Happy or Sad? Flip a Coin

By Abigail Trafford, the Washington Post

  April 20, 2004

SAN FRANCISCO -- Two coins in the fountain of age: On one coin, the sad face of decline; on the other, a smiley face of new life. One face is the traditional view of aging. The other is a more recent, radical vision.

Last week at the joint meeting of the American Society on Aging (ASA) and the National Council on the Aging, the two faces stared at each other. Who represents the reality of aging today? Who will dominate the country's aging agenda? Can there be two faces on the same coin?

The field of senior centers, nursing homes, advocacy agencies and disease organizations is geared to the sad face. Its purpose is to meet the needs of the sick and the frail, the isolated and the disabled. And rightly so. When the Great Society programs of Medicare and Medicaid were enacted in the 1960s, the elderly as a group were poor and vulnerable.

But over the last half-century, a social revolution has occurred. Older Americans are now healthier, richer, better educated and more active than ever before. Most people over 50 -- the age of eligibility to join AARP -- do not fit the sad-face profile.

"We need a different map" of aging, said Ken Dychtwald, president of Age Wave in San Francisco . Yes, aging is about loss and depression. But it's also about enlightenment, renewal and wisdom, he told the convention. "We're seeing a blossoming of a new maturity. We see a rising revolution of older adults who are discarding a lot of old stereotypes. The model needs to be continual reinvention. We've got to come up with some new maps."

I refer to this new maturity as the bonus decades of "My Time," an unprecedented period of vitality after midlife but before old age. The emergence of this new vision reflects the success of the aging movement to overcome poverty and manage illnesses of the elderly.

But will success spoil the aging movement?

The dual face of late life is creating tension within the ranks of the aging community.

The program for this year's meeting is mostly focused on the traditional image of aging, with papers entitled "A Best-Practice Model for Dementia Care" and "Models for Palliative Care in the Nursing Home Setting." Sometimes the sad-face sessions are zipped up with catchy phrases, such as "You Are Not Alone: Advocating for a Good Funeral," "What Do You Do When She Won't Bathe, Dress or Sleep?" and "My Neighbor Is Poisoning Me: Delusional Thought and Housing."

Here and there, the other view of aging pops up: "Transforming Boomers' Needs and Interests to Success in the Marketplace." "Vitality in Aging." "Better Sex at Our Age: Why Not?"

But in the trenches of health care, it's hard to see the smiley face of age. Over-stressed workers caring for Alzheimer's patients aren't about to worry about boomers who want a self-actualization program for unearthing some hidden potential.

The problems of the sad-face minority are so overwhelming that professionals in geriatrics don't have the time or inclination to think about needs of the healthy. "When you're working in the field, the problems present themselves with such extreme intensity," explained Patrick Cullinane, director of special projects on the ASA staff. "It really demands a lot of time and energy and resources."

But a total focus on the needy leaves out the majority of people in this age zone. Where are the institutions to support, train, educate and use this burgeoning population of healthy elders? Instead of being only a problem, people in the bonus decades could be an asset. Instead of a drain on taxpayer monies, a contributor. Rather than taking resources away from younger generations, they could give back to society in the form of community service, family stewardship, creative works, new business.

Programs that enhance the potential of older Americans are preventive medicine. They keep people healthy and engaged in work and relationships, shortening the period of frailty in late life. Yet health promotion and management of chronic illness have long taken a back seat in a health care system that focuses on crisis and acute care.

"People in the field have been geared to deal with the problems and the disabilities and less with the potential. It's a maturity challenge for the field of geriatrics, as it is for the society in general. We have to develop a more mature vision of aging," said Cullinane.

Otherwise, the sad face of aging will persist. So will the social virus of ageism. Without opportunities, retraining and support, generations of elders will likely fulfill the stereotype of being old and useless. They will become a problem rather than an asset.

"We have to reframe this issue for the public," said Patricia Polansky, assistant commissioner of the Department of Health and Senior Services in New Jersey . With the boomers now surging across the 50-year line, "we have about a decade. That's not a lot of time."

In an era of shrinking budgets for domestic programs, people in the aging field are dealing with cutbacks and trying to continue needed services. There's little incentive to take on new projects. But the aging movement now has a dual challenge: to give services to the needy and opportunity to the able. Can it do both?

As the two faces of aging collided at the conference, leaders sought to bring them together. "We are all aging. That's the one thing we have in common," continued Polansky. "We need to prepare ourselves. There is this untapped resource. I think it's a new world order."

The meeting began with an opening ceremony of drumming and dancing. Peter Podulke, 55, one of the dancers with the Kairos Dance Theater, was dressed in white silk trousers and a teal tank top, a large man with a gray-speckled beard who moved rhythmically to the beat. A bricklayer, Podulke turned to dance five years ago. "It was a liberating breakthrough for me," he said.

The dance performance aimed to set the tone for the meeting, which drew about 4,000 participants. As Podulke explained: "It's a celebration of life. We are weaving together stories of many people. We are creating community through dance."

Creating community from disparate factions in the field. Weaving together the stories of loss and joy, pain and renewal, crisis and growth. Celebrating the two faces of aging.

That's the hope, anyway.