Disrupt Aging

CHAPTER 1

The New Reality of Aging

Aging is not “lost youth” but a new stage of opportunity and strength.

—BETTY FRIEDAN

Make no mistake about it: America is aging. This is the transformational issue of our time. Its impact on the economy, jobs, education, culture and communities is pervasive. Just as the birth of the baby boom generation redefined American life in the 1950s, ’60s, and ’70s, the aging of the boomers will reshape the way we live and work in the 2010s, ’20s, and ’30s.

People today live longer and live better than ever before. Consider that two hundred years ago most of our ancestors were living at—or just above—subsistence level: farmers trying to eke out a living, village smiths, shoemakers, or craftsmen. If they developed diabetes, they would go blind and probably die early. If their eyesight started to give way as they reached middle age, they had to give up reading. Often a simple infection meant death. Meat was a rare luxury for most people. And instead of struggling to eat fewer calories as we do today, they fought to get enough to eat.

We have made phenomenal progress. Today most of us enjoy better health and a longer life than the wealthiest people in the wealthiest countries did just a century ago. And barring any catastrophic surprises in the first half of the twenty-first century, much of the world will come to share the long healthy life that is now enjoyed by the contemporary middle class in advanced countries.

The progress humanity has experienced over the last two centuries has no precedent. We can attribute this unparalleled progress largely to two factors. First, ours is the first age in which technological and material gains have been enjoyed by more than just a fraction of the population. It used to be that material gains were available to only the wealthiest in society—5 to 10 percent—while the rest of the population remained at mere subsistence levels.

Secondly, we have developed mechanisms for widely distributing information, knowledge, and wisdom. One hundred years ago a massive paper shortage and rationing along with the lowered purchasing power of the middle class (both the result of World War I) made information dissemination a challenge. Today, through mediums like television and social media, information is shared with all levels of society at incredible speeds. Fully 23 percent of the world’s population is connected to the Internet. By 2020 that’s expected to grow to 66 percent—5 billion people. Here in the United States virtually everyone who wants to be on the Internet is connected.

It’s an incredible time to be alive. In the United States we achieved a life expectancy of seventy about a generation ago. From the beginning of the modern calendar to 1900, life expectancy increased each year by an average of three days. Since 1900 it has increased by an average of 110 days a year. We added more years to average life expectancy in the last century than in all previous history combined.

In 1900 average life expectancy was forty-seven. Today it’s seventy-eight, and if you make it to age sixty-five, you can expect to live about nineteen more years.

For the first time in history long life isn’t a rarity. If you’re fifty, you have half of your life ahead of you. Over half of the people born today will live to be one hundred. By 2030 people age sixty-five and older will number over 71 million and comprise nearly 20 percent of the population. The fastest growing age group is people eighty-five and older. By 2040 people aged sixty and over will outnumber children for the first time in the history of the world. This new longevity is one of the great success stories of the twentieth century.

Living Longer and Living Better

The new reality is that we’re not just living longer; we’re also living better. We’re not tacking on more years of physical and mental decline at the end of life; in most cases we’re adding more years of healthy and productive living. This concept of “healthy aging” was once thought to be an oxymoron. At the beginning of the twentieth century acute infectious diseases such as tuberculosis, smallpox, diphtheria, tetanus, and others accounted for 80 percent of all deaths. By the 1970s the death rate from these diseases had been reduced by nearly 99 percent, and thus chronic diseases—heart disease, stroke, cancer, diabetes—became the major illnesses. As medical science increasingly prolonged life and then began to develop interventions for those diseases as well, the conventional wisdom was that the extra months and years resulting from those treatments would be spent in ill health and that although advances in medicine and public health could extend life, they could not delay the onset of chronic degenerative diseases.

Then in 1978 Dr. James Fries, a professor of medicine at Stanford University, hypothesized that if we could shorten the time between the onset of chronic illness or disability and the time in which a person dies, we could minimize the number of years people suffer, enabling them to live more successful and productive lives, which would benefit both them and society. This “compression of morbidity” theory, as he called it, revolutionized the concept of aging. Instead of merely accepting a gradual decline as inevitable, we began to focus on how to delay that decline through prevention, lifestyle changes, and health improvements aimed at pushing back the onset of morbidity.

We began exercising, joining fitness clubs, forming walking groups. We saw an explosion of research on nutrition. It seemed like a new diet appeared every week, and self-help books flooded the bookstores, telling us all the things we could do to “combat aging.” At the same time, public health campaigns to reduce smoking, promote preventive measures, and encourage people to get health screenings such as mammograms have further helped people to live healthier and longer. And innovations in medical care, such as joint replacements and better methods for controlling diabetes, have helped to push healthy living even further.

This combination of a longer life expectancy and compressed morbidity means that the transition into what we used to call old age is redefining how we live our lives. And its impact is felt not by a relatively small percentage of our population but by millions. This, combined with the sheer numbers of aging baby boomers, is disrupting the traditional demographic shape of our society. Think of it this way: we used to depict the age of our population as a triangle, with the largest number of young people at the base and a declining number of older people toward the tip. Now the triangle has become a rectangle and is even beginning to invert, with more people at the top than at the bottom. Older is the new normal, and this is not only changing what it means to age but changing how we live, permanently altering the courses of our lives.

Redefining Our Life Course

These huge demographic shifts happen very rarely in our society. In the latter part of the eighteenth century, for example, we began to further define and refine stages of life. We began by creating the concept of “childhood.” Up until that time children were considered little adults. Boys became adults either by entering the workforce or getting married. If he could do adult work, he was an adult. If he couldn’t, he remained a child. There was no in-between. Then, at the turn of the twentieth century, “adolescence” was born, bringing us high school and the concept of the modern teenager. In the 1950s and early ’60s a new life stage called “retirement” was introduced.

In the years following World War II older people in this country were seen as a huge societal problem. No group had been so ignored as older people were then. There was a period of time between the end of work and the end of life that former labor leader Walter Reuther aptly described as “too old to work, too young to die.” People entering this age were lost. Too many didn’t know what to do, and society didn’t seem to want them. Age was viewed simply as the residue of youth.

But in the 1950s we saw the emergence of a life stage we think of today as “retirement.” The plight of older people began to change. This was a time of tremendous demographic upheaval in the United States brought on by the birth of the baby boom generation. We created a social infrastructure to support and nurture this demographic disruption, woven together by private investment, public policy, and personal responsibility. The nation responded by investing in school construction, teacher education, housing, highways, and public health. The government created the Department of Health, Education, and Welfare and built the interstate highway system. The GI Bill made it possible for hundreds of thousands of returning soldiers to get an education and, thus, a good job. American families discovered a new place to live called suburbia. We invested in research and put America’s best scientists and doctors to work developing vaccines and cures for childhood diseases. As a result, diseases such as polio, which afflicted thousands of children every year, have all but been eradicated. Vaccinations for chicken pox, measles, and mumps are now the rule and not the exception. Businesses flooded the market with new products and services geared toward children and families. At the same time, nonprofit organizations like AARP began to advocate for the rights of the elderly and advance a new philosophy of productive aging. As the concept of retirement began to take hold and these new demographic and cultural shifts took place, old age was being transformed from purgatory to a much desired destination.

It’s no coincidence that we also began to see the dramatic rise of the middle class during this time. Business, government, private citizens, and organizations functioned under a social contract that saw America as a place where everyone had an opportunity to achieve the American Dream.

The benefits of this social contract were felt by people throughout society, including older Americans. The promise of Social Security was beginning to provide more and more people with a foundation for income in retirement. In 1965 we added Medicare, to ensure that older Americans would also have basic health care, and Medicaid, to protect and lift up the poor. And the number of Americans covered by guaranteed pensions rose steadily from 10.3 million in 1950 to 35 million in 1970. By 1980 28 percent of the workforce was covered by a defined-benefit pension plan.

Before long we began to see older adult living communities spring up with names like “Sun City” and “Leisure World.” And what used to be thought of as old-age hell was being transformed into what became known as “The Golden Years.” A retirement full of leisure became the reward for a life well spent—the cornerstone of the American Dream. Moreover, the sooner you got there, the better. To be able to retire was the ultimate symbol of success—and for many people, it still is.

We are now experiencing another demographic upheaval as the baby boomers age. Tens of millions of people in their fifties, sixties, seventies, and beyond are leading longer, healthier, more productive lives. They’re beginning to wake up to this new longevity—and what it means in their lives—and in the process are creating a new life stage.

The Extended Middle Age

Today, despite what the birthday cards say, turning fifty no longer marks the beginning of a long, slow descent into old age; instead, it marks the beginning of a new period of growth, an extended middle age that did not exist for most of our ancestors. It’s a time when people start embracing the idea of living longer, living better, and maintaining a balanced, vital lifestyle. This new life stage is still being defined. Some are calling it “The Third Chapter,” “The Opportunity Generation,” or “The Encore Stage.” I simply call it extended middle age. It’s now seen as a time when people have the freedom and opportunity to do things they’ve always wanted to do.

Those of us entering this period of our lives don’t want to be defined by our age, and we don’t want to live in fear that our possibilities become more limited as we get older. We believe our life experience has tremendous value. We still want to make a difference in the world. And because of increased longevity and generally better health, we still have a lot of years left to do it.

In September 2014 I had the opportunity to attend one of Oprah’s “The Life You Want” sessions. As she stood on stage, inspiring the crowd with her rags-to-riches story, I couldn’t help but see that through her life, she is perfectly embodying this hunger so many of us have to achieve more and greater things, no matter our age. I leaned over to my colleague and said, “Wow, she is still reaching for a deeper purpose.” She has fame, fortune, and influence, but listening to her, I could still sense something was missing, that she still felt she had more to do, more to give. This new life stage gives us more time—in many cases thirty years more—to do and to give and to fulfill.

This extended middle age is much more than the residue of youth; it is a chance to grow in new and rewarding ways, to discover new roles, to redefine ourselves in ways that would have not been thought possible a few short years ago, to unleash our passions, to find and fulfill our purpose in life. We can live our best lives, achieving financial security, strength, health, meaningful work, romance, and discovery.

The Five New Realities of Aging

This all sounds great, right? Well, not quite. We must face the fact that it’s not all sunshine, roses, and living the American Dream. Many people at this stage of life struggle to navigate economic, health, social, and technological realities unlike any generation before them. And many don’t know where to turn for help or guidance. They find that many of society’s institutions are stuck in a mindset designed for a twentieth-century life course. For example, many businesses are reluctant to recruit, retrain, and retain older workers. Colleges and universities are still trying to figure out how to attract older students who want to return to school. Our transportation systems are not designed to meet the needs of older people. Our houses were not built to accommodate our needs as we age. And many of our programs that assist people as they age were designed for a twentieth-century lifestyle and must be adapted to work better simply because people are aging differently today.

These disturbing trends bring into sharp focus many of the problems we face, highlighting the need to disrupt the system and rethink aging policies and practices in America. We not only have to help society adapt to the millions of people entering this new life stage; we have to help individuals as well. As we seek new solutions that give us more and better choices for living and aging, we, as individuals and as a society, have to face up to the new realities of aging.

Aging Is Really About Living

Once a month I have lunch with a group of girlfriends who range in age from their early fifties to mid-seventies. As we sit and chat about what’s going on in our lives, it always occurs to me that no one passing by our table would ever guess these women’s ages. They all look fabulous, dressed to the nines in stylish outfits that reflect their exuberance for life.

It seems like every conversation is about plans for the future—upcoming trips, home renovations, adventures. Of course, we also share stories of our struggles. But even those have a tone of optimism that illustrates their clear sense that experience has value. Each one of them owns her age, not trying to be, act, or look younger but simply trying to be the best lawyer, doctor, teacher, business owner, lobbyist, grandmother, caregiver, or homemaker she can be.

Everyone in the group understands the rigors of family caregiving and recognizes that they may need help in providing care for a loved one. They also wonder who will provide care if and when they need it. They love the idea of being up on the latest smartphone or tablet, even though they may need help figuring it out. They are aware that as they get older, they will become more of a target for a scam or for identity theft, and they want to know how to protect themselves. And they worry about increasing medical costs and how to meet them.

These women are realistic. When we are together, we dish out straight talk and help each other face what’s next. We know our needs are changing, and although we may not always like it, we face it head on. We are open to change and find strength in each other as we ponder downsizing, retirement, and the unpredictable future.

My girlfriends and I share these outlooks and attitudes with millions of Americans our age. Like most people, we’re busy living our lives, curious about what the future will bring and doing our best to make the most of it. We’re involved with our families, our friends, the people in our communities. We don’t stop and withdraw from society because we become a certain age. We understand that some aspects of life get a little tougher and some get a little easier as we get older, but it’s all part of living, and we’re determined to make the most of it. In short, we reflect the new reality of aging—it’s all about living.

50 Million Shades of Gray—Not Everyone Is Living Longer

Although we know that on the whole, people are living longer and better than ever before, we also know that great disparities exist among the people who comprise the fifty-and-over population. And though the US economy is the wealthiest in the world, quite a large part of our population lives in poverty, and there is a direct link between poverty and health and life expectancy. One of the new realities of aging is that we must understand and deal with the disparities that exist among our aging population.

How people age differs widely based on gender, race, and ethnicity. In 2010 white males reaching age sixty-five, on average, could expect to live to eighty-two. This is about three years less, on average, than white women, but two years longer than African American men. Black women, on average, do not live as long as white women.

Data from the Centers for Disease Control and Prevention show that Hispanics and blacks tend to be in poorer health than white non-Hispanics. They are less likely to exercise three days a week or more, suffer from higher rates of diabetes, are more likely to have a disability, and die at higher rates from various cancers. They are also more likely to suffer from cognitive impairment or Alzheimer’s disease than are white non-Hispanics. This is largely because they have less access to adequate health insurance, less access to quality care, and a lower rate of health literacy. They also tend to have lower incomes, less in savings, and less in home equity than white non-Hispanics.

Gender, race, and ethnicity are not the only factors that influence longevity; affluence and education are also key factors. Men in the upper half of income distribution now live roughly 6 years longer than they did in the 1970s, whereas men in the lower half live just 1.3 years longer. Shockingly, white women without a high school diploma actually lost five years of life expectancy between 1990 and 2008.

Where you live is also a factor in determining how long you will live. Life expectancy is nearly seven years longer where I live, in northern Virginia, than it is where I work, in Washington, DC. In Cook County, Illinois (the Chicago area), there is a thirty-three-year difference in life expectancy depending upon where one lives within the county. Researchers are not clear why this discrepancy exists, but they expect that it may be due to higher levels of stress, obesity, and smoking that are more prevalent among society’s have-nots, along with lower access to healthy foods and health care.

All of this matters because over the next forty years white non-Hispanics will continue to decline as a proportion of the US population. Today African Americans and Hispanics each represent over 10 percent of the over-fifty population, and Asians represent just over 4 percent. By 2030 racial and ethnic minorities will comprise 42 percent of the US population, and the Census Bureau projects that in 2044 Hispanics will surpass 25 percent of the population, making them America’s largest racial/ethnic minority. This new demographic is creating what author Guy Garcia calls “The New Mainstream,” where minorities make up the new majority, and the economic and cultural forces that are inherent within it will increasingly be a defining factor in the new reality of aging.

Older People Are Contributors, Not Burdens

Working in Washington, DC, I’m right at the heart of much of the misunderstanding about aging. Don’t get me wrong: misperceptions and outdated stereotypes exist everywhere. But their impact is felt most strongly in Washington. It is a place steeped in the outdated view that getting older is about decline, that it presents only challenges, and that older people are a burden society has to contend with, a drain on our communal resources. We at AARP hear this all the time, especially when it comes to discussions about Social Security and Medicare. We hear things like: The aging of the population will bankrupt the country. In twenty years the entire federal budget will be spent on programs for old people. We can’t expect younger workers with families to pay higher taxes to support older retirees. These attitudes ignore the new reality of aging: that it’s about growth, not decline; that although it presents challenges, it also creates opportunities; and that older people are not burdens but contributors. We have to correct these misperceptions so we can develop new solutions to allow more people to choose how they want to live and age.

In his book Boomer Nation, historian Steve Gillon observed that, “At heart the boomers were consumers, not revolutionaries.” As the boomer generation has moved into their fifty-and-over years—and as the first boomers turn seventy this year—they continue to be consumers. Along with their older brothers and sisters, they comprise a longevity economy that is disrupting conventional thinking and outdated stereotypes about aging’s impact on the country and our economy as well as changing America both economically and socially.

The 106 million people age fifty and older who comprise the Longevity Economy account for over $7.1 trillion in annual economic activity. By 2032 that number is expected to rise to over $13.5 trillion. And here’s a fact that may surprise you: the Longevity Economy is now larger than that of any country except the United States and China.

As people enter extended middle age, they contribute to the fabric of society socially as well as economically in their roles as volunteers, caregivers, and grandparents. Laura Carstensen, director of the Stanford Center on Longevity, says one of the true benefits of our increased longevity is having five to six generations living all at once. The impact of older generations with the ability to teach and influence younger ones is immeasurable.

I can’t help but think what a wonderful blessing it is to have a growing number of older adults available to nurture and teach our young people today. It’s true that families are more dispersed geographically; however, today we have Facebook, Skype, FaceTime, Twitter, Snapchat, and many other resources that help people stay connected.

People fifty and over love this technology. Half of all boomers are on Facebook, and women over fifty are the fastest growing segment of Facebook users. I know that when I get together with my family and friends, the first thing we do is get out our smartphones or tablets and show each other pictures of our kids, grandkids, nieces, and nephews and talk about what they are up to in their lives. And I’m sure many of you do the same thing. For some people, thinking of a grandparent brings to mind the image of a gray-haired little old lady with a child in her arms contently sitting in a rocking chair singing the baby to sleep. Although that makes for a lovely Norman Rockwell painting, the reality is much different today: the average age of a first-time grandparent in the United States is forty-eight, and grandparents do much more with their grandchildren than rock them in rocking chairs. They are paying for their college educations; buying them cars and clothing; and taking them to movies and restaurants and on vacations; and nearly 6 million grandchildren live with their grandparents. In 2009 grandparents spent nearly $52 billion as consumers (spoiling their grandchildren!).

Now, I ask you, when you read all of these numbers and consider all of these facts, can you really conclude that aging is only about decline? That aging presents only challenges? That older people are simply burdens? Frustratingly, a significant part of our government believes that addressing the needs of 106 million people who generate economic activity valued at $7.1 trillion is an unaffordable cost and a financial burden. But in the private sector more and more entrepreneurs are beginning to see the aging population as a great opportunity.

Aging Spurs Innovation

When we think of innovation we usually imagine some new product or service, an invention that revolutionizes our lives or that’s never been done or seen before—the smartphone or the 3D printer or the driverless car, for example. Of course, these kinds of innovations have a huge impact on how we live our lives, but our quality of life in the future will also be determined by innovations in how products are designed, how services are delivered, and how policies are implemented. For example, the emerging sharing economy with companies like Uber, Airbnb, and TaskRabbit are changing the way we obtain services we need and teaching us that we don’t necessarily have to own products in order to take advantage of the benefits they provide. We’re changing the way health care is delivered and developing new vehicles for saving for and financing our future. In other words, when we think about new solutions that enable us to age on our own terms, we also have to think about social innovation.