Proud aging in America is undermined by inequality and ongoing anxiety.
No topic in America may be as closeted and yet on the tips of people’s tongues as what really happens as loved ones pass through their senior years, especially the end of life.
This week, I told one verbose middle-aged friend who called that his college roommate has been taking care of his wife’s 91-year-old mother at his home, which silenced him. His ex-roommate, an accountant, was stunned when told by a local nursing home “to bring her in and we’ll figure out the finances later.” They charge $10,000 a month.
Before I could say this sounded like a senior version of a subprime loan, he blurted out that his 83-year-old ex-professor dad just had both knees replaced and was “wondering what he will do before he dies.” Then he recounted wanting to help a relative get a veterans’ stipend toward nursing home costs, griping that hiring an expert for the paperwork costs $4,500. And then he fretted about his mother-in-law in her 80s.
On the other hand, when I recently talked to a family member who is aproaching 80, fairly healthy, still working, not complaining about himself or taking care of his wife, there’s a positivity and acceptance lacking in my middle-age peers. He’s active and living at home—unlike many of the people profiled in Atul Gawande’s bestseller, Being Mortal, which chronicles the last phases of life: where decline and a loss of independence push most Americans to put loved ones in cold institutions in their final months.
These anecdotes are the tip of the an enormous iceberg about the struggles, fears and generational temperaments accompanying aging in America. While there is plenty to worry about, it is often not what is advertised in fear-based ads targeting greying mid-lifers and more elderly people. Different issues and existential concerns confront people in different phases of later life—financial, physical, emotional—especially at the end.
But aging does not have to be a one-way slide downhill, as stereotypes suggest. Studies have found people who feel younger than their age may live years longer. Positive social factors, if present, can improve physical and mental functioning. And several studies conclude that one’s emotional life isn’t richest until well into one’s seventh decade.
There is no single landscape of fears or concerns surrounding aging. Take the 77-million baby boom generation, born between 1946 and 1964 who today are between age 69 and 49. In a remarkable nationwide survey a few years ago, Pew Research Center found that the youngest boomers’ worst fears and highest hopes were not confirmed by the actual experiences of their older counterparts.
When asked, sizeable percentages of people under age 65 said that they expected to face all of the following problems as they aged: memory loss, losing ability to drive, serious illness, diminished sex lives, sadness, depression, loneliness, not being needed, trouble paying bills, and being a burden. Yet the prevalence of those problems among people over 65 was markedly lower in every category—sometimes by more than two-to-one. In contrast, expectations that people under 65 had about having more time for hobbies, family, volunteer work, travel and financial security in later life were also unmet.
“Getting old isn’t nearly as bad as people think,” Pew said. “Nor is it quite as good.”
Pew’s results suggest that two biggest variables affecting one’s well-being as one exits middle age are one’s health, physical and mental, and finances. The book by Gawande, a surgeon, teacher and New Yorker writer, is notable because it fills in what happens at the very end of life: how medical interventions and nursing home costs can roil family finances and emotions, and often do not bring well-being or dignity to people in their final months. Yet in between these two life passages—exiting middle age and the loss of independence—sits another expanse, often lasting decades, with its own spectrum of issues about aging gracefully.
As Americans enter a period where there will be more aging and elderly people than any other time in its history, we can point to a handful of facts, factors, fears and realities that will shape the quality of million of lives. These start with the financial landscape, which create a baseline from which other issues emerge or recede.
Inequality’s Older Face: The Retirement Income Gap
American may be living longer, but there are serious questions about whether millions of people will slowly slide into poverty because they lack the savings to supplement Social Security and other government safety nets. On one hand, millions of Americans are well-prepared for retirement in coming years. However, millions also will be in trouble.
The nation’s 77 million baby boomers control 67 percent of America’s wealth, or $28 trillion, ImmersionActive.com, an ad agency specializing in boomers, said, citing federal figures. That wealth, along with Social Security, has to sustain the living expenses of 40 million people who now are 65 and older, a cohort whose ranks will reach 86.7 million by 2050, according to the U.S. Census. The rub is that $28 trillion is mostly concentrated in upper-income households. So while millions of people can afford to stop working and might fret about unplanned expenses, namely health crises, millions of households—especially non-whites—face starker futures because they will primarily rely on government safety nets.
Alicia Munnell, director of Boston College’s Center For Retirement Research, testified this month in the Senate that Americans would need an additional $7.7 trillion in savings to maintain current living standards. Others, such as the National Institute on Retirement Security, estimated that the “retirement income deficit” could be $14 trillion. The reason for the massive shortfall is decades of middle- and working-class wage stagnation and the disappearance of pensions—delayed salary payments for retirement. Wall Street’s touted replacement, stock market index funds, have not yielded anything close to pensions.
According to AARP, half of all current retirees depend on Social Security—averaging $1,330 a month—for 50 percent or more of their income. That’s 20 million people today, which will grow every year. If that average monthly payment were a salary, it would be a dollar more than the federal minimum wage. While there has been a push by Democrats and Independents in Congress to increase Social Security payouts, Republicans keep balking, even though the fairest fix is lifting a cap on payroll taxes for the wealthy.
Politics aside, running out of money is perhaps the most oft-cited financial issue of older men and women in various surveys and polls. This fear brings up a related issue: elder financial abuse, which arises when seniors are duped into predatory investments or other scams. It’s hard to get a clear sense of the scale of this problem, because many groups or businesses issuing estimates want to sell their cure—adding to the inordinate amount of fear-based marketing aimed at the elderly. However, the numbers are striking.
True Link Financial, a California firm that helps detect these abuses, just issued a report saying seniors lose $36.48 billion this way annually. $17 billion is “when misleading or confusing language is used [to push investments]—often combined with social pressure and tactics that take advantage of cognitive decline and memory loss.” Criminal fraud, meaning various scams or identity theft, takes anotyher $12.76 billion, it said. “Caregiver abuse,” by someone in a trust relationship, “typically a family member but sometimes a paid helper, friend, lawyer, accountant, or financial manager,” creates another $6.67 billion in losses. “We estimate that 954,000 seniors are currently skipping meals as a result of financial abuse,” True Link’s analysis said, after warning that seniors who frequently receive telemarketing calls are often victims.
Health Issues: Real Versus Imagined.
The biggest fear cited by people under age 65 in Pew’s national survey of expectations about older life was that the majority—57 percent—expected that they would experience memory loss. But only 25 percent of Pew’s respondents over age 65 said that happened. This result partly refutes an old stereotype—that getting old means inevitable mental health decline.
Other research supports Pew’s finding. The federal Centers for Disease Control and Prevention reported that “approximately one in eight adults over age 60” had increased confusion or memory loss in 2010. Notably, less than half of those experiencing these difficulties sought help from a family, friend, or a health care provider, CDC said, for reasons ranging from shame to fear of health care expenses.
The American Psychological Association also said that 12 percent of older Americans, or 5.4 million people, experience dementia, a catch-all term for a range of memory and behaviorial lapses. APA said about one-in-five adults, 65 and older “met criteria for a mental disorder,” which also included anxiety, depression and suicide risk. In nursing homes, closer to the end of life, APA said that more than half of residents “have some form of cognitive impairment, and many nursing home patients have personality disorders exacerbated by chronic health problems.”
Again, the fears and concerns of aging wary with one’s life stage and even gender. As men and women leave middle age, caring.com reports that what they fear the most about aging differs. For women, the top concerns are “losing attractiveness/becoming ‘invisible,’” being left alone, becoming poor, developing cancer—especially breast cancer, and being dependent on others. For men, the top concerns are sexual impotence, physical weakness, becoming irrelevant by ending a career, losing the ability to drive and their independence, are dementia—or their wife suffering from it.
As people move beyond age 65, the focus seems to shift, according to other studies (yet again by senior marketing experts) where the greatest fears have to do with more concrete physical or cognitive impairments, and the existential issues that come from running out of money, having to move from familiar surroundings, the death of a spouse, or the inability to manage their daily activities and reliance on strangers caring for them.
It’s easy to conclude that there’s little that can be done to slow or stop these worst-case fears or inevitable bad endings. Yet one of the biggest takeaways from scouring recent reporting and research is there is a period between middle age and when people say they are old—an unnamed zone—where concrete actions can increase the quality of life. A handful of new research supports this.
According to one study by Becca Levy at the Yale School of Public Health, cultural attitudes and media messages about the elderly can translate positively and negatively—making older people feel better or worse in measurable ways. Another study that Levy participated in showed that cultural beliefs about the aging process also impact actual cognitive function, slowing or exacerbating the extent and speed of memory loss.
In the U.K., another study of 6,000 people over age 52 found that people who felt they were “at least three years younger than their chronological age were less likely to die over the next eight years than those who felt equal to or older than their actual age,” Reuters Health reported last December. In other words, feeling younger prolongs lifespans.
Caregiving Quandaries
As Gawande’s book notes, the most difficult period with the greatest unknowns comes at the end of independence of loved ones and their families. Here, too, there’s a progression that can be seen in caregiving, where each stage presents fears and challenges.
In a recent article, AARP said that “more than 42 million family members provide care to an older adult.” It continued, “But there is also a growing care gap, as boomers transition from giving care to needing care themselves.” It is not a new scenario to hear about families exhausting their assets to provide various forms of residential care—before qualifying for state-run Medicaid to cover what follows. But that is only part of the concerns facing families as loved ones age; as scary is having “the talk” about when long-term care is needed, medical intervention stops, and hospice begins.
Long-term care means a sequence of services for people who cannot care for themselves any more—starting with paid help at home. Of the 40 million Americans age 65 and over, 8 million people received some form of long-term care each day in 2012, the federal National Center for Health Statistics reported. This included 4.7 million people who “received services from home health agencies,” to 273,200 enrollees in adult day care, to 713,300 residents in residential care communities, to 1,383,700 residents in nursing homes, to 1,244,500 patients in hospice.
The challenges facing families who are wresting with how to best care for loved ones in these settings also varies with age. To middle-aged children arranging the care, their top frustration may finding the right caregiver or pinpointing costs. A friend, an accountant who helping to care for his wife’s 91-year-old mother, said government websites never reveal what financial assistance one can expect from state and federal safety nets. This gap—between fixed incomes and unknown living expenses—affects many aspects of senior life, said Paul Kleyman, editor of Generations Beat Online.
On the other hand, the older family member who is being told they must get help from a stranger in their home, or must leave their longtime home faces entirely different issues and emotions, as most don’t want to see familiar surroundings vanish, and they may be confused—and then very depressed—about what’s going on around them. The great service that Gawande’s book provides is showcasing these struggles in his family of physicians, humanists and teachers.
But stepping back from end of life issues, when one surveys the landscape of fears that face aging Americans, several big takeaways emerge. First, generalizations do not apply when life in every successive decade or phase presents different challenges. Moreover, lots of what is pedaled in the media, or by fear-mongering businesses, is wrong, because the real-life experiences of what often happens is different. And what really matters or scares people the most isn’t widely talked about at all—even though what’s really happening to aging loved ones sits on the tips of people’s tongues.
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