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PART I

GROWING OLDER IN THE 21ST CENTURY

PART I

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Al l ri gh ts r es er ve d. M ay n ot b e re pr od uc ed i n an y fo rm w it ho ut p er mi ss io n fr om t he p ub li sh er , ex ce pt f ai r us es p er mi tt ed u nd er U .S . or a pp li ca bl e co py ri gh t la w.

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Co py ri gh t @ 20 14 . Sp ri ng er P ub li sh in g Co mp an y.

1CHAPTER

We Are Growing Older

The learning objectives of this chapter include understanding

How the United States and the world are experiencing an aging evolution—we are grow- ■ ing older. How this population paradigm shift calls us to be joyful for extended years of life but ■ realistic about the personal and societal outcomes of longer life. The importance of mobilizing all sectors of society to address the realities of an aging ■ society. The categories of older people—the young-old, the aged, and the oldest-old—each hav- ■ ing different characteristics that uniquely impact society. How Baby Boomers will continue to impact the future of aging. ■

THE NEW AMERICAN REVOLUTION

America is going through a revolution. No, we are not being overthrown by some sinister internal plot or another nation. And no, we are not referring to the technological revolu- tion that swept business, industry, and education beginning in earnest in the 1990s that continues into the 21st century. We are referring to a revolution that some key leaders are beginning to recognize—the aging of America. It is a paradigm shift in the overall composition of not only the U.S. population, but also the world’s population. As a whole, Americans are becoming older, and there are many more older people among us than ever before in our history (U.S. Census Bureau, 2011).

Upon fi rst hearing this news, it may not sound too exciting or even interesting. We now have the opportunity to see what the aging of America really means to the life of each of us as individuals; persons in relationships; family members; students; workers; or poten- tial workers, retirees, and citizens. We can begin to understand how this social revolution

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4 I. GROWING OLDER IN THE 21ST CENTURY

is changing America. This revolution is not over—it is not even slowing down. In fact, with the aging of the 76 million Baby Boomers (who began turning age 65 in 2011) this revolution is gaining momentum. If we think that the United States is experiencing many issues dealing with all of the needs of an aging population currently, to paraphrase old- time comedians, “You ain’t seen nothing yet.” But in a new paradigm of aging, this does not mean that an aging population with all its associated needs is something to be feared or looked at as a burden to society. It simply means that as a society, we have to be joyful for our extended years, realistic about the outcomes of longer life, and creative in mobiliz- ing and utilizing our vast national resources for all sectors of our growing population.

AGE CATEGORIES OF OLDER AMERICANS

To better understand what an aging America means, it is important to look at whom we are referring to when we use terms such as older Americans, the elderly, senior citizens, mature persons, people of the third age, old people, and so forth. According to the U.S. Census Bureau, the overall older population is defi ned as people aged 65 and older. However, there are subcategories that are signifi cant when studying aging. We will need to use these subcategories of the older age population to adequately address the characteristics, issues, and needs of each age group. For convenience and simplicity, the U.S. Census Bureau (2011) provides three subcategories of the elderly population:

The young-old (65 through 74 years);1. The aged (75 through 84 years); and2. The oldest-old (85 years and older).3.

In addition to these major subcategories of older people, two other distinctions are important: the frail elderly and the centenarians. The frail elderly refers to persons aged 65 and older with signifi cant physical and mental health problems. Centenarians are per- sons aged 100 years or more. They represent a small but relatively fast-growing sector of the older population.

The reason these subcategories are important is because the characteristics, desires, strengths, and needs of people at different stages of life can be very different. There can be great differences between the vigor and good health of so many of those classifi ed as young-old to the multiple chronic conditions and frailties of so many of the oldest-old. This obviously does not mean that all persons who are in the young-old category are vigorous and healthy, but there is a greater likelihood of this being the case. Nor does it mean that most of the oldest-old persons are frail and living in a nursing home, but there is a greater likelihood of having some form of dependency as a person moves into the oldest years of life.

It is important to know that the fastest-growing sector of the American population is made up of persons 85 years and older. This is not the largest sector of our popula- tion—far from it. This group of the older population is important to focus on because the oldest-old consistently need the most assistance with their daily activities and the most support from their families, community agencies, and long-term care facilities to survive (U.S. Census Bureau, 2011).

THE EMERGING OLD

It is no longer adequate to consider just the categories of those persons aged 65 and older when studying the fi eld of gerontology. Another cohort of our population that is not technically defi ned as old or elderly has great impact on the study of gerontology. This C

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1. WE ARE GROWING OLDER 5

is the cohort called Baby Boomers, those persons born between 1946 and 1964 numbering between 76 and 77 million persons, depending on how immigrants are counted. The fi rst of the Baby Boomers began turning age 62 in 2008 (the fi rst year they could begin collect- ing old age Social Security benefi ts) and age 65 in 2011 (U.S. Census Bureau, 2011).

THE YOUNG-OLD

In contrast to the oldest-old sector of the population that is more likely to have character- istics that make them vulnerable and dependent, today’s young-old (aged 65 through 74 years) are more likely to be entering their later years with relatively good health, higher educational attainment, more vigor and vitality, more mobility, and fi nancial security. Of course, this is a generalization. The people in this young-old group are more likely to have these characteristics, just as we have seen that the members of the oldest-old category are more likely to have other characteristics. Obviously all cohorts (age group categories) of the population—youth, young adults, middle-aged, young-old, oldest-old—are het- erogeneous. They are all made up of different people with a wide range of needs and resources. Nonetheless, the young-old can be described as a pioneering generation in health, affl uence, and vitality.

Who Are the Young-Old?

The young-old are the youngest category of the population generally referred to as elderly. They are persons aged 65 through 74, by far the largest segment of the elderly population. Of the 40.3 million older people in the United States, over half (21.7 million) are in the young-old category compared to 13.06 million aged 75 through 84, and 5.4 million aged 85 and older (U.S. Census Bureau, 2011).

Among the young-old, the number of men compared to women is much closer than in the two other elderly categories. The excess of women is most pronounced at older ages. This is termed the sex ratio, which is defi ned as the number of men per 100 women. A sex ratio of 100 would show an equal number of men and women. A sex ratio under 100 would show more women than men. At birth, the sex ratio in the United States is about 105, meaning more boys are born than girls. Because death at every age is mostly higher for men, the sex ratio declines as people age. This sex ratio progresses through ages 85 and older, which results in more and more women compared to men as the population ages. As a result, for the three categories of older people, the sex ratio decreases as people progress from the young-old, the aged, and the oldest-old. However, between 2000 and 2010, the sex ratios increased somewhat for the three older-age categories due to increased longevity for men at the older ages (U.S. Census Bureau, 2011).

Health and Vigor of the Young-Old

When some people think about the elderly as a whole, they picture frail, weak, depen- dent persons, some in nursing homes and many confi ned to their homes. This is certainly not a picture of the young-old. Some 78% of the young-old consider their health to be good to excellent compared to 66% for persons aged 85 and older (Older Americans 2010). The rest consider their health to be good, or excellent.

The following chart (Figure 1.1) demonstrates the differences the various age cat- egories have in relation to selected chronic health conditions that cause limitations of activity.C op yr ig ht @ 2 01 4. S pr in ge r Pu bl is hi ng C om pa ny .

6 I. GROWING OLDER IN THE 21ST CENTURY

The Young-Old Helping Parents

Even though the health and vitality of the young-old person is likely to be good, it is this group and the middle-aged sector of the population that bears most of the responsibility for caring for aging parents and other elderly relatives. It has long been established that family members provide 80% to 90% of the care needed by the dependent old (Brody, 1990). Never before has there been so many middle-aged and young-old caregivers providing so much care to so many oldest-old dependent relatives. A MetLife Mature Market Institute report in June 2011 indicated that the number of adults aged 50 and older caring for parents has tripled since 1994. And an AARP study in 2009 showed that as many as 61.6 million family members were providing care for an older adult during that year (Abrahms, 2011).

Financial Status of the Young-Old

As might be expected, the young-old tend to be better off fi nancially than persons in the aged and oldest-old categories. The young-old are likely to have higher incomes (65+ in the United States, 2005).

In looking at income and poverty rates for the young-old compared to the aged and the oldest-old, it is easy to understand why the young-old are better off. Even though there had been a trend toward early retirement, many more of the young-old are work- ing compared to persons in the other elderly categories. And many in this category have had better paying jobs with pensions. Higher incomes also impact the amounts of Social Security benefi ts workers receive in retirement.

Mobility and Location of the Young-Old

It is the young-old who are likely to move, especially to put some fun into their lives. Research indicates that it is the healthier, fi nancially secure, and younger old that typically

P e rc

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22.5 18.6

49.5 50

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FIGURE 1.1 Percentage of People Age 65 and Over Who Reported Having Selected Chronic Health Conditions, 2007–2008.

Reference population: These data refer to the civilian noninstitutionalized population.

Source: Adapted from Older Americans 2010, Table 16a.

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1. WE ARE GROWING OLDER 7

travel to better climates or more ideal living environments in retirement. The frail-old, according to research over the years, particularly the oldest-old, are less likely to move unless they need to be placed in a nursing home or move to an area where they have rela- tives and friends when they need assistance with daily living (Rosenwaike, 1985).

Widowhood and Living Alone

Widowhood is much more common for elderly American women than for older men (Older Americans 2010). Women aged 65 and older are three times as likely as men to be widowed. Among the young-old, only 7% of the men are widowed compared to 25% of women. And among women 85 and older, 76% are widowed.

Closely related to widowhood is the probability of living alone. As women grow older, the likelihood increases that they will live alone, regardless of their ethnicity. This is because of the shorter life expectancies of men and the tendency of men to marry younger women. But living alone for young-old women does not necessarily mean they are iso- lated or experiencing a poor quality of life. If their health and economic status are reason- ably good, research going back many years has shown that women living alone can live satisfying lives (Chappell & Badger 1989; Riley, 1983). Women are better at developing and maintaining social contacts. They typically have more and better friends. Many enjoy not being dependent on others.

Implications of a Vigorous Young-Old Population

The emergence of a pioneering generation experiencing better health, greater affl uence, and more vitality is having, and will increasingly have, signifi cant impacts on the people in this age category, and on businesses, governments, and society as a whole.

THE OLDEST-OLD: A PIONEERING GENERATION IN LONGEVITY

The oldest-old sector of the elderly population—persons 85 years of age and older—has been defi ned previously. Having people in this age category among us is not new in America. Benjamin Franklin was in his 80s when he participated in the Constitutional Convention in 1787, but he was an exception. Most of the men who developed the U.S. Constitution were young. America has been a “young” nation, young in years, young in its people, and young in spirit; but the dramatic aging of its population is bringing about a social revolution.

The Growth of the Oldest-Old Population

Nowhere is the aging of America more evident than among its oldest-old population. Never before have we had so many people in this age category. As we have not had sig- nifi cant numbers of persons in this age group, not much attention had been paid to their characteristics and needs. Indeed, it was some years ago (1984) that the term oldest-old was coined by the American Association for the Advancement of Science (Suzman, Manton, & Willis, 1992). In that same year, the U.S. Senate Appropriations Committee recognized the importance of the rapidly growing oldest-old sector of the population and set up funds for the National Institutes of Health to carry out research concerning persons in this age group. Since that time, research and interest in this sector of the population have grown rapidly.

The oldest-old population could grow from 5.7 million in 2008 to 19 million by 2050 (U.S. Census Bureau, 2010). Some researchers predict that death rates at older ages will C op yr ig ht @ 2 01 4. S pr in ge r Pu bl is hi ng C om pa ny .

8 I. GROWING OLDER IN THE 21ST CENTURY

fall more rapidly than is characterized in the U.S. Census Bureau’s projections, which could lead to faster growth of this aged population (Older Americans 2010). This is because Baby Boomers will move into the oldest-old category.

Characteristics of the Oldest-Old

The following are characteristics that tend to defi ne the oldest-old population:

Female Predominance

At all ages, the death rates for men are higher than those for women. As a result, as people grow older, there are fewer and fewer men compared to women. This has been identifi ed earlier as the sex ratio. The 2000 Census indicated that the age of 85 years was the point at which there were twice as many women as men. That age point has increased by 4 years to the age point of 89 years, according to the 2010 Census. This later age point is further evidence of the narrowing gap in mortality between men and women at the older ages (U.S. Census Bureau, 2011).

Although the sex ratio of the oldest-old has indicated increased numbers of men between 2000 and 2010 and is expected to decrease in the future, it is still projected to show about 5 million more women than men in this oldest-old age category.

Higher Levels of Disability

As people get progressively older, their chances of having multiple chronic health con- ditions increase. Similarly, with advancing age, the need for assistance with the basic activities of daily living (ADLs) increases. ADLs include such functions as bathing, dress- ing, getting out of bed, going to the bathroom, and feeding oneself. The following chart (Figure 1.2) demonstrates the increase in assistance needed as people age.

Less Likely to Be Married

Only 15% of women aged 85 and older are still married compared to 55% for men the same age (Older Americans 2010). This has major social and economic implications for the lives of older women.

More Likely to Live in a Nursing Home

The likelihood of living in a long-term care facility increases with advancing age. Only 2% of people aged 65 to 74 live in a long-term care facility or community housing with services, compared to 15% of those aged 85 and older living in a long-term care facility, and 7% living in community housing with services (Older Americans 2010). And almost three fourths of older nursing home residents are women according to studies over the years (Centers for Disease Control and Prevention, 2004).

Implications of a Booming Oldest-Old Population

The main reason the study of the oldest-old has become so important is not simply because there are so many oldest-old people, nor is it because this group makes up the fastest-grow- ing sector of our population—and will continue to do so for years to come. The primary reason these people are so important is because they are having and will continue to have major impacts on themselves, their families, other groups in society, and governments.

Impact of the Oldest-Old as Individuals

When the authors surveyed members of the oldest-old group on how they prepared or looked forward to becoming 85, 89, 91, or 94 years of age, most laughed and said they had no idea or no expectation that they would ever live so long. Being so old and know- ing there are many like them were not part of their expectations while they were young C

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1. WE ARE GROWING OLDER 9

or middle-aged. To be sure, there were oldest-old people in the past, but not so many that reaching oldest age was a common expectation. Hence, a large proportion of our current oldest-old people did not prepare for these very elderly years. It could be argued that even if many had expected to live to 85 years and beyond, the social and economic conditions through which they lived offered limited opportunities to plan and prepare for these years. Having been born in the late 19th or in the early 20th century, these people lived through two world wars and the Great Depression plus other foreign and domestic crises.

Compared to today, there was little emphasis on health and wellness in the matur- ing years of our oldest-old. Cigarette smoking was considered a norm, especially for men. Physical fi tness and nutrition counseling were almost unknown. Essentially, phy- sicians had no training in nutrition until relatively recent times. And trying to survive through the economic crises of the 20th and 21st centuries has left many of the oldest- old incapable of coping with today’s prices and expenditures for everyday living.

Women Live Longer—Implications

We have already noted that the death rates for men are higher than those for women at all ages. Women simply live longer than men do—currently, by about fi ve years. The longevity advantage of women has great implications for the oldest-old. As noted, the proportion of widowed persons is higher at the older ages. Older women are more likely than older men to live in poverty. And poverty tends to increase with age (Older Americans 2010).

100

1992 1997 2001 2005 2007

5 to 6 ADLs

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1 to 2 ADLs

IADLs only

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13.7 12.7 13.4 12.3 13.8

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19.6 16.6 17.2 18.3 17.7

6.1 4.9 5.3 4.7

4.5

3.5

3.2 3 2.5 2.3

FIGURE 1.2 Percentage of Medicare Enrollees Age 65 and Over Who Have Limitations in Activities of Daily Living (ADLS) or Instrumental Activities of Daily Living (IADLS), Selected Years 1992 to 2007.

Note: ADL limitations refer to diffi culty performing (or inability to perform for a health reason) one or more of the following tasks: bathing, dressing, eating, getting in/out of chairs, walking, or using the toilet. IADL limitations refer to diffi culty per- forming (or inability to perform for a health reason) one or more of the following tasks: using the telephone, light housework, heavy housework, meal preparation, shopping, or managing money. Rates are age adjusted using the 2000 standard popu- lation. Data for 1992, 2001, and 2007 do not sum to the totals because of rounding.

Reference population: These data refer to Medicare enrollees.

Source: Adapted from Older Americans 2010, Table 20a.

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10 I. GROWING OLDER IN THE 21ST CENTURY

Women Predominate in the Dependency Years

Longer life expectancies, with women the clear winners, can bring mixed results for the oldest-old. The older the person, especially in the oldest-old category, the more likely he or she will suffer from chronic medical conditions that lead to dependency. Poor health and chronic conditions are not inevitable in the oldest-old years, but they are more likely. More and more people, especially women, are living long enough to experience more long-term chronic illness, disability, and dependency. More people are living long enough to suffer from diseases such as senile dementia and Alzheimer ’s disease.

Running Out of Money

Reaching the oldest-old years can mean running into fi nancial troubles. This may result from a combination of factors, many beyond the control of the aged persons and their families. Indeed, many of our oldest-old persons experience poverty or near-poverty sta- tus for the fi rst time in their lives. Some continue in poverty into their later years.

Most of the oldest-old worked at a time when wages, salaries, and prices were generally lower than they are today. Even among those who were able to save for their retirements, many were not prepared for today’s prices or needs. As noted previously, many had no idea that they would live so long. For many of the oldest-old, saving for their retirement years has been diffi cult. For example, only 19% of older persons’ incomes comes from private pensions (Older Americans 2010).

Even though Social Security benefi ts have had a tremendous impact on the eco- nomic lives of the elderly in America, receiving Social Security as the primary or sole income in old age does not protect against poverty. In 2008, Social Security accounted for 83% of the total income of the poor elderly (Older Americans 2010).

Perhaps the biggest economic threat most of the oldest-old face is the possibility of being placed in a long-term care facility. It is important to note that persons in the oldest- old category have the greatest probability of needing the services of a nursing home. With the high costs of nursing homes, a majority of older Americans are required to “spend down” into poverty to qualify for Medicaid assistance, currently the only major govern- ment assistance program available to pay for long-term care.

In addition, with the demise of defi ned-benefi t pension plans and the shift to defi ned-contribution retirement plans, where the employee is forced to save and invest in his or her retirement (typically in the equity markets), there is no guarantee that there will be retirement payments for life. There is a fi nite amount of retirement money, which can run out before death.

Impact of the Oldest-Old on Families

Never before in history has America had so many oldest-old people. This has great impli- cations for American families. We have already seen that as people reach their oldest-old years, they are much more likely to develop a variety of chronic and disabling conditions that limit their ability to perform the range of activities necessary for daily living. The likelihood of needing assistance increases with advancing age.

A good way to look at the roles families play in the lives of the oldest-old is to be aware that families provide most of the support the people in this age category need, and to consider the number of oldest-old people relative to the number of people aged 50 to 64, the age of the likely family-member caregivers. This is called the family or parent sup- port ratio. In 1960, the parent support ratio—the number of persons aged 85 and older per 100 people aged 50 to 64—was 3.4. In 2000, it was 10.1. By 2050, it will be 30.4 (65+ in the United States, 2005).

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1. WE ARE GROWING OLDER 11

THE BABY BOOMERS

So far, we have focused on the categories of older people as defi ned by the United States. According to the U.S. Bureau of the Census, these categories are the young old (aged 56–74), the aged (75–84), and the oldest old (85 years and older). The numbers and percentages of these groups have increased dramatically changing the nature of the American population. To fully understand the scope of this paradigm shift, how- ever, it is important to turn to another group in the American population, the emerging old. For planning purposes, preparations need to begin now to accommodate the larg- est group of persons ever born in one period of American history—Baby Boomers. The aging of Baby Boomers will solidify the shift America is experiencing with the aging of its population.

Born between 1946, the year following the end of World War II when millions of service personnel returned from overseas duty, and 1964, Baby Boomers number about 76 million. The huge number of births in this period was 70% greater than the number of babies born in the previous two decades (U.S. Census Bureau, 1993).

When Baby Boomers were babies, there were not enough of the things they needed. For example, when they began to go to school, there were not enough schools. Such has been the way with this generation. Their numbers have always given them visibility and power in American society. It was no accident that the TV program Thirty Something aired when it did—many of the Boomers were moving through their 30s. To date, the United States has had three presidents classifi ed as Baby Boomers: Bill Clinton, George W. Bush, and Barack Obama, although Obama is classifi ed by some as a post–Baby Boomer because he was born near the end of that period and because the culture of the youngest Boomers is often different from the oldest Boomers.

Baby Boomer Growth

According to the U.S. Census Bureau projections, a substantial increase in the number of older people occurred when the Baby Boom generation began to turn 65 years old in 2011. In fact, the older population is projected to grow by leaps and bounds over the next four decades—from 13% of the U.S. population in 2010 to over 20% by 2050. And, the percentage of those age 85 years and over is projected to more than double during this time (Older Americans 2010). The following chart (Figure 1.3) illustrates this projected increase.

Again, these rates are important because the oldest-old are the most likely to have daily needs for economic and physical assistance. The pressing needs of the oldest-old who require the assistance of their families, especially their adult children, are most likely to come at the very time when their adult children are planning for, or have reached, their own retirement years. Some of these caregiving adult children of the frailest oldest-old have health problems of their own or are caring for a spouse with such problems.

U.S. POPULATION GROWTH COMPARED TO OTHER DEVELOPED COUNTRIES

Despite the growth of the older population, the United States is still relatively young compared to other developed countries. For example, in 2010, 13% of the U.S. population was 65 and older, while in many developed countries, that proportion ranged between 16% and 18%. Some of the reasons for this difference are that the United States has had higher levels of fertility and immigration in recent decades than other countries have had (65+ in the United States, 2005; U.S. Census Bureau, 2011).

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12 I. GROWING OLDER IN THE 21ST CENTURY

GROWING DIVERSITY OF THE OLDER POPULATION

As the older population grows larger, it will also grow more diverse, which refl ects the changes in the overall U.S. population. By 2050, programs and services for the elderly will need to be more fl exible to meet the needs of a more diverse population (Older Americans 2010). For example, in 2008, non-Hispanic Whites accounted for 80% of the U.S. older popu- lation. Black Americans made up 9%, Hispanics 7%, and Asians 3% of this population. By 2050, it is projected that the composition of the older population will be 59% non-Hispanic, 20% Hispanic, 12% Black American, and 9% Asian (Older Americans 2010).

Even though the older population among all racial and ethnic groups will grow, the Hispanic population is projected to grow the fastest, from just under 3 million in 2008 to 17.5 million by 2050. During this same period, the Asian older population is projected to grow from just over 1 million to 7.5 million. That is why when studying gerontology, it is important to consider age, sex, race, education, and health status.

DEFINING RACIAL GROUPS

In discussing issues of race and older persons in the United States, it is important to be aware of the terms the U.S. Census Bureau uses to identify the different racial groups in the nation. The following descriptions used for the census are taken from the federal stan- dards the Census Bureau uses, as established by the Offi ce of Management and Budget (OMB) in 1997:

The term 1. White refers to people having origins in any of the original peoples of Europe, the Middle East, or North Africa. It includes people who indicate their

2010

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16.1

19.3 20.0 20.2

4.3 3.5

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2020 2030 2040 2050

65 and over

85 and over P

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Year

FIGURE 1.3 Percentage of the Population Age 65 and Over and 85 and Over, Selected Years 2010 to 2050.

Reference population: These data refer to the resident population.

Source: Adapted from Older Americans 2010, Table 1b.

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1. WE ARE GROWING OLDER 13

race or one of their races as White, or write entries in the Census such as Irish, German, Italian, Lebanese, Near Easterner, Arab, or Polish. Black2. or African American refers to people having origins in any of the Black racial groups of Africa. It includes people who indicate their race or one of their races as Black, African American, or Negro or write in entries in the Census such as African American, Afro American, Nigerian, or Haitian. American Indian3. and Alaska Native refers to people having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affi liation or community attachment. It includes people who indicate in the Census their race by marking this category or writ- ing in their principal or enrolled tribe, such as Rosebud Sioux, Chippewa, or Navajo. Asian4. refers to people having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent. It includes people who indi- cate in the Census their race or one of their races as Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, or Other Asian, or write in entries such as Burmese, Hmong, Pakistani, or Thai. Native Hawaiian 5. and Other Pacifi c Islander refers to people having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacifi c Islands (U.S. Census Bureau, 2007).

CENTENARIANS

Reduced mortality rates at older ages in recent decades has also increased the number of people living to very old ages, such as 100 years or more, who are called centenarians. Centenarians make up a small percentage of the total U.S. population. But researchers want to learn from their experiences. What helped them live so long? In 1990, there were 37,000 centenarians. By 2010, there were 53,364. Nine out of 10 centenarians are between 100 and 104 years of age (U.S. Census Bureau, 2011).

MEDIAN AGE

As the number of people aged 65 and older increases, the U.S. population as a whole becomes older. One measure of population aging is its median age—the age that divides a population into two groups—half younger and half older.

In 1900, the median age in the United States was 22.9 years, which represented a young population—similar to moderately high-fertility populations found in the devel- oping world today. Due primarily to a decline in fertility, the U.S. population became pro- gressively older, so that by 1950, the median age was 31.1 years. The Baby Boom era—a period of high-fertility rates—caused the U.S. median age to decline in the 1950s and 1960s. But since the 1970s, the population has been aging as the fertility rate dropped following the Baby Boomers. By 2010, the median age increased to 37.2 years and is pro- jected to increase to 39 years in 2030 before leveling off once again (65+ in the United States, 2005; U.S. Census Bureau, 2011).

OLDER WOMEN AND OLDER MEN

As in most countries of the world, older women outnumber older men in the United States, and women’s share of the older population increases with age. The reason for the preponderance of women at older ages is due to the sex differentials in death rates. Co py ri gh t @ 20 14 . Sp ri ng er P ub li sh in g Co mp an y.

14 I. GROWING OLDER IN THE 21ST CENTURY

Even though male births outnumber female births by about 5%, males generally have higher mortality rates at every age. These higher mortality rates translate into women outnumbering men starting at about age 35. The outnumbering of women over men is most pronounced at the older ages.

As men are generally older than their spouses and women have a longer life expec- tancy, high proportions of women, especially the oldest-old women (aged 85 and older), are widows, many of whom end up living alone. This situation infl uences the tendency for these women to be institutionalized, have reduced incomes, and live in poverty. All of these factors, combined with the large number of older and especially oldest-old women, raise the issue of what types of support systems—from families and the larger society including government supports—are needed and how they can be provided.

OUR AGING WORLD

To better understand aging in the United States, it is helpful to look at aging trends in the rest of the world. As fertility (birth) and mortality (death) rates have declined in most countries of the world, populations are aging in virtually all countries—although at dif- ferent rates. Developed countries have relatively high proportions of people 65 and older. But the most rapid increases in the proportions of older populations are in the developing countries. For example, even in countries where the percentage of 65 and older people remains small, the actual numbers of these people are increasing rapidly.

In 2000, 420 million people in the world were 65 and older, which was about 7% of the world’s population. By 2030, the number is expected to double to 974 million, which will be 12% of the world’s population. Also, in 2000, the majority of the world’s older population—59%—lived in developing countries. That proportion is expected to rise to over 70% by 2030 and to nearly 80% by 2050 (65+ in the United States, 2005).

LIFE EXPECTANCY (LONGEVITY)

Life expectancy represents the average number of years of life remaining to a person at a given age if death rates remain constant. Improvements in health with lower death rates have led to increases in life expectancy—more people living to older ages. Americans are living longer than ever before. Life expectancies of persons both 65 and 85 years of age have increased. Under current mortality conditions, people who survive to age 65 can expect to live an average of 18.5 years, about 4 years longer than people age 65 in 1960. The life expectancy of people who live to age 85 is 6.8 years for women and 5.7 years for men (Older Americans 2010).

At the beginning of the 20th century (1900), 88% of infants survived to their fi rst birthday, and 41% of adults lived to age 65. Over the course of the 20th century, the per- centage of people who lived to 75 years of age increased from 6% to 35% (65+ in the United States, 2005).

The Gender Gap in Life Expectancy

Historically, female life expectancy has been higher than male life expectancy at most all ages, and both Black American and White women live longer than their male counter- parts. The sex difference in life expectancy is due to differences in attitudes, behaviors, social roles, and biological risks between men and women. In 1900, life expectancy at birth was 47.9 years for men and 50.7 years for women. By 1940, the year before the beginning

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1. WE ARE GROWING OLDER 15

of World War II, life expectancy had increased to 61.6 years for men and to 65.9 years for women, about a 4-year difference. By 1990, the life expectancy difference between men and women had increased to 7 years (Centers for Disease Control and Prevention, 2010).

It should be noted that the gender gap in life expectancy has declined in recent years. This is due largely to male heart disease and lung cancer—both of which are related to widespread cigarette smoking among men. The gender gap in life expectancy has nar- rowed due to proportionately larger increases in lung cancer among women than men and a proportionately greater decline in heart disease among men than women (65+ in the United States, 2005).

Racial Gaps in Life Expectancy

While improvements in life expectancy have occurred across racial groups, racial differ- ences in life expectancy and survivorship remain. In 1900, an estimate of life expectancy at birth for Black Americans was 33 years, while life expectancy for Whites was 47.6 years. That nearly 15-year gap had narrowed to 5.7 years by 1982 but increased to 7.1 years in 1993 before renewing a declining trend after 1993. By 2006, the racial gap for life expectancy was still fi ve years (Centers for Disease Control and Prevention, 2010).

International Life Expectancy

Life expectancy at age 65 in the United States is lower than that of many other industrial- ized countries. For example, in Japan, women age 65 can expect to live 3.7 years longer than women in the United States. For men, the difference is 1.3 years (Centers for Disease Control and Prevention, 2010).

Limits to Longevity

Considerable progress has been made in increasing life expectancy over the past cen- tury. Although most of the advances early in the 20th century came from improvements in socioeconomic factors, living conditions, and a decrease in infectious disease deaths, gains during the later part of the century and into the 21st century have come from break- throughs in public health and medical research that have led to new treatments for, and a later onset of, chronic diseases.

Two basic views on human longevity are currently under debate. The fi rst contends that the practical limits have already been reached. The second view is that old-age mor- tality will decline at a more accelerated rate in the future. Some researchers believe that the maximum average life expectancy is about 85 years. They argue that the incremen- tal improvements needed to achieve much higher levels of life expectancy are unlikely. Others believe that recent declines in mortality rates will continue, given the steady prog- ress against the diseases of old age, that life expectancy could reach much higher levels in the 21st century, and that medical developments will extend life expectancy to 100 years or more.

Among the steps toward progress in life expectancy are advances in the prevention and treatment of heart disease; improved knowledge of the genetic links to cancer; and adoption of healthy lifestyles, such as engaging in physical activity, eating a balanced diet, and maintaining a stable, lean body weight.

Although women can expect to live longer than men, the gap is narrowing as death rates by sex have started to come closer together over the last couple of decades. Some

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16 I. GROWING OLDER IN THE 21ST CENTURY

researchers suggest that this narrowing of death rates is due to changes in women’s behavior, including increased cigarette smoking and stresses related to multiple roles such as housework, occupational activities, and caregiving (including childcare and elder care; U.S. Census Bureau, 2005).

A Snapshot of Older Persons

Figure 1.4 demonstrates the projected growth of the older population age 65 and over and age 85 years and over.

A CHANGING AMERICA

In colonial America, half the population was under the age of 16. Most people never made it to old age. At age 83, Benjamin Franklin was a rarity among the framers of the U.S. Constitution. Two factors kept America a youthful nation in terms of population: high-mortality (death) rates and high-fertility (birth) rates. But now fertility rates have dropped dramatically, from an average of seven births per woman to two. Death rates have also declined (U.S. Census Bureau, 2005).

65 and over

85 and over M

ill io

n s

1 9 0 0

1 9 1 0

1 9 2 0

1 9 3 0

1 9 4 0

1 9 5 0

1 9 6 0

1 9 7 0

1 9 8 0

1 9 9 0

2 0 0 0

2 0 0 5

2 0 0 6

2 0 0 7

2 0 0 8

2 0 1 0

2 0 2 0

2 0 3 0

2 0 4 0

2 0 5 0

Year

100

FIGURE 1.4 Population Age 65 and Over and Age 85 and Over, Selected Years 1900 to 2008, and Projected 2010 to 2050.

Reference population: These data refer to the resident population.

Source: Older Americans 2010, Table 1a.

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1. WE ARE GROWING OLDER 17

Population aging is one of the most important demographic dynamics affecting families and societies throughout the world. The growth of the population aged 65 and older is challenging lawmakers, families, businesses, and health care providers to meet the needs of aging persons. How people experience aging depends on a variety of factors including social and economic characteristics as well as health status. This text will detail the range of factors that impact aging in America in the 21st century as well as how an aging America is changing the social paradigm of our nation.

SUGGESTED RESOURCES

65+ in the United States: 2005: http://www.census.gov/prod/2006pubs/p23–209.pdf MetLife Mature Market Institute: http://www.metlife.com/mmi/index.html The MetLife Mature Market Institute is MetLife’s center of expertise in aging, longevity, and

the generations and is a recognized thought leader by business, the media, opinion leaders, and the public.

National Centenarian Awareness Project: http://www.adlercentenarians.org This nonprofi t organization celebrates active centenarians as role models for the future of

aging. U.S. Census Bureau: http://www.census.gov

Co py ri gh t @ 20 14 . Sp ri ng er P ub li sh in g Co mp an y.

http://www.census.gov/prod/2006pubs/p23%E2%80%93209.pdf

http://www.metlife.com/mmi/index.html

http://www.adlercentenarians.org

http://www.census.gov

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CHAPTER 2

The Evolution of Aging

The learning objectives of this chapter include understanding

The different perceptions of aging in American society. ■ The historical perspectives on aging that enhance our knowledge of aging in America. ■ The factors that impact the rules and status of older people in society. ■ The social theories of aging that have been developed over the years to attempt to ■ describe variation in the aging process. The major implications in recognizing the paradigm shift of an aging population. ■

Section A: Aging in a New Century

PERCEPTIONS OF GROWING OLDER

What is it like to grow older in America in the 21st century? What is “old” anyway? It is important to keep in mind that there are distinct stages or periods of old age. The young- old, persons aged 65 through 74, are very different in many ways from the oldest-old, persons 85 years and older. And the aged, people 75 through 84 years, are unique from the other two categories. In addition, it is essential to recognize persons in their 50s and early 60s (the older Baby Boomers) as these people already experience some of the conse- quences of being older, especially in employment. The large number of people in their 50s and early 60s who will become elderly in the years ahead requires us to alter our concepts of what it means to grow older.

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20 I. GROWING OLDER IN THE 21ST CENTURY

As the nation moves further into the new century, we are in a state of transition regarding our view of older people and their place in society. Since America has changed in many ways, and is continuing to change, the status and role of older people have changed and will continue to change.

Changing Perceptions of Old Age

As we will see in the following sections of this chapter, over the years there have been many views of older people, of growing older, and of old age. These views change as a result of changing circumstances in any society; America is no exception. We will look at specifi c factors that affect the role and status of the elderly in a society and how these factors came into play as America became an industrialized nation. We will then examine the changes that occurred as we moved into a postindustrial era, which should affect our views of older people.

Perceptions of Older People in the 21st Century

According to a massive survey by the National Council on Aging, the American public has various views of aging (Cutler, Whitelaw, & Beattie, 2002). Some of these views differ according to the age of the respondents. For example:

In identifying the chronological age at which “the average man” and the “aver- ■ age woman” become middle-aged, old, and very old, respondents aged 65 and older defi ned middle age beginning at 50 to 53, old age as starting at 70 to 75, and very old coming at age 80 to 85. To show an “age gap” in the perceptions of aging, persons aged 18 to 34 (both men and women) saw old age as beginning about age 50, while persons aged 65 and older saw old age as beginning about age 70 or later. On specifi c issues concerning health and fi nance, more than a quarter of older ■ respondents incorrectly believed that Medicare pays for about 100% of doctor’s bills for people over age 65, and more than half incorrectly believed that employ- ers who provide pension plans are also required to provide health insurance to their retirees. Many older adults (80%) thought there would be dramatic cures or treatments ■ that will improve their chances of living past 75 (or another 10 years for those already 75 and older). But nearly half were worried that they would not be able to afford these new treatments. In thinking ahead to their older years, ages 75 and beyond, the biggest worries ■ for most older adults were health-related issues. When asked about specifi c wor- ries, 61% said that they were worried about losing their memory; 49% were wor- ried about uncontrollable pain; and 45% were worried about spending all their money on long-term care. A majority of all age groups agreed that 75-year-olds can be sexy. ■

A NEW PARADIGM OF AGING

But these perceptions by and of older people are not the real concerns facing society in regard to an aging America. It is the contention of the authors that the nation is facing the reality of a new paradigm of aging in the 21st century—a new view of what it means to be older. In previous generations, older people were often viewed as unique or a separate Co py ri gh t @ 20 14 . Sp ri ng er P ub li sh in g Co mp an y.

2. THE EVOLUTION OF AGING 21

group from the population as a whole. One reason for this is that there were not too many of them. Another reason is that they were not too visible as they were part of extended families that generally looked out for them. Another reason they were not too visible is that in many instances they were somewhat frail and dependent; at least they were gener- ally thought to be.

But all this changed with the coming of the industrial revolution, nuclear families, increased longevity, senior power (where older people demanded their rights and support systems, such as entitlements), and the coming of Baby Boomers into their later years—a population shift that many experts believe will dramatically change the way we grow older in America.

The late Dr. Robert N. Butler, a leading expert in gerontology and geriatric medi- cine and a Pulitzer Prize–winning author and founder of the International Longevity Center—USA, outlined the challenges and changes of an aging society in his book, The Longevity Revolution, and in journal articles. He pointed out that writers, economists, politicians, and policymakers have been—and continue to be—afraid that the United States is unable to cope with the rapidly increasing number of older people as outlined in Chapter 1 (Butler, 2008). They are concerned about the cost of having so many elderly people in the country. They believe that a large percentage of older people in society will lead to intergenerational confl icts—the young and some middle-agers against the old, especially in regard to social supports from government sources. Many go on to predict that the aging of America will lead to the stagnation of productivity (Butler, 2008).

But Dr. Butler believed that society will adapt to the great achievements in longev- ity—so many people living much longer. To Dr. Butler, the greatest challenges of the new longevity include facing head on the fallacies and outright myths about old age and its costs that are so prevalent in society, especially in the media and among many politicians. These fallacies include: (a) the idea that Social Security and Medicare are too broken to be rejuvenated and that they will bankrupt the nation (this is addressed in Chapter 10); (b) that the older generation is the main factor causing the rise in America’s health care costs; (c) that at the end of life people are given expensive, heroic, high-tech treatments; (d) that ageism (prejudice against older people) has been eliminated by existing laws; (e) that older workers are not as productive as younger workers (see Myths About Older Workers in Chapter 10); and (f) that older persons are provided more public and private support than children or adolescents.

Dr. Butler believed strongly that it is important to confront and dispel these falla- cies and myths that permeate so much of our current culture in the United States—to promote an “active, engaged, and productive older population that once and for all buries the myths of selfi sh and useless old age” (Butler, 2008, p. 34). Butler goes on to say that this is possible by calling for new responsibilities, new goals, and new achieve- ments. He points out that developing new roles and new attitudes toward work and civic engagement will enhance the human condition in ways that society is just begin- ning to explore.

The authors contend that all of this will be possible only if the majority of society— politicians, pundits, civic leaders, and citizens in general, including older persons them- selves—develop a new paradigm of growing older in America. This paradigm consists of looking at aging and all the components of the older population—the near-old (aged 55–64), the young-old (aged 65–74), the aged (aged 75–84), and the oldest-old (aged 85 and over)—as an integral part of the whole society. Of course, some components in the older population—the oldest-old, the frail, the sick, and so forth—will continue to need special and unique support systems such as caregivers, disability income, and so forth. But a new paradigm of aging in America envisions older people playing vital roles as normal participants in everyday living—play, worship, personal relationships, family Co py ri gh t @ 20 14 . Sp ri ng er P ub li sh in g Co mp an y.

22 I. GROWING OLDER IN THE 21ST CENTURY

life, civic engagement, and overall citizenship. This theme—a new paradigm in aging—is the only way Dr. Butler’s goals for an integrated society can be realized. For additional information on ageism and how to overcome societal stereotypes and myths of aging consult the Practical Application at the end of Part I of this textbook.

HISTORICAL PERSPECTIVES ON BEING OLD IN AMERICA

After having looked at some of the perceptions of becoming older, as well as the need to develop a new paradigm of aging as we move further into the 21st century, it is helpful to examine the major factors that have infl uenced how the views of aging and the elderly developed throughout American history.

The Colonial Period

An examination of social perceptions of what it means to grow old indicates that percep- tions of aging varied over time. In Colonial America, the aged had a place of honor, espe- cially if they owned land or had other sources of wealth, prestige, or power. Fischer (1977) argued that in Colonial times sons had reason to give deference to their fathers because the fathers controlled the farm, owned the land, and had power in the community. Frequently at public gatherings special seating arrangements were made for older people. A study of the use of language at that time indicates that words of honor, prestige, and power were used to describe older persons. There was also a religious emphasis on honoring older persons; religious leaders stressed, “Thou shalt honor thy father and thy mother.”

While not rejecting Fischer’s contention that honored terms and special places were reserved for some older persons, other studies have pointed out that impoverished wid- ows and landless transients were often treated poorly (Haber, 1983). Poor widows often had to beg for food and lodging. Some had to wander from village to village trying to fi nd basic food and shelter. It is from this context that a perception of the old crone, an ugly withered old woman, began to surface in American culture. It is also from this era that a belief in old witches began to be part of the folklore of rural life.

In Colonial times, there seems to have been a mixed perception and treatment of older persons. Those who owned land were given respect; others, the poor, the widowed, and the landless, were not respected at all. At this time, though, the pervasive use of terms disrespectful of the elderly had not developed. Of the scholars studied, none argued that Colonial times were a golden era for older Americans where they were basking in respect from the family and society. Most people in Colonial times did not live into old age, and it is doubtful that overworked family members were eager to care for a deranged, frail, or incontinent older relative. Neither were there community resources comparable to today to give assistance to families struggling to care for older relatives. Older people of this era, however, were honored more than they were in the period that followed, a period that produced the industrial revolution and a massive migration from the farm to the city.

The Industrial Era

When Americans began to leave the farms to move to the cities and work in the factories, older people began to lose honor and respect because they had neither the knowledge of industry by which they could instruct their children, nor the knowledge of city life, which would enable them to be tutors to their children and grandchildren. In addition, older people began to be a serious fi nancial burden. Furthermore, they had no power by which they could help their children obtain positions in the new world of work. Increasingly, in C

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2. THE EVOLUTION OF AGING 23

the 19th century, very negative terms began to be used to describe older persons. These included terms such as old crock, old goat, old-fashioned, over-the-hill, fuddy-duddy, geezers, old codger, washed-up, out to pasture, hag, gummer (a person with no teeth), crone, old duffer, old fogy, old maid, dried-up old prune, old galoot, and even less fl attering terms referring to sexual incompetence. There is no comparable list of antonyms. Just try listing the exact opposite of each of these terms, words that have been used in American society to refer to older persons. It cannot be done.

America was beginning to change with a marked shift from a rural to an indus- trial society. Farming, which had been the focus of employment, began to decrease in importance. American young people began to leave the farms and move to the cities. Increasingly, employment opportunities were being created in the cities, employment opportunities that involved fewer hours of work and higher pay than workers received on the farm. Between 1880 and 1930, the hours worked in city-based jobs decreased from 60 to fewer than 45 a week. America became increasingly urbanized. Between 1800 and 1890, cities grew by 87-fold, while population increased only 12-fold. During this time, a national youth culture began to develop. Young people created fads that were featured in the national media and exploded into a national mania in the post–World War II years.

Older Americans were among the last to be affected by these changes. It was mostly the young who moved to the cities. Young people became a more dominant group in the population. Older persons mostly stayed on the farm and continued to work as long as their health permitted; there were no governmental pensions such as Social Security or Supplemental Security Income. Very few farmers had any type of private security in old age other than their children to help them farm, the value of their property, and their sav- ings. Social Security did not begin in the United States until 1935. There is no evidence that prior to the 20th century there was any widespread and signifi cant change in the lifestyle of older Americans.

Achenbaum (1983) stated that there were several factors that had an impact on older Americans. They slowly began to make up a larger percentage of the population. Prior to the Civil War, less than 5% of Americans were aged 65 or older. Since that time there has been a steady increase in the percentage of the elderly population. At the present time, about 13% of all Americans are 65 or older.

The Old as a Problem

Increasingly, Achenbaum (1983) pointed out, Americans began to perceive older people as a problem. More and more articles appeared describing the older person in terms of “pathological deterioration, eccentric behavior, and painful irrelevance” (p. 15). The rapid changes that occurred in American life emphasized the adaptability of youth and the irrelevance of the “wisdom” of the “old farmer,” who increasingly was the brunt of jokes about “country hicks.”

Social workers, policy makers, politicians, and writers increasingly portrayed the elderly as impoverished and maudlin stories began to appear concerning the tragic plight of America’s aged. Out of this type of environment, as well as the changes taking place in Europe in regard to the acceptance of various forms of social welfare, a movement began in the United States to help the elderly, which culminated in the Social Security Act of 1935. This movement and emphasis resulted in a political orientation that old age was a legitimate social welfare category. That emphasis, though, is being challenged by a contemporary view that does not see old age as a legitimate social welfare category and contends that social welfare policy should be based on need, not on age. The empha- sis by some today is that Social Security in the 1930s fulfi lled widespread fi nancial and social needs of older citizens, but that today with private pensions, private savings, and a C op yr ig ht @ 2 01 4. S pr in ge r Pu bl is hi ng C om pa ny .

24 I. GROWING OLDER IN THE 21ST CENTURY

lifetime of earnings, many older people should not be getting benefi ts on the basis of their age alone. This changing emphasis is tied to cultural changes that increasingly perceive older people, at least the young-old, as affl uent, vigorous, and consumer oriented. There is an element of truth in this perception, but it is an overgeneralization that ignores the oldest-old, minorities, and those suffering from chronic and catastrophic illnesses who are struggling to survive. Achenbaum (1983) stated:

Because the society in which we live is constantly changing, the normative foun- dations and socio-cultural political economy that sustain the realm of ideas and social policy are continually shifting. Thus, if we truly hope to address people’s real needs and help them satisfy their desires, we must forever be sensitive to the tension between tradition and novelty. We must be prepared to alter our concep- tions and policies to confi rm more accurately to current circumstances. (p. 176)

Historical Myths of Old Age

Every society has a conception of what it means to be old. In contemporary, rapidly chang- ing societies, these concepts are also in a process of change, and yet the myths and con- ceptions of the past persist. Are the modern conceptions of aging and the elderly based on reality, or are they just new myths developed within a specifi c cultural context? What does old mean? What should it mean? When is one old? How does one determine when a person is old? Is aging affected by cultural defi nitions or is it primarily a genetically driven biological process? Are old people wiser than young people? What is wisdom? Do we learn from experience and from wisdom acquired over the decades? Does the media accurately portray aging and the aging process?

Social Perceptions of Aging

Again, looking at history, Fischer (1977) argued that there are two main periods in American history that relate to social perceptions of the aging person. He referred to the years between 1600 and 1800 as a period of gerontophilia when old age was honored and in general, older persons were respected. He did not disagree with those who pointed out that there were older persons during this period who had characteristics that resulted in their being mocked and discriminated against. He contended that this began to change in the 1970s when there was some indication that the fear and loathing of the aging process was decreasing. But many myths about aging and the aging process persist (Riekse & Holstege, 1996). These include the following factors.

All Are Poor, Lonely, and Isolated

A Louis Harris poll back in 1981 showed that many Americans believed that older Americans are poor, lonely, isolated, in poor health, and decrepit. The reality is that most Americans 65 and over are not living in poverty, are not lonely, are not in poor health, are not isolated, are certainly not abandoned by their families, and are not in living institu- tions (Older Americans 2010).

Most Live in Long-Term Care Facilities

Only a small minority (about 4%) of Americans 65 and older are in institutions (Centers for Medicare and Medicaid Services, 2010). The majority (64%) of those not in institutions have no limitations that prevent them from independently taking care of themselves in their everyday lives (Centers for Medicare and Medicaid Services, 2010).C

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2. THE EVOLUTION OF AGING 25

Most Are in Poor Health

Poor health is not a common feature of life for the elderly, especially among the young- old. Some 75% of people aged 65 to 74 consider their health to be good, very good, or excellent (Older Americans 2010). The vast majority (74%) of persons aged 75 and older who are not in institutions also consider their health to be good, very good, or excellent (Centers for Disease Control and Prevention, 2006).

Most Have No Interest in Sex

Certainly many Americans in the past, and many younger persons today, perceive older people as being asexual. Even today, many birthday or anniversary cards for the elderly feature jokes about sexual impotence. Some older people internalize these myths and think that there is something wrong with them if they continue to have sexual desires into old and even oldest-old age. In reality, many older people enjoy active sex lives that they indicate are better than what they experienced in earlier years, as outlined in Chapter 6.

Aging Means Mental Decline

Some people think that with aging comes an inevitable mental decline, an inability to learn new procedures, and a signifi cant loss of memory. If one tests older persons who are not suffering from some chronic debilitating disease, the differences between old and young begin to disappear. It is true, whatever the reason, that older persons need a longer time to take tests. Reaction time does seem to decline somewhat with the aging process. However, research going back many years has shown that older persons can learn, be creative, and remember quite well as Chapter 5 describes.

Families Forget Them

Older Americans are visited regularly by their children and are part of holiday festivi- ties and family celebrations such as birthdays, anniversaries, and graduations. Research going back many years has consistently shown that older people generally are not being abandoned by their children, which is discussed later in Chapter 12.

Most Older People Have About the Same Amount of Money

The stereotype of fi nancial need or fi nancial greed on the part of older people points to complex questions, which are discussed in greater detail in Chapter 10. It should be stated, though, that most older Americans are not living in poverty. Until the advent of the cost of living adjustment (COLA) to Social Security, there were many more older Americans living in poverty than at the present time. There are categories of older people, primarily single women, minorities, and the oldest-old, who have many of their members living in poverty.

Older People Are Poor Workers

As long ago as 1977, Palmore found that a third of college students believed that older workers were not as effective as younger workers. Contemporary research evidence has indicated just the opposite. Older persons work as well as, or better than, younger persons. They have less absenteeism, work harder, have fewer acute illnesses, and have fewer accidents (Krauss, 1987). In addition, older workers pay more attention to satis- fying customers and are more willing to work overtime (Commonwealth Fund, 1991; Krauss, 1987).

A YOUTH-ORIENTED CULTURE

We have had a youth-oriented culture in the United States for some time. The Baby Boom (1946–1964) brought about a tremendous bulge in our population. Because their num- bers represented a huge market for sales, Baby Boomers got tremendous attention from C op yr ig ht @ 2 01 4. S pr in ge r Pu bl is hi ng C om pa ny .

26 I. GROWING OLDER IN THE 21ST CENTURY

the media and from retailers. In addition, the media began to emphasize youth as crime began to increase.

Who Is Considered Old?

Crews (1993) stated that, “chronological age alone is a poor proxy for the study of mea- sure of aging and senescence” (p. 30). We are almost entering a new period in American society where age by itself will mean less and less in our view of people, including ourselves.

In the United States, the age of 65 has been emphasized for retirement because of an event in history. Count Otto von Bismarck of Prussia, in the late 1880s, was under pressure from political forces to provide assistance to the elderly poor. He instructed his legislators to enact legislation for some type of help. They agreed to enact a law to sup- port the elderly, but were uncertain as to what age recipients should be able to collect benefi ts. After his advisors told the Count that the average Prussian lived to be about 65, benefi ts were granted to Prussians when they reached 65. France, Britain, and the United States followed in passing such Social Security–type legislation. The debate in the United States over this legislation was ferocious. Those advocating Social Security were frequently referred to as communists, Marxists, socialists, or leftists. There was, however, little debate over the concept that one was old at 65 and should retire or be retired from employment at that age. The fact is that from birth to death, the age 65 does not take on any physical or psychological signifi cance. In American society, we have taken that age, 65, and reifi ed it (constructed a reality about it that is not true, but which we believe is true). As a result, we treat people who are 65 and older as “old people.” That concept is being questioned. Who is old? How does one determine who is old? Is old primarily a question of chronological age or of functional ability? If determining what is old is based on functional ability, then what signifi cance should age play in political, economic, and educational decisions? Should age by itself give a person certain advantages or disad- vantages in governmental programs and policies? What do you think of when you use the word old?

CHANGING ROLES FOR OLDER PEOPLE IN THE 21ST CENTURY

Given the reality that we have moved into a postindustrial society, it is important to assess what the roles and status of older people are and will be in this new era.

A postindustrial era means a shift away from the ongoing expansion in manu- facturing and industry, even though they are important. Many believe that the postin- dustrial age can bring reduced working hours, a 4-day workweek, and a diminished emphasis on the old Protestant work ethic, which historically placed total emphasis on the role of work in a person’s life with recreation and leisure not being very important (Cox, 1994).

The postindustrial society puts more emphasis on the expansion of the service sec- tor of the economy, along with entertainment, athletics, recreation, and leisure activities. All of this can open new nonwork roles for older people, which could give them a higher status in a postindustrial environment than the status they experienced in an indus- trial environment. Indeed, older people in this new era could have a range of options to choose from. In a society that puts less emphasis on the importance of productivity and more emphasis on the quality of life, older people can choose roles that are more socially supported than they were for much of the 20th century. They may choose to focus on family roles, recreation and leisure roles, volunteer roles, political roles, or second careers (Cox, 1994).

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2. THE EVOLUTION OF AGING 27

A Normal Phase of Life

In an era of competition for governmental resources in the form of assistance programs, and given the realities of contemporary aging as outlined previously, we are going to need a perception of aging that fosters individual creativity and productivity regardless of age if we are to avoid worsening the intergenerational tensions that have already sur- faced. As far back as 1993, Theodore Koff and Richard Park stated in their book, Aging Public Policy, “It appears likely that older people will feel better about themselves when being old is accepted as being of no real consequence” (p. 274). What this can do to age- based assistance programs is discussed in detail in the chapter on public policy and poli- tics (Chapter 18). These programs can be intergenerational in nature. One could point out that even a program such as Social Security, typically identifi ed with older people, has provisions to help workers of all ages when they become disabled, as well as their family members of all ages if they lose the support of a covered worker through death.

Overcoming Ageism

Motivating people of all ages to perceive older people in a more favorable light, includ- ing older people themselves, is no easy task. Prejudice against the elderly—ageism—is real. It is real in the way much of society, including the elderly themselves, perceive what are believed to be the inevitable declines of aging. Georgia O’Keefe, Benjamin Franklin, Frank Lloyd Wright, and a long list of other creative individuals did some of their best work in their later years. Examples of people excelling in old age have been around for years; still, there is a general disregard of the abilities of the elderly, as if these examples were exceptions.

Liberating the Talents of All

What do these broadened perceptions of old age mean? In a complex society with all of the needs that are evident every day, the nation cannot afford to discard or ignore the ongoing contributions people can make, even in their oldest years, given reasonably good physical and mental health. Recognizing the diversity of the elderly population, within and between the specifi c elderly age groups, a new perception of aging needs to be developed that avoids stereotypes that have molded society’s perception of older people as well as the perception older people have of themselves. Too often in American society, people have acted “old” because they thought this was expected of them. By acting “old,” they begin to demonstrate the negative characteristics of what they thought was old. For example, how many older people upon misplacing an item such as car keys say, “I must be getting older,” as if younger people never misplace or lose anything.

What does it mean to grow older in the 21st century—when society begins to realize the social revolution it is undergoing, at a time when more and more people are reaching the oldest-old years (85 and older), and the ranks of the youngest-old are beginning to be populated with millions of Baby Boomers who are reaching their mid-60s and soon their 70s with more vigor, vitality, and better health than any previous generation? Growing older increasingly will need to be viewed simply as another phase of life without intrinsic negative characteristics. People need to be encouraged to continue to work if they need to or want to. Job training and retraining should be open to all, regardless of age, to secure or retain employment. This does not mean that entitlement programs for the elderly should be abandoned; they are vital. It does mean that our society needs to stop closing doors to people simply because of advancing years. The technologies of the new age, including the information superhighway, should open opportunities for older people to play a vital C op yr ig ht @ 2 01 4. S pr in ge r Pu bl is hi ng C om pa ny .

28 I. GROWING OLDER IN THE 21ST CENTURY

role in determining their own destinies and have an impact on their families and their communities in the 21st century.

Section B: Historical Social Theories of Aging In addition to looking at the perceptions of older people, their place in history since the beginning of our nation, myths and realities concerning them, and the need for a new paradigm of aging, over the years social scientists have tried to construct social as well as biological theories of aging. The main social theories have been outlined as follows:

Disengagement Theory

One of the earliest theories of aging was the Disengagement Theory by Elaine Cumming and William Henry in 1961. It was an attempt to explain the role and status of older peo- ple in the 1960s. This theory proposes that old age is a time when older people and society mutually separate. For example, older people leave work—retire—as this is the natural thing to do. According to this theory, it refl ects the basic biological rhythms of life. This theory grew out of a 10-year study of the transition from middle age to old age (known as the Kansas City Studies of Adult Life, Williams & Wirths, 1965).

This theory has been criticized by many scholars because older people may disen- gage from work activities but then become engaged in a range of other activities associ- ated with volunteering, family activities, and leisure pursuits. As Harry Moody (1998) pointed out, “Total withdrawal from society is quite uncommon” (p. 74). In addition, many older people do not accept a concept that leads to mandatory retirement because of age. Indeed, the resentment of a mandatory age for retirement led Congress to end such practices for most workers in 1986 (Moody, 1998).

But the Kansas City Studies did reveal that there is a trend toward more interiority— increased focus on an inner psychological world. Older people do seem to become more detached and more focused on an inner attitude toward life (Peak, 1968).

Activity Theory

Opposite from the Disengagement Theory of aging is the Activity Theory of aging. This theory contends that the more active older people are, the more likely they will be happy in older ages. According to this theory, self-perception in old age is largely based on the roles people have in society and the activities in which they participate.

Much research seems to support parts of the Activity Theory according to Harry Moody. Exercise, being involved socially, and productive roles tend to enhance mental health and satisfaction with being older (Moody, 1998).

Continuity Theory

A theory of aging closely related to the Activity Theory is called the Continuity Theory. This theory contends that as people grow older, they are inclined to retain, as much as they can, their same or similar personalities, habits, and lifestyles that they had in the pre- vious years (Costa & McCrae, 1980). Both the Activity Theory and the Continuity Theory contend that any decrease in activities in the later years is due to poor health or disability (Havighurst, Neugarten, & Tobin, 1968).

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2. THE EVOLUTION OF AGING 29

The Activity Theory goes on to contend that older people will develop substitutes for roles and activities they may be forced to give up due to retirement or age limitations (Atchley, 1985). But Moody (1988) points out that this theory may be better suited to the young-old rather than the oldest-old.

Modernization Theory

Closely related to all these theories is the role of older people. The Modernization Theory postulates that the role of the old declines in a modern society. Looking back through history, Moody (1998) pointed out that depending on the needs of the society at specifi c times, the roles and status of older people varied. In hunting and gathering societies, the status of older people was rather low because they were not as valuable as younger peo- ple in doing these types of activities. In agricultural societies, where the control of land was important, older people were more valuable because they tended to own the land. In industrialized societies, older people were not very valuable and their status was not too high. The Modernization Theory of aging suggests that technology reduces the status of the aged because wisdom and life experiences are not really important (Cowgill & Holmes, 1972). Moody (1998) stated that, “the history of old age includes variations according to race, gender, special class, and culture” (p. 72).

Moody (1998) contended that there is a problem with trying to construct an over- all social/psychological theory of aging. He went on to point out that “there is no clear agreement that a single social theory of aging is best” (p. 73). Indeed, all of the postulated social theories of aging, along with the historical views of aging, need to face the reali- ties embedded in an aging society and be open to looking at a new paradigm of aging as suggested previously in this chapter. As we embark on new journeys in the 21st century, we do so with a rapidly changing population in terms of age structure. From a nation absorbed with the culture of youth, we move to a society that is made up of people who are generally older and who continue to grow older. See the Practical Application at the end of Part I of this textbook for information on why it is important to examine the social theories of aging.

A NEW VIEW OF AGING

As indicated previously, the fastest growing sector of the population is made up of per- sons aged 85 and older. And as has been noted, these are the people who are most likely to need various forms of support from their families, their communities, and governmen- tal programs. It is clear from looking at the general characteristics of the young-old, the aged, and the oldest-old that it is inadequate to use one term, one theory, or one view to describe them.

All of this calls for a new view of aging—a view that does not automatically clas- sify persons as “over the hill” once they reach ages 62, 65, or 70; a view that takes into account the diversity and potential productivity of persons in each age sector. Some people are “burned out” at ages 50 or 55. Others are in their prime at ages 68 or 70. Some are vulnerable in their late middle years due to chronic health conditions. Others fi nd work the most important part of their lives in their late 60s and 70s. Some have experi- enced discrimination all their lives because their sex, race, or ethnic background has lim- ited their educational opportunities and negatively impacted their earning power and fi nancial status. This is particularly true for elderly minority women who have faced double discrimination when they were younger and then triple discrimination in their later years.

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30 I. GROWING OLDER IN THE 21ST CENTURY

With the booming growth of the oldest-old, and the young-old entering their later years as a pioneering generation in better health, affl uence, and vitality than previous generations experienced, we need a new and broader view of what growing older in America means. All who study aging must realistically understand the aging process; be aware of the major and rapid population changes that are occurring; examine what grow- ing older currently means to older people themselves and their families; be aware of the resources and supports that are available; realize the impacts of an aging society on busi- ness, government, and family structures; and participate in the discussions and debates that surround the issues affecting the elderly and their families. This book is designed to help the reader in these endeavors.

SUGGESTED RESOURCES

International Longevity Center-USA: www.mailman.columbia.edu/academic-departments/centers/ international-longevity-center/

Founded in 1990 by world-renowned gerontologist Robert N. Butler, the center was created to educate individuals on how to live longer and better, and advise society on how to maxi- mize the benefi ts of today’s longer life spans.

National Council on Aging (NCOA): www.ncoa.org NCOA is a nonprofi t service and advocacy organization. Bringing together nonprofi t organi-

zations, businesses, and government, it champions issues and creates innovative programs that focus on making life better for older adults, especially those who are vulnerable and disadvantaged.

Professor Palmore’s Amazing Facts on Aging Quiz: www.timegoesby.net/weblog/2004/09/dr_erd- mans_amaz.html

Website includes some background information on the quiz and the actual quiz.

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http://www.mailman.columbia.edu/academic-departments/centers/international-longevity-center/

http://www.ncoa.org

http://www.timegoesby.net/weblog/2004/09/dr_erd-mans_amaz.html

http://www.mailman.columbia.edu/academic-departments/centers/international-longevity-center/

Practical Application I

Growing Older in the 21st Century

Michael A. Faber

INTRODUCTION

Each of the six parts of this book will be followed by a practical application section. This section will include practical information that compliments content included in the chap- ters that precede it. You might ask, why include information on practical application in a gerontology textbook? Simply put, this book includes research-based facts, fi gures, data, and theoretical information related to aging and the realities of an aging society; yet to know these things is often not enough to work effectively with an older adult popula- tion. Therefore, the practical application sections of this book will share practice-based practical information learned through years of real life experience in working with older persons, their families, caregivers, and the professionals who serve them.

Ageism: Overcoming Societal Stereotypes and Myths of Aging

The fi rst two chapters of this textbook outline key aging demographics, perceptions of growing older and old age, historical perspectives on aging, common myths and stereo- types of aging, and the main social theories of aging. Yet, the section on “overcoming ageism” found in Chapter 2 may have the greatest relevance to the actual day-to-day practice of gerontology.

There is a tendency when writing about and/or teaching gerontology to generalize certain characteristics and attributes of aging to all older people. If taken out of context, this practice can lead to the perpetuation of many of the myths and stereotypes of aging that gerontology educators are working to dispel. Careful effort has been taken by the authors of this text to accurately report the facts, issues, trends, and concerns of aging and an aging society, and at the same time present a new and more positive paradigm of aging in the 21st century.

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32 I. GROWING OLDER IN THE 21ST CENTURY

Contrary to the stereotypes of aging, most older persons live happy, active, and pro- ductive lives. The stereotypic view of aging as a time of decline, poor health, and poverty is just not true for the majority of older persons. Yes, these conditions do exist for many older people, especially in the oldest-old age category; however, they are not common- place with all older persons.

Those who choose gerontology as a profession should not inadvertently perpetuate the myths and stereotypes of aging. Whether one is a student considering entry into the fi eld, or a seasoned professional, one should always ask: Is anything I am doing or saying helping to perpetuate a negative stereotype of aging? Damage might be caused by the jokes or the way one speaks of or to an elder. Education is the key to eliminating these negative biases. The myths and negative stereotypes of aging will not be dispelled until the roles that we all play in perpetuating these fallacies are recognized and altered.

For example, a person may feel free of biases toward older people until she or he is slowed by an older driver on a narrow, winding road. Does an old bias against older driv- ers suddenly return? At that point, it may be helpful to recognize that many older drivers are offered lower insurance rates for being good drivers with excellent safety records.

Unfortunately, middle- and younger-aged people are not alone in perpetuating the myths and stereotypes of aging. Often older persons themselves are their own worst cul- prits. This may not be intentional on their part, but rather the result of their buying into the myths and stereotypes of aging already so commonplace in our society. A frequent refrain in working with some older persons is “I’m too old to ____.” An example of this is an 89-year-old relative who has Parkinson’s disease and poor hearing. When she is asked if she is exercising, or invited to go somewhere away from the home, her usual response is, “I’m too old to do that.” In reality, she does have some very real physical challenges due to her condition, but she is able to do so much more than she allows herself to do. This response is not completely due to her view of aging. It is also the result of her fear of falling and not being able to communicate effectively with others due to her hearing loss. Her quality of life could be so much better than it is today if she just had a more positive view of aging and greater confi dence in her abilities. This is one of the greatest challenges we face in working with older persons, allowing them to have autonomy in making their own decisions (whether we agree or not) and still encouraging them.

A Personal Account by a Professional in the Aging Network

One of the earliest lessons that I learned in working with older persons came in my fi rst job after graduate school, when at age 25 I had just been hired to do case coordi- nation and support for frail homebound older persons. Armed with plenty of infor- mation, lots of energy, and a genuine zeal for meeting the needs of those I hoped to serve, I was shocked when the initial reaction of many of my homebound clients was less than favorable. I didn’t understand why my reception was so poor, where in some cases clients even refused to let me enter their homes. I guess I didn’t take into account the fact that I was young and how vulnerable some of these individu- als felt in the situation. For some reason, I thought that I should simply be accepted because I was a professional in a helping role. In reality, what I quickly learned was that respect is not simply given, it has to be earned, and fi rst and foremost, to earn respect one must give respect. This starts with the way that one addresses elders. It is important to address an older person in a way that he or she desires. Does she or he prefer to be addressed as Mrs. or Ms. or Mr. or by a professional title such as Dr. or to be addressed by her/his fi rst name?

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I. PRACTICAL APPLICATION: GROWING OLDER IN THE 21ST CENTURY 33

The language that we choose to use in addressing older persons is important. An October 6, 2008, article in the New York Times by John Leland speaks of what professionals call elderspeak. Elderspeak is the use of such sweetly belittling terms as “sweetie” and “dear” by those caring for older persons. In this article Dr. Becca Levy, associate professor of epidemiology and psychology at Yale University, is quoted as saying that research sup- ports the fact that “little insults [like these] lead to more negative images of aging, and those who have more negative images of aging have worse functional health over time, including lower rates of survival.” It is important to be careful about what one says and how one says it, because contrary to the old adage, words can hurt you.

Social Theories of Aging

Why is it important to examine the social theories of aging, and how can these theories help us to better understand and address the needs and issues of aging individuals? Social theories of aging help us to better understand the actions and reactions of aging individuals, as well as provide insight into how and why older people spend their time the way that they do later in life. Can each of these theories apply to all older persons? Of course not. As with any age group, everyone is unique and no two individuals are exactly alike. However, knowledge of these social theories does give us valuable insight into the actions and behaviors of those we attempt to serve within the aging community.

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