BY DR. STEPHEN GOLANT
In June 2023, its authors interviewed a nationally representative sample of older adults in the United States. Among its findings:
- Seventy one percent of people 65 and older say the best time of their life is right now or before them.
- They don’t feel over the hill but are just beginning to chart their best adventures and pursue new dreams—to start a new chapter in life.
- They are far more active, open-minded and curious—and less rigid, passive and isolated.
This report presents a much needed antidote to those earlier “misery perspectives” on aging that associated getting old with the four D’s: Dependency, disease, disability and depression. These ageist portrayals unduly emphasized the negative aspects of aging.
Some Alarm Bells
But embedded in this otherwise upbeat recounting of old age is a disturbing finding. It reported that when born, our lifespan (how many years we have left to live) is about 78 years, but our health span (length of time we are in good health) is only 66 years.
Simply put, debilitating diseases and physical and cognitive impairments may impact the last 12 years of older people’s lives. Living longer does not necessarily equate to living healthfully. We have a health span-lifespan gap.
On reflection, this observation should not be a surprise.
What we often refer to as old age can easily extend over three decades—that is, ages 60s to 90s. Although chronological age is far from a perfect indicator of physical and mental well-being, gerontologists have long distinguished third-age or young-old seniors in their 50s, 60s, and early 70s from fourth-age or old-old seniors in their late 70s and above. This latter group is more likely to suffer from mobility or functional limitations, memory issues, and health conditions such as cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases.
Confronted with these assaults on the quality of their lives, it becomes more challenging for those in later life to remain positive about getting old.
Such a pessimistic observation leads to an obvious question: Are those extra years of life worth celebrating if we must cope with health declines and losses over this period?
What many of us want is not eternal life but eternally feeling younger than older. As one commentator put it, “Right now, we live well, then we don’t live well, and then we die.”
Is there perhaps an argument for living well but then dying quickly before decline sets in?
Recognizing Age Group Inequities
The need to address such questions will only increase. Demographic projections tell us that, all over the world, the fastest-growing populations will be aged 80 and over. Our old-old or fourth-age populations will become more visible and demand “the highest possible levels of care and comfort.”
Making simple generalizations about the age 60- or 65-plus population will also become more problematic when we admit that old age is not a homogeneous life stage. Here’s why:
Numerically, our fourth-age seniors are a minority share of the older population. Consequently, if we do not separate them out for analysis, we can easily gloss over and camouflage their distinctive unmet needs and problems.
Reason for Optimism
But these inequities should not overly dampen our positive perspectives on aging. New medical discoveries and gerontechnological advances make it more possible to diagnose, prevent, delay, and even eliminate the worst aspects of disease and disability.
What is referred to as “morbidity suppression” will become more attainable. These innovations offer hope that older people can reduce (suppress) the number of years they must spend burdened with chronic and debilitating diseases (morbidity) before they die.
Of course, we now do not lack for individual advice about how to strive for morbidity suppression. The media bombards us with information about staying healthy and disability-free for longer.
Frequently on our self-help radar screens are nutritious diets, better sleep strategies, exercising, preventative health checkups, maintaining strong social connections, keeping vaccinated, caring for our emotional health, and exercising our brain.
Still, we must be realistic.
Not all older people are motivated or able to fend off the scourges of old age. Most importantly, we do not all have the genes of those 90-year-olds running marathons, climbing mountains, or obtaining new college degrees.
What are our chances of experiencing excellent health up to our deaths? A recent U.S. study offered some guidelines. It reported that about 20% of 65-year-olds will not need care or assistance for the rest of their lives, while 22% will have only minimal needs. However, about 58% will require supportive services or long-term care to cope with their severe or moderate declines and losses.
With Knowledge Comes Wisdom
There is an obvious takeaway from these findings. Let us indeed celebrate the “good life” of the young-old and significant numbers of the old-old. But let us also recognize, sympathize with, and find solutions for the demanding physical and mental health challenges that often arise at higher chronological ages.
Acknowledging these alternative visions of aging also enables us to be more effective change agents. So when we are in good health and living active lives, we should use this time to plan for the contingency that we may become less well and dependent on others.
There is no shortage of books and internet sites that enlighten us on what our financial, legal, health, housing, and long-term care preparations should look like.
We should strive to age optimally no matter how close we are to our mortality. We may not be able to mimic the best of our young-old times, but we can give it a mighty good try.
Stephen M. Golant, PhD, is a leading national speaker, author, and researcher on the housing, mobility, transportation, and long-term care needs of older adult populations. He is a Fellow of the Gerontological Society of America, a Fulbright Senior Scholar award recipient, and a Professor at the University of Florida. Golant’s latest book is Aging in The Right Place, published by Health Professions Press. Contact him at firstname.lastname@example.org.