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On the Brink of a Brand-New Old AgeThe New York Times, January 2, 2001
STANFORD, Calif. — The emphasis on Social Security in the presidential campaign reflected the growing awareness that in only a decade or so, millions of baby boomers are going to give America a greatly increased population over 65. Few seem to recognize, however, that unprecedented rates of longevity and a coming revolution in health treatments mean this group of older Americans will not only be larger, but will live longer, than those before. It's disturbing that the scope of our discussion about dealing with what's coming is truncated, as though we need only nibble around the edges — say, by deciding whether retirement should occur at 65 or 67 or how prescription drugs should be provided. There is another conversation to be had: one concerning the optimal design of a new stage in life. Old age, historically, was an experience for the few. Arguably, its transformation into an experience most of us will share — because of collective efforts to improve sanitation and prevent disease — represents the most important adaptive change in human history. In the 20th century, 30 years were added to average life expectancy. Yet this enormous gift is not only little celebrated, but even viewed as a crisis in the making, a change that could paralyze the nation, break the bank, destroy opportunities for younger people and place undue burdens on the middle-aged. In fact, we have before us the opportunity to rethink and reshape our lives so that these extra years are not only meaningful for the individuals who live them, but nonburdensome and productive for the society around them. Research shows that most people already function very well until just a few short years before death: better than 60 percent of people over 80 live independently. If we make the right investments in science, technology and cultural change, life for the elderly can be not only longer but healthier and richer. This year I headed a National Academy of Sciences committee on future directions in cognitive and neuroscience research on aging. From the research we surveyed, it appears that we are on the verge of solutions to normal age-related declines in memory. Molecular biologists have discovered that the death of neurons doesn't tell the whole story of cognitive aging. Evidence for neurogenesis has turned this notion on its head. It is becoming clear that biochemical interventions that preserve the mental functioning of people free from disease are on the horizon. As a social scientist working with experts in many disciplines on the problems of aging, I regularly learn of other advances, too, that could dramatically alter the aging process — and these efforts have only just begun. Evidence from biomedical engineers suggests that we are on the verge of understanding osteoporosis and developing ways to increase bone mass so that that our bones last as long as we do. Computer technologists are working on chips embedded in eyeglasses to expand peripheral vision and in clothing to signal changes in balance, preventing falls. Psychologists are searching for the underlying mechanism that makes intimate relationships add to longevity. Mechanical engineers are developing smart houses that assist people in activities of daily living. Economists are beginning to understand the incentives, financial and motivational, that influence older people's desires to retire or work. Of course, aging does not affect all people in the same way, a fact that is interesting to scientists because variability speaks against inevitability. We know, for example, that dementia is more likely to develop in people who have received little education, and that cognitive slowing disproportionately affects the poor, especially when they have had to make choices between medication and food. And we know that some ethnic groups — and women, overall — are especially likely to live with untreated chronic diseases. It behooves us all to identify the factors in people's surroundings that lead to optimal aging and design social structures to provide the right support. As a psychological consultant to the poor elderly at a center in Berkeley, Calif., I see older people working against the odds and achieving fulfilling lives. Imagine what life could be like if they didn't have to work against the odds. And all older people, no matter what their income, should be encouraged to see themselves as still vital and even as contributors to society, rather than dependents. Our national conversation about aging must expand beyond discussing how to care for a graying population. Encouraging passivity among healthy older people is not only bad for their health but bad for the country. There is nothing inherently wrong with an older, more mature society. It can be wonderfully adaptive for infants to be born into families that include multiple older generations who are invested in their survival. It's potentially wonderful to have a highly skilled and knowledgeable work force that only experience can deliver. We have a choice. We can sit back and let the advances in life expectancy create problems — and, mind you, if we continue to encourage older people to step out of the mainstream, the problems will be horrific — or we can actively and deliberately decide what this new phase of life should mean for individuals and societies. Just imagine the possibilities. With federal funding and philanthropic support, we can find cures for Alzheimer's disease and other forms of dementia. We can keep older bodies strong and mobile. We can find ways to strengthen the understanding of social roles for older adults. We can redesign old age. Laura L. Carstensen is professor of psychology and director of the Institute for Research on Women and Gender at Stanford University. |