HEALTH

Making Aging Positive

Many of my older-adult patients wanted to make a difference in the world but, finding no role for themselves, were treated as socially useless. Having created a new stage of life, the next step is to make it meaningful.

LINDA P. FRIED

JUN 1, 2014

Between 1900 and 2000, average life expectancy increased by nearly 30 years in the United States and most other developed countries of the world, and the developing world is catching up quickly. For the first time in history, most people now being born can expect to live seven, eight, nine, or more decades. This achievement changes not only the trajectory of individual lives but also the shape of societies: Adults 60 and older are now the fastest-growing segment of our population.

This achievement gives rise to new important questions: What do we want to do with an extra 30 years? How should we, as individuals and as a society, shape the trajectory of our longer lives? Can we design a trajectory that improves the well-being and opportunities of people at all ages? Should we be designing new social policies that will foster these opportunities? How do we prepare young people for longer lives—and can these questions be answered in ways that would be beneficial for all generations?

Unfortunately, rather than evoking celebration or innovation, the news of our longer life spans is generating fear and angst among individuals and concern among policymakers. The questions posed most frequently are not the ones mentioned above, but rather these: Can we afford all these old people? Will they bankrupt our society or ransom the future of our children and grandchildren?

The truth is that we have created a new stage of life but have not yet envisioned its purpose, meaning, and opportunities, and the space is being filled with our fears. [W]e are not looking for answers in the right places.

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When I was a young geriatrician practicing in Baltimore, I operated under the light provided by my medical training, which prepared me to prevent or treat the health concerns affecting my patients. My training was invaluable, and geriatric medicine is a specialty highly tuned to the needs of older adults. Yet, as they shared their lives with me, my patients taught me that many of the ills associated with aging were worsened—or even created—by the lack of meaning and purpose in people’s lives. Too many of my patients suffered from pain, far deeper than the physical, caused by not having a reason to get up in the morning. Many of my patients wanted to make a difference in the world but, finding no role for themselves, were treated as socially useless and even invisible.

We are a species wired to feel needed, respected, and purposeful. The absence of those qualities is actually harmful to our health, as public health and social scientists have demonstrated. In one pivotal study conducted in the late 1970s, psychologists Ellen Langer and Judith Rodin (now president of the Rockefeller Foundation) examined the significance of autonomy and personal responsibility for the health of nursing home residents. One group of residents was told that they could arrange their room furnishings however they wanted, decide for themselves which nights to attend a movie, and choose house plants to keep and nurture. A second group of residents, advised that the staff “want to do all we can to help you,” had their furniture arranged for them, were informed which movie nights to attend, and were given a house plant cared for by a nurse. After three weeks, almost all residents in the first group experienced significant improvement in physical and mental well-being, whereas most participants in the second group declined or stayed the same.

A follow-up study conducted 18 months later found, remarkably, that members of the disempowered group (which mirrored how we usually treat older adults) were twice as likely to die, compared to their empowered peers (30 percent mortality compared to 15 percent). Further, there is science to suggest that beyond just feeling useful, a key need for successful aging is to feel that you have contributed to leaving the world better than you found it.

So I began to write prescriptions for my patients: “Find something meaningful to do and report back.” Time after time, I would hear back from highly capable older adults that they couldn’t find jobs. If they tried volunteering, they were frequently assigned to roles that didn’t use their capabilities, like licking stamps for someone else’s mail. What a waste of people with a lifetime of experience!

I came to understand that these people, rich in experience and abilities, were being viewed through a lens of ageism that rendered their individual talents and achievements invisible. Few roles existed that used the experience and skills acquired over a lifetime. In our society, older adults are routinely dismissed as impaired, slow, or demented unless they can prove otherwise.

A story a few years ago in The New York Times on the invisibility and marginalization of older adults concluded that “such indignities seem to happen to almost everyone with gray hair or a few wrinkles, and at every sort of place. Store clerks, bank tellers, government workers, pharmacists, hairdressers, nurses, receptionists, and doctors alike ignore the older person and pay attention exclusively to the younger companion, regardless of who is the actual customer or patient.”

There is a growing body of impressive research showing that our attitudes toward aging affect our health, our resilience in the face of adversity, and our very survival. Becca Levy at Yale, a pioneer and leading researcher in this area, conducted a study that followed several hundred adults (50 years and older) for more than 20 years. She and her colleagues found that older adults who held more positive age stereotypes lived 7.5 years longer than their peers who held negative age-related stereotypes.

Ursula Staudinger, director of the Robert N. Butler Columbia Aging Center at the Mailman School of Public Health, has conducted groundbreaking research on the positive plasticity of aging. Her work shows that biology, behavior, and culture constantly interact to shape the development of our lives into the oldest ages. This work confirms the importance of physical environments and social institutions as well as individual attitudes towards aging across the life span.

Unfortunately, negative stereotypes are much more common than positive images; indeed, according to some researchers, ageism is more pervasive in our society than negative stereotypes based on gender, race, or sexual orientation. Our negative attitudes towards aging blind us to the fact that millions of people in their '60s, '70s, '80s, and beyond are robust, active, functional, experienced, capable and talented—and that they want to remain engaged and contributing. However, we have not yet created the social structures, roles, and institutions to capitalize on our success in adding years to life by also adding life to years.

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We have added 30 years to our lives, not just for the lucky few but for the majority of people in the developed world, and now the developing world. What does this new stage of life mean? Psychologists Erik and Joan Erikson viewed later life as a time when the impulse to give back to society (generativity) becomes an urgent need. Carl Jung, who was unique among early psychologists in his interest in the challenges of the second half of life, saw older age as a rich period of spiritual growth and individuation. Betty Friedan, who trained as a social psychologist, researched the issue of aging late in her life, and suggested that there is a “fountain of age,” a period of renewal, growth, and experimentation based on a new freedom.

The truth is, we don’t yet know what this new stage of life can be, but the first step is to change the lens through which we view aging and challenge our stereotypical assumptions.

For example, contrary to what we believed even in recent decades, exercise can significantly increase muscle mass in older adults, even among nursing home residents; physical and mental exercise can enhance the brain’s plasticity; and meaningful social engagement and activity can reduce the risk of social isolation, depression, and illness, while making a difference in our society.

One very hopeful sign for the future is that leading figures from many fields are starting to recognize that increased longevity is a game-changer for all sectors of society. Through my own service on the Global Agenda Council on Ageing, a special project of The World Economic Forum, I have had the opportunity to collaborate with innovative leaders in business, politics, academia, and health to proactively address how we build a successful aging society from multiple perspectives. We also want to engage the public in this dialogue. Toward this end, the Global Agenda Council on Ageing recently produced an e-book outlining the challenges and opportunities we see, and offering innovative approaches that we plan to undertake in the future.

These examples underscore the importance of investing in research and education on aging and health changes across the life course, and creating the means to achieve this, since the keystone for successful aging is our ability to enjoy good health and function. Having created a new stage of life, the next step is to make it meaningful.