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1st Qtr 10:43 2nd & 10, Own 45

opinion | Laura L. Carstensen and John W. Rowe

Aging isn’t the challenge; building an equitable society is

At the dawn of the 21st century, chronological age is a highly meaningful criterion. It signals access to benefits like pensions and health insurance, discounts at movie theaters, and set-aside seats on public transportation. The basis for its appeal is obvious: Age is an extremely reliable statistic.

We now know, however, that late in life, age by itself conveys little reliable information. In 2009, for example, 4 percent of those over 65 lived in long-term care facilities, and others needed some help in day-to-day life, yet the majority required no assistance of any kind. Scientific evidence shows that the older people become, the less like each other they become; consequently, age alone is a poor predictor of current or future physical and mental health. Indeed, in adulthood, education better predicts mental and physical capacity, even life expectancy, than age does. Discussions about “aging” societies often obscure the more important issue — the cumulative effects of disadvantage, where the “longevity dividend” associated with longer lives becomes elusive.

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The public discourse surrounding aging has become polarized. Two general stances sound as if they are describing entirely different groups of people. One calls for support and advocacy for elderly people who are living at or near the edge of physical and economic disaster. The other maintains that older people have plenty of resources and that they are greedily robbing the young of their fair share. Each position sees only one old America, but there is a spectrum — one that includes the wise, healthy, wealthy, and influential along with the frail, demented, poor, and forgotten.

It is true that aging societies will include an increasingly larger number of citizens who need assistance in their daily lives. Indeed, a period of disability is the logical consequence of deaths that are associated with long lives — as opposed to when acute illnesses, such as heart attacks, or accidents take people quickly and prematurely.

Yet the quality of life during most of the years we call “old age” varies dramatically among individuals. This variability is not based on good luck or solely on good genes. Rather, it reflects a range of behavioral, social, economic, and occupational factors that, at their core, stem from differences in education and social class. Aging among college graduates typically looks great until a relatively short period before death. Indeed, affluent elders offer societies a resource that has never before existed — millions of experienced, wise older citizens who are healthier and better educated than were any previous generations in the history of humankind.

Aging too often plays out much differently among less advantaged people. Instead of deepening expertise and well-being, the cumulative effects of poverty, harsh working conditions, and persistent stress leave an alarming proportion of people with little in the way of personal resources. A fifth of married couples and half of unmarried people rely on Social Security alone for at least 90 percent of their income.

As the population rapidly ages, we must proceed simultaneously along two paths. First, we must enhance our ability to limit dependency while also building our capacity to care effectively for those in need. A recent lifestyle intervention with pre-diabetics dramatically reduced participants’ progression to diabetes, for example, and team approaches to home-based care for medically fragile patients are pointing to ways to improve care and reduce health spending at the same time. The vast majority of us will reach a point in old age when we need assistance from families, communities, and governments — though we will do so at very different points.

Second, we need to increase productivity and engagement of able older citizens, both in the labor force and as volunteers in their communities. Offering flexible and part-time employment can help to retain valued workers. Providing people with opportunities to volunteer while in the workforce substantially increases the likelihood they will volunteer after retirement. A growing literature suggests that such engagement is self-reinforcing, enhancing physical and psychological health in old age. Doing so also will allow us to better support those who are truly in need.

In the longer term, though, the most effective way to achieve fair and equitable aging societies is to invest in education beginning in preschool and continuing all the way through life. Our goal must be to ensure that all fourth-graders read well, and that nearly all young people graduate from high school and either gain solid technical training or pursue college. Employers must begin to provide training for employees, including seasoned workers who will increasingly work past traditional retirement ages. Through tax relief for employers and employees, governments can promote longer working lives.

For the first time in human history, we must design policies and construct social norms that not only shape children into good citizens and productive working adults, but also ensure that the majority of people, and not just the privileged few, arrive at old age physically fit, mentally sharp, and financially secure.

Laura L. Carstensen, a psychology professor, is the director of the Stanford Center on Longevity. John W. Rowe MD is a professor of health policy and management at the Mailman School of Public Health at Columbia University.
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