Why it’s time to face up to old age
The social and economic costs of ignoring the elderly in a society bent on denying and defying age.
If film-studio executives sat down to create a movie that reflected Hollywood’s pathological aversion to seeing old faces as anything but cues for Depends jokes, they couldn’t outdo The Age of Adaline. The movie, out next year, stars Blake Lively as a woman born at the turn of the 20th century who has a freak accident at age 29 that stops her from physically aging over the next 100 years. Adaline is the ideal heroine in an “anti-aging”-obsessed culture: a centenarian with a twenty-something body and unlined face. The fact that Lively, 26, is younger than the impossibly young old woman she portrays is a telling detail, a reminder that even women on the cusp of 30 are now described as “aging,” that axiomatic process that begins with birth but is now code for “old.”
Lively graced this year’s annual “Age issue” of Vogue, which features no actual old faces but plenty of ads for “age-defying” products, a billion-dollar market now targeting children—Geo-Girls, Wal-Mart’s cosmetic line for preteens, includes an “anti-aging” cream with antioxidants. New “problem” areas create new markets, seen with the arrival of remedies for “old hair,” a curse of women over 40, surely resulting in part from using harsh product to cover the grey. There’s also new “smile lift” surgery to “re-establish youthfulness in a natural way,” as dentist Michael Apa told Forbes this summer.
A counterinsurgency to this airbrushed, commercialized—and flagrantly fraudulent —depiction of what it is to grow old has begun to mobilize, led by the old themselves. The emerging message is complex, cautionary and not the stuff of glossy marketing campaigns. “Getting old sucks!” the American sociologist and psychotherapist Lillian Rubin writes in 60 on Up: The Truth About Aging in America, published in 2007 when she was 82. Rubin was no “80 is the new 60” cheerleader; she wrote candidly of losses—her husband’s dementia, becoming a widow, losing her sight and contemplating suicide out of fear that “a burdensome, needy old woman replaces the independent, achieving person I’ve been.”
When Rubin died in June at age 90, Salon ran her essay, “The hard truth about getting old,” which calls old age “a time of loss, decline and stigma, and no one gains by denying it.” It was the site’s most-read story for days, a sign of the hunger for dispatches from the alien planet of “old.” The writer Nora Ephron was similarly cheered for taking on a taboo when she discussed the downside of approaching 70 a few years ago: she pointed out that the arduous Sisyphean “maintenance” she underwent to look younger, or not as old, didn’t prevent time’s march—friends dying, regrets, or memory lapses (“senior moments are now Google moments,” she wrote).
For now, such voices remain outliers. People are so busy denying and defying age, we’re unprepared for what old age actually looks like, says sociologist Stephen Katz, a professor at Trent University: “We talk about the ‘Rs’—revitalizing, rejuvenation, rementia. We don’t talk about the ‘Ds’—decrepitude, dependency, death. Not everybody is healthy or independent or prosperous.”
The truth of old age is unseen, and perceived as unseemly, says Katz. For more than a decade, he has shown classes a photograph of a 90-year-old woman in a bikini. She is healthy, strong, flexible, with a joyous expression on her face. Students always groan in revulsion, he reports. “They say, ‘That’s disgusting. How can you show that?’ And I ask, ‘What is so pornographically upsetting about older bodies? Those are your parents’ and grandparents’ bodies; they’re not from another planet.’ ”
Given the paucity of old people in recent popular culture, they could be. People over 65 appear in movies less than children do, according to a 2013 University of Southern California study: they make up only 5.5 per cent of male characters and 3.7 per cent of female characters. The elderly are viewed as such alien species that the model Heidi Klum was showered with attention when she dressed up for a Halloween bash last year as an old woman with pronounced wrinkles, age spots and varicose veins, as if donning a Chewbacca costume.
Within such cultural “grey-washing,” old age has been erased, sanitized or reduced to extreme stereotypes: doddering Grandpa Simpson types or upbeat, affluent exemplars of “successful” or “productive” aging involving yoga, kale and Sudoku.
But looking away from old age comes at great cost in a society that has never been older. Canadians born in 2012 will on average live to age 82, up from 77 in 1999. Almost one-fifth of us—20.8 per cent—are 60 or older; by 2050 it will be 31 per cent. The generation that ushered in the ’60s “youthquake” is approaching late life in a society that it reshaped: Care for the aged, long borne by families, even societies, has become an expensive proposition that falls to the individual. Yet a growing roster of studies suggest that how we perceive aging and the old has profound consequences in terms of how we actually age, the medical care we will and won’t get, and how financially and emotionally prepared we will be for what can be a long chapter in life. In this context, fear of looking at old age isn’t just foolish, it’s perilous, resulting in a society “backing into its future, not walking into it,” says Anne Karpf, the author of the newly published How to Age. “One sees aging as an inexorable process of decline, and old people as purely a burden, a drain on resources,” Karpf writes. “According to this model, the moment we hit 60 (or 50, or 40—take your pick), we become nothing but old—all other characteristics, idiosyncrasies and personal history erased.”
Samir Sinha, director of geriatrics at Mount Sinai and University Health Network hospitals in Toronto, agrees: “Most people are woefully unprepared for old age,” he says. The surprises are not all bad. Sinha spends a lot of time with patients dispelling negative myths, including the belief dementia and incontinence are normal parts of aging. Only 10 per cent of Canadians over 65 suffer from dementia, though the condition shadows how we see old age. Andrea Charise, an assistant professor of health studies at the University of Toronto and a geriatric researcher, speaks of reflexive “Alzheimerization” of old age. Dementia has become shorthand for old age in movies, Sally Chivers writes in The Silvering Screen: Old Age and Disability: it “symbolizes the overall horror that is assumed to be a part of the aging process.” Organs slow as a natural part of the aging process, as does memory—but not the brain itself. In the recently published memoir by 80-year-old British novelist Penelope Lively, Armonites and Leaping Fish: A Life in Time, she writes that a weakened body hasn’t affected her brain’s “healthy continuity, and some kind of inbuilt fidelity to itself, a coherence over time.”
But the imperceptible slowing and shrinking that marks aging beginning as early as the 30s—bones shrink; muscles atrophy; skin becomes thinner and dryer; hearing diminishes—is matched by a shrinking societal significance, what Karpf calls “age apartheid.” A 2013 study from University College London found one-third of British people over 50 reported poorer service in restaurants, ill treatment in hospitals, and harassment. A recent Yale University study found senior citizens were frequent targets of bigotry on Facebook. (The site’s “community standards” bans hate speech based on race, religion, gender, sexual orientation, disability, but not old age.) Facebook founder Mark Zuckerberg is on the record dissing the old: “Young people are just smarter,” he told an audience in 2007.
Ageism is rife, says Tiffany Chow, a behavioural neurologist at Toronto’s Baycrest Health Centre. She speaks of a friend who refuses to travel on one airline because they employ what he calls “old hags.” She called him on it, and he backed down, she says: “He said: ‘It’s not their age, it’s because they’re tired out and mean.’ But it translates into: you’ve got wrinkles, you’re not slim, you’re a hag, which is awful ageism.”
The attitude exists among the old as well. “No one wants to admit they’re old,” Ephron wrote in her 2010 book I Remember Nothing. “The most they will cop to is that they’re older. Or oldish.” Yet internalizing ageism can be pernicious, leading to social withdrawal, reluctance to go to the doctor, even reduced lifespan. Becca Levy, an associate professor of epidemiology at Yale who has conducted studies on people 50 and older, found that those with more positive perceptions of aging lived on average 7.5 years longer. People who were fed negative perceptions, on the other hand, exhibited memory decline, slower gait, balance problems and feelings of worthlessness.
Anxiety about growing old and hostility toward the old are strains of the same gerontophobia, writes Karpf, who calls ageism “prejudice against your future self.” Charise points to the alarmist, apocalyptic language used to describe aging Boomers—“grey tsunami” “or rising tide”—likening it to “Yellow Peril,” used in 19th-century to vilify Chinese immigrants. It’s a smokescreen, she says, to avoid discussion of much-needed social and economic policies. So many variables influence aging that “old” is difficult to define, says Charise: “Perhaps the biggest falsehood is that ‘old’ actually means something, or that you know something about someone—their politics, history, or character—by way of their age.”
Sinha agrees. People become less alike as they get older, he says, due to social, genetic and economic circumstances. “As geriatricians like to say, ‘If you’ve seen one 80-year-old, you’ve seen one 80-year-old.’ ”
Fixating on the upside of aging—on inspiring, active old people—is convenient commercially and politically: it helps absolve our responsibility for them. A 2010 Health Canada public awareness video, “Seniors are Cool,” made to combat the rising problem of elder abuse, features a young narrator: “I used to think older people were slow and boring and sat around all day,” he says, before introducing a woman who does tae kwon do at 87 and a man in his 80s who restores vintage cars, among others. Older people are “far from slow and definitely not helpless,” the boy concludes, which is a lie; some old people are slow and helpless, a fact that puts them at greater risk of abuse.
Heroic imagery surrounding the old can be oppressive, says Ashton Applewhite, the Brooklyn-based author behind the trenchant This Chair Rocks blog and advice column “Yo, Is This Ageist?” “It suggests we’ll always be able to do what we want to do,” she says, noting that “successful aging” is fraught with class assumptions—“that we all have access to the vitamins, doctors, personal trainers.” People have to be responsible for their own circumstances, she says, but some things can’t be controlled: “As long as it’s your personal responsibility to “age well,” it lets government off the hook, it lets society off the hook.”
Refusal to see old age has resulted in a health care system woefully unprepared for it, says Sinha, who leads Ontario’s Seniors Care Strategy. The system is structured to serve the population it was founded for more than 50 years ago—a 27-year-old with a single-source illness, he says. Today, 60 per cent of hospital users are over 65 and suffer from multifactorial chronic conditions.
A severe geriatrician shortage compounds the problem: we need 10 times the current number, Sinha says. He blames institutionalized ageism: “A culture that devalues the old places little value on those who work with them.” He says he was told he was wasting his talent when he went into geriatrics. Ageism is rife in the field itself, he says, reporting that one of his trainees asked a doctor at another hospital about protocols for dementia patients; he was told they don’t exist “because we don’t practise veterinary medicine.” Physician Brian Goldman also exposes systemic ageism in his new book The Secret Language of Doctors. Old patients with “complicated but uninspiring and incurable conditions” are dubbed “GOMERs” (“get out of my emergency room”), “bed blockers” and “failure to die,” he writes: “Today’s doctors are astonishingly ignorant of how to take care of older patients.”
The fact that old people are excluded from clinical trials, where researchers choose young, healthy subjects who don’t take medications, puts the population at further risk, Sinha says: “The dosage efficacious for a 45-year-old might be toxic for 85-year-old, but we only find that out through trial and error later on.” Canadians over 65 have scripts for five drugs, on average, he says: “If you’re on four or more medications, you have a 100 per cent chance of having a drug interaction.”
Yet for all of our shunning of the old, longevity is seen as a triumph of modern medicine: Medicine too has a booming “anti-aging” sector that dovetails with “anti-dying.” Aubrey de Grey, the British biomedical gerontologist, believes doctors will “cure” aging within decades. The American medical anthropologist Sharon Kaufman has coined the term “reflective longevity” to describe people facing increasing, often painful end-of-life medical options, or, as she puts it, “longevity by any means and at any cost.” Stories from the “anti-dying” front lines are also emerging. Roz Chast’s bracing new graphic memoir Can’t We Talk About Something More Pleasant? chronicles caring for parents who died in their 90s after being independent well into their 80s. The process was “a lot more painful, humiliating, long-lasting, and hideously expensive” than she’d imagined, the New Yorker cartoonist writes; at one point, her parents’ monthly living expenses totalled $8,000.
Greywashing old age shortchanges both young and old, Applewaite writes: “To reflexively choose ‘not old’ as an identity, whether for ourselves or our relatives, impoverishes us all. It robs us of the chance to form community, and strips away the experience that distinguishes paddler from pilot, sapling from sequoia, novitiate from seasoned hand, and from the pains and perks attendant to both states.”
Applewaite began researching and writing about old age in her 50s because she feared getting old. Within weeks of research, she says, “everything I was learning about longevity was so much more positive and nuanced than I thought.” That’s borne out by studies that indicate that though general quality of life declines in the 70s and 80s, happiness can increase. The English Longitudinal Study of Ageing, a research group based in University College London, reveals satisfaction with life rises in the 60s for many and remains higher into old age than for those who are middle-aged. Psychologist Laura Carstensen, a professor at Stanford University, believes those over 70 are more likely to “focus on the upside”; the amygdala region of their brains reacts more strongly to positive pictures than seen in younger adults.
“Late old age can bring out the beautiful and creative and poetic” says Katz, as we’re seeing. In Somewhere Towards the End, the British writer Diana Athill writes of aging intensifying engagement: “An important aspect of the ebbing of sex was that other things became interesting.” Rubin also wrote of growing insight: “Am I closer than before to the knowledge of the heart, to understanding more deeply than I ever thought possible that I can be both admired and loved—and perhaps more important, that I can be loved even when I can no longer be admirable? You bet I am.” The long view offers clarity, wrote Ephron: “Looking back, it seems to me that I was clueless until I was about 50 years old.”
The old are the subject of art as well. Anne Basting’s Timeslips project documents voices of people with dementia. Carrie Synder’s acclaimed new novel Girl Runner is narrated by a 104-year-old woman. Pandering to an emerging market wanting to see itself is evident too, seen in Dove’s “Pro-Age” line and older protagonists in film inspired by the success of The Best Exotic Marigold Hotel, dubbed “The Marigold effect.”
Change is happening in “cracks and corners,” says Katz, pointing to Peter and Cathy Whitehouse’s successful Intergenerational Schools in Cleveland, which pair old and young to learn. Recognition of the need to protect the old is reflected in mounting activism in Europe, where Scandinavia is upheld as a model. A “European charter of the rights and responsibilities of older people” has been drafted by a network of 150 agencies in 10 countries. Similar awareness is needed here. For individuals as well as for societies, Rubin’s description of encroaching old age serves as a social warning: “It tiptoes in on silent feet, taking a little here, a little there, none of it big enough to get our full attention, until one day, it’s there, and we’re left wondering, ‘What happened?’