Is There Such a Thing as Normal Aging?

Tracking some of the usual changes in body and mind, decade by decade

Journalist Bruce Horovitz asked four experts in geriatrics to explain what normal aging is apt to be like for people who have taken care of their health. The experts discuss the physiological changes that typically occur, from our 50s through our 90s. Kaiser Health News (KHN) posted Horovitz’s article on April 11, 2018. It also ran in USA Today

For 93-year-old Joseph Brown, the clearest sign of aging was his inability the other day to remember he had to have his pants unzipped to pull them on.

For 95-year-old Caroline Mayer, it was deciding at age 80 to put away her skis, after two hip replacements.

And for 56-year-old Thomas Gill, MD, a geriatrics professor at Yale University, it’s accepting that his daily five-and-a-half-mile jog now takes him upward of 50 minutes—never mind that he long prided himself on running the distance in well under that time.

Is there such a thing as normal aging?

The physiological changes that occur with aging are not abrupt, said Gill.

The changes happen across a continuum as the reserve capacity in almost every organ system declines, he said. “Think of it, crudely, as a fuel tank in a car,” said Gill. “As you age, that reserve of fuel is diminished.”

Drawing on their decades of practice, along with the latest medical data, Gill and two geriatric experts agreed to help identify examples of what are often—but not always—considered to be signposts of normal aging for folks who practice good health habits and get recommended preventive care.

The 50s: Stamina Declines

Gill recognizes that he hit his peak as a runner in his 30s and that his muscle mass peaked somewhere in his 20s. Since then, he said, his cardiovascular function and endurance have slowly decreased. He’s the first to admit that his loss of stamina has accelerated in his 50s. He is reminded, for example, each time he runs up a flight of stairs.

In your 50s, it starts to take a bit longer to bounce back from injuries or illnesses, said Stephen Kritchevsky, PhD, 57, an epidemiologist and co-director of the J. Paul Sticht Center for Healthy Aging and Alzheimer’s Prevention at Wake Forest University. While our muscles have strong, regenerative capacity, many of our organs and tissues can only decline, he said.

Times change. Many people today function as well in their mid-70s as those in their mid-60s did a generation ago.

David Reuben, MD, 65, experienced altitude sickness and jet lag for the first time in his 50s. To reduce those effects, Reuben, director of the Multicampus Program in Geriatrics Medicine and Gerontology and chief of the geriatrics division at UCLA, learned to stick to a regimen—even when he travels cross-country: he tries to go to bed and wake up at the same time, no matter what time zone he’s in.

There often can be a slight, cognitive slowdown in your 50s too, said Kritchevsky. As a specialist in a profession that demands mental acuity, he said, “I feel I can’t spin quite as many plates at the same time as I used to.” That, he said, is because cognitive-processing speeds typically slow with age.

The 60s: Susceptibility Increases

There’s a good reason why even healthy folks age 65 and up are strongly encouraged to get vaccines for flu, pneumonia and shingles: humans’ susceptibility and negative response to these diseases increase with age. Those vaccines are critical as we get older, Gill said, since these illnesses can be fatal—even for healthy seniors.

Hearing loss is common, said Kritchevsky, especially for men.

Reaching age 60 can be emotionally trying for some, as it was for Reuben, who recalls 60 “was a very tough birthday for me. Reflection and self-doubt is pretty common in your 60s,” he said. “You realize that you are too old to be hired for certain jobs.”

The odds of suffering some form of dementia double every five years beginning at age 65, said Gill, citing an American Journal of Public Health report. While it’s hardly dementia, he said, people in their 60s might begin to recognize a slowing of information retrieval. “This doesn’t mean you have an underlying disease,” he said. “Retrieving information slows down with age.”

The 70s: Chronic Conditions Fester

Many folks in their mid-70s function as folks did in their mid-60s just a generation ago, said Gill. But this is the age when chronic conditions—like hypertension or diabetes or even dementia—often take hold. “A small percentage of people will enter their 70s without a chronic condition or without having some experiences with serious illness,” he said.

People in their 70s are losing bone and muscle mass, which makes them more susceptible to sustaining a serious injury or fracture in the event of a fall, Gill added.

Seventies is the pivotal decade for physical functioning, said Kritchevsky. Toward the end of their 70s, many people start to lose height, strength and weight. Some people report problems with mobility, he said, as they develop issues in their hips, knees or feet.

Most older people—including those in their 90s and beyond—are more satisfied with their lives than younger people are. 

At the same time, roughly half of men age 75 and older experience some sort of hearing impairment, compared with about 40 percent of women, said Kritchevsky, referring to a 2016 report from the Centers for Disease Control and Prevention. 

Another conundrum common to the 70s: people tend to take an increasing number of medications used for “preventive” reasons. But these medications are likely to have side effects on their own or in combination, not all of which are predictable, said Gill. “Our kidneys and liver may not tolerate the meds as well as we did earlier in life,” he said.

Perhaps the biggest emotional impact of reaching age 70 is figuring out what to do with your time. Most people have retired by age 70, said Reuben, “and the biggest challenge is to make your life as meaningful as it was when you were working.”

The 80s: Fear of Falling Grows

Fear of falling—and the emotional and physical blowback from a fall—are part of turning 80.

If you are in your 80s and living at home, the chance that you might fall in a given year grows more likely, said Kritchevsky. About 40 percent of folks 65 and up who are living at home will fall at least once each year, and about 1 in 40 of them will be hospitalized, he said, citing a study from the UCLA School of Medicine and Geriatric Research Education and Clinical Center. The study notes that the risk increases with age, making people in their 80s even more vulnerable.

By age 80, folks are more likely to spend time in the hospital—often due to elective procedures such as hip or knee replacements, said Gill, basing this on his own observations as a geriatric specialist. Because of diminished reserve capacities, it’s also tougher to recover from surgery or illnesses in your 80s, he said.

The 90s & Up: Relying on Others

By age 90, people have roughly a one-in-three chance of exhibiting signs of dementia caused by Alzheimer’s disease, said Gill, citing a Rush Institute for Healthy Aging study. The best strategy to fight dementia isn’t mental activity but at least 150 minutes per week of “moderate” physical activity, he said. It can be as simple as brisk walking.

At the same time, most older people—even into their 90s and beyond—seem to be more satisfied with their lives than are younger people, said Kritchevsky.

At 93, Joseph Brown understands this—despite the many challenges he faces daily. “I just feel I’m blessed to be living longer than the average Joe,” he said.

Brown lives with his 81-year-old companion, Marva Grate, in the same, single-family home that Brown has owned for 50 years in Hamden, CT. The toughest thing about being in his 90s, he said, is the time and thought often required to do even the simplest things. “It’s frustrating at times to find that you can’t do the things you used to do very easily,” he said. “Then, you start to question your mind and wonder if it’s operating the way it should.”

Brown, a former maintenance worker who turned 85 in May, said he gets tired—and out of breath—very quickly from physical activity.

He spends ample time working on puzzle books, reading and sitting on the deck, enjoying the trees and flowers. Brown said no one can really tell anyone else what “normal” aging is.

Nor does he claim to know himself. “We all age differently,” he said.

Brown said he doesn’t worry about it, though. “Before the Man Upstairs decides to call me, I plan to disconnect the phone.”

KHN’s coverage of these topics is supported by John A. Hartford Foundation, Gordon and Betty Moor Foundation and the Scan Foundation. 

Have You Outlived Your Old Friends?

Here’s how to make new ones as you age

Many people are living longer, healthier lives today, but there’s one drawback: you may outlive the old friends you always counted on. It’s harder to make new ones in your later years, but there are ways to do it, and journalist Bruce Horovitz rounds them up in this article for Kaiser Health News (KHN). It was posted on the KHN website on July 9, 2018, and also ran on USA Today.

Donn Trenner, 91, estimates that two-thirds of his friends are dead.

“That’s a hard one for me,” he said. “I’ve lost a lot of people.”

As baby boomers age, more and more folks will reach their 80, 90s—and beyond. They will not only lose friends but face the daunting task of making new friends at an advanced age.

Friendship in old age plays a critical role in health and well-being, according to recent findings from the Stanford Center on Longevity’s Sightlines Project. Socially isolated individuals face health risks comparable to those of smokers, and their mortality risk is twice that of obese individuals, the study notes.

Baby boomers are more disengaged [from] their neighbors and even their loved ones than any other generation, said Dr. Laura Carstensen, who is director of the Stanford Center on Longevity and herself a boomer, in her 60s. “If we’re disengaged, it’s going to be harder to make new friends,” she said.

Trenner knows how that feels. In 2017, right before New Year’s, he tried to reach his longtime friend Rose Marie, former actress and costar on the 1960s sitcom The Dick Van Dyke Show. Trenner traveled with Rose Marie as a pianist and arranger doing shows at senior centers along the Florida coast more than four decades ago.

“When we were performing, you could hear all the hearing aids screaming in the audience,” he joked.

The news that she’d died shook him to the core.

Although she was a friend who, he said, cannot be replaced, neither her passing nor the deaths of dozens of his other friends and associates will stop Trenner from making new friends.

That’s one reason he still plays, on Monday nights, with the Hartford Jazz Orchestra at the Arch Street Tavern in Hartford, CT.

Genuine friendships grow from repeated contacts. You don’t meet someone and immediately become best friends.

For the past 19 years, he’s been the orchestra’s pianist and musical conductor. Often, at least one or two members of the 17-piece orchestra can’t make it to the gig but must arrange for someone to stand in for them. As a result, Trenner said, he not only has regular contact with longtime friends but keeps meeting and making friends with new musicians—most of whom are under 50.

Twice divorced, he also remains good friends with both of his former wives. And not too long ago, Trenner flew to San Diego to visit his best friend, also a musician, who was celebrating his 90th birthday. They’ve known each other since they met at age 18 in the United States Army Air Corps. They still speak almost daily.

“Friendship is not [to] be taken for granted,” said Trenner. “You have to invest in friendship.”

Even in your 90s, the notion of being a sole survivor can seem surprising.

Perhaps that’s why 91-year-old Lucille Simmons of Lakeland, FL, halts, midsentence, as she traces the multiple losses of friends and family members. She has not only lost her two closest friends, but a granddaughter, a daughter, and her husband of 68 years. Although her husband came from a large family of 13 children, his siblings have mostly all vanished.

“There’s only one living sibling—and I’m having dinner with him tonight,” said Simmons.

Where to Find New Friends

Five years ago, Simmons left her native Hamilton, OH, to move in with her son and his wife in a gated, 55-and-over community midway between Tampa and Orlando. She had to learn how to make friends all over again. Raised as an only child, she said, she was up to the task.

Simmons takes classes and plays games [in] her community. She also putters around her community on a golf cart (which she won in a raffle), inviting folks to ride along with her.

For his part, Trenner doesn’t need a golf cart.

His personal formula for making friends is music, laughter and staying active. He makes friends whether he’s performing or attending music events or teaching.

Simmons has her own formula. It’s a roughly 50-50 split of spending quality time with relatives (whom she regards as friends) and nonfamily friends. The odds are with her. This, after all, is a woman who spent 30 years as the official registrar of vital statistics for Hamilton. In that job, she was responsible for recording every birth—and every death—in the city.

Experts say they’re both doing the right thing by not only remaining open to new friendships but constantly creating new ways to seek them out—even at an advanced age.

Genuine friendships at any age typically require repeated contact, said Dr. Andrea Bonior, author of The Friendship Fix: The Complete Guide to Choosing, Losing and Keeping Up with Your Friends (2011). She advises older folks to join group exercise classes or knitting or book clubs.

She also suggests that seniors get involved in “altruistic behavior,” like volunteering in a soup kitchen or an animal shelter or tutoring English as a second language.

It’s important to create support systems that don’t isolate you with your own generation.
–Alan Wolfelt

“Friendships don’t happen in a vacuum,” she said. “You don’t meet someone at Starbucks and suddenly become best friends.”

Perhaps few understand the need for friendship in older years better than Carstensen, who, besides directing the Stanford Center on Longevity, is author of A Long Bright Future: Happiness, Health and Financial Security in an Age of Increased Longevity (2009).

Carstensen said that going back to school can be one of the most successful ways for an older person to make a new friend.

Bonior recommends that seniors embrace social media. These social media connections can help older people strike up new friendships with nieces, nephews and even grandchildren, said Alan Wolfelt, an author, educator and founder of the Center for Loss and Life Transition.

“It’s important to create support systems that don’t isolate you with your own generation.”

Many older folks count their children as their best friends—and Carstensen said this can be a big positive on several levels.

“I don’t think it matters who your friends are,” she said. “It’s the quality of the relationship that matters most.”

KHN’s coverage related to aging and improving care of older adults is supported in part by The John A. Hartford Foundation.

They’ve Still Got Bucket Lists—in Their 90s

Is it ever too late to go after what you’ve always wanted?

Perhaps there are things you always hoped to do but never got around to, and now you’re thinking it’s too late. Maybe not. In this article for Kaiser Health News (KHN), journalist Bruce Horovitz interviews two women—both in their 90s—who got the chance to make their own long-ago wishes come true. KHN posted Horowitz’s piece on June 5, 2017; it also ran in USA Today.

It is one thing to have a bucket list at any age. It is something else entirely to have a bucket list that sends you to college for the first time at 92—or that sends you on your maiden flight at the controls of a single-engine airplane at 97.

These are the bucket list accomplishments of Cecile Tegler (92) and Mildred “Milly” Reeves (97). And neither of them is done yet.

“I never even thought about having a bucket list,” said Reeves, a resident at Mount View Assisted Living in Lockport, NY, who became familiar with the insides of airplanes in her 20s, when she was a small-parts inspector for Bell Aircraft during World War II. After the war ended, she stayed home and had seven daughters—so the notion of ever flying a plane solo grew increasingly distant.

Nor had Tegler, her friend and fellow resident at Mount View, ever created a real bucket list. What she did have, however, was an urge to go to college, since her folks—who had to support their own parents—didn’t have the money to pay for college when she was in her late teens. Both of Tegler’s daughters graduated from college, but she never imagined that she could go to college too.

Within the past year—because of unusual outreach efforts by staff at the assisted living community where they both live—Tegler attended a community college, where she finally learned how to use and operate a computer. And Reeves took the controls of an airplane and flew it, on her own, for about 15 minutes. Whether or not these are actual bucket list items, they are accomplishments that have spurred both women to set even more goals.

Young people dream and old people remember. The goal of the bucket list is to give them something to dream about.

— David Tosetto

It stands to reason that bucket lists—specific life goals to accomplish before dying—are more popular as Americans live longer and find they have more time on their hands.

Such goals don’t have to be about flying airplanes or entering college in your 90s. Sometimes, bucket lists that focus on helping others can be the most effective. That, at least, was the plot line of the 2007 film, The Bucket List, starring Jack Nicholson as an eccentric billionaire who finds himself sharing a hospital room with a car mechanic played by Morgan Freeman. Both men suffer terminal illnesses but opt to complete their lifetime bucket lists together—only to discover their new friendship tops the list.

“The best bucket lists aren’t usually about skydiving or climbing the Great Wall of China,” said Marc Agronin, a geriatric psychiatrist who is vice president for behavioral health and clinical research at Miami Jewish Health Systems in Miami. “Our bucket lists need to be in line with our core values.” He suggests that people simply look around and see the riches they have and the potential for adventure right in their own communities.

Reeves, whose grandson eagerly came along with her on her maiden flight to capture the moment on video, totally gets that. She said that she took as much—if not more—pleasure in her grandson coming along for the ride as she took in the moment when the captain of the plane handed her the controls. Reeves takes the greatest pride in her seven daughters, 12 grandchildren and 14 great-grandchildren.

Meanwhile, Tegler, who attended computer class three times weekly at Niagara County Community College in Niagara Falls, NY, learned how to use Microsoft Word and Excel software. She was among the first at Mount View to enroll at the college and has since inspired others to do the same. Among those now considering a return to college is her friend Reeves.

“I’ve helped many people in my life,” said Tegler, who expressed no fear or hesitation about attending college with a bunch of 20-somethings. Many students in the class helped her learn how to use the computer. When Tegler was younger, she said, she often volunteered at homes for veterans because her husband, father and brothers all served in the Army.

Quietly helping Reeves, Tegler and 266 other residents of two assisted living homes in upstate New York accomplish their bucket list goals is David Tosetto, who owns both Mount View and Cobb’s Hill Manor in Rochester, NY. “Young people dream and old people remember,” said Tosetto. “The goal of the bucket list is to give them something to dream about.”

The way Tosetto figures it, happy residents make for longer-term residents and happier employees. So he doesn’t charge them one penny extra for the bucket list outings. Besides the flying school and college opportunities, he’s also putting together a scuba diving class at a local pool and a kayaking adventure this summer.

When the trip of a lifetime ends, you still have the rest of your life to live. Your real legacy is about the people you touch along the way.

Marc Agronin

“The ultimate goal of this is to get them more involved in society and in the belief that they can still do things,” said Tosetto. He puts the programs into motion by posting large “Bucket List” signs around the two assisted living facilities that announce the opportunities and encourage residents to sign up.

Tosetto won’t sponsor some activities, such as skydiving. “I just don’t know how they can land safely,” he explained. “Of course, if they choose to do it on their own, that’s up to them.”

In the end, said Agronin, author of the book How We Age: A Doctor’s Journey into the Heart of Growing Old, your legacy isn’t about how many planes you’ve jumped out of or how many countries you’ve visited. “When the trip of a lifetime ends, you still have the rest of your life to live,” he said. Your real legacy is about the people you touch along the way. “The relationships you create and what you teach your children is how you build your legacy,” he said.

At 97, Reeves is still building hers.

Asked to name the lifetime accomplishment of which she’s most proud, it’s not the plane flight at all. “I’m still a Girl Scout,” she boasted, noting that she earned the Gold Award, scouting’s highest honor. “I still pay my dues.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.