No one is going to avoid aging. It is a basic component of life. In fact, overall the globe is graying. With this, it’s worth noting that we are living longer on average, but are we living better? Are we learning to age to perfection? That’s difficult to judge because aging or aging well isn’t easily defined. It means different things to different people. This is one reason it is tricky to help promote healthy aging. But it is not impossible. Leanne Clark-Shirley, PhD of the American Society on Aging recently met with WellWell to help explain how to come to grips with an older America and how to make aging well less of a challenge. Read on.
How did you get into gerontology?
The simple answer is I needed to fulfill a couple of requirements in my undergraduate degree program. And I saw this class called, our aging society and it ticked off like two or three boxes. And I thought, huh, can you really talk about aging for an entire semester? And the joke is that, well, I’ve got three degrees in it and have worked for 25 years in the field. So, it turns out you can.
How are we doing? Is America aging well and in a healthy manner?
The simple answer to that question is some of us are and many of us are not. And that’s sort of the first thing that I think is important to acknowledge about how we even view aging in this country. In fact, the older we get, the more diverse we become, not only in our social identities but our needs, our wants, our skills, our abilities and our interests. So, putting one 75-year-old person next to another 75-year-old person, there’s not really a lot you can tell just based on how many candles are on the birthday cake. It goes deeper than that.
What is a general definition for aging healthy or is it impossible to define?
There are definitions that we talk about. Some folks frame it as living as long as you can disease-free. Some folks define it from an economic perspective. Are you able to live where you want and have enough money to continue that lifestyle that you enjoy? But that’s just it. Who defines healthy aging really matters here. If a marathon runner is defining healthy aging, I’m already out of luck. Like I’m behind the curve and I’ll never catch up. If someone defines healthy aging and it doesn’t include listening to music and pulling weeds in the garden, I’m out. It’s not relevant to me. So, on the one hand, there are important population-level indicators of how well we are aging. What is the incidence and prevalence of dementia, cancer and obesity? But when you drill down to it, our own experiences of growing older are what should define healthy aging for us.
Given that we live in a culture that is obsessed with youth. How does that affect our ability to deal with healthy aging?
There’s no question we get messages every day from media, journalism, movies, the grocery store and from our own selves about how youth is this ideal to keep chasing. A lot of those messages come to us as people are trying to sell us things or to change something. When we step away from that, I do think we aren’t as youth-focused as it might seem. And what do I mean by that? Look at our communities, look at our families. There are tons of communities, families, religious institutions and volunteer organizations where older people are meaningful participants at the table, bringing things that younger folks could never even bring. But I do want to say these messages that we get harm us and our health over time. There’s some real data on the harms of what we call ageism.
Ageism is discrimination based on how old we are. It comes internally. Doctors do it to us. Employers do it to us. We do it to ourselves. It’s a cycle that we perpetuate. It harms us. It harms our economy. $63 billion a year spent by the Medicare program is attributable to ageism’s under-diagnosis and over-treatment. Avoiding the doctor because you think well this ache or pain is just a normal part of aging. What could we do with $63 billion a year? We do idolize youth in the marketplace. I think it’s different in our own lives But it’s still harmful and we need to fix that.
How does the aspect of ageism show up in different situations other than that person may be too old for a job or to do something?
You’re touching on two forms of ageism. One is just explicit exclusion based on how we perceive or believe someone of a certain age is or wants or is capable of doing. You’re also picking up on paternalism, which is a big symptom of ageism. And that is this notion that the older we get, somehow we are in need of being protected and making sure that we’re safe kind of supersedes making sure we have the ability to make choices in our everyday life and to live the type of life that we have. I think this shows up when conversations about moving into some sort of senior living facility arise. There’s a constant dance between I want my mom to be safe and my mom is saying well I still like being outside and I might fall but that’s a risk I’m willing to take but what tends to happen is that gets overridden by this. Well, let me put you in a bubble and keep you safe. That’s part of ageism. There’s another expression of it called benevolent ageism, which I think is an interesting example of that using terms like honey, dear or sweetie. This actually happened to me recently. I walked into a restaurant and someone who was clearly younger than me said, well, hello young lady. I’m a middle-aged person and that’s fine. I’m not ashamed of it. Don’t call me a young lady. So, it’s this notion of, I’m going to treat someone in a way that I think is kind and caring. But really it’s baked in with minimizing my value as a human because you think I’m older than you are. So, it shows up in different ways.
What does ageism do to the mature adult? What are the ramifications for them emotionally and mentally?
There’s very real age discrimination in the workplace. AARP has done important research showing the breadth, scope and depth of ageism in the workplace. That research shows that our economic well-being at the midpoint of our life shapes how well we’re able to live the lives we want to when we grow older. So, there are very real economic consequences of being excluded from the workplace altogether, being excluded from employee development initiatives. What kind of training is your organization offering and are they offering them to you in the same way that they are someone who’s 20 or 30? The answer is no, by and large. There’s some bias there. We talked a little bit about how this shows up in medical encounters and research is pretty clear. For older patients, there’s a tendency for physicians, nurses and other healthcare providers to not even listen anymore. If there’s an older person and a younger family member in the room, oftentimes their attention will shift.
There’s also an incredibly dangerous underdiagnosis of substance abuse, depression and anxiety among older people that leads to all kinds of negative health outcomes. It sets us up for not getting the care that we might need or benefit from just because of assumptions, implicit or explicit, that healthcare providers are making.
We harm ourselves when we say things like, well, I’m having a senior moment, I just forgot. Once or twice you forget a word fine. I forget and I’m 44. I forget words all the time and I forgot words when I was 20 also. There are some normal age-related changes in processing speed. Our hearing might change, which affects that but this tendency to write things off as I’m just getting older leads to lower life expectancy, higher medical bills and more dependence on supports and services. So, it’s real.
What are the mental health aspects for somebody affected by ageism?
At the most personal level, it can erode your sense of self and your sense of confidence, which then can carry over into decisions you make. For example, my daughter thinks that I shouldn’t go to the grocery store anymore, so I’m just going to let her do that. That might cut off a significant form of social interaction for people. It might seem little at the moment, but what happens after that? And so over time, it can actually get in the way of us connecting with other people. We know connecting with other people, seeing other people and encountering other people is a huge driver of health, the older we get. The data surrounding social isolation and loneliness is striking.
Is this a new phenomenon?
No. It’s not a new phenomenon. The first instance that this showed up is something like 600 BC, a long time ago in some of our very early Greek writings. There was mention of frailty and decline and this need to protect. It’s been around forever.
Is the assisted living facility the adjunct? Are we not equipped to take in our mature family members any longer?
There’s this notion of the good old days. In the good old days, families would take care of their own. And, for anyone interested and who loves to get into sort of the academic angle of that, there was a great scholar named Andrew Achenbaum. He’s written a tremendous amount about the history of aging in our society and culture. He does a beautiful job of breaking down some of these myths of the good old days. But I think what it comes down to is our obsession with being productive, being viewed as productive. We put so much value on what we’re producing economically as a volunteer for our community, as a parent, as an aunt or uncles, you name it. We’ve had to contend with this notion that as our minds and bodies change, there’s this automatic assumption that your contributions go away.
I think AARP is a great organization, that came about because Ethel Percy Andrus noticed that retired teachers did not have access to health insurance. That’s how AARP was born. And look at what it’s turned into today. So, we have a long societal history of excluding people as their bodies, minds and faces change. And where the pendulum is swinging back a little bit is this notion of multi-generational households and intergenerational connections. I don’t think there ever were these good old days when we automatically took someone in. I think that what we need to be thinking about and striving for is how to make sure we’re able to stay as connected as we can to our families and to our communities. How we can remind folks that we are contributing and we are productive, even though it may not be in the kind of very narrow ways our society has defined them. And younger people need to remember to include older members of their communities, families, whatever, in their conversation, because we’re all better off for it. There’s no us versus them. This is a story of us.
Where does that extended longevity fit into your view of healthy aging?
There’s no question we’ve made really important gains in longevity, but I think it’s important to acknowledge that those gains are not available to everyone in the same way. You brought up changes in life expectancy. You’re right from looking back for the past hundred years, we’ve made really tremendous substantial gains in life expectancy and longevity. There’s some thinking that everyone will be a centenarian. And there’s a book that came out that children born today will live their life expectancy in the hundreds. I don’t know if that’s true. And as a side note, I don’t think we’ve set up the necessary infrastructure in our workplaces and our communities to even accommodate that. It is important to look at what’s happened in the past two years. We’ve lost two years in life expectancy. And we know that things like overdose deaths of despair, obesity, accidents, COVID-19, that’s a meaningful blip. That’s like from age 79 to age 77. That is tremendously important to look at. And I think a nuance that is also important to look at is it’s not just older people living fewer years. It’s more younger people dying younger. So, I think a way to look at longevity and who it’s available to and who it’s not, is there’s an entire cohort of people who aren’t able to age in the first place. I think the root of your question is really about the physical and cognitive health that we’re bringing with us as we get older. I think despite gains in longevity, people live a long time with pretty serious health challenges. So, I think the call to action here for healthy aging is to the extent we can, no matter what age we are, think about how we want life to be in five years and what we can do today to gain those five years of good health, good life and set yourself up as much as you can.
Living longer is certainly a goal for almost everyone, but is it equivalent to living well?
It depends on your perspective. It depends on your definition of healthy. And gosh, we have such a tendency to assume that if we are bound to a chair and this goes back to our notion of productivity and being a contributing member, I love to go outside and garden. If I couldn’t do that, my quality of life would be pretty low. But we make all these assumptions that, when my body does this, I no longer want to be around. There’s a theory about this, it’s called compression of morbidity. It’s this notion of pushing out, compressing as far back as we can, the age at which we see chronic disease affects our lives. No matter how old we are, I don’t care if you’re 20 or 95, what can you do today to set yourself up to push, delay the onset and delay the worsening of conditions that threaten the life that you want to live?
Do you think we look at mature adults differently today?
That’s an interesting question. I’m not a believer in generational labels. I don’t think there’s a lot of value in comparing Gen X to the boomers to Gen Y. We’re all humans, we’re all nuanced. And we change over time. There are certain things that we bring with us as we age. And so, I do think the baby boom cohort of older people, folks born between 46 and 64, are more out and about, engaging in the workplace, engaging in communities, aging, living, dying, getting better, getting sicker, building businesses, you name it. So, I do think given the sheer volume of people that are aging right now, things are changing. There are just more examples to see and learn from. But I have to say what we saw, particularly when Biden was still on the ticket, in the news, in magazine covers, in rhetoric, set us back into how we’re thinking about aging. I think it did real harm, really reinforced some ugly, harmful, dangerous stereotypes that once you’re old, you’re no longer valuable in the context of our most visible political race.
Is there some way we can help people age better? What do we need to do to rectify this?
There are two components of this I want to touch on. And I think I’ll start with, are we in a good place? We are in a good place in terms of the infrastructure that we’ve built to support us as we grow older in some respects and we’re lacking in others. But I think it’s important to remind people that we have what we refer to as the aging network and we’ve had it for a long time. There is a fabric of very good public policy, very good programs and very good state and local agencies to help us get what we need in order to live our lives in the way that we want to.
Social Security Comes to mind, that’s been a hugely important program for keeping older people out of poverty and children and families too. Medicare is part of that. The Older Americans Act is America’s best-kept secret, I think. It is a program that is available to everyone 60 plus. It doesn’t matter where you live, or how much money you have. If you’re 60 or older, you have access to a constellation of services from access to food, transportation, family caregiver services and supports. It’s available to all of us. And the Older Americans Act has been around for decades. It’s up for reauthorization right now. So, if you’re interested, I encourage you to Google the Older Americans Act and learn about what it is.
In one sense of the word, we’ve got a lot of amazing resources that are underutilized. However, here’s the bad news. The funding for those services has remained flat. People aren’t aware of them. And there are real workforce shortages that are affecting people’s access to those services when they need them. I see these as opportunities for whoever’s in the White House next to really lean into. But yeah, I encourage everyone to learn about the Older Americans Act. And if you’re inspired, call your elected official and ask them what they’re doing to reauthorize it and to shore up funding. Because again, this is a program for all of us once we reach 60.
To answer your second question, how well are we doing? We don’t have any sort of national long-term care plan. The only funder for long-term services and support is Medicaid. And you have to be below a certain income threshold to access that. Otherwise, I know most will relate to this, when you need care or help from your family member with something, it is an almost impossible maze to navigate and it’s a real problem in this country. So, from that perspective, we lack real coordinated public policy. But like I was saying earlier, there are more people than ever before who are growing older and people are doing all kinds of interesting things entrepreneurship in the 65-plus group is growing. That’s really exciting. Climate activism. There’s a group called the Third Act. Bill McKibben set that up and it is explicitly pulling in older folks who want to engage and activate around climate and other social justice issues. This leads to what we can do to set ourselves up for healthier aging.
I want to talk about some things that a couple of organizations are doing that you may be interested to know. Several organizations are innovating in this space. AARP has something called the Brain Health Action. Most of us care about brain health. And AARP is pulling together some neat groups like Us Against Alzheimer’s. They are really pushing the message that there are things we can do to improve our brain health and prevent cognitive decline. Those are not outside of our reach. Part of that Brain Health Action Collaborative is the Sound Health Network, which is based out of UC San Francisco. They are all about promoting the impact of music on health and well-being. Listening to music is a joy for many of us. It turns out that listening to music is very good for our brain health. Like innovative advances, just understanding how other aspects of life outside of going to the doctor can help us improve our brain health, is exciting and is something to look into. I also want to highlight the work of a couple of organizations that are trying to close this sort of longevity gap. Let’s say we know that longevity is not equally available to all of us. One part of the population that this is true for is the LGBTQ community. And there is an organization called Sage that operates out of New York City doing foundational work to change the narrative about what it means to age as someone who identifies as gay, bisexual, transgender and queer. They are focusing on the impact of the harms of discrimination that group experiences over their life course and helping other organizations understand how to do things differently and better to support longevity in that segment of our population. There’s also a group, a movement called Aging While Black. Raymond Jetson is the mastermind behind that group. They are all about breaking down this notion that growing older as a Black or African American person looks the same. They are leaning into the power of wisdom and wisdom transformation. They’re leaning into how the tech industry can be informed by and inform older Black lives. They’re doing some incredible work just to elevate the experience of people growing older in Black families and communities. The National Indian Council on Aging is doing something similar. They host a tribal elder conference every year. They pass tribal resolutions. So, my point here is we started this conversation by me saying aging doesn’t look the same for all of us. These are just a couple of organizations that are really running towards that and trying to move the entire field in that direction and figure out how to show up for people who need to be shown up for.
What is the biggest misconception of aging?
One big misconception is that there’s just one way to age well. And it’s not accurate. There are all kinds of ways to age well, and it needs to be anchored to how you want to age. We need to anchor that with the knowledge that humans are born to change. And so how aging well looks to you today may be different in five, 10 and 20 years and not just from a model of decline. You can get better. You can learn. You can be cured. You can develop a new interest or hobby. There’s not one way to age well and it’s not all about decline. And on a related note, I think too many of us have a misconception that aging well isn’t possible at all. And that’s what I’d really challenge younger listeners to think about is possible. And it’s real.
About Leanne Clark-Shirley, Ph.D.
Leanne Clark-Shirley, PhD is President of CEO of the American Society on Aging (ASA). A social gerontologist with nearly 20 years of experience working in aging-related nonprofit, consulting and academic environments. Clark-Shirley was AARP’s Senior Evaluation Advisor, responsible for strategic planning, before joining ASA. Prior to that, she led the Aging and Disability research practice at IMPAQ International, a think-tank and policy research firm. Clark-Shirley is a fellow of the Gerontological Society of America, teaches courses on policy and aging and regularly mentors students interested in non-academic careers in aging. She received her doctorate in gerontology from the University of Maryland, Baltimore County.
Please visit the American Society on Aging to learn more.
