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 is devoted to educating and empowering Americans to prepare for longer lives and retirements that could last for decades or more. Our podcast aims to help you plan for one hundred no matter what age you are today.
Freda Lee: [00:00:38] Hello, I'm Freda Lee, senior vice president, head of relationship management 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 a leading geriatrician, writer and professor of medicine at the University of California, San Francisco. She's been recognized as a top influencer in aging for her work on optimizing health care for older adults and creating a more positive perception of aging. A graduate of Harvard Medical School, Dr. Aaronson is a regular contributor to many national publications and scholarly journals, as well as the author of the New York Times bestseller 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 of elderhood?
Dr. Louise Aaronson: [00:01:43] Well, it's actually probably just what everybody imagines. So we have names for the first two stages of life. We call, you know, age zero to 19, thereabouts, "childhood," and age 20 to 65 or thereabouts. The transitions are a little up in the air for negotiation, but 20 to 65 or so, "adulthood." And then we kind of have this language vacuum, and the language vacuum leads to all kinds of policy vacuums, you know, structural vacuums, like things where we see kids and we see adults and we don't think about elders as well. I didn't make up the word elderhood, but it hasn't really gotten much play and I felt that the time was now, here, a fifth of the way into the 21st century with the oldest population in human history on the planet. So I think when we recognize that Elderhood is actually now longer than childhood for most people and as diverse, you know, you think of childhood, you've got the neonates to the teenager. In elderhood, we've got the same, somebody in their 60s versus somebody in their hundreds. These are very different humans and there's a range of needs, opportunities and abilities throughout each phase of life, childhood, adulthood, and elderhood.
Freda Lee: [00:03:01] You say retirement as we now live it, is bad for most people's health. 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 fairly close 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 right now we we have kept at the retirement age the same. And yet we've added decades to life. 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 early adulthood, and most of the others died some other time in adulthood. You know, there were always old people, but not so many. And we haven't really given much thought to what that means. And so people retire and then a bunch of different things happen. For some people, they retire and they simply don't have the money to live another 30 years in the way they'd like to. For others, they retire and life loses meaning and purpose. And we know the loss of meaning and purpose is really bad for your health. There was a study last year that looked at men aged 60 to, you know, about the same health and the ones who retired were much more likely to die in the next year. So I'm not saying people have 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, they absolutely 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 and what the opportunities are for you. And sometimes it's that you need more income and you do something that you've never done before. And for other people, it's an opportunity to be more creative. What we're seeing a lot of now is people who were in service sectors and didn't make a ton of money are becoming entrepreneurs. And people who maybe made a lot of money are now doing art or the service work that they felt like they couldn't quite afford to do earlier. It's kind of like one of my favorite analogies is that adolescence didn't really exist until the later 1800s and the industrial revolution. And now we nobody can imagine life without adolescence and it seems to be getting longer. So we kind of have this same thing in elderhood now, and we're the generation that gets to figure out what that means and what we can do with it. I think what we can do with it is lots of different things. And I guess just the last point is that when people lose meaning and purpose, a reason to get up in the morning, a sense that they are doing something of value with their day, their health goes down in all kinds of ways, more heart disease, more cancers, more depression, more trouble sleeping, more abuse of substances, shorter lifespan, increased risk of hospital stay. So you can do any number of things. You can do things within the family or in the community or in business or on tech or whatever you like. But having some reason to get up in the morning is really important.
Freda Lee: [00:06:18] Wow. That's very interesting. Tell us about the U-shaped curve of happiness 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 found across 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 it shows is that people are happiest in sort of childhood and very early adulthood. And then their happiness goes down through adulthood and their life satisfaction goes down through adulthood and their anxiety goes up through adulthood. And then in their late 50s and early 60s, life satisfaction and happiness begin to increase again and anxiety plummets. And through the decades of elderhood, people remain far happier, more satisfied and less anxious than they are in adulthood. So when we hear all the horror stories of old age, we're not hearing things that aren't actually happening. There are no obvious bodily disappointments, but there is so much more to life than your body and ailments. And this is this just keeps being found again and again. Why don't you tell the happy stories? Why don't we tell how nice it is to know who you are and how you want to spend your time and with whom? So I think it's really important to know about this curve and at the same time to recognize that not everybody gets happier and more satisfied. But a majority of people do.
Freda Lee: [00:07:43] Now, that's great. And just to keep with that thought a little bit more, if someone wants to retain health and feel well for a long time in old age. What do you recommend?
Dr. Louise Aaronson: [00:07:53] There's so many things. Well, it turns out probably our aging begins to be influenced, you know, by our forebears and even in utero. But those are not things we can control. So what can we control? Probably starting even in early adulthood. But actually, the good news is that you can start getting healthier at any age. I mean, this has been shown people through their 80s and 90s. Would it be better start at 22? Probably. But at 22, we all think we're immortal. So better late than never is one message. But the things that make a huge difference are activity or exercise in particular. And there are people who say, "I've never exercised, I'm not starting now at 68 or 88." But exercise means so many different things. Maybe it's dancing, maybe it's going for a walk, you know, or picking up your grandkids from school. Maybe it's actually taking up Tai Chi because you're worried you're gonna fall and you want to stay at home. Maybe it's learning a sport like pickleball, which is really good as we age. So there'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. So getting active, eating a healthier diet, totally terrific. And then there are some other things that that people don't always think of, but are equally important, it turns out. And so there's purpose, which I discussed before. There's also social engagement. And this can 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 a friend or partner of sixty years with someone new. But can you absolutely have meaningful and pleasurable social engagements? You can. And it's really important, I think, for all of us as we get older to start adding new friends so that we have maybe some reserves, some social reserves. And also, you know, by doing activities, we can have social engagement. And then the last thing really surprises people, which is that people who have more positive attitudes about aging tend to be much healthier as they age 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. If you feel hopeful, you're more likely to do the things that will make you happier and healthier. So it's not clear what the association is, but it's very clear that people who go in with more optimism and positivity seem to have fewer markers of dementia. They get heart disease years later, they recover better after hospital stays. It's just the data on that's pretty impressive. So lots of things we can do and then the other things we can't control like good luck.
Freda Lee: [00:10:39] So now that's great. In your book, you also talk about ageism in the 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 those four 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 a couple of weeks. If you're really lucky at certain schools, you might get three to four weeks 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 they handle medicines is different. We also know that older people have disproportionate health needs. We under-train people on the bodies and needs of older patients and we do this across sectors. So when we think of medicine, we think of medical training. So I just discussed what happens there. And in lots of programs like, you know, most people die of heart disease and cancer and in cardiology and oncology training, there's no geriatrics, over the three to four years. So it's just like this void, which is part of what I was talking about earlier, when we don't have a language, we have childhood and adulthood, 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 and mostly white men. And that was because in science it's easiest if you can control any factors that might interfere with whatever it is you're studying. So that actually made good sense. Let's take the people we know the most about where we can control the most things. But then what happened in this sort of later mid-century in the in the 20th century or maybe in the 70s? People started noticing that, you know, we don't study heart disease in women because women are different than men. But then when we apply the results we get from women, no, from men to women, the women have worse outcomes. Maybe it's because they're different. And so 30 years ago, they they made stipulations at the National Institutes of Health that you need to include women. And then 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 did the NIH require inclusion of old people in medical research? Well it was in 2019. There would be studies of diseases that happen principally in old people, and it would exclude old people either, frankly, on the basis of age or on the basis of having other diseases which are very common. And so there're just these huge voids. And, you know, you get kids' 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 if we 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 did this 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 is getting appropriate medical care?
Dr. Louise Aaronson: [00:13:53] It's such a good and hard question because it's so variable. I guess one of my favorite jokes I like to tell is actually based on a true story. It happened in New York. So a colleague of mine was traveling and a patient, a person was, I think about age 96 started having knee pain. So he went in to somewhere an acute care, and then he was evaluated and the doctor took a good history and Rubini around. And then he said to the 96-year old, "Well, you know, what do you expect? The knee is 96." And apparently this man, without missing a beat, said, "Well, my other knee is 96 too, and it doesn't hurt a bit." So that is like my favorite joke for geriatrics. But the point 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 respecting you, who's there to help you. Yes, it gets complicated. Yes, you accrue more things with age. 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. I also think when people are explaining things, they need to explain the harms as well as the benefits. And they need to know and explain that the harms tend to rise and the benefits tend to shrink as we get older. So the harms rise because bodies, all our organs and our ability to metabolize things and, you know, recover, go down. And the benefits go down because there are greater harms and also because maybe the life expectancy of somebody is 98. We're not thinking 20 years in the future. So it kind of depends on your horizon and it depends on your other health issues and it really depends on function. So one of the best predictors of how an older person will do is or are sort of funny, non-medical sounding things like how fast can they walk and what's their grip strength? And then last but not least, a person should always be thinking about medications and asking about medications and considering that medications are doing harm, whether or not that's listed when you Google it or whatever you do to search it. Basically in old age, any medicine can do anything. And the only way to find out often is to stop it.
Freda Lee: [00:16:16] What's your take on the various technologies being developed to try 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 funny concept because we age from the moment we're born. So if you're beating aging, are you beating living or what exactly do we mean? And immortality is actually something the human species has talked about for millennia and each generation thinks they are the 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't know that that's going to happen. And we also have to think about the ethical ramifications of that. We know when there's overpopulation and scarce resources, people begin to kill each other. You know, there could be more generational warfare than there is now. There, you know, there could just be some pretty scary things. And if we're thinking about the environment, you know, how how's the planet going to handle all of that? And on the other hand, I think an important distinction is, is between extending the lifespan, which is how long we live and extending the health span, which is how many of our years lived we are healthy for. And I think feeling better and functioning better for more of the years were live. Sounds like a pretty good thing to everyone 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 for good old age is good genes, good luck, enough money, and one good kid, usually a daughter. Can you tell us more about that?
Dr. Louise Aaronson: [00:17:53] Well, I came to that just based on, you know, 20 some years of geriatrics practice. So, you know, genes are sort of luck. But, you know, if a person's parents and siblings all lived into their nineties or hundreds and we're in pretty good shape, that person often is too. Not without exception. But, you know, it makes it a little more likely. Enough money. Yes. I tell my students or any learners I have with me, like, you know, having more money gives you more opportunities. And there's nothing that age changes about that. And eventually that the normal human life cycle is that we eventually need more help and we sort of act like that's a bad thing or a personal failure. But it's the normal human life cycle. It's what nature does with a body over time. And it's, I can see why it's you know, it's better to be a kid who can't do things and you're looking forward to hopefully being able to do it, that that's a more pleasing trajectory. Like, I'm not saying I don't understand people's natural responses to, you know, 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 or something 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 some pretty great sons and brothers and grandsons. And I do believe I am seeing more these days. So I'm not saying this to diss males in any regard. I think what we all know that traditionally females have done more caregiving and that they still do. And yet, you know, I think we can all do this. And it's actually turns out you hear a lot about caregiver stress. And what you don't hear about as much is how enriching and fulfilling and satisfying it is for people to do that for people they love, whether it's their children, their partners, their parents.
Freda Lee: [00:20:04] That's wonderful. Dr. Aronson, thank you so much for being our guest on the Plan for 100 podcast. We really appreciate your time today. And we hope you'll join us again soon.
Dr. Louise Aaronson: [00:20:12] Well, it was a pleasure. Thank you for asking such good questions.
Steve Lubetkin: [00:20:16] Thank you for joining us for AIG's Plan for 100 podcast. For more information, please visit our website, planfor100.com.