Retaining Health and Happiness in "Elderhood"
With Dr. Louise Aronson
Dr. Louise Aronson, a leading geriatrician, author and top influencer on aging, discusses ways to create a more positive perception of aging, how to maintain good health as we age and how we can optimize health care for older Americans.
Steve Lubetkin: [00:00:08] Thanks to medical advances and healthier choices,Americans are living longer, more active lives well into their 80s, 90s and beyond.Welcome to Plan for One Hundred, a new podcast from AIG. This podcast series isdevoted to educating and empowering Americans to prepare for longer lives andretirements that could last for decades or more. Our podcast aims to help you plan forone hundred no matter what age you are today.
Freda Lee: [00:00:38] Hello, I'm Freda Lee, senior vice president, head of relationshipmanagement for AIG Retirement Services. I will be your host today for AIG's podcast,Plan for 100. I'm excited to be joined today by Dr. Louise Aaronson. Dr. Aaronson is aleading geriatrician, writer and professor of medicine at the University of California, SanFrancisco. She's been recognized as a top influencer in aging for her work on optimizinghealth care for older adults and creating a more positive perception of aging. A graduateof Harvard Medical School, Dr. Aaronson is a regular contributor to many nationalpublications and scholarly journals, as well as the author of the New York Timesbestseller elderhood. Dr. Aaronson, welcome to Plan for One Hundred.
Dr. Louise Aaronson: [00:01:34] Thank you, Freda. It's a pleasure to be here.
Freda Lee: [00:01:36] Great. Let's start with your book. Can you explain the concept ofelderhood?
Dr. Louise Aaronson: [00:01:43] Well, it's actually probably just what everybodyimagines. So we have names for the first two stages of life. We call, you know, age zeroto 19, thereabouts, "childhood," and age 20 to 65 or thereabouts. The transitions are alittle up in the air for negotiation, but 20 to 65 or so, "adulthood." And then we kind ofhave this language vacuum, and the language vacuum leads to all kinds of policyvacuums, you know, structural vacuums, like things where we see kids and we seeadults and we don't think about elders as well. I didn't make up the word elderhood, butit hasn't really gotten much play and I felt that the time was now, here, a fifth of the wayinto the 21st century with the oldest population in human history on the planet. So I thinkwhen we recognize that Elderhood is actually now longer than childhood for mostpeople and as diverse, you know, you think of childhood, you've got the neonates to theteenager. In elderhood, we've got the same, somebody in their 60s versus somebody intheir hundreds. These are very different humans and there's a range of needs,opportunities and abilities throughout each phase of life, childhood, adulthood, andelderhood.
Freda Lee: [00:03:01] You say retirement as we now live it, is bad for most people'shealth. Can you tell us why and also what you suggest instead?
Dr. Louise Aaronson: [00:03:09] I think when we set the initial retirement age at 65,the average American died at 67. So retirement was really something you did fairlyclose to your death and the thought was you'd have a little rest or maybe, you know,there wasn't so much you could do. Now was there always variability? Yes. But rightnow we we have kept at the retirement age the same. And yet we've added decades tolife. I mean, what changed across the 20th century was that human beings now live 20,30, 40 years longer. And those decades have accrued principally to elderhood.Throughout most of human history, a majority of humans died in childhood or earlyadulthood, and most of the others died some other time in adulthood. You know, therewere always old people, but not so many. And we haven't really given much thought towhat that means. And so people retire and then a bunch of different things happen. Forsome people, they retire and they simply don't have the money to live another 30 yearsin the way they'd like to. For others, they retire and life loses meaning and purpose. Andwe know the loss of meaning and purpose is really bad for your health. There was astudy last year that looked at men aged 60 to, you know, about the same health and theones who retired were much more likely to die in the next year. So I'm not saying peoplehave to continue with their adulthood job forever and ever, particularly if they hate it.You know, some people love their jobs. And if they they can keep doing it, theyabsolutely should. And we see this all the time. People are doing it in all sectors of life.But for other people, I think we need to reimagine what it means to be an elder andwhat the opportunities are for you. And sometimes it's that you need more income andyou do something that you've never done before. And for other people, it's anopportunity to be more creative. What we're seeing a lot of now is people who were inservice sectors and didn't make a ton of money are becoming entrepreneurs. Andpeople who maybe made a lot of money are now doing art or the service work that theyfelt like they couldn't quite afford to do earlier. It's kind of like one of my favoriteanalogies is that adolescence didn't really exist until the later 1800s and the industrialrevolution. And now we nobody can imagine life without adolescence and it seems to begetting longer. So we kind of have this same thing in elderhood now, and we're thegeneration that gets to figure out what that means and what we can do with it. I thinkwhat we can do with it is lots of different things. And I guess just the last point is thatwhen people lose meaning and purpose, a reason to get up in the morning, a sense thatthey are doing something of value with their day, their health goes down in all kinds ofways, more heart disease, more cancers, more depression, more trouble sleeping,more abuse of substances, shorter lifespan, increased risk of hospital stay. So you cando any number of things. You can do things within the family or in the community or inbusiness or on tech or whatever you like. But having some reason to get up in themorning is really important.
Freda Lee: [00:06:18] Wow. That's very interesting. Tell us about the U-shaped curve ofhappiness and what it suggests about the benefits of old age.
Dr. Louise Aaronson: [00:06:26] I love this, so this is a curve that has been foundacross the world, not in every single country. So countries that are really, really poor,you don't find it in, but everywhere else, including United States, you do. And what itshows is that people are happiest in sort of childhood and very early adulthood. Andthen their happiness goes down through adulthood and their life satisfaction goes downthrough adulthood and their anxiety goes up through adulthood. And then in their late50s and early 60s, life satisfaction and happiness begin to increase again and anxietyplummets. And through the decades of elderhood, people remain far happier, moresatisfied and less anxious than they are in adulthood. So when we hear all the horrorstories of old age, we're not hearing things that aren't actually happening. There are noobvious bodily disappointments, but there is so much more to life than your body andailments. And this is this just keeps being found again and again. Why don't you tell thehappy stories? Why don't we tell how nice it is to know who you are and how you wantto spend your time and with whom? So I think it's really important to know about thiscurve and at the same time to recognize that not everybody gets happier and moresatisfied. But a majority of people do.
Freda Lee: [00:07:43] Now, that's great. And just to keep with that thought a little bitmore, if someone wants to retain health and feel well for a long time in old age. What doyou recommend?
Dr. Louise Aaronson: [00:07:53] There's so many things. Well, it turns out probablyour aging begins to be influenced, you know, by our forebears and even in utero. Butthose are not things we can control. So what can we control? Probably starting even inearly adulthood. But actually, the good news is that you can start getting healthier at anyage. I mean, this has been shown people through their 80s and 90s. Would it be betterstart at 22? Probably. But at 22, we all think we're immortal. So better late than never isone message. But the things that make a huge difference are activity or exercise inparticular. And there are people who say, "I've never exercised, I'm not starting now at68 or 88." But exercise means so many different things. Maybe it's dancing, maybe it'sgoing for a walk, you know, or picking up your grandkids from school. Maybe it's actuallytaking up Tai Chi because you're worried you're gonna fall and you want to stay athome. Maybe it's learning a sport like pickleball, which is really good as we age. Sothere's so many ways to be active and that is the best medicine we know of. Really,along with diet. So diet and exercise treat all diseases we worry about, you know,stroke, heart disease, cancers, all the things that kill us and also make us miserable. Sogetting active, eating a healthier diet, totally terrific. And then there are some otherthings that that people don't always think of, but are equally important, it turns out. Andso there's purpose, which I discussed before. There's also social engagement. And thiscan become hard as people move through elderhood, because, you know, spouses,partners, friends die. And you can't, I'm not going to tell someone you can replace afriend or partner of sixty years with someone new. But can you absolutely havemeaningful and pleasurable social engagements? You can. And it's really important, Ithink, for all of us as we get older to start adding new friends so that we have maybesome reserves, some social reserves. And also, you know, by doing activities, we canhave social engagement. And then the last thing really surprises people, which is thatpeople who have more positive attitudes about aging tend to be much healthier as theyage than people who are really negative about aging. And some of that may be a self-fulfilling prophecy. If you're feeling good, you're more likely to take care of yourselves. Ifyou feel hopeful, you're more likely to do the things that will make you happier andhealthier. So it's not clear what the association is, but it's very clear that people who goin with more optimism and positivity seem to have fewer markers of dementia. They getheart disease years later, they recover better after hospital stays. It's just the data onthat's pretty impressive. So lots of things we can do and then the other things we can'tcontrol like good luck.
Freda Lee: [00:10:39] So now that's great. In your book, you also talk about ageism inthe way medicine is practiced in the U.S. Can you explain that a bit?
Dr. Louise Aaronson: [00:10:48] Absolutely. So it starts at the very beginning. I mean,I think most people know doctors go to medical school, it lasts four years. So in thosefour years, we get about three, four months of training about kids. And until just recently,we got maybe three or four hours of training about older adults. And now we're up to acouple of weeks. If you're really lucky at certain schools, you might get three to fourweeks and then the other three and a half years plus is all about adults. So, you know,anybody knows that if you have an eight year old, a 48 year old and an 88 year old,their bodies are different, their lives are different, their physiology is different. How theyhandle medicines is different. We also know that older people have disproportionatehealth needs. We under-train people on the bodies and needs of older patients and wedo this across sectors. So when we think of medicine, we think of medical training. So Ijust discussed what happens there. And in lots of programs like, you know, most peopledie of heart disease and cancer and in cardiology and oncology training, there's nogeriatrics, over the three to four years. So it's just like this void, which is part of what Iwas talking about earlier, when we don't have a language, we have childhood andadulthood, but no elderhood, we have a void. In research, the best research, you know,the sort of cutting edge science of the 20th century was initially just done on men andmostly white men. And that was because in science it's easiest if you can control anyfactors that might interfere with whatever it is you're studying. So that actually madegood sense. Let's take the people we know the most about where we can control themost things. But then what happened in this sort of later mid-century in the in the 20thcentury or maybe in the 70s? People started noticing that, you know, we don't studyheart disease in women because women are different than men. But then when weapply the results we get from women, no, from men to women, the women have worseoutcomes. Maybe it's because they're different. And so 30 years ago, they they madestipulations at the National Institutes of Health that you need to include women. Andthen 20 years ago, they said you also need to include children and people of color.Unless you study people, you don't know how their bodies are to respond. But when didthe NIH require inclusion of old people in medical research? Well it was in 2019. Therewould be studies of diseases that happen principally in old people, and it would excludeold people either, frankly, on the basis of age or on the basis of having other diseaseswhich are very common. And so there're just these huge voids. And, you know, you getkids' hospitals and adult hospitals and you get kids' specialists and adult specialists.And with vaccines, we have 17 different ways we vaccinate kids based on their biology,age and social behaviors. And we have five for adults and then there's age 65 plus as ifwe stopped changing.
Freda Lee: [00:13:39] Wow. That's incredible.
Dr. Louise Aaronson: [00:13:40] I mean, really, you couldn't make it up and you didthis about any other group. Now everybody would be outraged.
Freda Lee: [00:13:47] So interesting. How can we tell that we or a family member isgetting appropriate medical care?
Dr. Louise Aaronson: [00:13:53] It's such a good and hard question because it's sovariable. I guess one of my favorite jokes I like to tell is actually based on a true story. Ithappened in New York. So a colleague of mine was traveling and a patient, a personwas, I think about age 96 started having knee pain. So he went in to somewhere anacute care, and then he was evaluated and the doctor took a good history and Rubiniaround. And then he said to the 96-year old, "Well, you know, what do you expect? Theknee is 96." And apparently this man, without missing a beat, said, "Well, my other kneeis 96 too, and it doesn't hurt a bit." So that is like my favorite joke for geriatrics. But thepoint is that aging is a risk factor. It's not a diagnosis. So somebody is being told, "oh,you're old, I can't do anything," that's not somebody who's seeing you, who's respectingyou, who's there to help you. Yes, it gets complicated. Yes, you accrue more things withage. But old age isn't a diagnosis. It’s sort of medical laziness. Unless the person says,look, I don't even want to know. But that's the patient's prerogative, not the clinicians. Ialso think when people are explaining things, they need to explain the harms as well asthe benefits. And they need to know and explain that the harms tend to rise and thebenefits tend to shrink as we get older. So the harms rise because bodies, all ourorgans and our ability to metabolize things and, you know, recover, go down. And thebenefits go down because there are greater harms and also because maybe the lifeexpectancy of somebody is 98. We're not thinking 20 years in the future. So it kind ofdepends on your horizon and it depends on your other health issues and it reallydepends on function. So one of the best predictors of how an older person will do is orare sort of funny, non-medical sounding things like how fast can they walk and what'stheir grip strength? And then last but not least, a person should always be thinkingabout medications and asking about medications and considering that medications aredoing harm, whether or not that's listed when you Google it or whatever you do tosearch it. Basically in old age, any medicine can do anything. And the only way to findout often is to stop it.
Freda Lee: [00:16:16] What's your take on the various technologies being developed totry to beat aging or even to become immortal?
Dr. Louise Aaronson: [00:16:22] So I'm ambivalent. So I think beating aging is a funnyconcept because we age from the moment we're born. So if you're beating aging, areyou beating living or what exactly do we mean? And immortality is actually somethingthe human species has talked about for millennia and each generation thinks they arethe one that's going to do it now. You know, do we have much more advanced science?Yes. But so far in human mortality is holding very steady at 100 percent. And I don'tknow that that's going to happen. And we also have to think about the ethicalramifications of that. We know when there's overpopulation and scarce resources,people begin to kill each other. You know, there could be more generational warfarethan there is now. There, you know, there could just be some pretty scary things. And ifwe're thinking about the environment, you know, how how's the planet going to handleall of that? And on the other hand, I think an important distinction is, is betweenextending the lifespan, which is how long we live and extending the health span, whichis how many of our years lived we are healthy for. And I think feeling better andfunctioning better for more of the years were live. Sounds like a pretty good thing toeveryone I've ever spoken to. So I'm in favor of that.
Freda Lee: [00:17:41] Got it. That's awesome. Finally, I've heard that your recipe forgood old age is good genes, good luck, enough money, and one good kid, usually adaughter. Can you tell us more about that?
Dr. Louise Aaronson: [00:17:53] Well, I came to that just based on, you know, 20some years of geriatrics practice. So, you know, genes are sort of luck. But, you know, ifa person's parents and siblings all lived into their nineties or hundreds and we're inpretty good shape, that person often is too. Not without exception. But, you know, itmakes it a little more likely. Enough money. Yes. I tell my students or any learners Ihave with me, like, you know, having more money gives you more opportunities. Andthere's nothing that age changes about that. And eventually that the normal human lifecycle is that we eventually need more help and we sort of act like that's a bad thing or apersonal failure. But it's the normal human life cycle. It's what nature does with a bodyover time. And it's, I can see why it's you know, it's better to be a kid who can't do thingsand you're looking forward to hopefully being able to do it, that that's a more pleasingtrajectory. Like, I'm not saying I don't understand people's natural responses to, youknow, not being able to do things. But if we just accepted it as normal and natural,instead of making it a pathology or a surprise or a failure of willpower or effort orsomething else, I think people could feel a lot better about it. And so we all need help.And traditionally, you know, most caregivers, 70 to 80 percent have been female,whether they're family caregivers or paid caregivers. I will say I have always seen somepretty great sons and brothers and grandsons. And I do believe I am seeing more thesedays. So I'm not saying this to diss males in any regard. I think what we all know thattraditionally females have done more caregiving and that they still do. And yet, youknow, I think we can all do this. And it's actually turns out you hear a lot about caregiverstress. And what you don't hear about as much is how enriching and fulfilling andsatisfying it is for people to do that for people they love, whether it's their children, theirpartners, their parents.
Freda Lee: [00:20:04] That's wonderful. Dr. Aronson, thank you so much for being ourguest on the Plan for 100 podcast. We really appreciate your time today. And we hopeyou'll join us again soon.
Dr. Louise Aaronson: [00:20:12] Well, it was a pleasure. Thank you for asking suchgood questions.
Steve Lubetkin: [00:20:16] Thank you for joining us for AIG's Plan for 100 podcast. Formore information, please visit our website, planfor100.com.