Don't call me old!

I recently celebrated my 74th birthday. Not surprisingly, I'm thinking more these days about fostering a positive and proactive approach to the physical, mental, educational and social needs of the elderly.

The topic of old age is surely an age-old one. Shakespeare in his seven ages of man has his sixth as a lean and slippered pantaloon; and his seventh age as mere oblivion— sans teeth, eyes, taste, everything.

But at a time when people 65 years or older represent one in every eight Americans, the topic assumes ever greater importance and urgency. The number of older Americans has increased 15.3 percent since 2000. A staggering 53,000 living Americans have celebrated their 100th birthday. And how many workers support one social security retiree? In 1950, 16; in 1980 3.2; today, roughly two.

Murdoch's retort

Better than the alternative, you might say. But the ramifications of this growing segment of society are huge. We need to harness its vast experience and knowledge to the benefit of everyone.

Just think: a 60-year-old in reasonable health will likely have 25 years more on this planet. Age 60 is a beginning, not an end.

Noam Chomsky, at 84, speaks of his full days spent teaching and writing; and Queen Elizabeth, 86, attends some 400 engagements a year; Rupert Murdoch at 82 is still firmly in control of a major media and entertainment empire (when asked when he will step down, Murdoch replies that his mother lived to 103).

Yet the perception that people in their 70s and 80s are consigned to Shakespeare's cloudy oblivion still persists.

They remember Hitler

I balk at the question I'm frequently asked: Are you still working? Yes, I am. And I expect to be until they carry me out feet first.

Perhaps the greatest benefit of reaching a truly old-age— aside from the attention and respect it commands— is that one will have lived through a large swath of history: Many of today's elderly will have witnessed World War II, the invention of penicillin, jet engines, TV, computers and cell phones. Why not encourage them to pass along this wisdom to the young?

Age 70 vs. age 50

At the World Economic Forum in Davos, Switzerland, last year and subsequently in a webinar, panelists considered the question, "What is old?" and concluded that a healthy 70-year-old is pretty much indistinguishable from a healthy 50-year-old. The main focus of advocacy for the elderly, that panel believed, is positive thinking— seizing the social and economic opportunities created by an aging population that the panelists perceived as an untapped resource.

To do that, we have to step up public health education and review our notions about pensionable age and Medicare eligibility.

The German chancellor Otto von Bismarck is credited with introducing health, accident and old age and disability benefits that kicked in at 65— this in the 1880s, when the average life expectancy was 48. But that's a myth: Bismarck's benefits actually started at 70 and didn't revert to 65 until 20 years later. Nonetheless, Bismarck's bet on life expectancy was pretty shrewd.

Goldman's 'returnship'

That Davos panel also discussed the need to redesign health care delivery to focus more on prevention and wellness, the importance of reforming labor laws to discourage putting people out to pasture at 65, and ways to introduce flexibility into the workplace. Goldman Sachs, for instance, has introduced a new wrinkle on internship called returnship— it encourages people at or approaching conventional retirement age to remain on the job part-time.

Sensible advocacy for the elderly today calls for an age-friendly work place, stepped-up training in geriatric medicine for primary care physicians, addressing America's possible 100,000 shortfall in physician manpower and an emphasis on personal responsibility rather than government largesse. It also has to do with inculcating a sense of worth in older citizens.

Advocacy also means a renewed focus on one area where government should get seriously involved: Looking for a cure for Alzheimer's, now the fifth leading cause of death in people over 65.

Potent voting bloc

A company called Home Instead, launched in 1994 by the Davos panelist Paul Hogan (whose mother was a longtime caregiver to his grandmother), provides nonmedical and non-nursing care onsite by community caregivers, 30 percent of whom are over 60 themselves. They offer companionship, reminders about drug regimens, help with financial and legal issues, and general tender loving care.

Yes, senior citizens are blessed with multiple advocacy groups, from the American Association of Retired Persons (AARP) with its 40 million members, to Advocacy Group for Elders (AGE), to CARIE, to state and municipal senior agencies.

And yes, these groups have made some strides in providing discounted theater tickets and free bus rides for senior citizens.

But perhaps the biggest force for advocacy is the elderly themselves, who constitute a powerful voting bloc— strong enough to influence (and scare) legislators.

Rise of hospice care

But aside from rights and benefits, the elderly also need good advice for the last stage of life—about living wills, assisted living, hospice care. According to Donald Schumacher, chief executive of the National Hospice and Palliative Care Organization, "Almost 45 percent of all deaths in the U.S. now occur in hospice programs, yet far too many receive care for a week or less. We need to reach patients earlier in the course of their illness to ensure they receive the full benefits that hospice and palliative care can offer."

Drawing up a living will is also best done sooner rather than later to make known— and legal— a person's wishes about life-prolonging medical treatments.

One other thing: seniors are readmitted to the hospital far too often, mostly because they don't know or aren't sure what they're supposed to do when they go home. Forbes magazine reports that the elderly claim to understand instructions when they really don't, or they say that they have a caregiver at home even if they live alone. Teaching communication skills to both providers and patients is central and urgent. And seniors whether 65 or 100 will benefit.

In my farewell editorial as editor of Canadian Family Physician in 1972 — yes, 1972— I wrote that we tend to cocoon the aged in euphemism and denial. Just as the Victorians covered piano legs in socks in order to discourage lascivious thoughts, we still tend to shield from view any reminder of human finiteness by consigning senior citizens to senior centers and retirement communities.

After writing that editorial, I went on to assume a new position as editor of Geriatics at the advanced age of 33. I wonder if Geriatrics would hire me now.♦


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