Medical Students Learn How to Talk to Patients about Dying

They’re taught how to deliver bad news with compassion—or admit a mistake

Doctors are usually taught very little about how to deliver bad news to patients and their families, so they often do it badly. JoNel Aleccia describes how one medical school is changing that. She wrote her article for Kaiser Health News (KHN), where she’s a senior correspondent, focusing on aging and end-of-life issues. KHN posted her article on March 13, 2018. It also ran in U.S. News & World Report.

The distraught wife paced the exam room, anxious for someone to come and tell her about her husband. She’d brought him to the emergency department that afternoon when he complained about chest discomfort.

Sophia Hayes, 27, a fourth-year medical student at the Oregon Health & Science University (OHSU), entered with a quiet knock, took a seat and asked the wife to sit too.

Softly and slowly, Hayes explained the unthinkable: the woman’s husband had had a heart attack. His heart stopped. The intensive care team spent 45 minutes trying to save him.

Then Hayes delivered the news dreaded by doctors and family members alike.

“I’m so, so sorry,” she said. “But he died.”

The drama, played out on a recent Friday afternoon, was a scene staffed by actors and recorded by cameras, part of a nerve-wracking exam for Hayes and 143 other would-be doctors. OHSU officials say they’re the first medical students in the United States required to pass a tough, new test in compassionate communication.

By graduation this spring, Hayes and her colleagues must be able to show that, in addition to clinical skills, they know how to admit a medical mistake, deliver a death notice and communicate effectively about other emotionally and ethically fraught issues.

It’s a push started in the last two years by Susan Tolle, MD, director of the OHSU Center for Ethics in Health Care, who wants to improve the way doctors talk to patients, especially in times of crisis.

How Doctors Go Wrong

Tolle has seen doctors who don’t make eye contact, those who spout medical jargon and still others who appear to lack basic compassion for patients and their families.

“They’ll stand in the doorway and say something like, ‘You need to call a funeral home,’” Tolle said.

Part of the problem is that, in the past, aspiring doctors were taught too little, too late about difficult communication and its nuances, said Tolle.

“My generation of faculty were not taught,” she said. “I had history-taking, but it was more about, ‘How long have you had chest pain?’ I did not have [instruction in] how to give bad news.”

Bad news, badly delivered, can have far-reaching effects on family.

At Tolle’s urging, the OHSU officials revamped the medical school curriculum to include new lessons in—and standards for—communication, ethics and professionalism woven through the course work, said Dr. George Mejicano, the senior associate dean for education.

“Most of the emphasis has been on the simplest aspects of communication,” he said. “The whole idea here is, how do you tell someone they have a life-threatening or even a fatal illness? How do you tell someone, ‘I’ve actually made a mistake?’”

OHSU isn’t the only center to focus on communication. All medical schools and residency programs in the United States are required to include specific instruction in communication skills to gain accreditation, according to Lisa Howley, senior director of strategic initiatives and partnerships for the Association of American Medical Colleges, or AAMC. Residents are required to prove competency in order to graduate from training and be eligible for board certification for individual practice. And there’s been a larger effort nationwide to help practicing doctors learn to talk to patients about dying.

But Mark Siegler, MD, director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, who closely follows communication issues, said he believes OHSU’s approach is new.

“So far as I know, there is no other school in the United States that has any such standard,” said Siegler. “No other program has both a teaching effort and an evaluation effort.”

What Happens When Students Fail

Hayes, the OHSU medical student, said she and her fellow students were nervous before the recent exam. But the practice with “standardized patients”—actors trained to portray people undergoing medical care—was crucial to understanding the right way to talk to families in a real-world situation.

“You realize you have this horrible information they don’t have yet,” she said.

Hayes did quite well and passed the test, Tolle said. So did most of the other OHSU medical students. But several—she wouldn’t say exactly how many—will need remedial coaching and testing before graduation.

Some of those students failed to introduce themselves properly or to find out what the family member had already been told, Tolle said. Instead, they bluntly announced they had bad news and quickly added that the patient was dead.

“You watched the screen and it looked like you hit [the spouse] with a truck,” Tolle said. “It comes across as incredibly uncaring.”

Med school faculty will also be offered a chance to learn how to communicate compassionately.

In real life, such botched conversations can have far-reaching effects. Mary George-Whittle was just 24 when her father had emergency, open-heart surgery in 1979. When the surgeon emerged from the operating room to face the family, his message was jarring.

“He blurted out that Dad had died, that he had too little to work with, that Dad’s veins were like working with the veins of a turkey,” recalled George-Whittle, now 63 and retired after a career as a chaplain in Oregon. “He told us he had Dad’s blood all over him.”

Nearly 40 years later, she and her 11 siblings can still remember the shock.

“The impact that that still has is like PTSD,” she said. “The experience gets caught up in how poorly the news was given.”

Changing the Medical Culture

This year’s test is a first step, Tolle said. It will be reviewed and refined for future classes. Students who need help will get it. At the same time, OHSU faculty will be offered sessions to help improve their communication skills so they can model what students are taught.

The long-term goal is to raise the bar across the profession, said Tolle, who’s had some practice shifting paradigms. She’s the co-creator of the Physician Orders for Life-Sustaining Treatment, known as POLST, a document credited with revolutionizing end-of-life instructions across the United States.

In the same way, Tolle said, the culture of communication among doctors can change too, starting with the latest generation.

“Our biggest goal is not to do a kind of ‘gotcha’ thing for the current medical students,” she said. “It’s to find where the pieces are missing.”

KHN’s coverage of these topics is supported by Gordon and Betty Moore Foundation and John A. Hartford Foundation.

Family Caregivers Are Older Than Ever

People in their 60s and 70s are caring for parents who are 80 and up

Perhaps it was inevitable: with so many people living longer, more and more empty nesters are taking on the care of parents who are frail and ill. Journalist Judith Graham explores what that means for the younger generation in terms of their health, finances and plans for retirement. She wrote her article for Kaiser Health News, and it was posted on KHN’s website on August 23, 2018.

“This won’t go on for very long,” Sharon Hall said to herself when she invited her elderly mother, who’d suffered several small strokes, to live with her.

That was five years ago, just before Hall turned 65 and found herself crossing into older age.

In the intervening years, Hall’s husband was diagnosed with frontotemporal dementia and forced to retire. Neither he nor Hall’s mother, whose memory had deteriorated, could be left alone in the house. Hall had her hands full taking care of both of them, seven days a week.

As life spans lengthen, adult children like Hall in their 60s and 70s are increasingly caring for frail, older parents—something few people plan for.

“When we think of an adult child caring for a parent, what comes to mind is a woman in her late 40s or early 50s,” said Lynn Friss Feinberg, senior strategic policy adviser for AARP’s Public Policy Institute. “But it’s now common for people 20 years older than that to be caring for a parent in their 90s or older.”

A new analysis from the Center for Retirement Research at Boston College is the first to document how often this happens. It found that 10 percent of adults ages 60 to 69 whose parents are alive serve as caregivers, as do 12 percent of adults age 70 and older.

I had plans for my retirement …Instead, I don’t take time off and leave my mother. A big thing I deal with is the loss of my freedom.
–Judy Last

The analysis is based on data from 80,000 interviews (some people were interviewed multiple times) conducted from 1995 to 2010 for the Health and Retirement Study. About 17 percent of adult children care for their parents at some point in their lives, and the likelihood of doing so rises with age, it reports.

That’s because parents who’ve reached their 80s, 90s or higher are more likely to have chronic illnesses and related disabilities and to require assistance, said Alice Zulkarnain, co-author of the study.

Problems Older Caregivers Face

The implications of later-life caregiving are considerable. Turning an elderly parent in bed, helping someone get into a car or waking up at night to provide assistance can be demanding on older bodies, which are more vulnerable and less able to recover from physical strain.

Emotional distress can aggravate this vulnerability. “If older caregivers have health problems themselves and become mentally or emotionally stressed, they’re at a higher risk of dying,” said Richard Schulz, a professor of psychiatry at the University of Pittsburgh, citing a study he published in the Journal of the American Medical Association.

Socially, older caregivers can be even more isolated than younger caregivers. “In your 60s and 70s, you may have recently retired and friends and family members are beginning to get sick or pass away,” said Donna Benton, research associate professor of gerontology and director of the Family Caregiver Support Center at the University of Southern California (USC).

Caregiving at an older age can put hard-earned savings at risk with no possibility of replacing them by re-entering the workforce. Yvonne Kuo, a family care navigator at USC’s caregiver support center, has been helping an 81-year-old woman caring for her 100-year-old mom with vascular dementia in this situation.

“There’s no support from family, and she’s used up her savings getting some paid help. It’s very hard,” Kuo said.

Judy Last, 70, a mother of three adult children and grandmother of six youngsters, lives with her mother, Lillian, 93, in a mobile home park in Boise, ID. Last moved in three years ago, after her mother had a bout of double pneumonia, complicated by a difficult-to-treat bacterial infection that put her in the hospital for eight weeks.

She cared for her parents for years. She didn’t know how to ask for help and no one volunteered it, even when her husband was diagnosed with dementia.

“You don’t know if it’s going to be permanent at the time,” said Last, whose father died of dementia in January 2016 after moving to a memory-care facility. “Mom had asked me several years before if I would be there when she needed help and I told her yes. But I didn’t really understand what I was getting into.”

Feinberg said this isn’t uncommon. “People in their 90s with a disability can live for years with adequate support.”

Last doesn’t find caregiving physically difficult even though she’s had two hip replacements and struggles with arthritis and angina. Her mother has memory problems and chronic obstructive pulmonary disease, relies on oxygen, uses a walker, has lost most of her hearing and has poor eyesight.

But things are hard, nonetheless. “I had plans for my retirement: I imagined volunteering and being able to travel as much as my bank account would allow,” Last said. “Instead, I don’t take time off and leave my mother. A big thing I deal with is the loss of my freedom.”

Hall, who’s turning 70 in September and who lives in Cumming, GA, managed her mother’s and husband’s complex needs for years by establishing a strict routine. Monday and Friday they went to a dementia respite program from 10 a.m. to 3 p.m. On other days, Hall cooked, shopped, did laundry, helped them with personal tasks, made sure they were well occupied, provided companionship and drove them to medical appointments, as necessary.

“I did not expect this kind of life,” said Hall, who has had two knee replacements and a broken femur. “If someone had told me it would be years caring for my mother and your husband is going to get dementia, I would have said, ‘No, just no.’ But you do what you have to do.”

A few weeks after our conversation, Hall’s mother entered hospice following a diagnosis of aspiration pneumonia and life-threatening swallowing difficulties. Hall said she has welcomed the help of hospice nurses and aides, who ask her at each visit, “Is there anything else you need from us that would make it easier for you?”

Where Caregivers Find Support

Though older caregivers get scant attention, resources are available. Over the years, Hall has shared caregiving ups and downs at—a significant source of information and comfort. Across the country, local chapters of Area Agencies on Aging run caregiver support programs, as do organizations such as the Caregiver Action Network, the Family Caregiver Alliance, the National Alliance for Caregiving and Parenting Our Parents, an outfit focused on adult children who become caregivers. A helpful list of resources is available here.

Sometimes, caring for a parent can be a decades-long endeavor. In Morehead City, NC, Elizabeth “Lark” Fiore, 67, became the primary caregiver for her parents when they moved around the corner from her, in a mobile home park, in 1999.

“My dad took me for a walk one day and asked if I could look after them as they got older and I said yes. I’m the oldest child and the oldest assumes responsibility,” she said.

For years her father—a difficult man, by Fiore’s account—had heart problems; her mother had a nervous breakdown and a slow, extended recovery. “They wanted me to be in their lives and I wanted to do for them—I’m a Christian—but it was killing me. My heart was in the right place but emotionally, I was a wreck,” Fiore said.

After her father’s death from kidney cancer in 2010, her mother became even more needy, and Fiore found herself spending more time responding to calls for assistance—often about suspected medical emergencies. “My mom had a way of acting as if something was horribly wrong and then it turned out it wasn’t,” she explained.

Fiore’s health isn’t good: she says she has chronic fatigue syndrome and thyroid problems, among other issues. But she didn’t know how to ask for help and no one volunteered it, even when her husband, Robert, was diagnosed six years ago with dementia. “I always expected myself to handle everything,” she said.

Finally, the stress became unbearable last year and Fiore’s mother moved to a senior living community close to Fiore’s 62-year-old sister, 400 miles away. Now, Fiore spends more time attending to her husband’s needs and tries to support her sister as best she can.

“At 90, my mom is healthy as a horse, and I’m glad of that but it’s been a long time caring for her,” she said. “I’ve changed a lot as a result of caregiving: I’m more loving, more aware of people who are suffering. I’ve found out that I am willing to go the extra mile. But I have to admit what I feel is tired—just tired.”

KHN’s coverage of these topics is supported by John A. Hartford Foundation and Gordon and Betty Moore Foundation.

The New Shingles Shot: Much More Effective Than the Old One

If you skip it, you could develop a painful and all-too-common disease

Shingrix, the new shingles vaccine, is so much better than the old one that medical experts are urging people who have already had the old vaccine to be revaccinated with Shingrix. But will their advice fall on deaf ears? Many older people fail to have the preventive shots that are available to them. Journalist Michelle Andrews digs into the reasons why in this article written for Kaiser Health News (KHN). The article also ran on NPR. KHN posted it on March 20, 2018.

Federal officials have recommended a new vaccine that is more effective than an earlier version at protecting older adults against the painful rash called shingles. But persuading many adults to get this and other recommended vaccines continues to be an uphill battle, physicians and vaccine experts say.

“I’m healthy, I’ll get that when I’m older,” is what adult patients often tell Michael Munger, MD, when he brings up an annual flu shot or a tetanus-diphtheria booster or the new shingles vaccine. Sometimes they put him off by questioning a vaccine’s effectiveness.

“This is not the case with childhood vaccines,” said Munger, a family physician in Overland Park, KS, who is president of the American Academy of Family Physicians. “As parents, we want to make sure our kids are protected. But as adults, we act as if we’re invincible.”

The new schedule for adult vaccines for people age 19 and older was published in February 2018 following a recommendation [the previous] October by the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and subsequent approval by the director of the CDC. The most significant change was to recommend the shingles vaccine that was approved by the Food and Drug Administration last fall, over an older version of the vaccine.

As you age, you’re more likely to develop shingles, and it’s more likely to create chronic problems for you.

The new vaccine, Shingrix, should be given in two doses between two and six months apart to adults who are at least 50 years old. The older vaccine, Zostavax, can still be given to adults who are 60 or older, but Shingrix is preferred, according to the CDC. In clinical trials, Shingrix was 96.6 percent effective in adults ages 50 to 59, while Zostavax was 70 percent effective. The differences were even more marked with age: effectiveness in adults 70 and older was 91.3 percent for Shingrix, compared with 38 percent for Zostavax. Shingrix also provided longer-lasting protection than Zostavax, whose effectiveness waned after the first year.

The guidelines suggest that people who already had the Zostavax shot be revaccinated with Shingrix.

The two-shot series of Shingrix costs about $280, while Zostavax runs $213.

“What’s remarkable [about the new vaccine] is that the high level of immunity persists even in the very old,” said Anne Louise Oaklander, MD, PhD, a neurologist who is an expert on shingles. “It’s pretty hard to get the immune system of older people excited about anything.”

Shingles is caused by the same varicella-zoster virus that causes chickenpox. The virus can re-emerge decades after someone recovers from chickenpox, often causing a painful rash that may burn or itch for weeks before it subsides. About one in three Americans will get shingles during their lifetime; there are roughly one million cases every year. People are more likely to develop shingles as they age, as well as develop complications like postherpetic neuralgia, which can cause severe, long-standing pain after the shingles rash has disappeared. In rare cases, shingles can lead to blindness, hearing loss or death.

Why Don’t More Older People Get Recommended Shots?

Although shingles vaccination rates have inched upward in recent years, only a third of adults who were 60 or older received the Zostavax vaccine in 2016.

Other adult vaccine coverage rates are low as well: 45 percent for the flu vaccine and 23 percent each for pneumococcal and tetanus-diphtheria-pertussis vaccines.

In contrast, by the time children are three years old, typically more than 80 percent of kids, and frequently more than 90 percent, have received their recommended vaccines.

What gives? Cost can be a big deterrent for adult vaccines. The federal Vaccines for Children program helps parents whose kids are eligible for Medicaid or are uninsured cover the cost of vaccines up to age 19.

Adults with private insurance who get vaccines recommended by the CDC also are sheltered from high costs because the shots must be covered by most commercial plans without charging consumers anything out-of-pocket, under a provision of the Affordable Care Act. Patients, however, should confirm their coverage before requesting the new shingles vaccine, because insurers typically add new vaccines gradually to their formularies after they have been added to the recommended list, and consumers may need to wait a little while for coverage.

Older adults sometimes lose track of which vaccines they’ve had, and sometimes there’s no record of what they’ve been given.  

But vaccine coverage under the Medicare program for people age 65 and older is much less comprehensive. Vaccines to prevent influenza and pneumonia are covered without a copayment under Medicare Part B, which covers outpatient care.

Other vaccines, including the shingles vaccine, are typically covered under Part D drug plans, which may leave some beneficiaries on the hook for all or part of the cost of the two-shot series.

That can pose a significant problem for patients. “Not every Medicare beneficiary elects Part D, and even if you do, some have deductibles and copayments,” said William Schaffner, MD, an infectious-diseases specialist at Vanderbilt University School of Medicine.

Even if adults want to get recommended vaccines, they sometimes lose track of which they have received and when. Pediatricians routinely report the vaccines they provide to state or city vaccination registries that electronically collect and consolidate the information. But the registries are not widely used for adults, who are more likely to get vaccines at various locations, such as a pharmacy or at work, for example.

“I’m always asking patients, ‘Did you get all the doses in the series?’ ‘Where did you get them?’” said Laura Riley, MD, vice chair of obstetrics at Boston’s Massachusetts General Hospital, who is a member of the Advisory Committee on Immunization Practices. “It can be very challenging to track.”

What Spirituality Means to Older People

It can provide a sense of purpose and connection—and a great deal more

This is part 1 in our series on spirituality and aging. Read part 2 here.

For many years, the Catholic faith was central to Debra Cook’s life. She grew up in a Catholic family, sent her children to Catholic schools and was an active leader in her parish. 

But now Cook, 65, of Dallas, finds herself looking beyond the walls of her church as she gets older. In recent years, her parish shifted toward a more conservative understanding of Catholicism; meanwhile, Cook’s beliefs have become increasingly more expansive.

She stopped going to mass every week, a step that once would’ve been unthinkable. Instead, she spends an hour outdoors early each morning, quietly observing nature. Cook completed an ecumenical Christian formation program that prepares participants as spiritual leaders or spiritual directors. This fall, she’ll lead a study program called the Soul of Aging, which deals with issues involved with aging but offers no specific religious doctrine.

 “I still view myself as a Jesus follower,” she said. “But my view of God has gotten so much bigger. I’ve realized there’s more out there that I don’t understand.”

Like Cook, many older adults say spirituality is an essential source of wisdom and guidance that not only helps them to cope with the challenges of aging but also to live more consciously, with a sense of wholeness and purpose.  

“Older people want meaning,” said Michael Gurian, author of The Wonder of Aging: A New Approach to Embracing Life After Fifty (2013). As people live longer lives, “we have the freedom now, in a miraculous second lifetime, to soul-search and soul-find.”

Spirituality, he adds, can help people cultivate the “realistic optimism” that will help them better navigate later life.  

Spiritual but Not Religious

The assumption that people become more religious as they age and confront their mortality is generally regarded as a myth among professionals who work with older adults, according to Holly Nelson-Becker, author of Spirituality, Religion and Aging: Illuminations for Therapeutic Practice (2018). Similarly, there’s no research that suggests an overall trend of people becoming more spiritual as they age. Older adults do represent the most religious demographic group in the United States, but Nelson-Becker suspects that’s because members of the older generations grew up when it was more common for people to participate in an organized religion.  

“What we do know is that people’s religious and spiritual trajectories change over time in many ways,” Nelson-Becker said. “People get enthusiastic, motivated, discouraged, and become more spiritual, more religious, less so, and otherwise in and out.”  

Some, like Cook, find themselves veering away from religion and into a growing segment of the population that demographers call the “SBNRs”—spiritual, but not religious. Defining exactly what that means, however, has posed a challenge.

‘Spirituality’ means different things to different people.

“Religion includes ethical principles, rituals, beliefs and practices, transmitted over time and shared by a community,” said Nelson-Becker. “The definitions of spirituality vary far more widely. Spirituality is a somewhat fuzzy concept that means different things to different people.”  

Nelson-Becker was part of an interdisciplinary team of 50 experts that developed standards of spiritual care in palliative care. They hammered out this definition: “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.”  

Life Changes Spur Shifts

Many who embrace spirituality later in life say they were spurred at least in part by changes in their life circumstances. After retirement, or a shift to part-time work, or fewer family responsibilities, they have more time for reflection.

“When you’re in your 30s, it’s all about go, go, go and get, get, get,” said Debby Thomas, 67, a real estate agent in Garland, TX. “Once you get older, those are not necessarily your top priorities.”

Thomas grew up in a Protestant church and converted to Judaism when she married in her 20s. When her marriage ended, she fell away from religion entirely. In her mid-50s, she discovered Unity Church of Dallas, a New Thought church that prescribes no doctrine but views Christian teachings as a practical path to health and happiness.

Thomas believes that maturity makes her more accepting and open to new ways of expressing her spiritual beliefs.

“When I was young, I was too busy arguing with [the church’s] dogma,” she said. “When you get older, you make it more personal, rather than trying to change the world to match your beliefs.”

Foundation for Living Longer and Healthier

One nationwide study of more than 1,000 obituaries found that people with religious affiliations lived nearly four years longer than those with no ties to religion, even after adjusting for other factors, such as gender and marital status. But researchers caution that it’s virtually impossible to separate the benefits of religion from related factors, such as the social connections among people in faith communities.

Anne Sadovsky, 77, is clear that the social and the spiritual, together, have enriched her life. A motivational speaker and real estate expert in Dallas, she’s benefited from the social support of “the Dalai Mamas,” a prayer circle of seven older women, ages 62-78, that’s been together for more than 10 years.

The women meet for birthdays and holidays, but the glue that bonds them is prayer. Via email, they share prayer requests for themselves and others. Often, they will schedule a time when they all pray at once, wherever they are, for a specific need. Originally the women met at Unity Church of Dallas, where Sadovsky is a member, but the group stayed together even after some moved to other churches.

“When the husband of one of the women died, we were all right there,” Sadovsky said. “I had major back surgery, and they were there for me. One stayed with me at the rehab facility and gave me my first shower after surgery.”    

Each woman prays according to her own understanding, Sadvosky said, but following Unity principles, they don’t see prayer as “begging or pleading” so much as a way to connect with divine energy.

“It’s a very powerful, loving support group,” she said. “Word has spread that our prayers are powerful; people we don’t even know will [ask for prayers].”

Some spiritual practices may have health benefits. Meditation, for example, may help reduce blood pressure.

Being a part of a group like the Dalai Mamas may have a positive impact on health. While the number of studies examining the links between religion, spirituality and health is mushrooming, according to Nelson-Becker, “The findings are difficult to align because they look at different factors, control for different factors, and ask slightly different questions.” While there appears to be a correlation, there’s no proof of a cause-and-effect relationship.

Some spiritual traditions do explicitly encourage adherents to avoid unhealthy behaviors. In exploring longevity hotspots, Dan Buettner identified a community of centenarians in Loma Linda, CA, in his book, The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest (2008). Many were Seventh Day Adventists, who don’t smoke, follow a plant-based diet, exercise regularly and maintain a normal body weight.  

Research also suggests that some specific spiritual practices, such as yoga, and meditation or prayer, may have health benefits. Meditation, for example, may help reduce blood pressure or relieve some menopausal symptoms, like hot flashes.

The Wonder of Aging author Gurian, 65, spends an hour each morning meditating in nature. He’s a practicing Jew but has lived around the world, and his spirituality draws on elements of many other religions, including Baha’i, Hinduism, Unitarianism and Christianity.  

“I think genuine happiness can come from having a spiritual practice,” he said. “As mind and body connect, that helps some people to end an addiction or to eat more healthfully. Also, there is something happening in the brain as people do spiritual practices. Spiritual practices direct more blood toward the temporal lobe, and that is good for de-stressing.”

Art as Spiritual Practice

Spiritual expression can range from communal activities like worship, scripture study or prayer, to personal practices such as journaling, meditating or spending time in nature.  

For Donna Bearden, 71, her spiritual practice centers on art and learning. She’s married to a retired United Methodist pastor but describes herself as spiritual but not religious.

“My spirituality could not develop within the church,” she said. “I believe a spiritual journey has to involve doubt, searching, asking hard questions. I couldn’t ask those questions without raising eyebrows.”

Bearden expresses her spirituality through art, writing and photography. She starts each morning writing in a journal and often heads outside with camera in hand. She’s fascinated by mandalas—a circular symbol in Hinduism and Buddhism that represents the universe—and creates them with the photos she’s taken.

“There is a zone artists and poets and other creatives talk about, the idea that words or an artist’s creation comes not from them but through them,” she said. “I have felt that zone, that connection to something greater than I.”

A Sense of Purpose

If there’s a link between spirituality and longevity, it might be ikigai (“what makes one’s life meaningful”), a Japanese term that Buettner cites in his work. Many faiths teach concepts of intrinsic human purpose that don’t require a youthful body or a sharp intellect: tikkun olam, the Jewish calling to repair the world; the Christian teaching of serving others; or the Buddhist idea of the bodhisattva, a person who chooses to strive for Buddhahood for the benefit of all sentient beings. Spiritual practices, such as meditation, can help people clarify and focus on their sense of higher calling.

Spirituality can also help older people turn outward when loss or physical limitations could easily spur them to turn inward, according to Missy Buchanan, author of Living with Purpose in a Worn-Out Body: Spiritual Encouragement for Older Adults (2008).  

“It’s the belief that ‘I’m here for a reason,’” Buchanan said. “Maybe I hurt today, but I can still do something good for somebody.”

For Cook, her work as a spiritual group leader provides a new sense of purpose and direction. In earlier years, she focused on career, raising kids, status and money—her family once lived in an 8,400 square foot home (“Isn’t that ridiculous?” she said). Those things don’t define her anymore.

“Now it’s about living a life in accord with who I was created to be,” she said. “The work I’m doing in spirituality is life-giving.”

At Death’s Door, Shedding Light on How to Live

Ronni Bennett, who blogs about aging, records her thoughts and emotions as she grapples with a terminal illness

In a moving interview, Bennett describes what’s it like to be told you’re dying of cancer. Talking with journalist Judith Graham of Kaiser Health News (KHN), she discusses how knowing that she’s terminally ill has changed her, how she’s coping and why she’s sharing her reactions and the final chapter of her life with the many people who regularly read her blog. This article was developed in part with support from the Silver Century Foundation. KHN posted it on November 8, 2018.

Nothing so alters a person as learning you have a terminal illness.

Ronni Bennett, who writes a popular blog about aging, discovered that recently when she heard that cancer had metastasized to her lungs and her peritoneum (a membrane that lines the cavity of the abdomen).

There is no cure for your condition, Bennett was told by doctors, who estimated she might have six to eight months of good health before symptoms began to appear.

Right then and there, this 77-year-old resolved to start doing things differently—something many people might be inclined to do in a similar situation.

No more extended exercise routines every morning, a try-to-stay-healthy activity that Bennett had forced herself to adopt but disliked intensely.

No more watching her diet, which had allowed her to shed 40 pounds several years ago and keep the weight off, with considerable effort.

No more worrying about whether memory lapses were normal or an early sign of dementia—an irrelevant issue now.

No more pretending that the cliché “we’re all terminal” (since death awaits all of us) is especially insightful. This abstraction has nothing to do with the reality of knowing, in your gut, that your own death is imminent, Bennett realized.

“It colors everything,” she told me in a long and wide-ranging conversation recently. “I’ve always lived tentatively, but I’m not anymore because the worst has happened—I’ve been told I’m going to die.”

No more listening to medical advice from friends and acquaintances, however well-intentioned. Bennett has complete trust in her medical team at Oregon Health & Science University, which has treated her since diagnosing pancreatic cancer last year. She’s done with responding politely to people who think they know better, she said.

And no more worrying, even for a minute, what anyone thinks of her. As Bennett wrote in a recent blog post, “All kinds of things … fall away at just about the exact moment the doctor says, ‘There is no treatment.’”

Four or five times a day, a wave of crushing fear washes through her, Bennett told me. She breathes deeply and lets it pass. And no, psychotherapy isn’t something she wants to consider.

“What has been most helpful and touched me most are the friends who are willing to let me talk about this.”

–Ronni Bennett

Instead, she’ll feel whatever it is she needs to feel—and learn from it. This is how she wants to approach death, Bennett said: alert, aware, lucid. “Dying is the last great adventure we have—the last bit of life—and I want to experience it as it happens,” she said.

Writing is, for Bennett, a necessity, the thing she wants to do more than anything during this last stage of her life. For decades, it’s been her way of understanding the world—and herself.

In a notebook, Bennett has been jotting down thoughts and feelings as they come to her. Some she already has shared in a series of blog posts about her illness. Some she’s saving for the future.

There are questions she hasn’t figured out how to answer yet.

“Can I still watch trashy TV shows?”

“How do I choose what books to read, given that my time is finite?

“What do I think about [rational] suicide?” (Physician-assisted death is an option in Oregon, where Bennett lives.)

Along with her “I’m done with that” list, Bennett has a list of what she wants to embrace.

Ice cream and cheese, her favorite foods.

Walks in the park near her home.

Get-togethers with her public affairs discussion group.

A romp with kittens or puppies licking her and making her laugh.

A sense of normalcy, for as long as possible. “What I want is my life, very close to what it is,” she explained.

Deep conversations with friends. “What has been most helpful and touched me most are the friends who are willing to let me talk about this,” she said.

Dozens of readers have responded with shock, sadness and gratitude for Bennett’s honesty.

On her blog, she has invited readers to “ask any questions at all” and made it clear she welcomes frank communication.

“I’m new to this—this dying thing—and there’s no instruction book. I’m kind of fascinated by what you do with yourself during this period, and questions help me figure out what I think,” she told me.

Recently, a reader asked Bennett if she was angry about her cancer. No, Bennett answered. “Early on, I read about some cancer patients who get hung up on ‘why me?’ My response was ‘why not me?’ Most of my family died of cancer, and 40 percent of all Americans will have some form of cancer during their lives.”

Dozens of readers have responded with shock, sadness and gratitude for Bennett’s honesty about subjects that usually aren’t discussed in public.

“Because she’s writing about her own experiences in detail and telling people how she feels, people are opening up and relaying their experiences—things that maybe they’ve never said to anyone before,” Millie Garfield, 93, a devoted reader and friend of Bennett’s, told me in a phone conversation.

Garfield’s parents never talked about illness and death the way Bennett is doing. “I didn’t have this close communication with them, and they never opened up to me about all the things Ronni is talking about,” she said.

For the last year, Bennett and her former husband, Alex Bennett, have broadcast video conversations every few weeks over YouTube. (He lives across the country in New York City.) “What you’ve written will be valuable as a document of somebody’s life and how to leave it,” he told her recently as they talked about her condition with poignancy and laughter.

Other people may have very different perspectives as they take stock of their lives upon learning they have a terminal illness. Some may not want to share their innermost thoughts and feelings; others may do so willingly or if they feel other people really want to listen.

During the past 15 years, Bennett chose to live her life out loud through her blog. For the moment, she’s as committed as ever to doing that.

“There’s very little about dying from the point of view of someone who’s living that experience,” she said. “This is one of the very big deals of aging and, absolutely, I’ll keep writing about this as long as I want to or can.”

KHN’s coverage of these topics is supported by John A. Hartford Foundation, Gordon and Betty Moore Foundation and The Silver Century Foundation.

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.

“While many see our aging society as a problem, we view it as a solution,” says’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, 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,”’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’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 “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, 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 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

“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.”

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.

Everything You Need to Know about the New Medicare Cards

They’re designed to prevent identity theft, but fresh scams keep cropping up

Journalist Judith Graham pulls together what you need to know about the new Medicare cards that are being mailed out now to replace the old ones. She’s a contributing columnist for Kaiser Health News (KHN), which posted her article on March 15, 2018.

In April, the government [started] sending out new Medicare cards, launching a massive, yearlong effort to alter how 59 million people enrolled in the federal health insurance program are identified.

Historically, Medicare ID cards have been stamped with the Social Security numbers of members—currently, about 50 million seniors and 9 million people with serious disabilities. But that’s been problematic: if a wallet or purse were stolen, a thief could use that information, along with an address or birthdate on a driver’s license, to steal someone’s identity.

For years, phone scammers have preyed on older adults by requesting their Medicare numbers, giving various reasons for doing so. People who fall for these ruses have found bank accounts emptied, Social Security payments diverted or bills in their mailboxes for medical services or equipment never received.

The new cards address these concerns by removing each member’s Social Security number and replacing it with a new, randomly generated, 11-digit “Medicare number” (some capital letters are included). This will be used to verify eligibility for services and for billing purposes going forward.

What to Expect and When

Such a major change can involve bumps along the way, so there will be a transition period during which you can use either your new Medicare card or your old card at doctors’ offices and hospitals. Both should work until Dec. 31, 2019.

If you forget your new card at home, your doctor’s staff should be able to look up your new Medicare number at a secure computer site. Or they can use information that’s already on file during the transition period.

“We’ve had a few people contact us and ask, ‘If I don’t have the new card at a doctor’s appointment, does that mean my provider won’t see me?’” said Casey Schwartz, senior counsel for education and federal policy at the Medicare Rights Center. “That shouldn’t be an issue.”

Cards will be sent to people covered by Medicare on a rolling basis over a 12-month period ending in April 2019. Older adults in Alaska, California, Delaware, the District of Columbia, Hawaii, Oregon, Pennsylvania, Virginia and West Virginia [were] the first to receive the mailings, between April and June, along with several US territories—American Samoa, Guam and the Northern Mariana Islands.

The last wave of states will be Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio and Tennessee, along with Puerto Rico and the Virgin Islands.

“If your sister who lives in another state gets her card before you, don’t fret,” the Federal Trade Commission explained in a new alert. Since the cards are going out in waves, “your card may arrive at a different time than hers.”

If you think Social Security might not have your current address, call 1-800-772-1213 or check your online Social Security account at, the FTC advised.

New Cards, New Scams

When you get your new Medicare card, don’t throw your old one in the trash. Instead, put it through a shredder or “spend time cutting it up with a pair of scissors” to make sure the part showing your Social Security number is destroyed, said Amy Nofziger, a fraud expert for AARP.

Those numbers remain sought after by scammers, and AARP and Senior Medicare Patrol groups tell of receiving fraud reports related to Medicare cards since last year.

In one scam, reported by California’s Area 1 Agency on Aging, a caller purporting to represent Medicare or another government agency claims to need your bank account information so Medicare can arrange a direct deposit of funds into your account. The new Medicare cards are used as an excuse for the call.

In another, circulating in Iowa, scammers are threatening to cancel seniors’ health insurance if they don’t give out their current Medicare card numbers. “We’re telling people, don’t ever give someone this number—just hang up,” said Nancy Ketcham, elder rights specialist at the Elderbridge Agency on Aging, which serves 29 counties in northwestern Iowa.

A month ago, Alfonso Hernandez, 65, who lives in Moreno Valley, CA, received a call from a man who told him, in Spanish, that Medicare was going to issue new cards and that he needed to verify some information, including Hernandez’s name, address and Social Security number.

“I said no, normally, I don’t give my Social Security number to anyone,” Hernandez said. At that point, the caller put his “supervisor” on the phone, who said the government needed to make sure it had correct information. Caught off guard, Hernandez recited his Social Security number and, “as soon as I did that, they hung up.”

“Immediately, I’m like, ‘Oh my God, what did I do?’” said Hernandez, who quickly contacted credit agencies to have them put an alert on his account. “I just keep praying that nothing happens.”

Medicare will never phone you or email you to ask for your Medicare number, old or new, but scammers may.

Just last week, California’s Senior Medicare Patrol program received a report of another scam detected in Riverside County: a caller claiming that before a senior can get a new Medicare card, he or she has to pay $5 to $50 for a new “temporary” card, according to Sandy Morales, a case manager with the program.

Nofziger of AARP said a Medicare representative will never contact an older adult by phone or email about the new cards and will certainly “never ask for money or personal information or threaten to cancel your health benefits.” The new Medicare cards are free and you don’t need to do anything to receive one: they’re being sent automatically to everyone enrolled in the program. Don’t give out any information to callers who contact you by phone, she advised.

If you suspect fraud, report it to the FTC, [or] AARP’s fraud help line, 1-877-908-3360, or your local Senior Medicare Patrol program.

If you’re among nearly 18 million seniors and people with serious disabilities who have coverage through a Medicare Advantage plan, keep the card that your plan issued you. Medicare Advantage plans are offered by private insurance companies, which have their own way of identifying members. Similarly, if you have prescription drug coverage through Medicare—another benefit offered through private insurance companies—keep your card for that plan as well.

KHN’s coverage of these topics is supported by John A. Hartford Foundation and The SCAN Foundation.