An epidemiologist and geriatrician, Dr. Fried, dean of the Mailman School of Public Health at Columbia University, has focused her career on what she sees as the definitive challenge of the 21st century: embracing our transition to an “aging society” in which, over the last century, our life expectancy has increased from fifty to eighty-plus years.
Pennar’s opening paragraph is the focus of today’s post:
“The signal public health achievement of the 20th century was the increase of the average human life span. Now, as that achievement helps raise the proportion of the aged around the world, what once seemed an unalloyed blessing is too often regarded as a burden — a financial burden, a health care burden, even a social burden.”
“It’s nuts,” said Dr. Linda P. Fried. “To assume defeat from what every one of us as individuals wants suggests we’re not asking the right questions.” She continues that findings from the science of aging should “reframe our understanding of the benefits and costs of aging.”
Dr. Linda P. Fried (Video by The New York Times06/25/2012)
Linda P. Fried: An interview with the geriatrician and dean of the Mailman School of Public Health at Columbia University on preventing frailty and the transition to an aging society
So how did we, as a society, grow to be so ambivalent towards growing older? Why do so many people seem to fear it? And what can we do to turn things around?
Not just to ameliorate that gnawing unease, but to begin to uncover, highlight, and advance the myriad benefits we, as a society, can reap from the huge jump we’ve achieved in average lifespan.
How can we support older adults in maintaining involvement in their communities post-retirement? There is so much to be gained, both by our aging population and society as a whole, if we can find positive ways to encourage lifelong engagement.
Dr. Fried has focused her career on what she considers to be the challenge of the 21st century: embracing our transition to an “aging society” in which, over the last century, our life expectancy has increased from fifty to eighty-plus.
Why the fear?
I am not a Baby Boomer and I don’t pretend to speak for their generation. But almost any media piece about them reveals a generally accepted truism: the Baby Boomer generation has largely been defined by their idealization of youth and youth culture. ‘Elderly’ No More, an April 2012 post in The New Old Age (also published by the New York Times), discussed the difficulty of even finding a terminology that people entering their older years will accept.(2) Words like “elderly,” “older adults,” “senior citizens,” “seniors,”…even “aging.” These are words that Boomers tend to reject when referring to themselves.
And there are so, so many of them.
As a result, our entire culture is often swung by Baby Boomers’ opinions. They always had, and continue to have, a huge influence over society by the sheer force of their numbers. Throughout their lives they’ve seen themselves as young and vibrant, a new generation able to redefine their relationships to one-another, to their parents, to their children. As aging adults, Boomers seem to identify more with their children, sometimes almost feeling like they are peers. Conversely, they continue to feel very separate from their parents’ generation.
Over the course of a typical Boomer’s life, life expectancy (in the US, from birth) has increased at least a decade. (3)
I posit that it is the Baby Boomers’ trepidation of aging that has led to a cultural fear. Whether it’s because they want to “never get like that!” or simply because they’re having a hard time adjusting to the implications of ever-increasing years, Boomers (as a whole) seem to really want to stay young…or at least act that way.
Because so much of America’s identity is determined by the Boomers, this fear of getting older became embedded in our culture. But it doesn’t need to be.
In truth, aging isn’t necessarily something to be afraid of. It is, however, something that needs to be openly discussed. That’s the easiest way to keep irrational fears at bay.
A lot of the uneasiness surrounding getting older seems to be rooted in one of two things: a lack of education about what aging actually means (hint: aging does not necessarily mean dementia), and our current failure to fully support and accommodate our elders.
MySimpleC.com is largely focused on dementia, and I want to take this opportunity to again state that, although many illnesses that cause dementia do correlate with older age, “aging” and “dementia” are by no means interchangeable. Even among those of us fortunate enough to reach the age of 85, less than half show symptoms of dementia.
In addition, the stigma surrounding dementia is often unwarranted. Is it symptomatic of an underlying chronic, possibly terminal, illness? Generally, yes.
But does it mean that your life is over the moment you’re diagnosed? Not at all.
I’ll save my extended thoughts on this for another day, but suffice to say that I believe that we have a lot of room for improvement with how we treat those with dementia.
The big take-away point here, though, is that GETTING OLDER does not necessarily mean GETTING DEMENTIA, and that having dementia shouldn’t preclude people from remaining involved in their worlds.
So, beyond separating “aging” from “dementia,” what else do we need to address? The way that we currently treat our elders.
There is an expectation that people will turn 65, retire, move to Florida or Arizona, and live out their days apart from the rest of us. For some people that may be a dream come true; there’s no reason not to do it if you want to.
But more often the problem is that older citizens find themselves increasingly unaccommodated and unaccepted in their own lives. They are marginalized.
There may not be outlets through which they can contribute their decades of knowledge. It may be difficult to get around without driving a car and facing cutthroat traffic. Their abilities may be undervalued or unacknowledged.
Sometimes there’s just a disconnect between the opportunities and those who could fill them.
But for whatever reason, too often our elders are brushed aside.
It’s really unfortunate that that’s the way things largely are. We miss out on a lot.
For one thing, we lose a lot of knowledge that our elders have spent decades accruing. We’re not hearing important perspectives. We’re too often content reinventing the wheel and too rarely seek input from those who have it to offer.
Plus, by encouraging our current elders to be more active participants in society, we will dissipate some of the strange fear we’ve built up around growing old. Seeing each individual’s personality, passions, and abilities acknowledged, it becomes easier to see their humanity. This allows us to better understand that, even with grayer hair or more wrinkled skin, each person is still fundamentally a person.
And that knowledge, encouraged by increased interaction between the generations, brings a myriad of benefits. It helps combat agism; older adults remain engaged; younger adults (and even children) learn from them; by allowing everyone to participate, communities begin to function better. And it also allows us to better envision a positive future for ourselves as we age.
So how do we get from point A (where we currently are) to point B (a more integrated society)?
Changing mindsets isn’t easy. I believe that the first steps are in encouraging seniors, as well as those approaching retirement age, to volunteer in their communities.
For many adults, retirement begins a steady decline as a lack of work leads to both boredom and a feeling of lost usefulness. If people began to seek out passions prior to retirement, their continued involvement in them post-retirement would help soften the transition from full-time employment to “what do I do with all of this time on my hands.”
Anything from mentoring young executives to knitting hats for premies, from leading a book club to starting a bocce team…just something outside of work and kids to stay involved.
As someone not yet of that age, I feel it’s my duty to encourage those ventures. I love knitting and singing, for example; I’d gladly join an all-ages knitting group or chorale. Look for small ways to continue to engage with people of all ages and you will ultimately support lifelong community involvement.
So, as a society, we have a largely unjustified fear of aging. For lack of a better term, we need to “grow up.” Being afraid of something that we simultaneously desire leads to so many strange conflicts, both internal and societal.
Because the largest generation we’ve seen is beginning to enter the “older adults” stage, it’s particularly important that we begin this now. We don’t want huge segments of the population shunned, cordoned off, or isolated; we want to integrate and utilize the knowledge and skills that we all have to offer to push our society forwards.
Plus, increased isolation correlates with a more rapid progression of dementia in those in its early stages; bringing people back into the world can help them as much as anyone else.
The first steps we can take are small, individual: don’t shy away from older people. If it’s appropriate, engage people you wouldn’t normally talk to. Be patient if someone’s a bit slower at the grocery store than you are. Be kind and open. We can make our society friendly to everyone and it will benefit us all; all we have to do is take the first step.
by Karen Pennar. June 25, 2012.
by Judith Graham. April 19, 2012.
Average Life Expectancy at birth (all races, both sexes) in years
2010 : 78.7
: 76.2 (Male, all races)
: 81.1 (Female, all races)
2000 : 77.0
1990 : 75.4
1980 : 73.7
1970 : 70.8
1960 : 69.7
1950 : 68.2
1940 : 62.9
1930 : 59.7
From Columbia University’s website:
DeLamar Professor of Public Health, Mailman School of Public Health
Dean, Mailman School of Public Health
Senior Vice President, Columbia University Medical Center
Professor of Epidemiology
and: Professor of Medicine, College of Physicians and Surgeons
Linda P. Fried, MD, MPH is a leader in the fields of epidemiology and geriatrics. She has dedicated her career to the science of healthy aging, particularly the prevention of frailty and disability, and design of approaches that will strengthen the benefits to all of being an aging society. The latter includes the design of health-promoting activities and roles for older adults that solve major societal needs. Dr. Fried co-founded Experience Corps, a community-based senior volunteer program designed to support the academic success of children while also serving as a health promotion program for older adults. Dr. Fried’s scientific career has defined the phenotype of frailty as a new clinical syndrome, provided evidence as to its causes and identified opportunities for prevention. Her research has also identified approaches to prevent cardiovascular disease and the loss of independence with aging.
Dr. Fried is the recipient of numerous honors and awards, including the APHA Archstone Award, the U.S. national Bridge Builders Award, the Maxwell Pollock Award of the Gerontological Society of America, and has been named a “Living Legend in Medicine” by the U.S. Congress. Dr. Fried is an elected member of the National Academy of Sciences’ Institute of Medicine and of the Association of American Physicians where she serves on the governing Council. She is a member of the World Economic Forum Global Agenda Council and Council on an Aging World, and of the MacArthur Network on an Aging Society.
Previously, Dr. Fried served as the Mason F. Lord Professor of Geriatric Medicine at The Johns Hopkins Medical Institutions, with appointments in the School of Medicine, and Bloomberg School of Public Health and School of Nursing. She directed The Johns Hopkins Center of Excellence for Aging Research, the Center on Aging and Health, and the Division of Geriatric Medicine and Gerontology, and led major multidisciplinary research programs on the causes and consequences cardiovascular disease, frailty, cognitive impairment and disability in older adults, and approaches to prevention.
Dr. Fried received her MD from Rush Medical College in Chicago and her MPH from Johns Hopkins. She trained in internal medicine at Rush Presbyterian-St. Luke’s Medical Center in Chicago and in general internal medicine, cardiovascular epidemiology and geriatrics at Johns Hopkins.
Linda P. Fried: An interview with the geriatrician and dean of the Mailman School of Public Health at Columbia University on preventing frailty and the transition to an aging society.
Transcribed by VLR on 6/26/2012
“Most young people, in fact most middle-aged people, can’t imagine being 70- or 80- or 90-years of age. At this moment in human history do we know how to become this population of longer lives? do we know how to step into this unknown and do it well?”
It’s about my kids, because they are living in a world where life expectancy has increased from fifty to eighty-plus in 100 years and they’re going to have four to five careers over their lifetime, and they may not retire until they’re seventy or eighty.
I actually was not planning to go into medicine, it never occurred to me when I was in high school or college, I was a history major who was interested in law. Then I started thinking that, in a lot of ways, the challenges of turning into an aging society in a way that was good was going to be the challenge of the 21st century.”
“Geriatricians understood that some people, somehow, as they got older, became “frail.” But there were lots of definitions in the field about what frailty was and I can go through a long litany of what they were, but, fast forward 20 years of science. The 5 criteria for frailty are: whether someone is thin and has lost weight; whether they are weak; whether they have slowed down (measured by whether their walking speed is slow); whether they’ve declined in their physical activity; and whether they have a sense of low energy or exhaustion.
The advice is absolutely to get moving, and to get moving particularly in terms of maintaining strength. That’s critically important, that will also maintain muscle mass and it appears that you need to have a certain amount of strength to have the energy to get up and go.”
“I’m extremely impressed with New York as a great city to grow older and to retire, because of the ability to get to lots of culture and access churches and synagogues and all kinds of things that are important to peoples’ well-being; to get on the bus and go see friends; and to stay engaged in a lot of civic activities because New Yorkers are so civic-minded and community-focused.”
“One of the things I heard a lot in the mid- to late-eighties from my patients was how difficult the transition to retirement was, and is, for many people. And how role-less they felt, and how unproductive they felt. So people who had been busy and engaged and contributing to so many peoples’ lives suddenly were cast off into the American sea of rolelessness, post-retirement. And with great difficulty in terms of lack of purpose and lack of ability to find roles that mattered.
Part of a successful transition to being an aging society is to create new, unanticipated roles through which older adults can stay engaged in ways that are deeply meaningful for them and make a profound difference for society. And if we create those roles, we will actually amplify hugely the benefits ahead of us of being an aging society.”
Video/Photography: Tony Cenicola/The New York Times)
Photographs courtesy of: Dr. Linda P. Fried
Reporting/Producing: Thomas Lin/The New York Times
New York Times © 2012
Select quotes from Unafraid of Aging
by Karen Pennar
June 25, 2012
New York Times © 2012
Findings from the science of aging, Dr. Fried said, should “reframe our understanding of the benefits and costs of aging.”
she believes that research on aging and health changes “across the life course” are central to designing solutions to public health problems in the 21st century.
Dr. Fried has spearheaded a large body of scientific research on aging. She spent more than two decades at Johns Hopkins University studying data collected on the health of more than 5,000 men and women 65 years and older as part of the Cardiovascular Health Study, and later mined data on 1,000 women over 65 for the university’s Women’s Health and Aging Study.
She broke new ground in defining frailty in the elderly, developing a simple assessment tool that uses five criteria to test for frailty. She also developed the concept of a “frailty syndrome,” and continues to guide younger colleagues in studies exploring how the frail respond to various stressors.
After training and fellowships in public health at Johns Hopkins, she was recruited for a fellowship in the geriatrics program at the university’s medical school by Dr. William R. Hazzard, and hasn’t looked back. Dr. Hazzard, now an emeritus professor of medicine at the University of Washington, said that at the time, most physicians were daunted by the challenges that go with the aging process. Dr. Fried, he said, “embraced the complexity.”
Indeed, the frailty syndrome that Dr. Fried describes is at once simple in its constituent elements and complex in the manner in which those elements interact. In a sort of negative synergism, insufficient nutrition can lead to loss of muscle mass, which can reduce strength and walking speed, which in turn reduces overall activity and energy. All of these factors interact to dysregulate the immunological, endocrinological and other systems in the body.
Dr. Fried is still looking for new ways to engage members of an aging population. She and Dr. Laura L. Carstensen, director of the Stanford Center on Longevity, both of whom serve on the MacArthur Foundation’s Research Network on an Aging Society, recently wrote an article together for the World Economic Forum, calling for the development of “infrastructures that tap the real talents and potential contributions that healthy older people can make to societies.” One idea that Dr. Fried has weighed in on, now being developed at the Stanford Center, is a program that would steer people who are close to retirement to volunteer activities that they can continue to pursue in retirement.
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