(This article is the first in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity from the Milken Institute Center for the Future of Aging.)
Why a series of essays on the future of aging? Because the issues could not be more important, and attention is needed now. The global demographic shift, a product of increasing longevity and lower birthrates across much of the world, will, like climate change, affect humanity forever.
Paul Irving, Chairman, Milken Institute Center for the Future of AgingAt the Center for the Future of Aging, we’re proud to be associated with a group of extraordinary advisers — thought leaders — who are working in their own domains and in their own ways toward a stronger society and a better future for people of all ages. Their essays identify challenges and opportunities that must be urgently considered. Will the future of aging realize the breathtaking possibilities stemming from longer life, or heighten the risks and costs of an aging population?
In the United States, about 10,000 people turn 65 each day, and one in five Americans will be 65 or older by 2030. Globally, the number of people age 60 and over is projected to leap from about 900 million in 2015 to 2 billion by 2050, according to the World Health Organization. Between 2000 and 2050, the 80-and-older cohort will almost quadruple, and those 65 and over will outnumber children under the age of 14. It should be noted that many experts see these demographic predictions as too modest. In the wake of the decoding of the human genome, even longer lives and larger aging populations may be just ahead.
More Change to Come
Increasing longevity has contributed to unprecedented global economic growth and wonderful opportunities for personal fulfillment. This gift of more years, due to advances in science, sanitation and safety, may be the most momentous accomplishment in human history. But, as remarkable as this progress has been, there is more change to come.
The demographic aging shift will have massive impacts on government budgets, living standards, individual health and well-being and economic and social stability. While longer lives mean exciting possibilities for individuals, families and societies, increasing longevity will also bring great challenges — from financial insecurity and disease to intensifying strains on social and financial safety nets and health care systems.
The issues are big, and the stakes are clear. But there’s reason for optimism.
The Reasons for Optimism
Today’s older adults are generally healthier and more vibrant than those of generations past. They are changing retirement norms as they seek to learn, work and contribute. They are driving growth and opportunity in entrepreneurial ventures and bolstering economic vitality as creators and consumers. In workplaces and classrooms, their guidance and beneficial support enhance performance and intergenerational collaboration. In encore careers, volunteering and civic and social settings, their balance and problem-solving abilities contribute to society’s well-being.
They are the beneficiaries of continuing advances in health and technology that will change the aging experience.
In times of economic stress and seemingly intractable social challenges, there is a need for fresh ideas and collaborative solutions. Older adults may provide just that. This largely untapped resource has much to offer — not just wisdom, but the practical experience and skills that can enrich families as well as work, educational and social settings.
Realizing the Potential of the Aging Population
But to realize the potential and value of the aging population, we must shift course and shape a future that’s different from yesterday’s model. We envision a future that advances public health, creates age-friendly homes and communities, enables and encourages lifelong learning, work, and entrepreneurship, and promotes purposeful engagement and volunteerism.
It’s a future that speeds the development of empowering technologies, social networks and accessible transit systems, and builds a vibrant longevity economy to increase access and opportunity for the current generation of older adults as well as generations to come.
It’s a future that enables and empowers a population seeking fulfillment, ready and willing to engage so long as engagement is possible. It’s a future that elevates beneficial purpose as a new life course model, harnessing the talent of a vast cohort — and calling on them to remain actively and valuably involved by contributing to the lives of younger people as educators, mentors and coaches.
Beginning a Different Conversation
We must combat ageism, magnify opportunity, celebrate contribution and enhance dignity. We must change hearts, minds and attitudes about the possibilities of healthy, productive and purposeful aging. We must begin a different conversation about getting old.
We are at an inflection point, at the intersection of a fundamental demographic change and a search for a new model. If we join together and do what’s needed, we’ll enrich aging lives, strengthen families, businesses and communities and ensure a better future, not just for older adults, but for people of all ages in every corner of society.
We hope you enjoy these essays by our “Future of Aging” authors. We believe their ideas will expand perspectives and encourage involvement. Let us know your reactions, and, please, join the conversation.


A New Model for the Future of Aging

Paul Irving

(This article is the 14th in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity, published by the Milken Institute Center for the Future of Aging. Links to the rest of the series appear at the end of this article.)
“With the right policies and services in place, population ageing can be viewed as a rich new opportunity for both individuals and societies.” — Dr. Margaret Chan, Director General, World Health Organization, in the Preface to the 2015 World Report on Ageing and Health
 
Yves Joanette, scientific director, Institute of Aging, Canadian Institutes of Health ResearchOur global society is already the oldest in the history of mankind. In less than 35 years, nearly 50 countries will be super-aged, joining Japan, where already more than 30 percent of the population is over 60. Now that we can expect more years in our lives, we have to make sure that these extra years are healthy ones.
The road to healthy aging is long, starting as early as conception and birth. In fact, the future of our healthy aging is a trajectory, which goes back into our yesterdays and moves forward with us as we advance.
Determinants of Healthy Aging
Major research efforts are being made to better understand the determinants of healthy aging. If public health programs and campaigns would support them, we would see a much brighter future of aging.
Let us consider a few examples:
Make early days good days: The trajectory of healthy aging is partly determined by the genes we inherit from our parents. Our susceptibility to various metabolic diseases, for example, will influence our lifelong condition. Nothing can be done about those genes, but the booming science of epigenetics tells us that the nature of our very early exposures can have a major impact on the manner in which our genetic potential actualizes itself.
The future of aging would be brighter if there were programs to inform the public about the early-life optimal conditions that favor the good sides of our genes and diminish their dark sides.
Skillfully navigate the trajectory: Research offers more and more evidence on the life events that interfere with healthy aging and lifestyle choices that favor it.
For instance, we know that head concussions — even very minor ones — will accumulate along our life course, enhancing our susceptibility to neurodegenerative diseases such as Alzheimer’s. At the same time, we know that dodging the risk factors for chronic diseases such as diabetes is a crucial factor in healthy aging.
Here again, public health campaigns would empower people to make the right choices.
Proactively preserve cognitive health: Cognitive disorders that can result in dementia, such as Alzheimer’s disease, are among the most feared and disabling health conditions that can befall us as we age. Despite efforts to diminish the risk factors associated with neurodegenerative disease, such as maintaining vascular health, they still can cause damage.
One can be proactive, however, by enhancing brain health by developing a “cognitive reserve.” Such a reserve does not diminish one’s susceptibility to developing a brain disease, but it offers the functional brain ways to delay its clinical manifestation, thus shortening the time one must suffer.
For example, it is now known that learning a second language strengthens the brain and has the potential to delay the first signs of dementia two or three years. Therefore, a country that encourages its people to learn a second language would see the domestic prevalence of dementia decline.
Strong social networks: Healthy aging definitely requires a connection to others. Humankind is by nature social and must be interconnected to share, support and so on. Opportunities to connect are facilitated by transportation and social networks. Policymakers should encourage our social lives, our intergenerational contacts, our urban social hubs and our transportation to favor such networking.
In summary, ensuring that the extra years will be good years represents a daily, lifelong task. Aging, and its future, is the trajectory. Policymakers and public health leaders are essential to the task of empowering everyone with knowledge.
The rest is in our hands. The future of healthy aging is indeed yesterday, today and tomorrow. Let us act.
 
The first article in this series was A New Model for the Future of Aging. The second was Personalized Aging: Extending Lifespans and Healthspans. The third was Boomers: Less Tied to Friends and Family Than Others Are. The fourth was What It Will Take for the U.S. to Profit From the Longevity Dividend. The fifth was Work, Retirement and Financial Security in the 21st Century. The sixth was Technology, Aging and the Coming Fifth Wave. The seventh was 5 Course Corrections Needed for a Better Future of Aging. The eighth was Let’s Make the Most of the Intergenerational Opportunity. The ninth was How We Can Use Our Longer Lives to Do Good. The 10 was Building Cityscapes for Healthy Aging. The 11th was Aging in the 'Right' Place. The 12 was How to Make Longer Working Lives Work. The 13 was Four Freedoms That Will Define the Future of Aging. 
 


The Future of Healthy Aging Is...Yesterday

Yves Joanette

(This article is the seventh in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity published by the Milken Institute Center for the Future of Aging. The first article in the series was A New Model for the Future of Aging. The second article was Personalized Aging: Extending Lifespans and Healthspans. The third article was Boomers: Less Tied to Friends and Family Than Others Are. The fourth article was What It Will Take for the U.S. to Profit From the Longevity Dividend. The fifth article was Work, Retirement and Financial Security in the 21st Century. The sixth article was Technology, Aging and the Coming Fifth Wave.)
Longevity is truly humanity’s new frontier. In fact, two-thirds of the people who have ever lived past 65 in the history of the world are alive today. As the baby boomers turn 65 at the rate of 10,000 a day, America is becoming a “gerontocracy.” Are we prepared?
No.
Just as society’s institutions were grossly unprepared for our baby boom, we have done far too little to prepare for the coming age wave.
Based on 40 years of research, dialogue, analysis and activism, I have come to believe that there are five essential — and achievable — course corrections that are needed if we are to optimize our newfound longevity:
1. Create a Worthwhile Purpose for Maturity
Although medical science can increasingly prolong life, political, religious and community leaders have yet to create a compelling vision for those additional years.
Ken Dychtwald, CEO of AgeWaveCurrently, 65 million-plus retirees spend an average of 49 hours a week watching television. Let’s reorient the tasks and timing of today’s youth-centric volunteerism to take better advantage of the talents and skills cultivated over a lifetime.
Why not mobilize an elder corps so tens of millions of retirees can share their values, knowledge and skills with young people in need? We could unleash our greatest growing natural resources that are hiding in plain sight: longevity and wisdom.
2. Align Our Health Spans With Our Lifespans
Unless we intervene, the nightmarish afflictions of later life will become tomorrow’s pandemics.
We must turbocharge scientific breakthroughs to control, delay or, even better, eliminate the diseases of aging, such as heart disease, cancer and diabetes — with priority given to Alzheimer’s, which is 100 percent fatal, 100 percent incurable and affects one in two people over 85.
We must also insist that health-care professionals are properly trained (note: currently, they’re not) to care for our aging population by requiring standards of geriatric-related competence. And we need a more humane, respectful approach to late-life palliative care and the dying process.
3. Unleash Lifelong Productivity
It’s time to replace the “linear” life paradigm with a new “cyclic” one that views maturity as a time for personal reinvention, late blooming and/or new beginnings.
And we should challenge our educational systems (with particular attention to community colleges, workplaces and the Internet) to distribute learning across the lifecourse and help adults remain relevant by repeatedly rebooting their skills and intellectual abilities.
Employers would be wise to provide more flex-work, job-sharing, phased retirement and sabbaticals so that longer-lived workers have more balance in heir lives.
4. Retire Retirement, 65 and Ageism
In the 1880s, German leader Otto von Bismarck chose 65 to be the standard retirement age — when life expectancy at birth was only 45! It’s now 79, and rising. If it continues to climb without adjustments in the eligibility for “old age” entitlements, the cost of programs like Social Security and Medicare could crush the younger generations that must support them.
Boomers must do the right thing and agree to affluence testing and the indexing of entitlements to their rising longevity.
While we’re at it, we should also liberate the media and the consumer marketplace from their ageist youth orientation to increase the comfort, security, well-being and involvement of older adults.
5. Avert an Era of Mass Elder Poverty
Approximately one-third of boomers have saved responsibly and will benefit from family inheritances. Another third will likely extend their work lives five to seven years to enjoy a satisfactory retirement. Yet financial inequality among tomorrow’s elders is worsening, and around 25 million boomers have virtually no savings, pensions or promise of inheritance.
We need a bold national education “intervention” that stimulates financial literacy at every stage of life. Government and employers could help us help ourselves by encouraging increased personal savings rates, possibly through mandated tax-advantaged programs.
Do we as a nation have the guts and wisdom to take these steps? I believe we do, and I surely hope we will make the course corrections necessary to usher in a healthy and purposeful future of aging.


5 Course Corrections Needed for a Better Future of Aging

Ken Dychtwald

(This article is the third in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity published by the Milken Institute Center for the Future of Aging. It was originally titled: Keeping Our Eyes on the Ball: The Sightlines Project. The first article in the series was A New Model for the Future of Aging. The second article in the series was Personalized Aging: Extending Lifespans and Healthspans.) 
A recent survey by Peter Hart Research Associates found that three of four Americans would like to live to 100 if they could do so in good health. Yet close to the same number reported that they anticipated retiring from work at 65, ate too much and didn’t exercise as much as they should. Thriving in an era of longevity demands that we change the way we live.
Laura Carstensen, Director, Stanford Center on LongevitySmall and seemingly innocuous choices we make on a daily basis exert far more influence over our health and well being than our genes. Yet people are relatively insensitive to patterns that put us at risk, like spending a little more money than we earn, eating poorly or gradually disengaging from our neighborhoods and even close friends.
To make matters worse, it’s difficult, if not impossible, for people to see into the distant future. We take great care to ensure we’ll feel happy this evening, but we take far less care of our future selves.
The Sightlines Project
To help individuals, policymakers and thought leaders see the future more clearly, the Stanford Center on Longevity launched the Sightlines Project, a partnership with Time magazine, in February. The project is based on analyses of eight nationally representative, high-quality multiyear studies involving more than 1.2 million Americans over two decades. We analyzed the percentage of Americans in each of six age groups who are doing well in three areas that are crucial to long-term well being: healthful living, financial security and social engagement.
Rather than compare younger people to older people, we compared people today to people who were of the same age 15 to 20 years ago. This way, we produced a dynamic snapshot of trends for better and for worse.
The report card is mixed.
Americans have made substantial progress in several areas, while problems have worsened in others.
Smoking — the top preventable cause of morbidity and early mortality — has declined in every age group, and for the first time in decades, Americans are exercising more regularly.
Problems related to diet and sleep, in contrast, are widespread and show no signs of abating. Student debt is far higher than it was in 2000. Sightlines reveals that fewer younger people are buying homes or making other types of investments, thus risking their long-term financial security.
Startling Findings About Social Engagement
Findings about social engagement were startling and have serious implications for an aging society. Feeling socially connected to others is critical to physical and mental health, and across age groups, traditional modes of social engagement are waning: Younger and older Americans are not as likely to visit with neighbors or participate in community or religious organizations as their counterparts 20 years ago. One in five Americans report that they do not have friends or family on whom they can rely for help.
The most dramatic change in social engagement was observed in 55- to 64-year-olds. This cohort, which is nearing retirement, is not only engaging less with their communities, but they have fewer meaningful interactions with their spouses or partners and weaker ties to family and friends.
Because of the size of the boomer cohort, the norms they set will not only have short-term ramifications, they may endure for generations. A great deal is at stake. If boomers establish expectations about giving back to communities and investing in younger generations, they can put the United States on track to become a better nation. In contrast, if they bow out and withdraw — as Sightlines suggests they may — we risk a different, dimmer future.
What Boomers Need
One of Sightlines’ key aims is to identify critical junctures when change is needed and initiate discussions about solutions. Finding purposeful engagement may be just what boomers need: A growing body of research suggests that volunteering produces benefits to the physical and mental health of volunteers.
Near-retirement age represents a “sweet spot” for recruitment. More than 70 percent of people who volunteer prior to retirement continue to volunteer afterward — far more than those who had not volunteered while working. It’s time to ask boomers to reengage and enlist in organizations like Encore.org to lead a social movement to improve the world.
This time, let’s trust people over 30.
The Sightlines Project will continue to monitor signs of progress and areas of concern as we position the nation for longevity. We look forward to engaging the public, employers, industry leaders and policymakers in discussions about creating a culture that supports long life.
Amy Yotopoulos co-authored this article.


Boomers: Less Tied to Friends and Family Than Others Are

Laura Carstensen

This article is the 16th in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity, published by the Milken Institute Center for the Future of Aging. Links to the rest of the series appear at the end of this article.)
In what ways do the “retirement” years provide new opportunities for creative, purposeful activity?
Barnaby Marsh, principal, Mandarin Global HoldingsIn recent years, scholars have been finding that positive, focused intentions can make all the difference for people in terms of activity, success and life fulfillment. For example, Stanford University psychologist Bill Damon has demonstrated various ways that youth can be encouraged to explore positive purpose in their lives and the effects it has on early life: better relationships, better health and better academic achievement.
But is a focus on exploring positive purpose beneficial only for the young?
Revolution in Later-Life Engagement
We are witnessing a revolution in later-life engagement, as many people remain active into their 70s, 80s and even 90s. At the same time, research is accumulating on the positive effects of staying engaged, active and vital.
Patricia Boyle of Rush University Medical Center has found that people who look for ways to have more positive purpose in their lives may also limit the progression of disease. Her research shows that “engaging in meaningful and purposeful activities promotes cognitive health in old age.”
Boyle’s most recent study went even further to reveal that “mental health, in particular positive psychological factors such as having a purpose in life, are emerging as very potent determinants of health outcomes.” She also discovered that it is important for each individual to find his or her own particular purpose, as it differs for everyone, and reaping the rewards seems to be tied to this observation.
Boyle’s is just one of many recent studies that suggest that explorations of positive purpose and activity make a big difference in long-term quality of life.
Encore.org and the Eisner Foundation
Not surprisingly, the emerging picture of positive purpose, health and vitality has attracted the interest of those in the nonprofit sector as well as government.
Encore.org, an organization spearheaded by social entrepreneur Marc Freedman, was an early entrant into the field with its annual Purpose Prize, which highlights inspirational “second acts” (the prize is now operated by AARP). It also gave us Experience Corps (now run by AARP), which bridged generations and enabled older adults to mentor struggling students. Encore.org has expanded to offer special fellowships, education and networking services for older adults. These combined efforts have impacted and improved the lives of tens of thousands of people.
Other organizations, such as the Eisner Foundation, have looked at creative ways to support intergenerational learning for the betterment of the community. The Eisner Foundation points out that intergenerational activity is not just nice; it is necessary.
Intergenerational work allows those who have built up an immense catalog of experience, know-how, relationships and inspirational pathways to share their knowledge with the next generation. The benefit goes both ways, and we are starting to see “reverse mentoring,” in which younger generations share perspectives and new skills with older people.
Tax Incentives for Later-Life Engagement?
Such connectivity allows older adults to engage in more productive, satisfying experiences. For social, political and financial reasons, it would not be unrealistic to see future governments enact tax incentives for companies and individuals who are committed to later-life engagement.
Many agencies are working to address the challenges associated with living longer lives, and with research such as Boyle’s coming to the forefront, finding ways to encourage purpose in retirement could help alleviate some of these concerns.
Exploration of beneficial purpose is not only for the young. As this outlook grows, we will see a big change in traditional concepts of retirement and fresh thinking about staying engaged during later life. Instead of a career path that winds down, or simply working longer to pay the bills, the focus may shift to purpose that evolves as we age.
One can imagine how such a shift in mindset could transform individuals, communities and society.
Ericka Peterson contributed to this article.
The first article in this series was A New Model for the Future of Aging. The second was Personalized Aging: Extending Lifespans and Healthspans. The third was Boomers: Less Tied to Friends and Family Than Others Are. The fourth was What It Will Take for the U.S. to Profit From the Longevity Dividend. The fifth was Work, Retirement and Financial Security in the 21st Century. The sixth was Technology, Aging and the Coming Fifth Wave. The seventh was 5 Course Corrections Needed for a Better Future of Aging. The eighth was Let’s Make the Most of the Intergenerational Opportunity. The ninth was How We Can Use Our Longer Lives to Do Good. The 10 was Building Cityscapes for Healthy Aging. The 11th was Aging in the 'Right' Place. The 12 was How to Make Longer Working Lives Work. The 13 was Four Freedoms That Will Define the Future of Aging. The 14 was The Future of Healthy Aging… Is Yesterday. The 15 was You’re Going to Get Old, So Think About It Now. 
 


Does Purpose Only Benefit the Young?

Barnaby Marsh

(This article is the 17th in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity, published by the Milken Institute Center for the Future of Aging. Links to the rest of the series appear at the end of this article.)
The Robert Wood Johnson Foundation (RWJF) believes that everyone in America should have the opportunity to achieve the healthiest life possible, no matter where they live or work, the color of their skin or their economic status. For older people, this goal might seem like a pipe dream, a reality only for the young, the strong, and the well.
Robin Mockenhaupt, chief of staff, Robert Wood Johnson FoundationBut it is possible to build a culture of health that helps the elderly achieve optimal health — not perfect, but the best for each individual. We can get there, I believe, by hewing to these overarching strategies:
Building a Shared Value of Healthy Aging  Too many of us think that old age equals poor health and that older people can’t adopt healthier behaviors. In fact, the majority of older adults are able to manage independently until their very advanced years, even those with chronic disabilities and illnesses. And retired people continue to play productive roles in their families and communities.
It is never too late to benefit from increased physical activity, social engagement, and other healthy behaviors. One way is through volunteering.
AARP’s Experience Corps uses nearly 3,000 older volunteers in 22 cities to tutor struggling elementary school children in reading. The Corps is improving literacy rates, enriching the lives of its volunteers and strengthening schools and communities — a triple win.
Cross-Sector Collaboration  Partnerships among businesses, public agencies, community groups, health-care providers and older adults themselves can develop innovations that help seniors remain independent and productive for as long as possible.
It’s a lesson the tech sector learned after years of developing digital devices for the elderly that were too complex or hard to manipulate. Aging 2.0, a platform for connecting aging care innovations, now includes older adults on panels to evaluate concepts. It is also partnering with the AARP Foundation on the Aging in Place Challenge, which offers a $50,000 price for the most innovative solutions to help low-income older people continue to live in their homes as they age.
Creating Healthier, Equitable and Age-Friendly Communities  We need more towns and cities where people of all ages and circumstances can safely go for a walk, get around without a car, enjoy public spaces, buy healthy food and find the services they need.
Lawrence, Mass., one of RWJF’s Culture of Health Prize winners, is such a place. This predominantly Latino, working-class city has integrated its senior center into the community, with programs ranging from citizenship classes to diabetes self-management training to Zumba. It welcomes residents of all races, cultures and ages. The city even moved its weekly farmers’ market next to the Senior Center; business tripled as a result.
RWJF is also proud that Princeton, N.J., the foundation’s hometown, was the first city in the state to be named an “age-friendly community” by the World Health Organization, thanks to its walkable downtown, access to cultural activities, safe and affordable transportation and range of housing options. There are 75 such communities in the United States, and AARP offers a toolkit to help others join the movement.
Strengthening Health Services and Supports  In a culture of health, health care must be equitable, accessible, efficient and timely for all patients, no matter their age.
To make sure that older patients get the care they need, the nation must address the severe shortage of geriatricians. There also is an overwhelming need to “gerontologize” other professionals and clinicians so the older population receives the best care across the board.
Additionally, we must also come up with better supports for family members that are serving as unpaid caregivers, often at a cost to their own health.
By keeping these tenets in mind, we can better promote health for all ages. That means older adults can spend more time with their grandkids, engage with their communities, work if they want to, volunteer, travel — the possibilities are endless.
 
The first article in this series was A New Model for the Future of Aging. The second was Personalized Aging: Extending Lifespans and Healthspans. The third was Boomers: Less Tied to Friends and Family Than Others Are. The fourth was What It Will Take for the U.S. to Profit From the Longevity Dividend. The fifth was Work, Retirement and Financial Security in the 21st Century. The sixth was Technology, Aging and the Coming Fifth Wave. The seventh was 5 Course Corrections Needed for a Better Future of Aging. The eighth was Let’s Make the Most of the Intergenerational Opportunity. The ninth was How We Can Use Our Longer Lives to Do Good. The 10 was Building Cityscapes for Healthy Aging. The 11th was Aging in the 'Right' Place. The 12 was How to Make Longer Working Lives Work. The 13 was Four Freedoms That Will Define the Future of Aging. The 14 was The Future of Healthy Aging… Is Yesterday. The 15 was You’re Going to Get Old, So Think About It Now. The 16 was Does Purpose Only Benefit the Young? 



How to Help Achieve Optimal Health for the Elderly

Robin Mockenhaupt

This article is the 10th in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity published by the Milken Institute Center for the Future of Aging. Links to the rest of the series appear at the end of this article.)
Extraordinary public health advances such as clean water, immunizations and new medical treatments have doubled the average American’s life expectancy over the past 150 years. These extra years of life bring rewards, along with some challenges. For example, many people today live in communities that are increasingly difficult to physically navigate as the years go by.
Dr. Lynn Goldman, dean, Milken Institute School of Public Health, the George Washington UniversityIn the United States, the population of older adults, including the oldest of the old, is growing rapidly. According to the White House Conference on Aging, over the next 50 years, the number of people aged 65 and older is expected to more than double to 92 million and those 85 and older will likely triple to 18 million.
What's Making It Hard to Age in Place
AARP research strongly suggests that this generation expects to be active and independent as long as possible. Up to 90 percent want to age in their own communities and at home. Yet, neighborhoods built around the automobile do not make it easy for them to stay active.
Older people may not be able to cross the street because the lights are timed to a younger person’s faster gait. They may not be able to walk to the grocery store to buy fresh food or to a town center where they can go to the library, find a job or sign up for a class.
Still others live in places that lack access to public transportation, affordable housing, health care, green space or opportunities to volunteer. High-rise apartment buildings and gated communities designed to be convenient and safe may inadvertently contribute to such isolation.
With the graying of America, we need transformative changes in the built environment, changes that will make our neighborhoods, cities and counties healthier places to grow old.
To that end, the Milken Institute has produced a series of reports on the best U.S. cities for successful aging. Although we often think of a warm climate as the most important environmental asset for older people, this research shows that other factors — those that help older residents stay engaged, active and productive — are much more essential.
AARP's Most Livable Cities Tool
AARP has created an online tool that can identify the best cities for older people. The tool not only celebrates the best in U.S. cities, but also helps residents, county and state officials, business and health-care leaders and others find, and then address, important gaps — such as the lack of walking paths or parks.
That online tool and other Internet resources can promote healthy aging, according to recent research. Computer-savvy older adults can find the latest updates on a health condition, visit a doctor or nurse in cyberspace — or even summon a quick ride from a ride-sharing service or van.
3 Ways to Build on the Momentum
We have taken great steps toward a healthier future, but we need to build on that momentum.
First, officials from all sectors, including transportation, health, housing, education and others, must start working with urban planners and property developers to imagine and then create a future in which people are not just growing older, but getting better.
Second, policymakers must create incentives for developers and others to invest in buildings, landscapes and urban plans that make it easier to adopt health habits that support successful aging, such as active lifestyles, eating plenty of fresh, healthy food and jobs or volunteer positions that engage the mind.
Third, we all must look at our own town or neighborhood, identify the gaps and advocate for better conditions so we can stride into the future with good health on our side.
Working together, and with the help of smart and supportive organizations such as AARP, we can build better neighborhoods — healthier places to live for all generations.
We can lift the barriers that prevent people from contributing to their communities and the economy and ease their paths through their cities and towns as well as from one stage to another.
 
The first article in this series was A New Model for the Future of Aging. The second was Personalized Aging: Extending Lifespans and Healthspans. The third was Boomers: Less Tied to Friends and Family Than Others Are. The fourth was What It Will Take for the U.S. to Profit From the Longevity Dividend. The fifth was Work, Retirement and Financial Security in the 21st Century. The sixth was Technology, Aging and the Coming Fifth Wave. The seventh was 5 Course Corrections Needed for a Better Future of Aging. The eighth was Let’s Make the Most of the Intergenerational Opportunity. The ninth was How We Can Use Our Longer Lives to Do Good.



Building Cityscapes for Healthy Aging

Lynn Goldman, M.D.

(This article is the second in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity published by the Milken Institute Center for the Future of Aging. It was originally titled: Personalized Aging. The first article in the series was A New Model for the Future of Aging.) 
Since the dawn of humanity, people have been seeking anti-aging remedies, and this field has continued to grow unchecked. Many billions of dollars have been spent on unproven and sometimes dangerous treatments as well as potentially useful but simplistic and broadly targeted, “one-size-fits-all” advice, often informed by limited data and anecdotal success stories.
In the last few decades, we have witnessed waves of contradictory dietary recommendations, such as low-fat, low-carb, caloric-restriction and low-protein, and seen popular supplements come and go (fish oil, vitamin C, vitamin E, vitamin D). The list goes on and on.
Seeking Guidance About Anti-Aging and Aging
When we seek guidance, the best offerings often come from people who understand what makes each of us unique and can relate their wisdom to our individual goals. Why should aging — and the recommendations for healthy longevity given to aging adults — be different?
Pinchas Cohen, dean, Davis School of Gerontology at USCTaking individual characteristics into account in supporting maximal longevity is a concept I’ve termed “personalized aging.” And, as we try to ensure that the additional years in our extended lifespans are spent in good health, this idea’s potential impact is enormous.
In recent years, phenomenal advances in genetic research, coupled with increased application of high-performance computing to the analysis of large data sets, have transported this idea of precisely tailored health recommendations from the realm of science fiction to a likely next step in the progression of the medical field.
Personalized, or Precision, Medicine
The science of genomics has undergone a massive increase in applicability and accessibility in a relatively short time. What started with the discovery of gene mutations tied to specific rare diseases is now enabling physicians to determine which treatments for common age-related illnesses — from diabetes to cancer — will be most effective based on the patient’s genome. This approach is often referred to as personalized, or precision, medicine.
Over the same period, the cost of genetic sequencing has shrunk from several million dollars per individual genome to a few hundred dollars.
Similarly, it is now possible to determine one’s genetic makeup from the comfort of home, sending a vial of saliva through the mail.
Recommending Preventive Interventions Individually
In this time of incredible opportunity, our goal is to gain support for, and conduct, large genome-wide association studies, develop even more powerful computing techniques and sift through millions of genetic variants to identify those that determine responsiveness to diets, exercise, supplements and more. This information can then be used to recommend optimal preventive interventions on an individual basis.
For instance, the emerging discipline of “nutrigenomics,” or the study of how dietary factors interact with our genes, is especially promising.
As scientists, including several here at the USC Leonard Davis School of Gerontology, uncover links between specific diets and resistance to aging’s maladies, we recognize that there isn’t one ideal diet for everybody. Instead, the benefits of dietary variations — from high-protein to veganism to periodic fasting to Mediterranean and everything in between — appear to vary based on genotype.
Providing personalized, genomics-based guidance could make a huge difference in our society’s perception of aging and the huge costs of age-related disease that we collectively bear.
Personalized aging strategies can identify which diseases one might be at high risk for and develop appropriate prevention methods. Someone whose genes put them at high risk for diabetes should probably adopt a low-carbohydrate diet, while a person at high risk for coronary disease will benefit from a Mediterranean diet. Similarly, an individual with a genetic predisposition to cancer may reduce their risk by eating a low-protein diet.
Advice About Alzheimer's
Perhaps the most compelling case for personalized aging advice can be made for people with a genetic susceptibility to Alzheimer’s disease, which can now be determined with precision. The risk can vary dramatically based on the variants of several genes, particularly one known as APOE. People with the alleles [different versions of a gene] of APOE4, indicating high Alzheimer’s risk, could initiate a customized diet and exercise program along with brain-training exercises, enabling themselves to remain cognitively sound and independent for a longer portion of their golden years.
Much like the precious advice from those who know us best, receiving personalized aging support informed by genetic and lifestyle factors could help us better understand ourselves and empower us to confidently take steps to improve our lives.


Personalized Aging: Extending Lifespans and Healthspans

Pinchas Cohen, M.D.

(This article is the fifth in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity published by the Milken Institute Center for the Future of Aging. The first article in the series was A New Model for the Future of Aging. The second article was Personalized Aging: Extending Lifespans and Healthspans. The third article was Boomers: Less Tied to Friends and Family Than Others Are. The fourth article was What It Will Take for the U.S. to Profit From the Longevity Dividend.)  
Catherine Collinson, president Transamerica InstituteImagine that you’ve entered a design contest. You have the opportunity to redesign 21 century life based on the assumption that people will live to 100 years and older — and in good health. You are asked to address the concepts of work, retirement and the ability to achieve long-term financial security. Putting your design together involves asking questions:
What are the implications of living to 100? In my work as a retirement researcher, I think about this a lot, especially given that so many people are already living to 100 and older.
The first thing that comes to my mind is that age 65 seems quite young for retirement. It leaves us with decades of time to fill, without earned income and potentially without a purpose in life.
Financially speaking, if we enter the workforce at 22 and retire at 65, we would be working for 43 years and saving for a retirement that could last 35 or more years. This proposition may be attainable for some, but it is mathematically impossible for many. Clearly, the long-held notion of stopping work altogether and fully retiring at 65 is ripe for disruption.
Should retirement be a fixed moment in time? A more flexible approach would enable us to extend our working lives, gradually transition and fully retire at an older age. It would afford the ability to stay active and continue earning income while saving for the day when we stop working altogether. In redesigning retirement, we must enable people to create their personalized transition based on their wants, needs and financial circumstances.
Why shouldn’t society provide the opportunity to work to 75, 85, 95, 105, or as long as we are physically and mentally capable of doing so? Of course, we all should be able to work until we’ve built a large enough nest egg and achieved long-term financial security. Once upon a time, the physical aspects of aging, such as changes in vision and hearing, may have limited our ability to work. Today, thanks to technology and improvements in health care, we can remain in the workforce much longer.
For people of all ages, it is vital that we foster age-friendly work environments and provide access to meaningful employment, self-employment and other ways to earn income.
How can we successfully navigate our long careers? Times are changing quickly and the pace of change is accelerating with advances in technology and artificial intelligence. An essential survival skill is adaptability, so we can evolve with our jobs or embark on entirely new professions.
We all need to keep our skills fresh, relevant and marketable. Expanding access to lifelong learning and continuing our education is essential for this quest.
Are we forgetting anything? The notion of working to live, versus living to work, is well worth integrating into our long careers. Our working lives should afford time for raising families, staying healthy and fit, maintaining social connections, pursuing hobbies, traveling and attending to the needs of our loved ones. We need more flexible work arrangements so we can achieve work-life balance and enjoy our long lives.
What is the most formidable barrier to change? The human race tends to be its own worst enemy. One of our greatest challenges will be overcoming biases about aging, including societal beliefs, employer perceptions and personal attitudes. Longevity is far too great a gift to waste. Now is the time to transform our youth-centered popular culture to celebrate people of all ages.
My vision for balancing work, retirement and financial security seems grounded in common sense, yet it calls for dramatic changes in public policy, employment practices and basic assumptions that we take for granted in our daily lives.
The costs associated with this vision are implementation-related, while the benefits can dramatically improve lives and even pave the way for economic growth. In addressing the needs of an expanded, multi-generational workforce, opportunities abound for innovative products and services. New solutions are needed to support personal savings and long-term financial security, lifelong education and training, career assistance, housing, transportation, health care, entertainment and even fashionable attire to wear.
What It Will Take to Succeed
No entity can implement this vision alone. Success requires a highly collaborative effort among stakeholders, including government, industry, education, nonprofits, employers and everyday people.
At Transamerica Institute, a nonprofit private foundation, and Aegon Center for Longevity and Retirement, we are conducting research and participating in the global debate about population aging, longevity and retirement security. We strive to effect positive change.


Work, Retirement and Financial Security in the 21st Century

Catherine Collinson

This article is the 11th in a weekly Next Avenue series, The Future of Aging: Realizing the Potential of Longevity published by the Milken Institute Center for the Future of Aging. Links to the rest of the series appear at the end of this article.)
Older adults consistently report a desire to stay in their current homes as they age, which has given rise to the phrase “aging in place.” Indeed, an AARP survey in 2014 found that 88 percent of those 65 and older agreed that they would like to stay in their homes as long as possible.
Christopher Herbert, managing director, Harvard Joint Center for Housing StudiesThere are many reasons that staying in one’s home makes a lot of sense. Homes are full of memories and they evolve over time to take on the character of their owners. Staying in one’s home also preserves connections to family, friends and social groups, all of which are essential for older adults to remain engaged and productive members of their communities. But there are also many reasons that aging in one’s longtime home may not be the best option.
The Stairs Problem for Aging in Place
For one, more than 60 percent of the homes occupied by people 65 and older require the use of stairs to either enter the residence or get to a bedroom or bathroom. But by the time people are in their 80s, more than 4 of 10 have serious difficulty walking or climbing stairs.
Staying in these homes well into old age raises the risk of falls, which are the leading cause of injury and injury-related deaths among the elderly.
In addition, a large majority of older people live in single-family homes in suburban and rural areas and depend on cars to stay connected to their families and communities. But about a quarter of those age 80 and over are carless, while many of those over 60 who do drive, limit it to certain times of the day. Aging in place thus raises the risk of isolation as one’s ability to drive declines.
Of course, people can wait to move until the time comes when the old homestead is no longer suitable for them. But that may not be so easy to do. The process of moving is demanding physically and emotionally, and it only gets harder at an older age.
Absence of Good Local Homes
The other challenge that arises all too often is finding a suitable new home in the same community, one that is smaller, located close to shops and other destinations and accessible by public transit. The absence of good close-by alternatives is another reason many people often don’t move late in life — or why, when a move becomes inevitable, they are forced to leave their communities behind.
With the oldest boomers just turning 70 and the youngest now around 50, there is still time to ensure that the growing wave of older households are in the position to make choices about where to age that anticipate their needs in the years to come. But we as a society need to take certain steps to make it easier to “age in the right place.”
To start with, we need to get people thinking earlier about the type of housing they’ll need later. Using popular media to spread the word will go a long way. So too will getting real estate agents, contractors and architects to incorporate this way of thinking into their work advising clients.
The Need for New Zoning
We also should adapt local planning to accommodate a broader range of housing options. There’s a clear need for zoning to allow for higher-density housing close to town centers as well as group-living arrangements, such as cohousing. Such arrangements will take on increasing importance as the number of elderly people without adult children or other relatives to care for them grows. Making these changes means overcoming NIMBY (“not in my backyard”) concerns.
But there is a strong case that expanding housing options would be good not just for seniors, but for younger households, too. Getting older households to trade in their single-family homes would free up a lot of housing for young families because nearly 7 million single people over age 65 are living in single-family detached homes, as are 5 million between 50 and 64.
But even if these efforts are successful, there will still be instances in which staying in one’s home will be the only option for aging in one’s community. So we also need to expand state and federal financial support for home modifications to be sure that homes are safe and for local transportation systems to help older people avoid isolation.
The starting point for accomplishing all of these goals is greater awareness of the critical importance of having appropriate housing options as we age. The good news is that many baby boomers won’t have to look beyond their parents’ situation to appreciate what needs to change for boomers to age in the right place.
 
The first article in this series was A New Model for the Future of Aging. The second was Personalized Aging: Extending Lifespans and Healthspans. The third was Boomers: Less Tied to Friends and Family Than Others Are. The fourth was What It Will Take for the U.S. to Profit From the Longevity Dividend. The fifth was Work, Retirement and Financial Security in the 21st Century. The sixth was Technology, Aging and the Coming Fifth Wave. The seventh was 5 Course Corrections Needed for a Better Future of Aging. The eighth was Let’s Make the Most of the Intergenerational Opportunity. The ninth was How We Can Use Our Longer Lives to Do Good. The 10 was Building Cityscapes for Healthy Aging.  


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Christopher Herbert

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