How the White House & Others are “Gauging Aging”

If you were to host a conference on aging, what would you put on the agenda?

And how would you talk about it?

I found myself mulling this over as I watched the first part of the White House Conference on Aging (WHCOA), which took place on July 13th.

What’s your frame on aging? Start with the Gauging Aging report

It’s especially interesting to consider the WHCOA in light of the recently published “Gauging Aging” report by the Frameworks Institute.

“Gauging Aging,” simply put, is a report about the differences in how aging experts and the public think about aging. It’s based on an in-depth analysis of how experts talk about aging and supporting an aging society, compared to how the public views the issues and the potential solutions.

By understanding the differences, experts can then get better as using communications that brings us to a shared understanding of the problems to be addressed,  in order to effect changes that are meaningful and beneficial. After all, narratives and ideas are important in framing how people perceive problems, and their options for addressing them.

(The Gauging Aging report was commissioned by a coalition of eight national aging organizations: AARP; the American Federation for Aging Research; the American Geriatrics Society; the American Society on Aging; the Gerontological Society of America; Grantmakers in Aging; the National Council on Aging; and, the National Hispanic Council on Aging. The funders were AARP, the Archstone Foundation, the Atlantic Philanthropies, the John A. Hartford Foundation, the Fan Fox and Leslie R. Samuels Foundation, the Retirement Research Foundation, and the Rose Community Foundation.)

If you’re interested in addressing “aging issues”, you should absolutely read this report, because it will change the way you listen, when you hear people talking about aging! Here are some resources to get you up to speed:

• The Gauging Aging PDF report is online here.
• There is also an excellent webinar in which Frameworks staff discuss their findings and recommendations so far:
  • Video of the webinar is here.
  • Slides for the webinar are here.
  • A short fascinating video of Frameworks staff interviewing people on the street about aging is here.

How do we characterize older adults?

“What Characterizes Older Adults?

• A growing population with increased and unprecedented longevity: Older adults are living long and healthier lives, and their numbers are growing.

• Highly heterogeneous: There is enormous variation in health, functional ability and financial status. Disparities exist along the dimensions of income, gender, race/ethnicity and education.

• Social and economic impact: Older adults hold a disproportionately large share of our country’s wealth, represent a enormous source of consumer spending and economic productivity, and contribute in myriad ways (eg., support to grandchildren, child care) to family and community life.”

 
How does this look to you? I think it’s all true.

But it lacks something that’s very important to my daily work, and that I feel is important to providing older adults with the right supports so that they can make the best of life regardless of health and functional state.

That something is a more open acknowledgement of an important issue that is common among older adults: significant levels of functional impairment.

Now, the exact prevalence of impairment depends on what data set you look at, but there is plenty of data backing this up:

• The Census Bureau report “65+ in the United States: 2010” finds that 38.6% of seniors have at least one functional limitation (see Fig 2-14 on page 43).
• The White House’s own “Statistical Profile of Older Americans” reports that in 2009, 41% of Medicare seniors had a functional limitation and 25% had difficulty with at least one activity of daily living.
• This study of Medicare beneficiaries (mean age 77) found that over an average of 8 years of follow-up, “declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities.”

Why do I feel it matters to bring this up?

Because according the Frameworks staff, the public is constantly oscillating between this vision of independent vigorous aging and pitiful dependent aging.

Whereas the truth is that yes, getting older brings on vulnerabilities and yes, many seniors have some impairments, and yes, if you live long enough you’ll probably develop some impairments. (And that’s not your fault, by the way — in this I entirely agree with expert consensus — a lot of it is due to the fact that we lack the right geriatrics and aging infrastructure to prevent and slow down functional decline as much as we could.)

But just because you need care, or need a little extra help or accommodation to mitigate vulnerabilities and impairments, does not mean that you have little to offer to society.You can be an older adult in need of care and help, and still be a person who delivers care and help. Think spousal caregivers, or even a functionally-impaired senior who volunteers, especially when her health is optimized.

One of the things I love love love about my work is the way it’s almost always possible to optimize an older person’s health and wellbeing, so that he or she can get more out of life, and usually give more to those around.

Also, if you want to be effective in terms of “healthy aging” and delaying declines in physical or cognitive abilities, the best way to do that is to take actions that counter or mitigate the vulnerabilities. For instance, when it comes to cognition, we need to get better at reducing exposure to psychoactives (why don’t anticholinergics have a big fat warning label??) and preventing delirium, along with promoting healthy lifestyles.

So personally, although I see why it’s impolitic to bring up the vulnerabilities and functional impairments of older adults — we’re trying to get people to feel more positive about aging! — I worry a little when we minimize this side of aging. Because I think it makes it just a little harder to set up better interventions and accommodations, so that older adults can make the most of their lives, even as they experience late-life challenges to their bodies and their health.I would like for it to be ok for us to say yes, many older people need some help. But there’s nothing wrong with that. It’s common, it’s bound to happen to most of us, and guess what: we have lots of ways to help them and when we use them, seniors often are able to help us, as well as help each other.

But that’s just my take on aging and making our country better for older adults. Let’s now review what the White House put on their agenda for their aging conference.

The White House Conference on Aging

It’s actually impressive that this event took place, given that Congress never reauthorized the Older Americans Act, which in the past has provided the legislative and financial backing for this once-every-ten-years event. (In a blog post about the WHCOA, Dr. Muriel Gillick accuses Congress of “dissing aging” and being engaged in a “massive denial of aging.” She also provides some good insider info on how the White House pulled off this conference on its own.)

A few months before the conference, the organizers released a series of policy briefs, on four topic areas. They are:

• Healthy Aging
• Long-term Services and Supports (the needs of family caregivers are covered here)
• Elder Justice (which is actually about elder abuse, and doesn’t include addressing age-related discrimination, which was my original assumption)
• Retirement Security

The actual conference itself also added in some content on technology, innovation, and the ever-popular theme of “disruption.” Susannah Fox posted the one-day agenda in detail on her blog here, and you can watch the whole conference on YouTube here. (Want to watch President Obama’s 20 minutes of remarks? That’s here.)

I can’t go through all this content in details — I was only able to watch the first hour of the event — so I’ll just make a few comments related to the briefs.

• Having read the Gauging Aging report — which notes that the public tends to feel aging is strongly linked to attitude and choices — I was struck by the fact that the “Healthy Aging” brief starts off with quite a lot of content on what older people should be doing to maintain their health:

“Older adults can do a number of things to promote good health and prevent disease and injury. Healthy behaviors such as exercising regularly, good nutrition, and getting recommended health screenings can contribute to longer, healthier lives. Even if someone has a chronic condition or a disability, these activities can improve health and quality of life.”

•  Am I the only person who has qualms about emphasizing “healthy aging?” What if you’re a senior who has several chronic conditions, struggles to manage them, and maybe has a mobility problem. Have you fallen out of the favored “healthy aging” group? Shouldn’t we be emphasizing “healthier aging” or “better health in aging,” so that there isn’t this dichotomy between those who are aging healthily and those who need long-term care? (My feelings about promoting “healthy aging” are similar to my discomfort with emphasizing a “Culture of Health” rather than a “Culture of Better Health” and a “Culture of Care.”)

• The Long-term Services and Supports brief opens with this statement: “Despite efforts to stay healthy and prevent disease, many older adults will eventually develop some degree of limitations and need additional paid or unpaid help with basic daily living activities.” Really? Maybe it’s semantics, but according to LongTermCare.gov, 70% of people turning age 65 can expect to use LTC in their lifetime. (And I’m not sure that figure accounts for needing some help from family with IADLs.) So why are they saying “many” instead of “most”? The Gauging Aging report notes that a pervasive problem is the tendency to “otherize” older adults, especially those who aren’t fully independent and vigorous. When in truth, most of us should expect to undergo a period in which we need help in late life. Long-term services and supports aren’t for the many who develop limitations “despite efforts to stay healthy”, they are for most of us. Given that there’s a lot of data indicating Americans underestimate their future need for long-term care, I’d like to see briefs on this topic start by reminding us that we’re all likely to need this help.

Despite my frequent grousy moments, the briefs contain a lot of important information and they all end with important questions for experts and the public to consider.

So in the end, I have to agree with Muriel Gillick. The White House Conference on Aging wasn’t everything it could be, but it achieved a lot, especially given the lack of Congressional support.

What is most important is for us to keep talking about aging, and how we can support aging adults to live the best lives possible, which includes optimizing their health and valuing their participation in society. (And not burning out their family caregivers.)

I hope the White House doesn’t wait another 10 years before hosting another conference on aging.

I hope as many people as possible benefit from the work the Frameworks Institute is doing.