to activities and friends that are a car trip away. So when retirees choose a place to live, “it’s not simply because the housing is more appropriate or there’s extra buses. It’s more that the new environment provides an opportunity to safely and securely meet one’s needs for connection or fulfillment.”

For the age-friendly movement to make a real difference, it must earn taxpayer support by engaging people of all ages.

That was true for Carla Williams, 62, and her husband when they moved to Sedona, AZ, after living in Anchorage for 40 years. No longer able to tolerate Alaska’s extreme cold and dark winter days, they decided to retire in a city they’d fallen in love with a decade ago.

“It’s probably one of the more beautiful places in the United States to live,” says Carla. “Being here is like being on vacation every day.” For years before retiring, the couple owned a house in Sedona and would visit periodically, but now that they’ve made the permanent move, Carla is thrilled.

For her, the main draw was Sedona’s walkability. The area has over 200 trails, and the more popular ones have volunteers who help people who are lost, need water or have a medical emergency, Carla says. Plus, a short drive away, there are art galleries, shopping, a year-round film festival that attracts retirees, and volunteer opportunities galore. “We haven’t really decided what we want to get into because there’s just so many options,” Carla says of the nonprofits scene. “It’s almost endless.”

“People are moving away from gated, Sun City type ideas about retirement and beginning to use a different set of criteria to evaluate the communities that they want to live in,” Stafford says. “These intangibles—being able to walk to the grocery store, walk to the library or to have coffee—are becoming more and more important to people. And less important is being around people only your own age, you know, playing golf.”

The Next Frontier

The age-friendly trend is still young. After cities get the basics down—such as curb cuts for wheelchairs, crosswalk lights that last long enough for slower-paced walkers and benches in parks for resting during long walks—there are some other difficult challenges that will need to be addressed.

Stafford, who’s involved in Lifetime Communities—an effort to make his town, Bloomington, IN, more age-friendly—believes the next frontier in the movement is accessible housing. He says too few homes are built with universal design principles, which would make them appropriate for people of all abilities. “It can be really expensive to have to adapt a bathroom for a wheelchair or something like that,” Stafford says.

Scharlach’s focus, on the other hand, is on community involvement. He believes that for the age-friendly movement to really make a difference, it must go beyond city initiatives. It must engage citizens of all ages to a wider extent. Only then will taxpayers more strongly and universally support funding age-friendly projects. “Real change involves changing priorities,” he says.

Funding the projects is, in fact, the main challenge Hoskins predicts Princeton will face with its age-friendly initiatives. She attributes this to limited resources—not unusual for city programs—but also to an added hurdle: ageism. “I think communities think more quickly about what can we do for our children than what can we do for our elders,” she says.

Scharlach’s favorite age-friendly effort right now is AARP’s Livability Index. This service allows people to plug their zip code into a search engine and get scores in various categories for how “livable” their area is. Scharlach likes the tool “not because of content but because it has potential to engage people all over the country in thinking about age-friendliness.”

Becoming truly age-friendly can be a long, sometimes difficult process for a city. But that shouldn’t stop it from trying. “You don’t have to solve all the problems,” Scharlach says. “You just have to get started and begin to make some changes. And that’s not hard at all.”

Successful Aging—It’s Not Impossible

How the experts define ‘success,’ plus some thoughts on setting your own goals

Maybelle lives with her daughter, Ella, in a two-bedroom house in rural Nevada. At 76 years old, Maybelle controls her type 2 diabetes and high blood pressure as best she can. Years of caring for her ailing husband left little time for exercise and little money for health checkups. Breaking her hip didn’t help with mobility. She uses a walker, though she doesn’t go out much.

But Maybelle loves to paint. She’ll sit for hours creating landscapes that she donates to a local charity to sell. And she sings. Maybelle and Ella sing a hymn every night before bed—a brief but welcome respite in Ella’s stressful day. And she loves. She doles out words of wisdom whenever her 24-year-old grandson will lend an ear.

In Vail, CO, Ralph, a 76-year-old former business executive, maintains a season pass to the ski slopes and travels around the world with friends, hiking and bicycling in magical landscapes Maybelle only imagines. His hometown newspaper recently profiled him as an inspirational citizen. His doctor was quoted as saying, “Ralph sets a standard we should all aspire to.”

The question: Who’s aging more successfully?

Academics have been debating theories of successful aging for decades. They’re trying to identify what it takes to have a good old age so we can all follow the prescription, ideally starting in middle age or before. But the criteria have proven difficult to pinpoint. Many attempts have all but designated groups of people as failures at aging, even though they thought they were doing pretty well, thank you very much.

At least, though, these theories promote the possibility of a fulfilling, active old age. Not long ago, that particular focus was revolutionary.

Old and Only Getting Worse

In 1984, screaming teenagers celebrated the launch of the irreverent MTV Video Music Awards, and the popular movie Footloose preached freedom for young people against the tyranny of stuffy, middle-aged fogies. To be young was to be free and cool.

And to be older? Think Murder She Wrote, which also premiered in 1984, starring Angela Lansbury as an amateur detective. Neat, huh? Yet Washington Post critic Tom Shales described Lansbury’s character as “a diminutive old auntie” and a “cute and cuddly…granny Mary Poppins.” Lansbury was 58.

If 58 was “old,” what was 78, 88…98? Just plain sad. People in later life were likely to be viewed in terms of the four D’s: dependency, disease, disability and depression, wrote Kansas State University professor Rick J. Scheidt and colleagues in a 1999 article in the Journal of Applied Gerontology. Aging meant declining, and there was little positive about it.

Before the next century rolled around, however, that view would change.

What Is Successful Aging?

In 1984, while people were celebrating youth and dreading their elder years, a large philanthropic organization, the John D. and Catherine T. MacArthur Foundation, assembled 16 scientists to study ways to help improve how people aged.

Fourteen years later, in 1998, the group’s leaders, John W. Rowe, MD, and Robert L. Kahn, PhD, published the results of their research in the book Successful Aging. It explained what separated “successful” agers from everybody else. “In sum, we were trying to pinpoint the many factors that conspire to put one octogenarian on cross-country skis and another in a wheelchair,” they wrote.

The MacArthur findings revolutionized how people looked at growing old. As the cover promised, the book showed “how the lifestyle choices you make now—more than heredity—determine your health and vitality.” Healthy living in midlife and beyond could lead to active, fulfilling later years. It seems an obvious message today. But back then, it was unusually empowering and hopeful.

Though Rowe and Kahn didn’t coin the term “successful aging,” they helped popularize it. “This model was a real game changer and paradigm shifter,” says David C. Burdick, PhD, a professor of psychology and director of the Stockton Center on Successful Aging at the Richard Stockton College of New Jersey. “Once researchers changed their focus from decline and negativity, they started to find many more positive aspects of aging.”

When Rowe and Kahn studied older people, they culled out the cream of the crop and called them “successful.”  In a nutshell, they said successful agers have:

  • No disease or disease-related disability and a low risk of developing either.
  • High mental and physical ability.
  • An “active engagement with life,” meaning they maintain good relationships and engage in productive activities.

Sounds pretty good … but maybe a little too good. Amidst the praise and hoopla came concern. Meeting criteria that lofty wasn’t realistic for many people, some pointed out. And if you don’t successfully age, what does that make you? A failure? Or are you just a normal ager? 

The Downside of “Successful Aging”

The book Successful Aging asserts that if you try hard enough and do the right things, you have a good chance of aging healthfully and happily. But not everyone is in a position to make the best choices. For example, what if you go through a time when money’s scarce, or you have responsibilities that leave little time for personal care?

This model “implies that we are able to choose lifestyles that will lead to successful aging,” says Share DeCroix Bane, PhD, assistant research professor at the Center on Aging Studies at the University of Missouri-Kansas City. “This can lead to blaming those who do not have access to that lifestyle or who have had debilitating illness.”

One group of people this affects most is women. In their 2003 critique of Rowe and Kahn’s concept of successful aging, published in the Gerontologist, researchers Martha B. Holstein, PhD, of Chicago’s DePaul University, and Meredith Minkler, DrPH, of the University of California, Berkeley, argue that many women have been in and out of the workplace, taking time to care for children, parents or a spouse. They’re more at risk for poverty and may not have had time or funds to care for themselves. Yet they make up the majority of people who live longer lives.

The Many Faces of Successful Aging

What, then, does successful aging mean these days? And how do we accomplish it?

The Rowe and Kahn model focuses largely on health. In order to accomplish its idealistic goals, you need to:

  • Stay healthy. Exercise, eat wholesome food, don’t smoke, and get appropriate health screenings and vaccines.
  • Nurture personal relationships. These give you emotional and physical support and may help you maintain health-promoting activities, such as participating in walking groups.
  • Maintain a good sense of self-efficacy. Rowe and Kahn define this as a belief in your ability to solve problems and meet challenges. Also, don’t let people do too much for you. Doing things for yourself rather than letting someone else take over can help maintain that self-efficacy.
  • Participate in productive activities. Work in a traditional career, volunteer, help friends and family, spend time on home maintenance or improvement, or do housework, for example.

If you’re not meeting all of those criteria, you’re not alone. Studies suggest that when older people are judged solely on this model, fewer than a fifth are successfully aging, wrote British researchers Ann Bowling and Paul Dieppe in a 2005 article from the British medical journal BMJ. Yet, according to the older people themselves, half are successfully aging by their own standards, which include having good mental health and a sense of purpose.

“Today, there are actually a number of other successful-aging theories, which build upon Rowe and Kahn’s work,” says Burdick. “They don’t so much reject the theory as build in other elements—for example, as a chef would take a good recipe and add or subtract ingredients.”

According to Burdick, some of the other theories include the following characteristics:

  • Good attitude. It helps to have guarded optimism about aging—believing in your ability to change and to grow.
  • Purpose. A sense of meaning and purpose in life is important.
  • Spirituality. “It doesn’t necessarily need to be a traditional belief in God,” Burdick says. “Some sense of being part of something bigger than one’s self—some sense of transcendence beyond one’s body and surrounding—all seem to be helpful.”

Bowling and Dieppe say researchers have explored other criteria as well. Their theories suggest that you’re aging successfully if you’re still independent, for example, or you’re learning new things or you have good coping skills. Lay people add other characteristics.  For instance, to them you’re successful if you’re satisfied with your life, or you’re financially secure or you still have a sense of humor.

What Does Successful Aging Mean to You?

With all of those theories—physical, cognitive, mental, spiritual—it’s difficult for anyone to meet the criteria. But looking on the bright side, this gives us lots of options.

We can each choose what successful aging means to us. Perhaps, like Maybelle, we’ll decide it includes expressing ourselves creatively, giving back to our community, deepening our spirituality, and being a wise and nurturing grandparent.

Or maybe we’re more like Ralph. Fitness and adventure are our calling, meeting new people, our passion.

We could even be like Brian Nelson, a 50-year-old who wrote in 2009 in the New York Times blog Well that he had survived over 40 years of bad health. At the time, side effects from cancer treatment were taking a toll. He wrote:

I get up each morning and remind myself that I’m going to be swollen, tired and nauseous. So if I get something done, like epoxy the hatches of the kayak I’m building, it’s a great day. Or if I get through all my (liquid) food, it’s a great day. Or if one of our cats comes up to say hello, rubs itself on my leg and settles down for a nap near me … yep: great day!

Nelson passed away later that year. Did he age successfully? Judging by his blog post, surely few would argue he didn’t. In fact, he was an inspiration to others—someone we could all learn from. And really, what better criterion for success is there than that?

Tim Carpenter: Retirement Can Unleash Creativity

Founder of classes in the arts—and of artists’ colonies—for elders

This article is the second in our series on the future of aging: interviews with people who are experts in their fields and are also visionaries. We’re asking them to talk about what they believe will happen in the years ahead to change the experience of aging. 

If all goes according to Tim Carpenter’s plan, the future will be full of engaged older people who look at the world creatively and who are considered integral parts of their communities. Through arts programs and celebrated “senior artists’ colonies,” he’s helping this future come to pass.

When you’re talking to Tim Carpenter about how he envisions the future of old age, at some point it strikes you: he’s talking about older people as … people.  They’re not “seniors.” They’re not “the 62-and-older crowd.” They’re not … other.

And this makes you think of how often older people are automatically pictured in a rocking chair. When you say 82-year-old, the first thing that comes to most people’s minds doesn’t seem to be painter, writer, student or mentor.

But that’s exactly what Carpenter sees.

To him, retirement is a beginning. It’s like college: a chance for discovery and impact. He believes this is the natural order of things. Our culture is just out of step with “normal,” as he puts it.

So he’s working to set us right. Through his nonprofit organization, EngAGE, which connects older people to both the arts and their communities, he’s manifesting a future where older adults aren’t shuffled away to apartments with kitchenettes and bingo nights. They’re creating. They’re affecting. They’re … important.

Inspired through Friendship

In the mid-1990s, Carpenter was frustrated. As a health care administrator, he was developing primary care practices in Southern California that were targeted to older people. The clinics were meant to improve management of the patients’ care. But change was slow and bureaucracy was big.

“I just don’t think the business was, at that moment, prime for innovation,” he says.

Then he found a business that was.

Carpenter met John Huskey, founder of Meta Housing Corporation, who was developing traditional senior housing communities but had, like Carpenter, come to a place in his life where he wanted to make a change.

“He ended up being both a mentor and someone who listened to me at the same time,” Carpenter says.

“What I was doing was asking questions. So I walked into my first independent senior housing community. And what I noticed was there was a lack of connection. There was a lack of community. There was a lack of things going on.”

At the Burbank Senior Artists Colony, amenities include studios, performance spaces and a sculpture garden.

One day, he visited a clubhouse at one of these places. A calendar on the wall listed activities like bingo and doughnuts. He struck up a conversation with a resident.

”He told me his life story, which was really, really interesting,” Carpenter says. “At the end of it, I was thinking, ‘You’re amazing; what are you doing here?’ And he just said, ‘I’m dying.’

“That was the moment where I said, I really think I’m going to create some way to change this. So I just started tinkering away at it.”

Drawing on skills from his earlier work as a journalist and a copywriter, Carpenter launched a writing class at an independent living community. The class culminated in the students performing their work on stage. The housing community where he taught it filled up within a few months.

From Class to Colony

In 1999, inspired in part by that first class, Carpenter founded EngAGE (then called More Than Shelter for Seniors). Today, this nonprofit organization provides free, college-style arts programs at over 30 senior-living communities throughout Southern California. Especially targeted to people with low incomes, classes are given on a semester basis. They’re open not just to residents of the housing communities but to anyone in the surrounding area who’s 55 or older, as long as there’s room. Each class culminates in a special event, such as a play, musical performance or art show.

The events are as much about engaging with the community as about students showcasing their skills. They often take place in nontraditional venues to shake up preconceived notions.

“We’ve done poetry slams in wine bars where young people go to have yuppie food,” Carpenter says. “They see this group of 70- and 80-year-olds get up and start reading poetry. It just breaks the mold.”

In 2005, Carpenter and Huskey teamed up to develop an independent living community that centered around the arts rather than old age. At the now-thriving Burbank Senior Artists Colony, amenities include studios, performance spaces and a sculpture garden. There’s an independent film company, a music program and an intergenerational arts program with the Burbank Unified School District.

When the colony opened, it made the cover of the Sunday New York Times.

“It was the most emailed article for three weeks in the world,” Carpenter says. “I was shocked.”

The cool thing about creativity is it can be applied to almost anything. It’s a way of looking at the world.
–Tim Carpenter

He realized the colony was giving people a different way to think about their own old age. The story’s popularity wasn’t about, “Would I put my mom there?” he says. It was about, “Wow, I could live there.”

His arts programs got a scientific boost in 2006 when the National Endowment for the Arts and the Center on Aging, Health & Humanities at the George Washington University released a report based on their two-year Creativity and Aging Study. The organizations hailed the study as the first of its kind to compare the health of older people in professionally conducted, community-based arts programs with the health of older people who weren’t in such programs. The study included 300 people ages 65 to 103.

The researchers found that, overall, people in the arts programs had more positive health outcomes than people who weren’t in the programs. For example, after a year the arts students reported a greater increase in overall health, a greater reduction in doctor visits and less of an increase in medication usage. The study also found potential, positive impacts on morale and depression.

“The significance of the art programs is that they foster sustained involvement because of their beauty and productivity,” the report says. “They keep the participants involved week after week, compounding positive effects being achieved.”

EngAGE and Meta Housing Corporation now have three artists’ colonies in California. Through EngAGE’s programs, older people learn directly from professional artists and art teachers. They explore painting and drawing. They sing, dance and cook. They mentor young people. And they work to improve the future by changing the culture today.

We talked with Carpenter about his vision for that future.

SCF: As we get older, do you think we get more creative—or better at our creative pursuits?

TC: I’m not sure we get better at creativity but maybe more receptive to it.

Not that long ago we thought, we are who we are, and then we age, and what happens, happens. What we’re seeing now is, as people either continue to engage in certain types of behavior or start to engage, it has pretty drastic effects on their health, both physical and mental.

What we’ve always believed [at EngAGE] is that if you [are exposed] to exciting opportunities to engage in creativity or lifelong learning or anything that really turns the mind on, it has effects on your mental health, because you have this sense of purpose and learning and engagement and a reason. And then on the physical side, you’re able to achieve behavioral change [that benefits your physical health] in a much easier way.

Creativity opens up a lot of pathways. And the seniors that we’re dealing with in our model are World War II generation or early baby boomer generation, and some of them have never really had an opportunity to pursue this for whatever reason. I’m sure they’ve been working their whole lives and they have families. They don’t see themselves as artists. Yet I think that there’s something that appeals to everyone by being creative, whether it be learning to be an oil painter, or making a little film, or developing a plot of garden [or] cooking creatively. The cool thing about creativity is it can be applied to almost anything. It’s a way of looking at the world.

SCF: In the future, if the country is filled with perfect communities for older people, what do they look like? Are they all like the Burbank Senior Artists Colony, or do some people have different needs than access to the arts?

TC: To me, it’s not necessarily about building the perfect senior housing community. It’s about changing the way people think about [aging] altogether—to value it as a new experience and a place in life where I’m going to have all these opportunities because I know that other people have done it.

Building a place like the senior artists’ colony helps to move that dial back to some sense of normal. But better is, if I live in the city of Burbank, the city of Burbank would look at aging in a new way, because we’ve shined a little flashlight on what’s possible and how these people can actually be an important [part of the] fabric of the community.

We throw around words in the aging world like sage and respect and wisdom and dignity, and I think half the people who work in my business have no idea what any of those things means. There’s this sense that, ooh, they’re old people, and let’s put them on a dais and bring them grapes and make their older years easy and bountiful and fruitful. And I think what people really want inside is just to have [old age] be a next phase of their life and have the same kind of exciting opportunity that they had when they were 30 or 40 or 50.

But it’s about all ages. It’s not necessarily about saying this is the way we treat seniors, and this is the way we treat kids, and, you know, this is the way we treat teachers or gas station attendants. It’s about how do you create a sense of community where you live—and feel like you’re connected to something and that you’re a part of something greater than yourself.

SCF: So the idyllic future has many more aspects to it than just communities for older people.

TC: Yeah. And I think communities for older people should be built next to schools in the middle of town where they can walk to things. If you look at the retirement housing, there’s this huge pendulum swing towards let’s just move to the middle of nowhere on a golf course with this sea of old people and you get a golf cart and a view. And then you’re 70. And if you die five years later that’s great, because I just can’t imagine living on a golf course doing nothing for more than a weekend. [Laughs.] It’s just a bad idea. Maybe some people like that. I just think that we need to look at a much more expansive way of creating communities that are age friendly and exciting and catalyze the next phase of life.

SCF: When you think about making your vision come true, are there some logistical challenges we need to overcome?

TC: Yes. And I think we know what all of them are. Some of them I mentioned.

As we get older and as our needs increase, there’s the independent, healthy population; there are people who are becoming frail; obviously dementia and Alzheimer’s are a huge issue. So you have this combination of health care issues and transportation and socialization—educating the public on what this means.

I live in Los Angeles. To me, it’s interesting that I chose this place to do this because it’s the heart of darkness for getting older.

SCF: True.

TC: [Laughs] I live in the mecca for anti-aging and youth culture. So that’s one of the things that needs to be looked at really carefully and unwound. [When you address that], people stop being afraid of aging and dying; people are much more willing to engage at every age.

SCF: You’ve said Burbank has been greatly affected as a community by the artists’ colony there.

TC: Burbank is a relatively small town within Los Angeles, and [the colony has] had huge impact there because of that—because people know what it is. We have community programs with schools, and we’ve created a community garden next door, and we’ve had our residents performing on stages and in libraries. We’ve made films. We’ve done radio shows.

It’s about changing perception. And part of that is just making people look at it and say, “Wow, that’s something that’s cool. I could do that.” And then they want to know more. We have events, and people come to them. It really creates a ripple effect that’s almost immeasurable on a community.

SCF: Do you plan to spread EngAGE’s services wider than Southern California?

TC: We’re looking at ways to try and replicate what we’ve done. We have put together kind of a how-to on what we’ve done. I’ve done a lot of speaking engagements in the last few years. And I’ve been approached by a lot of grantmakers and foundations to try and find ways to get organizations to do what we do in different communities. So we’re trying to find ways to do that.

SCF: Traditionally, our culture has talked about aging as a winding down process. You just kind of sit on the front porch. But your vision says, no, life continues.

TC: I think people who want to sit on the porch probably always enjoyed sitting on the porch. I don’t think that’s a large representation of the human population. [Laughs.] I don’t know a lot of people who like to sit on the porch.

I have nothing against sitting on the porch. I’ve never done it myself, and I don’t want to do it when I retire.

I would like to jog up and down the porch steps maybe. And talk to my neighbor. Listen to a ball game and have a beer or something like that.

But I think people need to step back and say, we’ve had 50, 60, 70 years of figuring out our life and how it works, and all this is an extension of that and hopefully a period of growth: what more can I do?

This interview was edited for clarity and length.

Katherine Freund: Imagining a Time When Older People Won’t Need to Drive

Her goal: to provide convenient, affordable rides in private cars

This article introduces our new series on the future of aging: interviews with people who are experts in their fields and are also visionaries. We’re asking them to talk about what they believe will happen in the years ahead to change the experience of aging.

The fact that so many of us now live so long is a triumph for humanity, but there are a few drawbacks. For one thing, many of us will outlive our ability to drive—a devastating loss because with it goes much of our independence. Recognizing how important that is, Katherine Freund re-imagined transportation and found a way to provide convenient, affordable rides for older people who have given up driving. She’s at the forefront of change.

Her knees aren’t great. She uses a cane. She doesn’t walk as quickly as she used to. And the nearest bus stop is a couple of miles away. She promised her kids she wouldn’t drive. So what now? 

Well, first things first: she gets out those reading glasses and puts on that thinking cap because it’s time to figure out the route. Red line? Blue line? Oh, there’s a quick underground connection. Run to catch it?

Um, no.

Oh, for Pete’s sake. Where are the car keys?

“Only about 2 1/2 percent of the trips that older people take in the entire country are on mass transportation of any kind,” says Katherine Freund, an advocate for improving transportation for elders. 

That means, to get to the doctor and the grocery store, to see friends and beat isolation, most older people are driving—whether they should be or not.

Millions of boomers will have to give up their car keys in the next few decades.

In 1988, Freund and her family faced that reality from the other side of the steering wheel when an 84-year-old driver hit her 3-year-old son. Her son sustained a traumatic brain injury. “He was in a coma and on a respirator for three days,” she says. (He recovered but has lingering issues, including a tendency to get headaches.)

But instead of cultivating bitterness or vengefulness, Freund jumped into action. “I just really wanted to spare anyone else from such an experience,” she says. “The only way to feel better is to fix something.”

She began envisioning that fix—and ended up with a plan to change the world, one driver at a time.

Mission Impossible

Many older people just don’t have great alternatives to driving themselves. Even if they are willing to navigate mass transportation, rural and suburban areas may not have it. Taxis aren’t cheap. Adult children who could offer rides often live far away. And asking a neighbor for help? Elders would often rather stay home.

“They don’t want to say, ‘I can’t do this anymore,’” Freund says. “Older people want to say, ‘I’m independent, I’m proud, I can do it myself.’” Even if they shouldn’t.

After her son’s accident, Freund started brainstorming for a convenient, affordable alternative. Ideally: something with door-to-door service, cheaper than a taxi, and with specialized help for people with wheelchairs and walkers. 

Impossible? That’s not the way she saw it.

Launching the Future

In 1995, Freund launched a small, nonprofit organization called the Independent Transportation Network. ITN provided relatively low-cost rides in private vehicles to people 65 and older in greater Portland, ME. Donations from individuals and organizations kept the rates reasonable.

In that first year, “we exploded with growth,” Freund says. After a newspaper article about the launch, “I got about 300 phone calls in the next two days, and the waiting list to use ITN started.”

In 2003, Freund took ITN national, calling it ITNAmerica. Today, the organization has about two dozen affiliates. Drivers offer door-to-door service within their communities, helping with walkers and wheelchairs. Many are volunteers who use their own cars and earn points toward future ITNAmerica rides for themselves or for someone else, such as a parent. 

Since 2005, the Silver Century Foundation has given ITNAmerica a number of grants to support the organization’s national rollout and to fund research on mobility issues for older adults. 

 “I Use ITN”

Millions of boomers—the oldest will turn 80 in 2026—will have to give up their car keys in the next few decades. By continuing to expand ITNAmerica, Freund hopes to help bring about a revolution in the way they’ll get around. 

Yet ITN is expanding more slowly than she expected. Challenges include fundraising and finding enough volunteer drivers. Plus, when she rolled out ITN nationally, she did so during “the teeth of the recession,” she says. “I mean, established nonprofits folded in that recession, and we were just an infant national organization.”

But Freund believes that over the next couple of decades, services like hers will grow quickly. By then, “in the same fashion that people will now say, ‘I own a Toyota’ or ‘I own a Ford’ and feel a sense of brand loyalty to that,” older people will instead be saying, “I use ITN” or another car service, she says.

We talked with Freund about her vision for the future and how she’s racing to make it happen—soon.

SCF: First of all, your son turned 30 this year. How is he doing now?

KF: He is healthy and happy. He just completed a Tough Mudder obstacle event. He has a tendency to get headaches, and he can’t look at bright lights or hear loud sounds. When he was little, the doctor said we should always be careful not to “rattle his squash,” and he still always takes care. 

All in all, he is my miracle boy. He is the chief operating officer for Common Census, a software company for employee benefits.

SCF: We’re glad to hear that.

As you’ve worked to change transportation over the years, you seem to have found that not only are there few federal dollars for funding public transportation but the subject is not a popular one in the political realm. What will communities need to do to ensure that people can remain mobile as they age? 

KF: The first step is basic community awareness of the issue. I think people assume transportation the way they assume oxygen, and they assume that there are going to be supermarkets around, where they can buy food. I don’t think people take a lot of personal responsibility for planning for transportation.

Part of this is that we’ve just added so many years to our lifespan in such a short period of time. It’s like our understanding of needs hasn’t caught up to reality or how long people live. 

That’s the first step. So once that happens, there is planning for the built environment—sidewalks and streetlights and curb cuts. That’s happening a little bit, but it needs to happen more.

And then public policy needs to remove barriers to the use of private resources. 

SCF: For example?

KF: Right now in a lot of cities, it’s illegal to charge a fare for a ride delivered by a volunteer. So livery laws are not current with current technology and current transportation solutions. 

You cannot solve problems long-term by giving everything away or by expecting the government to pay for it. So those old-fashioned livery laws are a barrier to sustainable transportation.

SCF: Is public transportation for older adults becoming a private-sector responsibility?

KF: It is inevitably going to become more of a private—I don’t want to say responsibility; let me say private opportunity. 

It used to be that you could only create any kind of efficient community mobility by putting people together in a high-occupancy vehicle—bringing the people to the place where that vehicle is, or to the bus stop, right? And putting all those people in that great, big vehicle together and moving them together. 

But people now live in these geographically dispersed population patterns because they’ve owned cars for 100 years and they live in all these suburban communities. You don’t have the density for those big, mass-transit solutions. It just doesn’t work in suburban America, which is where most older people are. Three out of four older people live in rural and suburban communities. 

So what’s happened is—and this is what’s going to happen in the future too—that people use information technology to know where is the car when, and where is the person when, and match them up.

You’ve read about Uber and Lyft and all these ride services. They’re a different form of the same thing that ITN is doing. They’re all different versions of creating community mobility without using public money—using privately owned transportation capacity. 

SCF: Your plan is to eventually launch ITNEverywhere, which will make rides available through online software to people of all ages. Private cars will be available for rent too. It sounds like all of this could supplement mass transit—even substitute for it in rural areas.

KF: The growth of this “share economy” makes it less necessary for services to be provided by the government, which is a good thing because the tax base is shrinking. The government can’t continue to fund everything. That’s kind of an antiquated model.

There’s still a role for it. But we all know that Medicare doesn’t cover all your medical bills. Social Security doesn’t really pay for retirement. It’s just a piece. It’s the same thing with transportation. Public transportation is just a piece. 

SCF: Thinking of this share economy, along with other car services that are succeeding worldwide—Uber, Lyft, Sidecar—is this concept going to shape travel as a whole in the near and distant futures?

KF: That kind of economy is escalating. You can rent power tools from somebody now. You can rent the use of somebody’s car. And they don’t have to be Avis or Hertz; you can just rent a person’s car for a couple of hours now. There are all different ways that people are sharing. Well, transportation is a very big part of this because there is so much capital in transportation and it is sitting unused a lot of the time.

So transportation for older people is going to change. It’s really good news.

SCF: Since we’re thinking futuristically, how do you think driverless cars could play a role in mobility, once they become available to the public? 

KF: I think they can play a role, and I think they can help some older people. 

[But] a lot of the people at the advanced age that we currently serve need more than just a ride. So even if a vehicle is driverless, it’s not enough. For our population, for example, half the people we serve have some sort of mobility impairment. They have a cane, they have a walker, they have a visual impairment. They need to lean on someone’s arm when the sidewalk is icy. They need somebody to help them with their packages, or they need a little assistance up the stairs.

So a driverless car is going to be some help to some people, but that human piece is going to remain a factor. Right now, often, the driver provides that piece. It may be that with a driverless car, a personal assistant or a friend can provide that human piece.

SCF: How bad could things be for older adults who wish to remain mobile if communities and governments don’t change their approach to transportation? 

KF: Really very bad. It means a whole bunch of bad things. 

For people who continue to drive, it means that they’re really at risk for getting hurt or killed. And it also means that they’re at risk for, at the end of their long life, being responsible for hurting someone else. How’d you like to do that? And sometimes they hurt their family members and their neighbors, their spouses, their children. It’s a bad thing.

So that’s from a safety perspective. Now, if they stop driving when it’s no longer safe and there are no solutions, well, people will be prisoners in their houses. They will not have access to good nutrition. They will not have access to social interaction. They will not have access to health care. 

It’s a very significant, life-changing loss not to have mobility in the last 10 years of your life. 

SCF: What is your most hopeful vision of travel in the next five, 10, 20 years? 

KF: My big, big, big vision is I would like there to be a national endowment for transportation—private resources to help foster private transportation solutions.

I would like public policy—at every municipal, county and state level—to remove the barriers to using private resources, whether it’s trading your car or charging a fare [for a ride] delivered by a volunteer or making sure that insurance companies do not unfairly increase insurance premiums for people who want to participate.

SCF: You’re also trying to raise awareness of the fact that there are few good alternatives to driving for older people.

KF: I want to open up everybody’s mind about this issue—that it is not somebody else’s issue. It is every family in America.

We are aging with the automobile for the first time in history. Everyone who experiences this, they all think that they are alone, when it is universal.

And this is a very, very solvable problem—the answer is literally parked in everybody’s driveway. 

If you look around and see older people who need help, offer them a ride because they don’t want to ask. They will sit home without groceries. They will miss doctors’ appointments. Suggest they bake something for you in exchange for the ride. But just open your eyes and help somebody.

Conversation edited for length and clarity.

What Kind of Old Age Will You Have?

Four different paths to fulfillment in later life

Imagine that researchers could tell you how to plot your way to a satisfying old age. Would you listen?

The researchers think you would, and they’ve been trying to map that elusive path for decades. They’ve quizzed countless older people about their health, relationships, mental issues, spiritual beliefs and so on. 

The result? Not one theory. Not one path. Not one…but a bundle. The road to a satisfying old age has many branches—different ones appealing to different personalities.

Paths from the Good Ol’ Days

People who are happy and preferably healthy in their later years are doing what some researchers call successfully aging. What’s not crystal clear is how they got there.

Early on, there were three main theories of aging. Recognize anyone you know in them?

  • Disengagement theory: Introduced in 1961, this concept claimed it’s good for older people to withdraw from work and some relationships, as a benefit to them and to society.
  • Activity theory: This rival idea took over and claimed that successful agers are active and busy.
  • Continuity theory: Choosing the right activities is the secret here—using skills and interests you had at younger ages, just in different ways. 

Though each theory fitted some people, none fitted all. So researchers kept exploring and developing ideas. After a while, they finally agreed on the current consensus: there is no consensus. And the search for new ideas and explanations continues. 

Today’s Theories

“There is no one way to age successfully,” says Jennifer Kinney, PhD, professor of gerontology at Miami University in Ohio. “There are several popular perspectives.”

According to the newer theories, successful agers might focus on physical issues such as health and fitness. They could seek satisfaction in intensified relationships. Or they might turn inward, nurturing their spirituality or inner growth.

There are so many options, you can pick what fits you best. With that in mind, the Silver Century Foundation describes four personality types, each with a different approach to aging happily and successfully:

  • Life Savorers appreciate the meaningful things in life more and more.
  • Strategic Maintainers focus on keeping their quality of life the same.
  • Transcenders slough off the mundane to connect with another level of existence.
  • Preparers set themselves up in earlier years for a good old age.

Which type you’re likely to be depends on what’s most important to you.

The Life Savorer

Life Savorers let go of some activities and relationships. This isn’t a depressing development. And it’s not happening just because their bodies are aging. They become choosier because they realize time is winding down.

People who think they’ll live quite a while longer are more focused on meeting others and learning things that may come in handy one day, according to a theory called socioemotional selectivity. As they get older and realize their time is limited, they focus more on emotional goals and enjoying the present.

Life Savorers invest in meaningful relationships. They pay attention to positive things more than negative ones. They feel good about themselves and life, despite physical challenges that can accompany growing older.

The Strategic Maintainer

Say a woman has been growing her own vegetables for decades. Gardening keeps her active, and it feeds her body and soul. But lately, knee problems have kept her from kneeling in the dirt. What does she do? She buys a bench to sit on while she digs.

With this practical solution, this gardener has fallen smack dab into a theory called selection, optimization and compensation. It says that throughout life, in order to be successful, we do three things:

  1. Select: Choose goals, narrowing them down from countless options. (Garden).
  2. Optimize: Get skills and resources to accomplish chosen goals.
  3. Compensate: Make up for losses that make accomplishing the goals harder. (Get a bench.)

When I am an old woman I shall wear purpleStrategic Maintainers use these steps to maintain their quality of life as abilities change. Like Life Savorers, they narrow down goals and activities, but they do it so they can focus on areas that help them live better. For example, they set out to stay healthy, avoid injury, remain independent or spend time with loved ones.

While their physical or mental abilities might decline, quality of life for Strategic Maintainers remains relatively high.

The Transcender

With a red hat which doesn’t go, and doesn’t suit me.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
And run my stick along the public railings
And make up for the sobriety of my youth.

(Excerpt from “Warning,” by Jenny Joseph)

According to a theory known as gerotranscendence, successful agers toss many social expectations out the window. They’re beyond those concerns now—beyond many things, actually.

“The mistake we make in middle age is thinking that good aging means continuing to be the way we were at 50. Maybe it’s not,” said Lars Tornstam, the Swedish social gerontologist who developed this theory, in a 2010 interview for a New York Times blog, the New Old Age.

Transcenders focus on spirituality. They become less concerned with how their bodies look. They reminisce and reflect. As they mentally break down boundaries of time and space, they become less fearful of death.

They spend their time on intimate relationships, not superficial ones, and they cherish their alone time. They become wiser and less self-centered. Life starts falling into place, but they also accept its mysteries.
“There is also often a feeling of cosmic communion with the spirit of the universe,” Tornstam writes in his book Gerotranscendence: A Developmental Theory of Positive Aging (2005).

For Transcenders, why not wear purple with a red hat? Life is about more than what we see. And aging is about moving beyond it.

The Preparer

So far, the theories have focused mostly on what people do once they’re older. But there’s a big theory that takes one’s entire life into account. It’s called the life-course perspective.

“I tell my students, ‘Now this one’s the bomb,’” says Denise Lewis, PhD, assistant professor of gerontology at the University of Georgia. “Right now, I think it’s probably the best way for us to understand aging.”

Preparers start affecting their old age before they even get there. Lewis recommends five research-backed steps to age successfully. They fit into this theory, and people can start at a young age:

  1. Make a lot of friends—people you can have both deep and casual conversations with.
  2. Get together with those friends often—maintain contact, even if you do it through email or social networking.
  3. Eat nutritious food—the kinds that give you the most nutritional bang for your caloric buck.
  4. Laugh a lot—it may increase self-esteem and well-being.
  5. Go for long walks with your friends—exercise and keep active throughout your whole life. 

Diverse People, Diverse Paths

Today, there are a variety of aging-well paths to choose from, and if you’re not sure you’re headed toward a satisfying old age, now’s the time to change your trajectory.

In her book, The Search for Fulfillment (2010), psychology professor Susan Krauss Whitbourne, PhD, offers advice for people who want to make a change in order to age successfully:

  1. Honestly examine where you’re headed.
  2. Ask someone close to you to give feedback.
  3. Start with small changes if you need to.
  4. Don’t be afraid to get counseling.

Whether you’re a fitness buff, a spiritual sage or a meticulous planner, there’s a successful-aging path for you. Whichever you choose, it’ll be fascinating to see what’s over its horizon.

Pioneering the New Old Age

How to make the most of a long life

It’s like cancer. Like a heart attack. Like death. Old age—it’s something that happens to other people. And it’s not pretty.

That’s how some of us think of it, anyway, if we think of it at all.

“Most people in their 40s and 50s have a strong fear of aging and mostly imagine a bleak time of life,” says Marc E. Agronin, MD, a geriatric psychiatrist and author of How We Age: A Doctor’s Journey into the Heart of Growing Old (2011).

But once they reach older age, many find it to be anything but bleak, and that can come as a surprise. People are thriving and learning well beyond the age their parents died or started declining. Celebrities like Betty White give a public face to this trend, but mothers, fathers and next-door neighbors are paving the way more personally in small towns and big cities across the country.

Instead of preparing for a quiet slope to death, perhaps we should be preparing for a vibrant life. “In my work as a geriatric psychiatrist I have learned that aging equals vitality, wisdom, creativity, spirit, and, ultimately, hope,” Agronin writes in the introduction to his book (emphasis, his).

We found four people in their 70s and 80s who are living active, fulfilled lives and asked them to tell us how they got there. We found that comfortable finances and good health are important to them. But it’s what they’re doing with what they have that really makes the difference.

Doris VonFange, 86
Volunteer

In 1965, in the little town of Lincoln, KS, then 40-year-old Doris VonFange had a husband she loved, a wonderful daughter and a good job doing secretarial work and accounting. But something was bothering her.

“When I was 40, that was my hardest time,” she says. “I felt, what have I done with my life half over with?” Mostly, she worried she hadn’t given back enough—hadn’t helped others enough.

But this midlife crisis didn’t last long, she says. She had a good life, after all. “I felt blessed.” And that was enough.

Until 1999, when the thing so many of us dread happened: her husband passed away, leaving her alone in that house they had lived in all their married life. “I could not stay home,” she says. It was too lonely.

So VonFange threw herself into volunteering. “I volunteered as much as I could and everywhere I could,” she says.

Our later years can be a time for each of us to define what older age means to us—and what kind of elder we want to be.

Through the years, she has judged high school forensics competitions, helped the local arts center, acted as secretary and treasurer for her church, joined the library board and served as president of the local Council on Aging.

For VonFange, older life seems to be fulfilling what younger life didn’t leave time and energy for. She enjoys other activities that stave off loneliness too. She loves going to concerts—bluegrass, gospel, Bach. And she travels. She has taken trips with her niece to various states and has been to Canada twice, “once by train, once by tour bus.”

When asked what advice she would give people in their 40s and 50s, VonFange doesn’t say save your money, as she did at that age. She doesn’t tell you to live near family, an aspect of life that’s very important to her now. She doesn’t even preach exercise, though she walks regularly. Instead, what comes to mind for her is a different type of advice: be a good parent, spend time with your children, get involved with your community, love your neighbor as yourself.

Those are all nice things, to be sure, but one can’t help but wonder why they’re so important in preparing for your 80s. VonFange has a ready answer. “It brings contentment and a peace,” she says. “I’m very content here. I’m very pleased God put me in this life.”

Jack Biddle, 76
Jack of All Trades

Jack Biddle has been a ski instructor, massage therapist and horse caretaker (“manure mover,” as he calls it) since he retired at age 55.

After 31 years in information technology, “I really kind of liked the idea of retiring,” Biddle says. So in 1991, when his company tried to move him to a position he didn’t want, he moved, all right—right out of his career.

But Biddle’s idea of retiring wasn’t exactly traditional. “I went from a five-day-a-week job, which I left on Friday, to a six-day-a-week job that I started on Saturday,” he says. His new gig was ski instructor. When that job ended, he cared for horses.

Sounds like a free spirit. Live for today and all that. Of course, Biddle doesn’t have to worry about finances because he was practical in younger years, saving money from a well-paying job. But there’s another reason he’s chosen such a carefree life. Cancer.

In 1992, at age 56—the year after he retired—Biddle was diagnosed with nonaggressive non-Hodgkin’s lymphoma, a lymph cancer. So he decided to cut back on stress. Tossing hay bales didn’t cause anxiety. And giving massages (he became a massage therapist in 1998) was as calming for him as it was for his clients.

The cancer remained nonaggressive for 16 years. But in 2008, despite his efforts to avoid stress, it turned aggressive—a diagnosis he got three months after he broke his hip in a bicycling accident.

Now begins the real old age, right? Broken hip, cancer, downward spiral. A year after diagnosis, though his cancer had gone into remission, Biddle decided not to go back to work. He was truly retired.

But retirement is relative. These days, Biddle spends his time taking Spanish lessons and singing in the Boulder (CO) Chorale. Plus, there’s bicycling, yoga and lifting weights.

“There was a time when I thought 60 was incredibly old, and nobody could expect to be in particularly good physical condition,” Biddle says. Sure, he may not be as strong as he once was. But that happens when you’ve been around long enough. It’s not necessarily an age issue, he says. You just “get beat up a bit.” Big deal.

Diane and Jim Peiker, 75 and 76
Business Owners

When you visit the Castle Marne bed and breakfast in Denver, CO, you might notice a 76-year-old man working in the yard. “I’m the gardener,” he’ll tell you.

Inside this historic mansion, a 75-year-old woman walks by with a tray in her hands. Does she work here too? “Yes,” she’ll respond. “I’m the queen.”

This gardener and his queen are the owners of this establishment. Jim and Diane Peiker bought the Castle Marne in 1988, when they were in their 50s. Their daughter and son-in-law work there too, and now one grandson is on the payroll.

In 1987, bad economic times put Jim and his daughter, Melissa, out of work. They had always thought of trying a family business. Why not now? “Nothing clicked until someone said, ‘What about a bed and breakfast?’” Jim says. That was it. They found a place and renovated it, and the family works together there to this day. 

“People ask us, ‘What are you going to do when you retire?’” Diane Peiker says. “And we always say, ‘We are retired.’ This is a wonderful life that we have been lucky to find.”

Of course, Jim says, they’ve worked hard for it. They still work seven days a week, 18 hours a day. “We didn’t open a bottle and there it was.” But at the same time, all of this really wasn’t supposed to happen. In fact, they weren’t even supposed to be alive right now.

It never occurred to them that old age would come someday, Diane says. Both of their mothers died in their 50s. Living beyond that almost came as a surprise. “When we passed that time, we just figured, wow, this is fun!”

And they have made the most of these bonus years—for themselves and their community. They helped transform the not-so-nice neighborhood their new business was in and have been honored by the city government and other organizations. “We are living lives that are far more involved than we ever did before,” Jim says. “When I get up in the morning, I’m facing a wonderful day with wonderful experiences and interesting people to meet.”

Across the nation, people like the Peikers, Biddle and VonFange are working out all kinds of lives for themselves, paving the way for each of us to define what older age means to us—and what kind of elder we want to be.

How to Save a Life

You’re never too old to become an organ donor

Sally Jacobson had about a month to live.

A few months before, she’d been tired, sure—not feeling so great. But she was bustling along, balancing work and family in Grand Forks, ND. Then she got some great news: a promotion at work.

Within a week, her health had deteriorated so much that she couldn’t walk and breathe at the same time.

The diagnosis was autoimmune hepatitis, a disease of undetermined cause that made her body attack her liver as if it were an infection that needed to be destroyed.

She ended up in a wheelchair, with her husband as her caregiver. She couldn’t get out of bed by herself—couldn’t get off the toilet by herself. And every two to three days, she underwent thoracentesis, a process that involves having a needle stuck in your chest to remove fluid buildup.

On March 31, 2006, at 61 years of age, Jacobson was placed on the waiting list for a liver transplant. “And that’s when the surgeon asked if I would accept an older liver,” she recalls of her Mayo Clinic doctor. “He said, ‘It might give you 15 years.’ And when you know you don’t even have a month left to live, that 15 years is a pretty awesome gift.”

Many older people believe they can’t donate because their organs are worn out. Mostly, they’re wrong.

Three-and-a-half weeks later, Jacobson received her liver—from a man who died at 82.

Today, Jacobson is doing well. In fact, her doctor now believes that her liver will last past those initially predicted 15 years, she says. She spends her days volunteering at an impressive pace, spreading the word about the desperate need for more organ donors—especially the fact that, despite what too many people believe, you’re never too old to be a donor.

Why Older People Don’t Sign Up as Often to Be Donors

These days, registering to be an organ donor can be accomplished at as mundane a place as the Department of Motor Vehicles. But when today’s older generations were in their formative years, the idea of donating an organ was a profound one.

The year 1954 marked the first time an organ was successfully transplanted. It was a kidney from a living donor. In the 1960s, organ transplants from deceased donors began—and made a media splash. The surgery was featured on magazine covers and in headlines.

“Some time ago, organ failure meant certain death,” pioneering transplant surgeon George M. Abouna later reflected. “With the advent of transplantation came the hope of a second chance of life.”

During the early years, organs were generally only transplanted from younger people. It was in part because of Abouna’s work that doctors gradually learned that organs from people over 60 could work well too.

Nowadays, organs from older people are transplanted all the time, usually to people who are of a somewhat similar age. Still, members of older generations are less likely than those of younger ones to register to be organ donors.

According to a 2012 Gallup survey of more than 3,200 people, 66 percent of Americans ages 18 to 34 have granted permission on their driver’s license, and 52 percent of people 66 and older have done so.

Sixty-six percent of people on the waiting list for a transplant are 50 and older—prime candidates for an organ of about the same age.

This lesser willingness among older people matters because every donor matters. For one thing, not everyone who registers to be a donor can become one in the end—no matter their age and health.

“You need to die in a hospital to be considered an organ donor, and the majority of people do not,” says David Klassen, MD, chief medical officer of the United Network for Organ Sharing (UNOS). “Most die at home or in some other place.”

You also must die in a manner that preserves organ function—usually from an event that causes brain death, such as trauma or a severe stroke.

But older donors in particular matter because “the most rapidly growing subgroup of the waiting list is older adults,” says Dorry Segev, MD, a transplant surgeon and associate vice chair for research at Johns Hopkins University School of Medicine. “A 70-year-old waiting for a kidney doesn’t need kidneys from a 20-year-old. They could benefit significantly from kidneys from a 70-year-old.”

The problem isn’t that older people don’t believe in organ donation. Over 90 percent do, according to the Gallup survey, which was conducted for the US Department of Health and Human Services.

The first reason they say they’re not signing up is they think they’re too old—that their organs are worn out and undesirable, says Kimberly Downing, PhD, a social behavioral researcher who’s been studying donor registration among older adults for 10 years. 

But that’s just the surface answer. Probe deeper, and you find that the reasons are also health related. Because of a chronic illness, disease or medication, they’ve decided, “I’m not good for anybody,” says Downing, who’s the codirector of the Institute for Policy Research at the University of Cincinnati.

Experts say they’re often wrong—and it’s costing lives.

Why Older Organ Donors Are Desperately Needed

If today is an average day, 22 people will die waiting for an organ transplant.

This minute, over 122,000 people are on the waitlist. Almost 80,000 of them are medically eligible to receive an organ right now. Yet only 29,532 organ transplants were performed in 2014.

The necessary organs just aren’t available. The number of donors has been pretty stagnant for over a decade, yet the number of people on the waiting list has kept right on growing. (In 2005, there were just 90,526 people on it.)

And 66 percent of people on the waiting list are 50 and older, according to UNOS, the nonprofit organization that manages the United States organ transplant system. These are prime candidates for similarly aged organs.

How Health and Age Affect Organ Donation

Both your age and your health can affect what you’re able to donate—but not to the extent many people think.

Health-wise, what affects one organ doesn’t necessarily affect them all. “If you die of heart failure, you’re not likely to be eligible as a heart donor, but you might still be acceptable as a liver donor, for instance,” explains Klassen, who was a transplant nephrologist for 28 years at the University of Maryland before he joined UNOS in 2014. “Or a person who has had diabetes for many years might have suboptimal kidney function and therefore not be really a good kidney donor but might be a liver donor.”

Even if you’ve had cancer or have been told you can’t donate blood, that may not preclude you from being a donor.

Age has a similar sometimes/sometimes-not effect.

When David Coffee’s mother, Christine, died suddenly of a brain hemorrhage in May 2015, he was promptly told that she’d make a great liver donor. “I said, ‘You’re kidding me! A 90-year-old lady?’” he recalls. She was an active woman—healthy and vigorous—but still, “I was just surprised that they could use an organ from her at that age.” Her match was a 60-year-old man in New York.

Donated tendons help people move, donated veins prevent amputations and corneas help people see.

Coffee would soon learn that his mother had become the second oldest organ donor in the history of LifeGift, the organ procurement organization for north, southeast and west Texas, which was established in 1987.

The nation’s oldest donor was also a LifeGift donor: in 2006, Carlton Blackburn’s liver went to a 69-year-old a few days before Blackburn would have turned 93.

To transplant doctors, age really is just a number. “Seventy is the new ‘we’re not sure,’” says Segev.

That said, in general, organs are often matched up with people of similar ages. “One of the latest paradigm shifts in transplantation is to try to match the wear-and-tear of the organs with the wear-and-tear of the patient receiving them,” Segev says. “The phrase is, ‘to find organs that look like you.’”

“Typically, at least for kidney transplants, what we attempt to do is match organs that are expected to last the longest with patients who are expected to live the longest, or require them the longest,” says Klassen. “So we try to match the expected longest-lasting organs with, say, younger people.” But an organ that has a more limited, predicted lifespan can work well for someone who’s older. Klassen also notes that older people can sometimes be living donors—for example, donating a kidney to a family member.

How Organs Are Evaluated

Organs are medically evaluated before they’re transplanted. During her research, Downing has found that many older people don’t realize that—and therefore choose not to be donors. Women, especially, often fear they could actually harm a recipient through donation.

Depending on the organ—kidney, pancreas, liver, intestine, lung or heart—it may go through lab tests, physical tests, examinations or a biopsy, Segev says. Some organs can even undergo a bit of renovation before transplantation. “For example, kidneys, liver and lungs can go on perfusion machines,” he says. “Once you’ve taken the organ out of the patient, you can put it on a machine, and that machine can improve the function of the organ.”

But say it turns out none of the organs are usable after all. There are still many more things people can donate—namely tissues. For example, donated skin can help people with serious burns, reducing pain, scarring and infections. Donated bones can be used for spinal fusion and dental implants, or for filling in around knee or hip replacements—and even to replace bone that was lost to cancer. Donated tendons help people move, veins prevent amputations and corneas help people see.

At age 71, Robert Kauffman of Arizona died two weeks after he underwent elective surgery for a brain aneurysm. He’d been an athlete all his life, even playing NCAA basketball. “He was still playing singles tennis,” says his wife, Betsy Kauffman, who volunteers to tell her story through her state’s organ procurement organization, the Donor Network of Arizona. “He was very active physically.”

After some of his tissue was donated, Betsy Kauffman received a letter from a recipient’s family to thank her. “It turned out their daughter was trying to be in the 2016 Olympics and tore her ACL,” Kauffman says, referring to a serious knee injury. “So we were able to fix that. How cool is that?”

Other Factors That Keep People from Donating

Though concerns about age and health are the main reasons older people cite for not becoming organ and tissue donors, some other factors do come into play.

For one thing, organ transplantation is relatively new. It made the news in the ’60s, but it wasn’t until the1980s that it started becoming more common, thanks to the newly discovered immunosuppressant cyclosporine, which helped prevent people’s bodies from rejecting the organs. Because older generations didn’t grow up knowing anyone who had a transplant or who was a donor, they’re dealing with a learning curve, Downing says.

Jacobson, who had the liver transplant in 2006 at age 61, experienced some of that learning curve—mostly through relatives. “My mom had a hard time understanding it,” she says. “She’d introduce me to people, ‘This is my daughter, Sally. She had implants.’”

Another factor that affects older people more than younger ones is concern about how the donation may impact their family, Downing says. One thing they worry about is cost. They needn’t worry, though. Donation costs donor families nothing.

As far as emotional impact goes, organ donation can actually be a source of comfort. In fact, 83 percent of people believe it helps families cope with their grief, according to the Gallup survey.

Coffee, whose mother donated her liver at age 90, can testify to that. “There’s the comfort of knowing that even in that sad situation, good is coming out of it,” he says. “And then also it’s that little bit of immortality—to say, oh my gosh, she’s still living on—and it’s kind of amazing.”

It is a good idea, however, for people to talk to their family about their decision to become a donor, because if the family were to object at the hospital, their wishes would likely be respected. “Organ procurement organizations do pay very close attention to family wishes,” Klassen says. Though a family’s distressed pleas could legally be ignored, it would be unusual for the organization to go against significant family objections.

How to Register as an Organ Donor

In the United States, organ donation is completely humanitarian. Buying and selling organs is illegal, and organ procurement is highly regulated by a number of federal agencies. (It’s also overseen by UNOS and carried out according to state laws.)

So each person on that transplant waiting list is dependent on the charity of their fellow human beings. Signing up to be a donor, therefore, is a profound, potentially lifesaving thing to do. Yet it’s very easy. You can register online or when you renew your driver’s license at the Department of Motor Vehicles.

In 2012, the US Department of Health and Human Services launched the 50+ campaign—complete with a video, brochures and public service announcements—to urge people 50 and older to register as organ donors. More information about donating organs as an older adult, including downloadable materials, is available through that campaign here.

Jacobson, whose liver turned 91 this year, is grateful for the time her donor has given her. She and her husband have now been married 52 years, and since her transplant, they’ve welcomed three new grandchildren into the world.

Jacobson volunteers tirelessly with LifeSource to spread the word about organ donation. “I believe in paying it forward,” she says, “because I’ve received the most awesome gift of all—the gift of life.”

Can a Fighting Spirit Cure Cancer?

Hope or hype? What science has to say about positive thinking

The pink teddy bears were what really got her. Here she was, a 59-year-old woman with breast cancer, and a stuffed animal was supposed to make her feel better.

No thank you. “That did not go down well with me. It seemed like an insult to my dignity,” says Barbara Ehrenreich, author of Bright-Sided: How Positive Thinking Is Undermining America (2009). She was diagnosed with breast cancer in 2000.

So maybe she didn’t want a teddy bear. But the intent is fair, right? Cheer up, because we all know positive thinking and a fighting spirit will help cure this thing.

Actually, no, we don’t know, Ehrenreich says. And scientists are backing her up.

Guilted into Laughter

The cancer world is steeped in messages to think positively and employ your fighting spirit. “FIGHT like a girl!” reads a bright pink T-shirt from Susan G. Komen for the Cure, a breast cancer nonprofit. “Never Give In,” implore dog tags from the Prostate Cancer Foundation.

A company called MedTees sells humorous shirts for all sorts of problems. Burn victims can declare, “I used to be a tour guide for Chernobyl.” Think dementia has no upside? Not so. Another shirt reads, “The nice thing about being SENILE…you can hide your own Easter eggs.”

Laugh or fight. They may seem different, but the ideas are similar, Ehrenreich says. The message is that changing your mind will change your outcome.

It’s possible that optimism strengthens the immune system. But explanations are elusive.

There’s nothing wrong with laughing or taking a fighting stance—if that’s your natural way of coping. The problem, scientists say, is that the message is taken too far. Positive thoughts alone are no cure. And not everyone can manifest them.

“If you just aren’t that kind of a person or you can’t summon up that upbeat attitude when you’re in the throes of retching from chemotherapy, you’re set up for feeling terribly guilty,” says Richard P. Sloan, PhD, a professor of behavioral medicine at Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine (2006).

What the Science Shows

Though scientists generally believe your thoughts alone won’t cure you, some studies have found that optimism could lead to a healthier immune system, make wounds heal faster and lower your risk of heart disease and stroke, among other things. But the reasons remain somewhat elusive.

In February 2010, the scientific journal Annals of Behavioral Medicine devoted 47 pages to a debate about positive thinking and health. Arguing for the benefits, researchers Lisa G. Aspinwall, PhD, and Richard G. Tedeschi, PhD, wrote that optimistic people are more likely to take better care of themselves—exercise, eat healthfully and not smoke. They also may adhere better to medical instructions and rehabilitation. So the actions, not the thoughts, are what account for at least some of the good health outcomes.

“Positive feelings are signs of health; they do not cause good health,” says Howard S. Friedman, PhD, coauthor of The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study (2011). “Thinking positive thoughts will not cause your cancer cells to decide to self-destruct, but it might help you get up and out of bed, eat your spinach, complete your chemotherapy, improve your digestion and get a good night’s sleep.”

It’s possible that optimism strengthens the immune system. But for cancer in particular, the evidence is “quite limited and unconvincing,” wrote researchers James C. Coyne, PhD, and Howard Tannin, PhD, in their skeptics’ argument for the Annals debate.

Plus, then you have to prove that it matters. “In some instances, tumors may even enlist the immune system to accelerate development,” they wrote. So strengthening it may not always be a benefit.

“Even if you were to accept that the connection between optimism and better health is plausible, and that’s a hypothetical, we don’t have any evidence that people changing—becoming more optimistic or more positive—reduces their risk of disease,” Sloan says. “For example, some third factor, perhaps a genetic factor, could cause both.”

When Belief Means Hope

The idea of changing your mind to change your health has been around in America since the mid-1800s, Sloan wrote in a 2011 New York Times op-ed. In 1952, Norman Vincent Peale popularized it again in his bestseller, The Power of Positive Thinking. Today, we have Rhonda Byrne’s runaway hit, The Secret (2006), with its “ask, believe, receive” philosophy.

Despite the popularity of messages that you can cure yourself through thoughts, researchers generally contend that the science doesn’t back them up. Yet many people continue to believe—and they say they have seen it work.

Patricia Wagner, a cancer patient in Arizona, is one such believer. Scientists look at this issue “strictly from the perspective of matter and scientific proof,” she says. “I am looking at it in a more holistic way.”

Wagner employs positive thinking, visualization, meditation and other complementary and alternative methods to help fight myelofibrosis, a bone-marrow disorder. She has had it since 2004 and has outlived the average life expectancy of about five years. While Wagner credits her doctors at Mayo Clinic in Scottsdale with good medical care, she gives her fighting spirit a lot of credit too.

Some people die feeling their death was their own fault because they didn’t have enough of a fighting spirit.

It led her to educate herself and to seek out what she believed was the best treatment, she says. And when her doctor told her she wouldn’t live much longer without physical therapy, visualization helped her start the process.

“I don’t think I would have had the frame [of mind] to do that had I not already been working on those positive images,” Wagner says.

The medical world can be a negative one, Wagner says. When she told a doctor about her alternative treatment methods, he responded by saying there was no evidence to support what she was doing. “You have a terminal disease,” he reminded her. “We can continue to provide palliative care, and we can hope for the best and see how long this lasts.”

“It’s not a very positive frame of mind, is it?” she says. Though she still gets appropriate medical care, she sees it as mainly precautionary.

“I have been working with my mental images so thoroughly that I really don’t believe that I could possibly have a physical problem anymore. I would just love for that moment to arrive where they say, ‘Gee, Pat, I think we must have misdiagnosed you.’ Because they’re not going to admit there was a miracle cure,” she says, laughing.

Scientists who don’t believe in the curative power of the mind don’t necessarily tell people like Wagner to stop believing. They advise them to do what’s right for them.

“People get through illness in many different ways,” Sloan says. “Some people become furious at the illness, and other people become very upbeat, but there’s no one right way.”

The Dark Side of Positive Thinking

“In the old days a man could just get sick and die. Now they have to ‘wage a battle,’” comedian Norm Macdonald quipped in his 2011 Comedy Central special Me Doing Standup. “That’s no way to end your life. ‘What a loser that guy was. The last thing he did was lose.’”

That is how the positive-thinking movement makes some people feel.

“The ugly thing is, if someone’s cancer is metastasizing, and she is being told, ‘If you just had more of a fighting spirit, you’d beat this thing,’ that’s a terrible thing to say because it’s blaming her,” Ehrenreich says. “I’ve heard also from a lot of individuals about their sisters or their mothers who died, but died feeling that it was their fault.” 

Her advice to cancer patients: “Don’t let people tell you how to feel. You know how you feel. You need people who are strong enough to hear that.”