# data[].attributes.body
Here's an explanation of this theory with examples.
-Ashley Collado

# data[].attributes.attachment_link.readable_text
❍ The basic premise that, as an adult ages and becomes a senior citizen in society, he/she tends to maintain their unique mentality, behavior, and physical and social activities, as they did in the past when they were younger. This theory is considered to be a micro-level theory, as it concerns individuals rather than a broad group. In terms of functionality, it is deemed to have a constructive nature, since it tries to establish a state of equilibrium between the individuals and the society.

# data[].attributes.attachment_link.title
Here's the Continuity Theory of Aging Explained With Examples

# data[].attributes.attachment_link.description
❍ The basic premise that, as an adult ages and becomes a senior citizen in society, he/she tends to maintain their unique mentality, behavior, and physical and social activities, as they did in the past when they were younger. This theory is considered to be a micro-level theory, as it concerns individuals rather than a broad group.

# data[].attributes.body
-Ashley Collado

# data[].attributes.body
-judit sedano

# data[].attributes.body
This article really highlights the struggles many people over the age of 65 are facing and will face in the future. These projections and data are very worrying to me. I find it hard to learn so many elderly are financially unstable and stressed and how it actually is affection their emotional state and health.

-judit sedano

# data[].attributes.body
For the most part I think there is some truth to this, but nobody can stay young forever. People can't change their age by what they eat, but they can feel healthier and than look healthy because they radiate from the inside out.
-Olga Yanko

# data[].attributes.body
Most of the people that watch this movie won't realize all the ageism. When seniors go back into the work place they have to accommodate to young people that work there in order to fit it better. I personally never noticed it, but it'll be nice to notice it when I watch it later.

Olga Yanko

# data[].attributes.headline
Whoever shared this post might like to get credit.  Don't forget to sign you posts. Prof G

# data[].attributes.subject
Whoever shared this post might like to get credit.  Don't forget to sign you posts. Prof G

# data[].attributes.body
Prof G

# data[].attributes.body
I have been trying to start living a healthier life, I don't want to be one of those people who don't make it to a certain age, or start to deteriorate from living an unhealthy lifestyle. The post definitely showed me food I need to add to my diet. I had no idea blueberries fought against Alzheimers, and protect eyes. I never even knew sardines are healthy for someone. People would definitely have a higher chance of living to a ripe old age if they paid more attention to their diet and lifestyle.
-Wendy White

# data[].attributes.body
I'm really glad this was posted, because now I know what to look out for for anyone I suspect of having Alzheimers. The usual signs of confusion, or forgetting things that either just happened, or are done often are symptoms everyone knows. I don't think personality changes, or withdrawal are ones looked at by people, usually.
-Wendy White

# data[].attributes.body
Cherie Vallero

# data[].attributes.attachment_link.readable_text
Abstract

Subjective Age

Unlike chronological age, subjective age is a multidimensional construct that indicates how old a person feels and into which age group a person categorizes himself or herself (e.g., Barrett, 2005; Settersten & Mayer, 1997). After early adulthood, most people feel younger than their chronological age ( Galambos, Turner, & Tilton-Weaver, 2005; Montepare & Lachman, 1989; Rubin, & Berntsen, 2006). Kastenbaum, Derbin, Sabatini, and Artt (1972; see also Barak, 1987) distinguish between felt age (psychological age) and the subjective age associated with one's physical appearance (i.e., when looking in the mirror). Perceived physical age (sometimes called look age) is considered a self-appraisal of biological aging. To date, only a few studies have investigated whether these two dimensions of subjective age show different patterns of association with chronological age and other correlates. Findings are mixed. Whereas some studies find that physical age shows a less youthful deviation from actual age than felt age (e.g., Kastenbaum et al.; van Auken & Barry, 1995), others report no differences in discrepancies (e.g., Goldsmith & Heiens, 1992). Although momentary evaluations of felt and physical age are moderately correlated, in the present study we analyze individual differences in the change trajectories separately for each dimension, following proposals by Kastenbaum and colleagues that these dimensions reflect different aspects of age identity. It could be that youthful feelings of felt age are maintained during old age yet the discrepancy between physical and actual age diminishes in magnitude over time. Clarke (2001) found that older women frequently describe incontinuities between their felt age and the image of their body reflected in a mirror.

Satisfaction With Aging

Self-Perceptions of Aging as Indicators of Successful Aging

Theoretically, positive self-perceptions of aging are viewed as indicators of successful aging, age identity, and self-regulation processes (e.g., Baltes & Smith, 2003; Heckhausen & Krüger, 1993; Sneed & Whitbourne, 2005). Although these perspectives propose different underlying processes, there is consensus that positive self-perceptions of aging serve to sustain levels of social activity and engagement, enhance self-esteem and well-being, and boost biophysiological functioning. Studies that address questions about successful aging find that youthful subjective age is associated with good health and high levels of well-being ( Hubley & Hultsch, 1994; Westerhof & Barrett, 2005). High satisfaction with aging is associated with good health ( Levy, Slade, & Kasl, 2002) and few daily health symptoms ( Rakowski, Julius, Hickey, Verbrugge, & Halter, 1988), and it is uniquely related to living longer, after other predictors of mortality have been controlled for ( Levy, Slade, Kunkel, & Kasl, 2002; Maier & Smith, 1999). Studies about age identity report that subjective age is associated with group differences in social roles and the experience of life course events (e.g., retirement or widowhood; see Barrett, 2005; Kim & Moen, 2002). Researchers who focus on self-regulation report the benefits to self-esteem garnered by strategic changes in standards and selection of comparison targets (e.g., Heckhausen & Krüger; Sneed & Whitbourne).

Changes in Self-Perceptions of Aging

Despite the similarities between these theoretical perspectives, different expectations about trajectories of change in self-perceptions of aging can be derived from them. Models of successful aging and self-regulation, for example, suggest that, over time, older adults should maintain (or even increase) their positive self-perceptions of aging. The negative discrepancy between subjective age and actual age (i.e., feeling younger) should increase and satisfaction with aging should not change. This expectation is qualified by theories of self-regulation (e.g., Baumeister, 1989), which suggest that there may be an optimal margin for positive illusions: Accurate perceptions and extremely positive biases may be equally detrimental to well-being (see also Taylor & Brown, 1994).

Rubin and Berntsen (2006) observed cross-sectionally that, from the point a person reaches the age of 40 onward, the gap between actual and subjective age appears to reach a plateau that is 20% of chronological age. They found no age differences in this proportional amount up to the point at which a person reaches his or her 70s: Older age is correlated with larger negative discrepancies between subjective and actual age but the relative ratio of subjective age to chronological age does not differ. In other words, the discrepancy must increase with age if the 20% plateau is to be maintained.

Hypotheses

In the present study, we ask if felt age, physical age, and aging satisfaction change over 6 years during old age and whether there are individual differences in change. In line with proposals linked to successful aging and adaptive self-regulation, we hypothesized that the subjective age discrepancies would increase over time whereas there would be no change in aging satisfaction. We recognize that hypotheses based on the successful aging perspective may be overly optimistic given the advanced age of our sample ( M age = 85 years at baseline; age range = 70-104). Indeed, life span theory (e.g., Baltes & Smith, 2003) and recent evidence about decline in life satisfaction during old age ( Gerstorf, Ram, Röcke, Lindenberger, & Smith, 2008; Mroczek & Spiro, 2005) suggest that there may be limits to aging successfully in very old age.

On the basis of the literature, we expected older chronological age and better health status at baseline to be related to larger discrepancies in felt and physical age. We also expected poor health at baseline to attenuate the rate of change, contributing to reduced increases in subjective age discrepancies and deviations from stability in satisfaction with aging. We added gender and socioeconomic status to the models but, following Rubin and Berntsen (2006), we did not expect them to significantly account for individual differences in level or change. We also explored the effects of perceived lack of social contact (indicated by social loneliness) and cognitive functioning. Thompson and Heller (1990) found that socially isolated older adults report low satisfaction with aging.

Sample and Procedure

We used four-wave longitudinal data from the Berlin Aging Study (BASE), collected over 6 years (for detailed information about study design, longitudinal samples, and procedures, see Baltes & Mayer, 1999 and Smith, Maas, Mayer, Helmchen, Steinhagen-Thiessen, & Baltes, 2002). The first wave of data (T1) was collected between 1990 and 1993 ( N = 516); the second (T2) was collected between 1993 and 1994 ( N = 361); the third (T3) was collected between 1995 and 1996 ( N = 206); and the fourth (T4) was collected between 1997 and 1998 ( N = 132). Attrition over time was primarily due to death ( Gerstorf, Herlitz, & Smith, 2006). Not all individuals participated on all four measurement occasions; however, we used all available data at each time point. Because subjective age was not assessed at T2, our analyses for these dimensions included only three measurement occasions (T1, T3, and T4). Consequently, the total number of observations differed for each construct: N = 846 for felt age, N = 822 for physical age (with fewer observations for physical age than for felt age because those participants who were severely visually impaired were not asked how old they looked in the mirror), and N = 1,285 for aging satisfaction.

At T1, researchers stratified the total cross-sectional sample ( N = 516; M age = 84.9 years, SD = 8.7; range: 70-104) by age and gender, with 43 women and 43 men in each of six age groups (70-74, 75-79, 80-84, 85-89, 90-94, and 95+). For recruitment, the researchers randomly drew 1,908 persons from the obligatory Berlin city registry and asked them to participate. Our longitudinal analyses deal with the sample of 516 individuals who completed a 14-session multidisciplinary protocol at T1. 1 At T3 and T4, the survivors of the 516-person T1 sample completed at least six multidisciplinary sessions. Trained research assistants assessed each individual participant face to face. Each session lasted on average 90 minutes and, except for some medical assessments, took place at the participant's place of residence (private home or institution). Individuals received 50 Deutsche Mark (approximately $25) for their participation in each session.

Selectivity analyses (following Lindenberger, Singer, & Baltes, 2002) indicated that individuals who contributed the most data (i.e., over four time points as compared with one time point) were on average younger (−0.76 SD), more satisfied with their aging (0.33 SD), and felt younger than the 516-person T1 baseline sample (−0.46 SD for felt age, −0.34 SD for physical age). Such a selection effect in BASE is expected given the average age of the baseline sample ( M = 85 years), and the fact that attrition was primarily due to death ( Gerstorf et al., 2006). Individuals who participated at T4 ( N = 132) differed only slightly from persons who were alive at that time but did not participate fully in all levels of the T4 assessment protocol ( N = 107): −0.20 SD for age, 0.12 SD for aging satisfaction, −0.13 SD for felt age, and −0.03 SD for physical age.

Measures

Subjective age

We included two dimensions of subjective age. We assessed felt age with this item: "How old do you feel?" We assessed physical age with this item: "How old do you feel when you look at yourself in a mirror?" Researchers showed the participants an age scale ranging from 0 to 120 years and asked them to select a specific age for felt and physical age. For each dimension, we calculated the discrepancy between subjective age and chronological age as the dependent variable (i.e., discrepancy = subjective age − chronological age). Although felt and physical age were correlated at T1 ( r =.54, p <.01), for the theoretical reasons already outlined, we analyzed both dimensions separately. Estimated individual time-related latent change in felt age was related to individual latent change in physical age ( r = −.51, p <.01).

We acknowledge that difference scores are controversial (e.g., Cronbach & Furby, 1970; Rogosa, 1995). Our decision to use them was guided by three considerations. First, using difference scores rather than residuals enabled us to communicate directly how much younger individuals felt in years (e.g., 12 years younger). Second, this method has a long tradition in the literature on subjective age. Third, partialing chronological age from subjective age eliminates age-related variance and does not allow us to investigate age differences in change of self-perceptions of aging over time.

Satisfaction with aging

We assessed satisfaction withaging by using the Attitudes Toward Own Aging subscale from the Philadelphia Geriatric Center Morale Scale ( Lawton, 1975). The scale consists of five items: "Things keep getting worse as I get older," "I have as much pep as I had last year," "As I get older, I am less useful," "As I get older, things are better than I thought they would be," and "I am as happy now as I was when I was younger." Research assistants read items aloud and participants rated how much they agreed with each statement on a 5-point scale (1 = low, 5 = high). Interitem consistencies were acceptable: Cronbach's α =.75 at T1. At T1, aging satisfaction was significantly correlated with felt age discrepancy ( r = −.26, p <.01) but not with physical age discrepancy ( r = −.17, p =.06). Estimated individual time-related change in aging satisfaction was not significantly correlated with individual estimates of change in felt age or physical age (all p s >.12).

Covariates

To examine sources of interindividual differences in change in self-perceptions of aging, we included the following T1 covariates: age, gender, socioeconomic status (SES), number of illnesses, cognitive functioning, and social loneliness. Age was a continuous variable, centered at the T1 mean (85 years). We coded gender as 0 = men and 1 = women. We measured SES with a unit-weighted composite, which included (a) net household income weighted by the number of persons per household; (b) occupational prestige; and (c) years of education ( Mayer, Maas, & Wagner, 1999). We operationalized health by the number of moderate to severe chronic illnesses (e.g., diabetes mellitus, coronary heart disease), diagnosed by a physician in clinical assessments in BASE ( Steinhagen-Thiessen & Borchelt, 1999). To measure cognitive functioning, we assessed participants' performance on 14 tasks. These tasks could be described by five first-order factors representing five intellectual abilities ( Lindenberger & Baltes, 1997) and one second-order factor representing general intelligence. In our analyses, we use the second-order factor as a unit-weighted composite of cognitive functioning. We measured social loneliness by using four items from the UCLA-Loneliness Scale (Cronbach's α =.70; Russell, Peplau, & Cutrona, 1980; see also Cacioppo, Hughes, Waite, Hawkley, & Thisted, 2006). The items were as follows: "There are people I feel close to," "There are people I can turn to," "I feel part of a group of friends," and "There are people I can talk to." Participants rated each statement on a 5-point scale (1= low, 5 = high; note that all intercorrelations between the covariates at T1 were below r =.46).

Data Analysis

We used individual growth (i.e., multilevel) modeling as implemented in SAS PROC MIXED (Littell, Miliken, Stoup, & Wolfinger, 1996) to examine change in self-perceptions of aging and predictors of interindividual differences in change. In all models, we designated measurements collected on four occasions (T1, T2, T3, and T4) as the time variable and we centered time at T1. At Level 1, we parameterized the baseline models as follows:<--?1-->

The self-perception of aging, SPA (either felt age, physical age, or aging satisfaction), of person i at time t is a function of an individual-specific intercept parameter, L (level at T1), an individual-specific slope parameter, Sl (change over time), and a residual error, e. In our models, fixed effects define the overall trajectory (intercept/level and slope) for the sample and random effects define the within-person trajectory (i.e., each person's deviation from the overall trajectory). Random effects over time (i.e., variance of change) and the 95% plausible value range of individuals' change scores are indicative of interindividual differences in intraindividual change trajectories ( Sl ± 2 × √Var Change).

We used an unstructured covariance matrix to specify the random effects. At Level 2, we introduced the T1 covariates of age, gender, SES, number of illnesses, cognitive functioning, and social loneliness to explain interindividual differences in the trajectories of self-perceptions of aging.

As we expected, participants generally felt younger than they actually were (i.e., discrepancy with chronological age) and showed relatively high levels of aging satisfaction over time. Table 1<--?2--><--?3--> includes descriptive information for felt and physical age and satisfaction with aging on all measurement occasions.

To establish a standard against which to evaluate the models of change, we fitted random intercept-only models initially for each construct. These analyses revealed considerable amounts of between- and within-individual variance over time: 65% of the total variance in the felt age discrepancy (54% for physical age; 57% for aging satisfaction) was related to differences between individuals, and thus 35% was within-person variance (46% for physical age; 43% for aging satisfaction). The fact that there was considerable intraindividual variation in the data warranted further modeling of time-related change and its underlying covariates.

In a second step, we analyzed change over 6 years ( Table 2).<--?4--> A subsequent set of multilevel models included six indicators (i.e., age, gender, SES, number of chronic illnesses, social loneliness, and cognitive functioning at baseline) to predict interindividual differences in level of self-perceptions of aging and its change over 6 years ( Table 3). Results from the respective analyses are reported separately for subjective age and satisfaction with aging. Figure 1 illustrates the different trajectories found for the three constructs.

The multilevel modeling indicated that there were significant interindividual differences in the average discrepancy (intercept random effect) of felt age from chronological age over time but, on average, felt age did not change over time (nonsignificant fixed effect for time: refer to first column of Table 2). On average, individuals felt 12.86 years younger than their actual age over time. There was some variance around the slope but the effect did not reach significance. However, significance tests of variance components in multilevel modeling have long been questioned with regard to their utility. Because of their sensitivity to departures from normality and imbalance (unequal numbers of observations per individual), results have to be examined with extreme caution (e.g., Singer & Willett, 2003). Following the recommendations of Snijders and Bosker (1999), we calculated the 95% plausible value range to describe individual differences in change. This indicated that the direction and amount of change in felt age discrepancy varied between individuals from −3.88 (i.e., discrepancy increased by 3.88 years between two measurement points) to 4.32 (i.e., discrepancy was reduced by 4.32 years between two measurement points). Some participants felt even younger over time, whereas others reduced the gap between their felt and actual age. A second set of models examined potential factors underlying interindividual differences in level and change over time ( Table 3). Several factors were related to mean-level (intercept) differences in felt age discrepancy: Individuals who were 1 year older at the first measurement occasion reported a felt age that was more discrepant (−0.29) from their actual age, indicating that they felt an additional 0.29 years younger than the sample average. (Intercept average sample = −13.58; Intercept 1 year older than average = −13.58 −0.29 = −13.87).

Having a higher number of illnesses and reporting less social loneliness compared with the average sample was associated with a smaller discrepancy between felt and actual age. After taking into account predictors of mean-level differences, we found that age at baseline also functioned as predictor of interindividual differences in change of felt age: The felt age discrepancy of participants who were 1 year older at T1 increased on average 0.20 years more between two measurement occasions than the discrepancy of the average sample. This means that the older participants were, the younger they tended to feel over time. There was a counteracting effect associated with the number of illnesses: Increases in felt age discrepancy were attenuated for participants with more chronic illnesses.

For physical age, there were also significant interindividual differences (intercept random effect) in the average discrepancy from actual age (see the second column of Table 2). In contrast to felt age, the main effect for change over time was significant. On average, participants reduced their subjective discrepancy between physical age and actual age over time (0.85 years from one measurement occasion to the next). Although variance in change was not significant in the model, follow-up analyses suggested individual differences in the direction and rate of change. Change ranged between an increase of −2.44 and a decrease of 4.14 years in the discrepancy from one measurement point to the next. Smaller mean-level discrepancies (i.e., a physical age that is closer to the actual age) in this dimension were associated with being a woman, as well as being younger, suffering from a higher number of illnesses, lower social loneliness, and higher cognitive functioning than the average sample. However, none of the covariates accounted for differences in change in physical age discrepancy.

Participants differed significantly from each other in satisfaction with their own aging (see the third column of Table 2). On the sample level, mean aging satisfaction decreased by 2.28 points from one measurement occasion to the next (i.e., 6.84 points or 0.68 SD units over the 6-year interval). Individuals differed in their change trajectories over time, ranging from a decrease by −6.15 points to an increase by 1.60 points. Several predictors explained mean-level differences between individuals ( Table 3): On average, higher satisfaction with aging was reported by men, participants with a smaller number of illnesses, lower social loneliness, and higher cognitive function. After controlling for covariates of mean-level differences, we found that three predictors could further explain change in aging satisfaction over 6 years: Satisfaction with aging decreased more in men, and in participants who were older or had lower SES than the sample average.

Discussion

Consistent with the literature (e.g., Gana et al., 2004; Rubin & Berntsen, 2006), participants in the present study reported feeling and looking younger than their chronological age and being relatively satisfied with their own aging. We extended previous findings by examining intraindividual change over time in these constructs and asking about sources of individual differences in change. Our hypotheses that subjective age discrepancies would increase over time and that satisfaction with aging would show no change were not confirmed. They had been derived from proposals about successful aging and the continuity of self-enhancement processes in old age. Instead, we found that there was no time-related change in the felt age discrepancy on average, whereas the gap between physical age and actual age was reduced over time and satisfaction with aging decreased.

When the differential trajectories found across felt age, physical age, and satisfaction with aging are considered together (see Figure 1), a picture emerges of the adaptive challenges faced by the aging self. Regardless of the interpretation of the lack of change in felt age, the reduced discrepancy between physical and actual age over time and decreased satisfaction with aging are less-than-desirable outcomes; poor health exacerbated these patterns.

The differential patterns also suggest variations in the vulnerability of each of these self-perceptions of aging. One scenario might be that satisfaction with aging changes first, followed by a reduction in feeling that one looks younger than one's age and subsequently a decrease in felt age discrepancy. An alternative scenario is that individuals may show different dynamics of change in subjective age and satisfaction with aging that are dependent on their age, gender, social embeddedness, cognitive status, and health. Our finding that women are less satisfied with their aging and have a more accurate perception of their physical age suggests that the tension between physical age and satisfaction with aging may be more salient for women than for men (Clarke, 2001). Further studies with larger samples and more measurement points are needed to investigate these scenarios.

Why did older individuals in our sample report larger discrepancies between subjective and chronological age than the sample average? One explanation may lie in selective mortality: The participants older than the BASE mean age of 85 years are positively selected survivors of their birth cohorts. This is especially true for men older than 85 years of age. Many of the oldest-old participants in this study may indeed experience delayed (or slowed) rates of decline in functioning compared with those in their mid-70s who may not survive to be 85. The different experience of oldest-old survivors, especially those in relatively good health, may contribute to their feeling much younger than their chronological age. Another explanation for this effect could be that the loss of social roles and first diagnosis of a chronic illness have a dampening effect on positive self-perceptions of aging in the young-old adults, whereas the oldest-old adults have had time to adapt to these life changes. We were not able to distinguish among these interpretations in the present study.

Another interesting finding, which requires replication, involved the effects associated with social loneliness. This construct is generally associated with poor health and the loss of significant others (Cacioppo et al., 2006). In the present study, it was related to higher subjective age discrepancies and lower levels of aging satisfaction. Perhaps individuals who experience social loneliness attribute it to aging and are dissatisfied with their age-related changes.

The differential patterns of change may also reflect different viewpoints on self-perceptions of aging. Satisfaction with aging is measured by concrete questions about the cognitive-emotional experience of age-related change. The items prime temporal comparisons about changes in energy level, perceived usefulness, happiness, and life quality ( Lawton, 1975). Other studies find that temporal comparisons about age-related change are negatively related to well-being and self-esteem (e.g., Filipp, Ferring, Mayer, & Schmidt, 1997). In contrast, no specific comparison context is primed in the question about felt age. The instruction for physical age cues a comparison between subjective appearance and a less malleable mirror image. These different methods may partly explain differential patterns of change over time.

Partly consistent with former research, women reported higher physical age and lower aging satisfaction than men did ( Kim & Moen, 2002; Montepare & Lachman, 1989). Women older than 70 years of age might experience changes in their physical appearance more negatively than older men do, and this might contribute to less positive self-perceptions of aging ( Clarke, 2001). Given the inconsistent findings in current studies of midlife and older age, further research is needed to address these questions.

Several limitations of the present study should be acknowledged. More measurement points and a longer time period are needed in order to determine if change is robust and differs from linearity. It would also be worthwhile to assess change in individuals who, as a result of frailty, transit from high functioning to frailty and increasing health problems. This transition may accelerate negative changes in self-perceptions of aging. Models that estimate the dynamics of change over time in self-perceptions of aging and related covariates would provide information that could be used to disentangle conflicting interpretations.

Taken together, the present results demonstrate the value of investigating subjective perceptions of one's aging. In particular, our study suggests that an examination of changes in self-perceptions of aging over time in very old age provides information about the resilience and vitality of the older self. Future research should examine whether and how changes in self-perceptions of aging are associated with survival. Initial insight into the importance of maintaining a sense of positive well-being during old age has been gained from findings that satisfaction with aging and emotional vitality predict mortality (e.g., Levy et al., 2002; Maier & Smith, 1999; Penninx et al., 2000), and that negative changes in life satisfaction are more associated with distance to death than age per se ( Gerstorf et al., 2008).

The extent to which feeling younger and being satisfied with one's aging translates into behavior and physiological parameters on a daily basis is also intriguing. The experimental literature suggests that priming a sense of "feeling younger" contributes to improvements in memory (e.g., Levy, 2003). It is not known whether an older adult who feels younger also behaves accordingly and is perceived by others to be younger than his or her actual age. The interpersonal interactions that occur in such a scenario may facilitate positive well-being and also contribute to better health. Such a scenario is consistent with evidence that higher levels of subjective well-being are associated with better health in old age. Thus, studies on self-perceptions of aging can contribute to our understanding of potential indicators of resilience in older adults and the aging self.

Decision Editor: Karen Hooker, PhD

This article reports data from the Berlin Aging Study ( www.base-berlin.mpg.de). BASE was initiated by the late Paul B. Baltes, in collaboration with Hanfried Helmchen, psychiatry; Elisabeth Steinhagen-Thiessen, internal medicine and geriatrics; and Karl Ulrich Mayer, sociology. Financial support came from the Max Planck Society, the Free University of Berlin, the German Federal Ministry for Research and Technology (1989-1991, Grants 13 TA 011 and 13 TA 011/A), the German Federal Ministry for Family, Senior Citizens, Women, and Youth (1992-1998, Grants 314-1722-102/9 and 314-1722-102/9a), and the Berlin-Brandenburg Academy of Sciences' Research Group on Aging and Societal Development (1994-1999).

All authors contributed equally to this article. We especially thank the anonymous reviewers and editor for insightful comments on an earlier version.

References

# data[].attributes.attachment_link.title
Self-Perceptions of Aging: Do Subjective Age and Satisfaction With Aging Change During Old Age? | The Journals of Gerontology: Series B | Oxford Academic

# data[].attributes.attachment_link.description
The present study examined time-related change in felt age, physical age, and satisfaction with aging in old age and covariates of this change. Using 6-year-longitudinal data from the Berlin Aging Study (age range = 70-104 years), we found that individuals' felt age remained on average about 13 years below their actual age over time, whereas they reported a decreasing discrepancy between physical and actual age and a decrease in aging satisfaction over time.

# data[].attributes.body
Cherie Vallero

# data[].attributes.attachment_link.readable_text
4. Women who live alone are dying to get married. Not quite. The entry of large numbers of women into the labor force has made the single life a much more attractive option than matrimony with an unsatisfactory partner. Older women, particularly widows who have nursed a dying spouse, often decline their boyfriends' marriage proposals; they're "more interested in having someone to go out with than having someone to come home to," Klinenberg found.

5. Older people living alone are lonely, unhappy and isolated. As if! A study of 3,000 Americans ages 57 to 85 discovered that those who lived alone are more likely to socialize with friends and neighbors than their peers who were married.

6. Older people living alone are frequently poor and desperate. Thanks to Social Security and private pensions, "Americans over 65 are in much better financial shape than they were in 1950," reports Klinenberg. Back then, only 1 in 10 of them lived alone; today it is1 in 3.

7. Americans are more likely to live alone than people in other countries, because of our national faith in individualism and self-reliance. Au contraire. The four countries with the highest rates of living alone are Sweden, Norway, Finland and Denmark. One of the reasons so many Scandinavians live alone is that they enjoy extensive social services that make it easier: "Living alone is a collective achievement," Klinenberg observes.

8. People living alone consume more of the planet's resources. Because living alone is largely an urban phenomenon, Klinenberg asserts, singletons living in multiple dwellings that use mass transit or walk have a much smaller carbon footprint than a family of four with two cars in a 2,500-square-foot house in the suburbs.

9. Aging alone leaves people extra-vulnerable if their health fails. 'Fraid not. Single people who have built strong social networks - and most of them do - often turn to their friends to support them in times of illness. In addition, says Klinenberg, older people are much healthier and more active today than in the past - one of the reasons they feel free to live alone.
You may also like: Where to meet great singles. >> Wendy Smith, a contributing editor of the American Scholar, writes frequently for the Washington Post, the Los Angeles Times and the Chicago Tribune.

# data[].attributes.attachment_link.title
Nine Myths About Living Alone - Benefits of the Single Life

# data[].attributes.attachment_link.description
4. Women who live alone are dying to get married. Not quite. The entry of large numbers of women into the labor force has made the single life a much more attractive option than matrimony with an unsatisfactory partner.

# data[].attributes.body
https://www.theodysseyonline.com/the-new-social-norms-of-today
DISAGREE
Not sure that this really does reflect the attitude of the older generation but it is the 'opinion' of the author. Prof G.  Not sure who posted this to give credit for completing the assignment.
Prof G
Thanks for sharing to teach each of us to really examine if there is any data behind something found on the web.

# data[].attributes.body
https://www.globalcitizen.org/en/content/13-amazing-coming-of-age-traditions-from-around-th/

# data[].attributes.headline
How to Keep Your Brain Healthy As You Grow Old?

# data[].attributes.subject
How to Keep Your Brain Healthy As You Grow Old?

# data[].attributes.body
EXERCISE!!

# data[].attributes.attachment_link.title
How to Keep Your Brain Healthy As You Grow Old?

# data[].attributes.attachment_link.description
We all want to stay sharp as we get older, there is a lot, you can do to keep your brain young. Watch out the video to keep your brain healthy as you grow old. See more at: https://www.consumerhealthdigest.com/brain-health/how-does-your-brain-change-with-age.html Video Transcription - Hi, We all want to stay sharp as we get older.

# data[].attributes.body
This man is killing it!

# data[].attributes.attachment_link.title
Vernon - The 70 Year Old Basketball Shooting Sensation...

# data[].attributes.attachment_link.description
Vernon - The 70 Year Old Basketball Shooting Sensation ,,,, Phenomenal Story ... Of Vernon leaving a life of Drugs & Poor Health ,,,,, Changing his situatation at the age of 70 accomplishing the great feats of success through hard work....

# data[].attributes.body
- Sandra Poppert
DISAGREE
People of all ages get crabby for the same reasons stated in this blog.  Another example of 'opinion' that is rampant on the web without any data. Prof G
Thanks for sharing to teach each of us to really examine if there is any data behind something found on the web.
https://capitaleap.org/blog/2013/03/01/anger-and-the-elderly/

# data[].attributes.body
- Sandra Poppert
https://www.usatoday.com/story/news/nation/2014/01/20/when-should-elderly-people-stop-driving/4659103/

# data[].attributes.body
I moved in with my grandparents when I was about 12. and my 17 year old brother moved in with us recently. My grandparents also are responsible for baby sitting in my family.
They do a wonderful job at not seeming over whelmed or resentful. I know the could be on vacation all the time but I think having to take care of every one and have things to do helps them age gracefully and keeps them form being lonely. I agree and think this is a good article

-Amber hobart

# data[].attributes.headline
Insurance company talks about how seniors on the road drive

# data[].attributes.subject
Insurance company talks about how seniors on the road drive

# data[].attributes.body
-Kai McMiller

# data[].attributes.attachment_link.readable_text
Almost 90 percent of senior citizens fail to make simple adjustments to their vehicles to improve safety while driving and extend their time behind the wheel, according to a new report from the American Automobile Association (AAA).

The organizations's Foundation for Traffic Safety said drivers who are 65 and older are more than twice as likely to be killed when in a car crash compared to younger motorists. However, a survey of senior drivers found that the overwhelming majority did not take advantage of inexpensive adjustments and vehicle features that can significantly improve safety.

AAA looked at a dozen vehicle modifications that it says can keep seniors safer on roads. It recommends the following inexpensive devices for senior drivers:

Steering wheel covers, which improve the grip of the wheel for those with arthritis

Convex or multifaceted mirrors for minimizing blind spots and increasing visibility

Pedal extensions for allowing drivers to remain a safe distance from detonating airbags

Seat pads and cushions for alleviating hip and back pain

Hand controls for operating the vehicle without using lower extremities

About 9 percent of the drivers surveyed said they had at least one of 12 modifications listed by AAA. Of those who had at least one adaptation, about 45 percent said they used seat cushions and 39 percent reported using convex or multifaceted mirrors. About 83 percent of drivers said they learned how to use the technologies themselves, as opposed to being taught by a professional.

AAA said that in-vehicle technologies that improve safety are expected to become more standard in vehicles in the future. Such improvements can keep seniors on the road for longer. Previous studies have found that seniors who stop driving are more likely to become depressed or move into long-term care facilities.

For more information about the study, visit AAA's website.

# data[].attributes.attachment_link.title
AAA finds most senior drivers lack simple devices for improving safety

# data[].attributes.attachment_link.description
Almost 90 percent of senior citizens fail to make simple adjustments to their vehicles to improve safety while driving and extend their time behind the wheel, according to a new report from the American Automobile Association (AAA).

# data[].attributes.body
Good cars for older drivers that keep them safer on the roads.
-Kai McMiller

# data[].attributes.attachment_link.title
Best Cars for Older Drivers | Senior Drivers - Consumer Reports

# data[].attributes.attachment_link.description
Consumer Reports' list of the best cars for older drivers.

# data[].attributes.body
Posted by Matthew Rye - Absolutely heart-wrenching straight talk from four "senior" ladies living in poverty. A quote from Myrtle: "Forget about livin' from paycheck to paycheck, let's talk about from day to day. Let's talk about eating, versus buying your medicine."

# data[].attributes.attachment_link.readable_text
Senior poverty is on the rise. Combine an aging population with levels of income inequality not seen since the 1920s and you have a epidemic of suffering. Housing costs are rising, and skyrocketing health care costs devour more of the monthly budget than ever before. The solution is to preserve and expand social safety net programs like SSI and Medicaid to meet the growing needs of growing numbers of low-income seniors.
Need by the numbers:

Every day 10,000 people in America turn 65.

By 2030 there will be 72 million seniors living in poverty in America.

Pensions are rare in today's economy and the average worker doesn't have enough opportunity to save for retirement

Nearly 1 in 5 seniors approaching retirement have no retirement savings at all.

54% of working-age households were unprepared for retirement in 2010 compared to 31% in 1983

Homelessness among seniors is projected to increase 33% by 2020 and 100% by 2050

In 2013, 2.9 million (9%) households with seniors experienced food insecurity.

The number of food insecure seniors is projected to increase by 50% when the youngest of the Baby Boom Generation reaches age 60 in 2025

Hungry seniors are 60 percent more likely to experience depression, 53 percent more likely to report a heart attack, 52 percent more likely to develop asthma, 40 percent more likely to report an experience of congestive heart failure.

Resources:

Issue Brief: Aging, Women, and Poverty in California: We must do more Published November 2016 in collaboration with the California Commission on Aging, The California Commission on the Status of Women, and the California Women's Law Center

Special Report: How to Prevent and End Homelessness Among Older Adults Published in April 2016 by Justice in Aging

Visual Slides: Race, Gender, Poverty, and Income Inequality Among America's Seniors, presented at the National Aging and Law Conference in October 2015

Senior Poverty Forum: Dignity for All: Ensuring Economic Security as America Ages. On November 15, 2016, Justice in Aging hosted a forum in Washington DC, featuring researchers, service providers, and advocates exploring the issue of economic security for older Americans and their families. Our three panels focused on the growing numbers of seniors living in poverty, efforts local providers are undertaking to serve these seniors, and policies we can advance to improve their lives.

Our work fighting senior poverty is more important today than ever. We need you to join us. Learn more about our work to defend the right of seniors to age in dignity, sign our petition to end senior poverty, and donate to support our work.

# data[].attributes.attachment_link.description
Senior poverty is on the rise. Combine an aging population with levels of income inequality not seen since the 1920s and you have a epidemic of suffering. Housing costs are rising, and skyrocketing health care costs devour more of the monthly budget than ever before.

# data[].attributes.headline
In response to Kelseys post on Social Security. 

# data[].attributes.subject
In response to Kelseys post on Social Security. 

# data[].attributes.body
I went to a few websites, and landed on the one below.  The first sentence in the introduction is utterly terrifying.  It indicates that unless there's an overhaul, funds, as they are now will be exhausted by 2037. That said, it does explain that modifications have been made for people who receive it now, and will also need to be made in the future.  However, if they know about the problem now, I'm concerned on why they are putting the solution off to the future.  I also wonder if paying into social security is required by each person to pay for living expenses when they get old, how can there be a justification on why any money put in will not be there to take out.

https://www.ssa.gov/policy/docs/ssb/v70n3/v70n3p111.html

Sandra Poppert

# data[].attributes.body
I enjoyed that video, I feel like it can be hard to relate to really old people sometimes I never knew anyone over 80 and still genuinely having wonderful quaintly of life. I'm comforted that I can get old and still have hobbies. I'm up for leaning more about how to age optimally!

-Amber hobart

# data[].attributes.headline
The 2030 Problem: Caring for Aging Baby Boomers

# data[].attributes.subject
The 2030 Problem: Caring for Aging Baby Boomers

# data[].attributes.body
Posted by Matthew Rye - A troubling report about the outlook for Baby Boomers' quality of life in the not-too-distant future.

# data[].attributes.attachment_link.readable_text
Abstract

Objective

To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages.

Study Setting

A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the basis of a review of the challenges related to caring for seniors that need to be faced by society.

Study Design

A series of analyses are used to consider the challenges related to caring for elders in the year 2030: (1) measures of macroeconomic burden are developed and analyzed, (2) the literatures on trends in disability, payment approaches for long-term care, healthy aging, and cultural views of aging are analyzed and synthesized, and(3)simulations of future income and assets patterns of the Baby Boom generation are developed.

Principal Findings

The economic burden of aging in 2030 should be no greater than the economic burden associated with raising large numbers of baby boom children in the 1960s. The real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life.

Conclusions

To meet the long-term care needs of Baby Boomers, social and public policy changes must begin soon. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if necessary changes are made now rather than when Baby Boomers actually need long-term care.

Keywords: Long-term care, financing, Baby Boomers, community-based delivery system

A major public policy concern in the long-term care field is the potential burden an aging society will place on the care-giving system and public finances. The "2030 problem" involves the challenge of assuring that sufficient resources and an effective service system are available in thirty years, when the elderly population is twice what it is today. Much of this growth will be prompted by the aging of the Baby Boomers, who in 2030 will be aged 66 to 84-the "young old"-and will number 61 million people. In addition to the Baby Boomers, those born prior to 1946-the "oldest old"-will number 9million people in 2030.

This paper assesses the economic dimensions of the 2030 problem. The first half of the paper reviews the literature and logic that suggest that aging in general, and long-term care services in particular, will represent an overwhelming economic burden on society by 2030. Then, a new analysis of burden is presented to suggest that aggregate resources should not be a major issue for the midcentury economy. Finally, the paper presents four key challenges that represent the real economic burden of long-term care in the twenty-first century. These challenges are significant but different from macro cost issues.

What type of economic burden might be considered overwhelming? Existing literature never explicitly defines this but the sense is that the burden might be considered overwhelming if: (a) tax rates need to be raised dramatically, (b) economic growth is retarded due to high service costs that preclude other social investments, or (c) the general well-being of future generations of workers is worse than that of current workers due to service costs and income transfers.

The discussion has significant implications for public policy and for private actors focused on developing an effective care system for the mid-twenty-first century. Public policy goals related to an aging society must balance the need to provide adequate services and transfers with an interest in maintaining the economic and social well-being of the nonelderly. The economic challengesdiscussed are such that public and private progress that begins in the near future will make the future burden substantially easier to handle.

Definitions and Background

Various aspects of economic burden are associated with an aging population: social security payments will increase, medical care insurance costs will grow, the burden associated with uncovered medical expenses such as pharmaceuticals will become quite serious, and long-term care costs will grow. Much of the logic of the paper applies to each of these financial resource challenges. However, we focus principally on the implications of long-term care services, which along with prescription drugs, have had the fastest growing costs in the list cited.

Every elder has to prepare for four key "aging shocks": uncovered costs of prescription drugs, the costs of medical care that are not paid by Medicare or private insurance, the actual costs of private insurance that partially fills in the gaps left by Medicare, and the uncovered costs of long-term care.

If the lifetime costs of each of these "aging shocks" are calculated, the long-term care burden is the worst by far. The typical 65-year-old faces present value lifetime costs for uncovered long-term care of $44,000. By contrast, the present value of lifetime out-of-pocket prescription drugs costs averages $12,000, uncovered medical care comes to $16,000, and uncovered private insurance premiums come to $18,0001 ( Table 1 ). It should be noted that because of the United States' approach to financing these services, aging shocks represent burdens borne by individuals more than society. In most other countries, these items tend to be financed socially.

Table 1

*Uncovered Prescription Drugs

$12,000

*Uncovered Medical Care

$16,000

*Uncovered Insurance Premiums

$18,000

*Uncovered Long-term Care

$44,000

Long-term care includes a broad continuum of services that address the needs of people who are frail or disabled and require help with the basic activities of everyday living. The services can vary from informal care delivered by family and friends to the formal services of home care, assisted living, or nursing homes (see Table 2 ).

Table 2

INCREASING SEVERITY

Informal Care by Family and Friends

Volunteer Services

In-home Supports (e.g., meals)

Personal Care

Adult Day Care

Assisted Living

Home Health Care

Nursing Home Care

Hospice Care

Long-term care professionals generally distinguish two types of supportive care needs for the frail: assistance with instrumental activities of daily living (IADLs), such as shopping or cleaning, and assistance with physical activities of daily living (ADLs), such as eating, bathing, or moving around.2 Among the 31million noninstitutionalized elderly, 1.8 million have IADLs and 3.3 million have ADLs ( Table 3 ). Of the 3.3 million, 1.5 million need help with three or more ADLs, indicating a very high level of need that requires extensive home care or institutional care. Another 1.4 million elderly are cared for in nursing homes and most of these elderly have 3 or more ADLs ( Georgetown University Institute for Health Care Research and Policy 1994-5).

Table 3

There are 31.2 million community-dwelling elderly

with only IADLs*
1.8 million

with 1-2 ADLs**
1.8 million

with 3+ ADLs**
1.5 million

Total w/LTC needs
5.1 million in the community

There are 1.4 million elderly residing in nursing homes

These statistics measure the number of elderly who are disabled at any given point in time. Most elderly who live beyond 75 or 85 years of age become frail at some point and need some form of assistance, making lifetime risks much higher. In fact, 42 percent of people who live to the age of seventy will spend time in a nursing home before they die ( Murtaugh et al. 1997).

The current "long-term care system" is built around private providers of services-some nonprofit and some for-profit. When resources expand, new services develop quickly, and when resources contract, capacity can also shrink quickly. In home health care, for example, annual expenditure growth rates went from more than 10 percent in the 1980s and early 1990s to minus 3 percent between 1998 and 1999 ( Levit et al. 2000). Recent policy revisions including the Home Health Prospective Payment System and the Balanced Budget Refinement Act, along with projected strong growth in out-of-pocket spending by individuals and families, cause many analysts to believe that home health care spending will rise again in the coming decade (Heffler et al. 2001). Of course, expansion and contraction of nursing home beds respond more slowly to market forces because of the durable capital aspect of nursing home care.

The Congressional Budget Office (CBO) estimates that expenditures on long-term care totaled more than $120 billion in 2000, with 59 percent of all expenses covered by the public sector ( Congressional Budget Office 1999). Out-of-pocket expenses account for almost all of the balance, with private insurance covering just 1 percent of long-term care costs (See Figure 1 ). Conservative CBO estimates suggest total long-term care expenditures will increase at a rate of 2.6 percent per year above inflation over the next thirty years, to $154 billion in 2010, $195 billion in 2020, and a staggering $270 billion in 2030. The numbers are slightly different if one assumes that long-term care insurance does not become more common, but the stark upward trend remains.

The $120 billion in current expenses underestimates the economic resources devoted to long-term care, however, because most care is delivered informally by family and friends and is not included in economic statistics. Among the elderly who require assistance with daily activities, 65 percent rely exclusively on families and friends and another 30 percent rely, at least in part, on informal care. It has been estimated that the economic value of such informal care-giving in the United States reaches $200 billion a year-one and a half times the amount spent on formal care giving ( Arno, Levine, and Memmott 1999).

Economic Burden of Long-term Care: The Dire Case

The argument that caring for an aging society could disable the American economy has been made by various commentators, perhaps most forcefully by Peter Peterson and others in the Concord Coalition ( Peterson 1996). Their concern focuses on the large growth in the number of elderly over the coming years, from 35 million in 2000 to more than 80 million in 2050 ( Figure 2 ). This growth in elderly could lead to a precipitous drop in the number of workers per elderly if current working and retirement patterns do not change ( Figure 3 ).

These trends could be particularly troublesome for the long-term care system because the largest growth in the over-65 population will be among the "oldest-old," who are disabled at the highest rates. Thus, the ratio of workers to frail elderly could decrease even more dramatically than the ratio of workers to all elderly.

A second part of the argument that long-term care could be a large burden focuses on the rapid inflation in expenditures for long-term care in recent years. Medicare and Medicaid expenditures on nursing home care were $9 billion in 1980, more than doubling to $25 billion by 1990, and doubling again to $54 billion by 1999. Likewise, Medicare and Medicaid expenditures on home health care increased from less than $1 billion in 1980 to $5 billion in 1990 and to $16.1 billion in 1999, down from a high of $17 billion in 1996 ( Health Care Financing Administration 2000; Heffler et al. 2001). These increases have not been offset by lower out-of-pocket payments, although growth rates for the latter have been lower and more consistent, with average increases of 7 percent for home health care and 3.3 percent for nursing home care each year over the last decade ( Levit et al. 2000). Finally, many professionals believe that even at current expenditure levels, there is a significant amount of unmet need for long-term care among the frail, and no foreseeable end in upward pressure on per diem service costs ( Allen and Mor 1998).

A final part of the argument for concern about long-term care costs comes from unsettling survey results reported by Curran, McLanahan, and Knab (in review) suggesting that children who experience divorce may be less willing or able to care for their aging parents. Their data indicate that the probability of an elderly person perceiving an availability of emotional support from his or her children is reduced from 71 percent for those who marry once and remain married to 56 percent for those who marry and divorce. Remarrying after divorce provides some additional support, but does not completely offset the result of the first divorce. With the legacies of the divorce boom getting older, the percent of the elderly who are divorced or separated is projected to double for men and triple for women between now and 2030. It may be the case that informal care resources will shrink and thus result in even more pressure on public and private resources that support the formal care system.

A Reassessment of Future Economic Burden

It is possible to construct a counter-case that is more optimistic about the macro burden of long-term care in the twenty-first century. Most importantly, the typical analysis of dependency ratios overstates the impacts of aging on burden. While standard calculations include only the 20- to 64-year-old population as producers, and places all of the 65-and-older population in the dependency group (because of eligibility for Social Security and Medicare), this approach is not appropriate in the case of long-term care.

At the very least, the denominator should include only people 75 and older since the 65- to 74-year-old age group does not use large amounts of long-term care. The percentage of elderly older than 85 years who are ADL impaired or institutionalized is more than six times the rate of 65- to 74-year-olds ( Manton, Corder, and Stallard 1997). In fact, if the Baby Boom generation is healthier than past generations (as argued later in the paper), it very well could be that the young elderly might work longer and thus be considered producers. In addition, in considering macroeconomic burden, the other group of dependents in society-children-should be included in the denominator with the elderly, as both groups are dependent on the adult population.

Recalculating dependency ratios using these new principles (see Table 4 ) indicates improvements rather than deteriorations in the adult to dependency ratios, especially when the year 2030 is compared to 1960 when children were present in the population in peak numbers. When 20- to 64-year-olds are compared to children and individuals 75 or older, the dependency ratio actually improves between 1960 and 2030. If the 65- to 74-year-old cohort is considered "productive" and enters the numerator, the dependency ratio becomes substantially more favorable in 2030 than it was in 1960.

Table 4

Ratios

1960

2030

% Change

20-64/65+ (i.e., The number of 20-64 year olds for every 75+ year old)

5.66

2.67

−53%

20-64/0-19 & 65+

1.10

1.15

+4.5%

20-64/0-19 & 75+

1.26

1.50

+19%

20-74/0-19 & 75+

1.40

1.80

+29%

All of these ratios change in unfavorable directions between 2000 and 2030, but the changes are not substantial.3 The key point is that the United States prospered through the 1960s with dependency ratios less favorable than will be experienced in 2030 and the burden did not overwhelm the economy. Richard Leone, among others, has argued this point ( Friedland and Summer 1999; Leone 1997; Singer and Manton 1998). Many other countries are years ahead of the United States in population aging; some will reach the "2030 burden level" as early as 2010 ( Congressional Budget Office 1994). The United States will have more time to prepare than most industrialized nations and will be able to learn from these nations' experiences.

A second factor that might make the burden of long-term care less striking than expected in 2030 is improvement in the health status of the elderly. Recent data from the National Long-Term Care Survey reported by Manton and Gu (2001) indicates that the disability rate for all elderly dropped from 26.2 percent in 1982 to 19.7 percent in 1999. This meant that there were more than 100,000 fewer disabled elderly in 1999 than in 1982, despite a one-third increase in the population of the elderly. In prior work, Singer and Manton (1998) estimated that a relative rate of disability decline of 1.5 percent a year over the next few decades would maintain the current level of burden each disabled elderly places on economically active Americans. This decline is actually significantly less than the 2.6 percent relative rate of decline experienced between 1994 and 1999. Declines in the nursing home population, particularly among the oldest old, have accompanied these disability trends ( Bishop 1999). A more mixed, although guardedly optimistic, picture of disability trends has been offered by other demographers ( Crimmins 1997; Reynolds et al. 1998; Schoeni, Freedman, and Wallace 2001). Schoeni, Freedman, and Wallace's analysis of NHIS disability data reports a 1.1 percent average annual decline in disability between 1982 and 1996. However, they caution that this decline was not persistent or consistent through this period, with most of the decline occurring in the 1980s.

Although trends will need to be watched closely over the coming decades, declines in disability probably will continue.4 This is because the two most salient factors influencing the recent declines in disability-better-educated elderly and better science-will continue to exist in the coming decades ( Freedman and Martin 1999; 2000).

The elderly of 2030 will be much better educated, with a college graduation rate twice (and high school drop out rate one-third) that of the current generation of elderly ( U.S. Department of Education 1998). This bodes well for the future physical health of aging Baby Boomers, as there is a strong correlation between education level and disability; college graduates have a disability rate about half that of high school dropouts.

Expected advances in medicine, through prevention, pharmaceuticals, and surgical treatments, should also reduce the need for long-term care. More and more older patients are benefiting from restorative treatments, such as knee replacements and coronary angioplasty, once unavailable due to age ( Lubitz et al. 2001). Although such advances in medicine tend to increase acute health care costs, these treatments can delay entrance into nursing homes and other long-term care needs. Better pharmaceuticals for preventing and treating disabling conditions such as osteoporosis, arthritis, and rheumatism will continue to decrease the number of elderly who need assistance with IADLs and ADLs ( Neer et al. 2001). Because about 60 to 70 percent of nursing home residents have dementia-related symptoms ( Rovner and Katz 1993), progress in treating or preventing Alzheimer's and other dementias associated with later life could lead to large reductions in the number of elderly with the most intensive long-term care needs. This is already happening: Freedman, Aykan, and Martin (2001) found that the proportion of noninstitutionalized elderly-particularly the very elderly-with severe cognitive impairment between 1993 and 1998 fell from 6.1 percent to 3.8 percent.

If as a result of further medical advances and social shifts, the disability rates continue to decline in the coming years at the same pace that Manton reported for 1994 to 1999, or an average 0.56 percent a year, the number of disabled elderly in the year 2030 would be a remarkably low 1.6 million people, or less than three percent of the elderly population. This seems extremely unlikely. A more conservative estimate for declines in disability rates would be an average annual decline of 0.13 percent between 1994 and 2030. Although this decline would be half the 0.26 percent average annual rate of decline experienced between 1982 and 1989, about one-third of the 0.38 percent average annual decline experienced between 1989 and 1994, and significantly less than the 0.56 percent average annual decline experienced between 1994 and 1999, it would still result in a manageable 11 million disabled elderly in 2030, 40 percent less than the estimate in 1982 of 18 million disabled elderly. Even a moderate decline in disability would have dramatic impacts on the economic burden of long-term care.

The optimistic forecasts could be affected by demographic changes that are difficult to forecast. Most relevant perhaps are trends in immigration. It is possible that unexpected growth in immigration could increase the number of elderly in the year 2030, making burdens worse. Or, immigration trends might also bring larger than expected numbers of working-age adults to America, thus decreasing dependency ratios. In addition, Wolf (2001) makes the case that decreases in disability rates that are due to higher educational attainments among the Baby Boom generation will not continue past the year 2050.

The final and most important factor that will affect the macro burden of aging is the future of the American economy. When the pessimistic literature on the burden of an aging society was published, the economy was growing at anemic rates and inflation rates were relatively high. If the economy grows at a steady, healthy pace, the overall burden of long-term care will be moderate. Social security actuaries issue three different economic scenarios for the coming century. In their "bad" economic growth scenario, with average real Gross Domestic Product (GDP) growth a little more than 1 percent over each of the next 30 years, long-term care expenses for the elderly would be almost 40 percent higher as a percentage of GDP than in their "great" economic scenario, with real GDP growth averaging 2.1 percent. During the 1990s, a decade when yearly change in real GDP shifted from negative numbers to above 4 percent, GDP actually averaged about 3 percent real annual growth per year. If GDP growth were to continue at 3 percent over the next three decades, a rate which few believe is possible, LTC expenditures as a percentage of GDP would actually decline between 2000 and 2030. Whether real GDP growth averages 1, 2, or 3 percent will make an enormous difference over a thirty-year timeframe.

Taken together, these three factors-newly calculated dependency ratios, declines in disability rates, and healthy economic growth-could work together to make the macro burden of long-term care no worse than it is the beginning of the twenty-first century. While the future remains uncertain, there seems to be little reason for dire concerns about the future burden of long-term care. Our estimates are meant to be broad outlines rather than specific forecasting. Others have eloquently discussed the power of and caveats to making demographic and economic projections ( Lee and Skinner 1996).5

The Real Economic Challenges for Long-term Care in 2030

Despite the preceding positive analysis of the macroeconomics of aging, there remain some substantial challenges to getting ready to meet the long-term care needs of Baby Boomers. In fact, four types of challenges need to be addressed:

1. Creating a finance system for long-term care that works

2. Building a viable and affordable community-based delivery system

3. Investing in healthy aging in order to achieve lower disability rates, and

4. Recharging the concept of family and the value of seniors in American culture.

Each of these challenges is considered in the remaining sections of this paper.

A Workable Long-term Care Financing System

Current Sources of Financing

Four sources of payments currently finance long-term care services for the elderly: Medicare, Medicaid, private insurance, and out-of-pocket payments (see Figure 4 ).

The federal Medicare program pays for approximately 24 percent of all long-term care costs ( Congressional Budget Office 1999). Medicare's long-term coverage, however, focuses mostly on home care that is related to medical problems, such as broken hips. Services generally are restricted to people receiving rehabilitation for some medical condition. In principle, Medicare does not cover custodial long-term care, but in practice it is an ongoing challenge for Medicare and providers to distinguish custodial care and rehabilitative care.

The federal/state Medicaid program is perhaps the most important player in the long-term care financing system. Medicaid acts as a backstop, paying for long-term care services for the frailest elders when they are poor. In most states, the Medicaid program pays for care for the poor and for elders who become poor when long-term care expenses impoverish them. In 1995, 64 percent of elderly nursing home residents used Medicaid to finance at least some of their care ( Dey 1997). In many states, a large share of all Medicaid long-term care dollars supports frail elders who had been middle class before becoming frail. In New York State, for example, the Medicaid program pays for 80 percent of all nursing home costs; clearly, 80 percent of New York elders are not poor before they become frail.

Most states direct the lion's share of Medicaid dollars to nursing homes as opposed to home care. In 1995, almost 85 percent of elderly Medicaid long-term care expenditures were for institutional care and only 10 percent were for home care services ( Wiener and Stevenson 1998). This is a result of Medicaid's attempts to focus on the most frail, who tend to be in nursing homes. Many experts feel that this emphasis on nursing homes means that not enough resources are devoted to preventing elders who have some disabilities from becoming more and more frail ( Kane, Kane, and Ladd 1998). Since elders tend to avoid nursing homes as long as possible, the Medicaid emphasis on nursing homes means that many elders go without community-based services that really could help them live better lives.

Private insurance accounts for just 4 percent of long-term care costs. Despite aggressive attempts by the insurance industry to develop a private market for long-term care, the growth of this market has proceeded slowly. Part of the reason is the nature of the contract between an insurer and an elder. The insurer needs to guarantee a service that often will occur twenty or more years after the contract is set. The uncertainty leads insurers to keep prices high and makes elders nervous about purchasing a private insurance policy. In addition, the "door-to-door" sales approach by individual agents adds to the costs of long-term care insurance. And, the reluctance of people to think about purchasing such insurance at younger ages makes the payments on an insurance policy beyond the reach of many elders. Finally, the availability of Medicaid as a substitute for private insurance leads many elders to forego insurance premiums and take their chances on remaining healthy ( McCall etal.1998).

Out-of-pocket costs finance about 36 percent of long-term care, but the burden of these payments is very unevenly distributed. The 42 percent of elders who spend some time in a nursing home-one-half of them for two years or more-pay most out-of-pocket costs for long-term care.

Barriers to Reforming the Financing System

Why is it so hard to devise a financing system to replace the current patchwork payment approach? One subtle but crucial factor is what Washington officials call the "woodwork" effect, which is the fear that many elders will demand long-term care services if a more hospitable financing system helps them receive care without having to use personal savings. It is very difficult to judge who really needs formal long-term care services, and there may be large amounts of pent up demand currently taken care of by families and friends. The woodwork effect predicts that total expenditures could grow substantially if public and or private insurance expanded ( Weissert, Cready, and Pawelak 1988; Kane, Kane, and Ladd 1998). Imbedded within the woodwork issue is the real social challenge of determining how best to allocate limited resources.

A second barrier to reform is Americans' aversion to taxes and saving. Any expanded public insurance system would require new taxes. And private insurance would be paid for from private savings, which are in short supply for most middle-income elders. One interpretation of the indifference of working-age Americans to either save privately or approve taxes to cover future long-term care services is that Americans are not adequately aware of the implications of these nonactions. Perhaps Americans, more so than other societies, are less mindful of the needs of aging due to a relatively age-stratified society. The other interpretation, however, is that Americans do not value long-term care services. This interpretation is bolstered by the fact that many moderate-income elderly who could benefit from long-term care and could afford to pay for some services choose to make do on their own.

In addition, financing reform has had to compete with various other social priorities. In recent years, lawmakers have directed more attention toward uncovered pharmaceutical costs. Medical care costs in general are high for elders-even with Medicare, elders and their families pay more than a third of their health care costs out of their own pockets. The large number of uninsured among the nonelderly population continues to be a problem that demands attention. The needs of elders also compete for resources with other problems facing other age groups. Many have concluded that elders have done rather well with social policy compared with other needy subgroups of our population. Child poverty, for example, is higher today than it was three decades ago, while poverty among the elderly has decreased significantly. Finally, tax cuts and a sluggish economy could completely eliminate the funds needed for any new social programs.

The result of the patchwork financing system is the "aging shock" presented in Table 1 : Uncovered long-term care averages $44,000 in lifetime costs for the typical elder. The $44,000 figure also underestimates the burden of long-term care in that it represents the expected value for a typical elder. Any specific person who becomes frail may face higher burdens because the expected value averages high costs for those who become frail and zero costs for those elders who avoid the need for long-term care services. Conservative estimates suggest that an elder should be prepared for more than $150,000 in costs to cover the small but real probability that he or she will spend two or three years in a nursing home. And, home care costs can be just as high for a frail elder wanting to live at home.

Long-term Care Financial Viability

In other research, Knickman, Snell, and Hunt (2000) estimate which elders can afford a $150,000 long-term care "shock" and how long-term care financial viability will change over the coming years as the Baby Boomers reach old age.6 The best way to estimate the elderly's financial viability is to consider three subsets of people ( Figure 5 ): Medicaid Bound, Financially Independent, and Tweeners.7

The Medicaid Bound: These are individuals who have few financial resources available for long-term care and who have no choice but to rely on Medicaid. A person is Medicaid Bound if he or she does not have at least $50,000 in liquid assets or current income available for long-term care in the year 2000, or $70,000 in the year 2030.8

The Financially Independent: These are individuals who have $150,000 or more in liquid assets or current income available for long-term care and who can take care of themselves financially with or without private insurance, and surely without Medicaid. In 2030, $210,000 is the minimum amount necessary for independence.

The Tweeners: This is a group whose lifetime income and wealth are adequate but who cannot handle a long-term care shock. Individuals with liquidity between $50,000 and $150,000 and $70,000 and $210,000 comprise the Tweeners in 2000 and 2030, respectively.

Estimates calculated using the Lewin Long-Term Care Financing Model indicate some good news about the future financial viability of elders.9 (See the footnote for an explanation of model.) In the year 2000, an estimated 45 percent of elders are classified as Medicaid Bound but this estimated percentage drops to 29 percent in the year 2030. By contrast, the share of the elderly who are financially independent increases from 27 percent in 2000 to 38 percent in 2030.

As with all simulations and forecasts, the estimates into the future depend on key economic assumptions. The assumptions used follow the principles of the middle estimates of the social security forecasting model: economic growth averaging 1.3 to 2.0 percent per year and real wage growth averaging 0.9 percent per year. Perhaps the most "bullish" assumption in the simulation is that the costs of long-term care will increase just 1 percent per year in real terms. To meet this forecast, long-term care cost inflation would need to be brought under control. If long-term care costs increase at 2.3 percent above inflation, the distribution of the population not able, barely able, and able to pay for long-term care would remain almost identical to the distribution today. Thus, a relatively modest increase in long-term care inflation rates could eliminate the rosy simulation estimates of changes in the Medicaid Bound as reported above.10

The other interesting forecast that emerges from the simulation exercise is that the percentage of people in the Tweeners category will not shrink, but will actually increase from 28 percent to 33 percent. This implies that there will continue to be a large number of middle class elderly who will spend down to Medicaid coverage unless new financing arrangements help make the Tweeners more self-reliant.

How do assumptions about future disability rates affect the simulation results? In fact, disability rates only affect the estimates indirectly in that higher disability rates lead to lower income and asset estimates-particularly for the nonelderly-and this increases the number of Medicaid Bound. Disability rates do not directly affect the simulation estimates because the calculations assess who is able to afford long-term care at a point in time whether a person is disabled or not.

Emerging Options to Improve the Financing of Long-term Care

Despite the size of the economic shock associated with long-term care needs, very little policy attention is being given to designing new approaches to pay for long-term care. The Kaiser Family Foundation issued a side-by-side comparison of key health policy positions advanced by the Gore campaign and the Bush campaign in early October 2000. Under the category "long-term care" the policy brief reported that the Gore campaign had no published proposals while the Bush campaign supported tax deductibility of private long-term care insurance. The quiet long-term care issue for the elderly was completely eclipsed by attention to prescription drug coverage and the future of social security during the presidential campaign.

When attention does focus on financing options for long-term care, three serious types of options need to be considered: tax deductions for private insurance, public provision of long-term care insurance, and mandatory savings starting at younger ages for private insurance.

Tax deductibility for private insurance premiums clearly would expand the number of people who purchase long-term care insurance. Deductibility would lower the after tax cost of insurance by 15 percent to 40 percent (the range of the current marginal tax rates). Unfortunately, the largest after-tax price breaks would go to the most wealthy people who do not need insurance because they can afford to pay for long-term care from existing resources. Thevast majority of working age, middle-class people-who comprise the Tweeners-would experience between a 15 and 25 percent reduction in the costs of insurance premiums after tax deductibility. While this would be a welcome incentive, past experience with lowering the marginal cost of insurance for middle class families suggests that most will not begin to purchase long-term care insurance unless a major portion of the premium is paid for. ( Bilheimer and Colby 2001)

The most likely option for a public program for insuring long-term care would involve a voluntary-type program based on out-of-pocket payments for premiums similar to Part B of Medicare. This type of program could offer graduated subsidies to make long-term care insurance more affordable for moderate-income people. In order to make the insurance affordable for most people, however, the subsidies would probably need to be large. While this type of program should lead to substantial reductions in Medicaid payments for Tweeners, the net public sector costs would likely be substantial.

Public offerings of insurance would avoid many of the marketing problems associated with private long-term care insurance and would create some healthy competition between existing private insurance policies and the new public offering. A public long-term insurance program with targeted subsidies would likely cause a much bigger expansion of insurance for middle-class families than would occur in a comparably scaled, tax deductibility program.

The third type of financing improvement would follow the logic of advocates for privatizing social security: Mandatory savings in private investment accounts could be required for all individuals starting at an age that would make annual savings affordable.11 Then, the annual savings would grow over time in the private investment accounts, and when a person turned 65 or perhaps 75, a private insurance option could be selected. Deborah Lucas presents a detailed plan for a mandatory savings approach to private financing. Her analysis suggests that saving $40 to $80 a month during working years would cover approximately 80 percent of long-term care expenses. However, the estimated savings rate for prefunding starting at age 55 is almost four times that of prefunding starting at age 35 and would also be quite sensitive to interest rates ( Lucas 1996).

More analysis of these options-and others that might emerge-is needed to encourage some consensus about how to improve the financing of long-term care for the Medicaid Bound and Tweeners. A few important principles that should guide reform debates emerge from the analysis presented here:

Long-term care is an expensive item that most middle-class families are not prepared to pay

If some type of insurance plan-whether voluntary or mandatory, whether public or private-does not begin to catch hold, the public sector is going to see its expenditures grow faster and faster

The sooner alternatives to the current Medicaid-based financing system emerge, the less painful the costs of the new system will be.

Perhaps consensus about which option is the best reform approach for long-term care financing can emerge only if there is consensus about the criteria for judging options. Unfortunately, the criteria tend to conflict with one another, forcing stark trade-offs. For example, one desirable criterion for assessing options is the extent to which individuals have free choice to select a method of preparing for their possible long-term care needs. Options strong on this criterion tend to be weak on another desirable criterion: the assurance that a financing approach does not result in people becoming a public burden if they fail to prepare for long-term care needs. A third criterion also may conflict with the other two desirable features: the ability to maintain incentives to allocate scarce long-term care resources efficiently. At the very least, debates about options need to make clear what criteria related to effectiveness are under consideration.

Building a Viable and Affordable Community-based Delivery System

While the Baby Boomers were growing up, the needs of young families were a high priority in community development, with particular concern for family-friendly housing, parks, and schools. In 2011, these children will start turning 65 in large numbers. Many predict that if communities want to be successful in caring for their aging population, they will have to make significant, yet certainly feasible, changes in housing, health care, and human services.

In preparing for the needs of large numbers of elderly, it is crucial to think of the challenge as a community issue. If the care of the elderly begins and ends with entry into a formalized system that takes over when a person is almost unable to function day to day, society will face large service costs and will miss opportunities to help the elderly function as productive, independent citizens for larger portions of their elderly years. A community's social and economic systems need to become attuned to arranging services to meet the needs of an aging society in natural, informal ways.

Most Baby Boomers would like to stay in their own homes, or at least in their own communities, as they age. Nearly three-quarters of all respondents in a recent AARP survey felt strongly that they want to stay in their current residence as long as possible ( Bayer and Harper 2000). The image that most elders will move to a retirement village away from their communities is the exception rather than the rule. Most people will not have the resources or the inclination to move to Florida or its equivalents; communities cannot rely on "exporting" to meet the needs of an aging population.

In thinking about community capacity, three stages of community aging can guide planning: the healthy-active phase, the slowing-down phase where the risk of becoming frail or socially isolated increases, and the service-needy phase when an elder can no longer continue to live in the community without some active service in and around the home.

Perhaps the most important challenge of the healthy active phase of aging is for a community to learn how to tap the human resources that elders represent in the community. This is a phase where elders can be key volunteers to improve the life of many segments of a community. Healthy elders can be considered a potential component of the paid workforce if jobs can be structured to meet their changing preferences and capabilities.

The second phase of aging, when elders begin to slow down and may face some challenges in doing the every day activities required of community living, represents a subtle challenge for communities. Elders in this phase often need assistance with transportation to remain independent, and communities need to take the lead to develop affordable transportation systems ( U. S. Department of Transportation 1997). Safe and affordable housing options also are a priority for community capacity efforts. At this phase of aging, many elders want to move into smaller housing units that are more aging-friendly but still are affordable and integrated in the community. It is important to begin developing such options on a large scale in the coming 10 to 20 years. In a community with five thousand projected elders, for example, a project with 30 units will not meaningfully attack the problem.

Voluntarism is an important community need for elders who are mostly independent but slowing down ( Butler 1997). Volunteers can provide services in a manner that makes elders continue to feel connected to a community and not dependent on a formal care system. And, volunteers often can act as preventive medicine, keeping away the effects of social isolation and keeping elders as active and engaged as possible. Volunteer capacity does not emerge without effort, however. Communities need to recruit, train, and support volunteers.

The most prevalent form of "voluntarism," of course, is the care provided informally by families and friends. These caregivers also need support through training programs and respite programs. Many believe that additional financial assistance for family caregivers is needed as well ( Stone and Keigher 1994). Such efforts to support family care-giving also represent an important aspect of community capacity to support elders.

While communities need to make day-to-day aspects of community life more aging friendly and while volunteers and family caregivers represent crucial "capacity" to meet the needs of elders, a well organized, affordable formal long-term care system still is essential for every community. It is unclear whether such local care systems can emerge naturally through market forces or whether market failures will emerge to block the evolution of care systems that reflect the wants and needs of elders. Clearly, the large financing roles of Medicare and Medicaid give the public sector an interest in ensuring that adequate systems of care emerge.

How many people will require formal services in 2030? As discussed earlier in the paper, this is an unanswerable question in the year 2002. If efforts at healthy aging are successful and if informal caregivers and volunteers can help to meet the needs of elders, the total number of frail who need formal services in a community in 2030 could be quite similar to the number in 2000, even though the number of elders will more than double. Keeping the number of frail constant at 2000 levels must be the goal of every community to keep costs affordable.

However, even if the aggregate number of frail elders stays the same or grows slowly, formal care capacity must be better structured at the community level. Importantly, most communities rely too much on nursing homes as the source of formal care, at least for Tweeners and the Medicaid Bound populations. Sixty-seven cents of every public dollar supporting long-term care for the elderly is spent on institutional care ( Congressional Budget Office 1999), despite the clear preferences of frail elders for services in the community.

Why does this mismatch of dollars versus preferences happen? In part, nursing homes are seen as the long-term care "safety net" and most public dollars are invested using a safety-net mentality: only pay for services when it would be socially unconscionable not to do so. We have not developed social consensus about when and for whom community-based services should be supported with public dollars; therefore few public dollars are allocated to community-based services.

This overreliance on nursing homes-what some people call an "unbalanced" long-term care system ( Kane, Kane, and Ladd 1998)-may be changing with help from the federal court system. Recent court rulings support the idea that the disabled have a right to receive services in community settings ( Pear 2000). Such rulings are putting pressure on public programs to rethink the balance between nursing home services and community-based services.

The challenge over the next 10 to 30 years is to develop new approaches to delivering community-based care. Home care, using a range of unskilled to highly skilled workers, represents the dominant type of community-based care. But, this service type, relying on a one-on-one model, is expensive and creates challenges for providers to assure quality. New models, such as adult day services and housing-based services that can use one caregiver to assist more than one elder at a time, need to become more prevalent ( Feldman 1990). In addition, emerging technologies might increase the ability of one caregiver to meet the needs of two or three elders through enhanced ability to communicate and monitor a person's needs ( Gottleib and Caro 1999).

One other key challenge in assuring community capacity is to recruit the required numbers of caregivers working in formal settings. With changing demographics and a strong overall labor market, it is becoming increasingly difficult for home care agencies and other providers to find and retain qualified caregivers. New incentives and organizational structures will be required to maintain a stable workforce in long-term care settings.

Finally, every community needs to think about what types of institutional long-term care should be available. Even if community-based services expand, the most frail among the elderly will sometimes require the high level of care that traditionally has been provided by nursing homes. It is possible, however, to think about restructuring nursing homes to make their living environments and caring style more attractive to elders and their families ( Allen and Mor 1998). Assisted living is emerging as a significant option for many elderly-both disabled and nondisabled. The idea of institutional care should not be considered as a static model that cannot evolve, improve, and become more responsive to the preferences of elders.

Expansions in community capacity to care for elders need to be paid for in some way. In the case of formal services, the financing options discussed previously are the source of expanded resources. In the case of community-based changes beyond formal services, the give and take of the political process will shape how high a priority health-promoting community programs become among the range of local priorities. And, the willingness of seniors and their families to allocate private resources to long term care and related services will determine the scope of "caring features" in twenty-first century communities.

Investing in Healthy Aging in Order to Achieve Lower Disability Rates

Perhaps the most important challenge related to aging populations is the challenge of healthy aging. Healthy aging (or successful or productive aging) is the concept of keeping seniors disability-free and thus avoiding some of the need for long-term care ( Rowe and Kahn 1998). Keeping seniors healthy and functioning could have significant economic impacts ( Posner 1997). In addition to reducing long-term care costs, healthier elderly are more likely to be productive members of society. In contrast to the scarce attention being paid to improving financing for long-term care, the healthy aging challenge has generated significant interest.

Both national and cross-national studies indicate that the rate of disability in a population can be extremely variable. Studies of elderly Americans with high, average, and low levels of physical activity have shown ranges in the onset of disability of up to ten years, with much lower lifetime disability among exercisers compared to sedentary people. Right now Americans spend 72 percent of their post-65 years free of disability. Our goal should be to match the Japanese, who spend 91 percent of their time past the age of 65 disability-free. For example, Japanese females at age 65 have an average life expectancy only 4 months longer than American females at age 65, but Japanese elderly women spend just 1.8 years disabled while American elderly women spend almost 5.5 years disabled ( Waidman and Manton 1998).12 While researchers caution that some of these differences could be due to varying cultural perceptions of disability and the reporting of disability to survey researchers, most observers of Japanese society believe that there are substantial differences in disability and that they relate to lifestyle choices.

Although disability and disease were once thought to be commensurate with old age, the examples above, along with many others, have made it increasingly clear that for all but the most genetically programmed diseases, lifestyle choices, social factors, and the environment play just as large or larger roles than genetics in influencing health in later life. Less than a third of the biological process of aging is attributed to genetics, and the potency of genes that affect aging declines even further after age 65 ( Finch and Tanzy 1997). Thus, society has the ability to promote successful aging and reduce and prevent disability among the elderly.

Efforts to Avoid Disease and Disability Related to Medicine and Medicare

Advances in genomics and medicine may represent the most straightforward strategy (at least compared to changing behaviors and lifestyles) to reduce disease and disability. The budget for the National Institutes of Health more than doubled between 1988 and 2000, from $6.6 billion to $18 billion, and appropriations are projected to reach $27 billion by 2003. More than $2.5 billion has been spent on the Human Genome Project since 1988 ( Human Genome Project Information 2000). These investments should lead to advances in earlier detection of disease or genetic predisposition to disease, more rational drug design, and possibly even gene therapy. Future medical interventions might transform the initial stages of chronic disease-such as the onset of Alzheimer's or arthritis-into acute disease events that can be remedied (or even prevented through vaccination) after one or two visits to the primary care physician ( Singer and Manton 1998). Consider Alzheimer's disease alone; an estimated 14 million people in the United States could suffer from Alzheimer's in 2040 if today's prevalence rates remain constant. In recent years, however, understanding about the neurobiology of the disease has increased as genes and proteins that increase susceptibility to Alzheimer's have been identified and studied ( Selkoe 1999). This new knowledge is leading to earlier diagnosis, the development of better drugs that treat symptoms, and some hope that vaccines and other methods for at least slowing the onset of Alzheimer's will emerge.

Better management by the medical care system of a broad range of chronic diseases could also reduce the incidence of disability. Society's understanding of what the health system needs to do to encourage prevention and clinical care management of chronic diseases has improved tremendously in recent years. Despite this, the right formula has not emerged for setting incentives that will lead to widespread adoption of good clinical care management principles among the numerous medical providers who care for the elderly ( Wagner et al. 1999). Increasingly, however, public and private payers are beginning to demand better clinical care management approaches for the chronically ill.

Although Medicare has clearly improved the health status of the elderly through access to acute medical care ( Lubitz et al. 2001), additional interventions are necessary to improve health care services for the elderly. Much more must be done to facilitate better clinical care management of chronic diseases ( Wagner et al. 1996) and encourage healthy aging. This could include better use of clinical preventive services to reduce the costs of Medicare ( Russell 1998), thorough implementation of chronic disease management practices, and incentives to increase the use of behavioral interventions that could help patients quit smoking, better monitor diabetes, and promote physical activity. Although Medicare acute care costs are positively affected by prevention efforts, there is little payoff to medical care providers who invest in preventive efforts. This lack of connection between Medicare prevention efforts and savings is a current barrier to better integration of prevention efforts into Medicare.

Efforts Related to Socioeconomic and Lifestyle Factors

Although medical advances generate the most excitement, basic social and lifestyle factors might have the largest long-term impact on disability rates. Various studies indicate that having income above the lowest quintile, having a high school education or greater, not smoking, and exercising are among the most important determinants of healthy aging ( Strawbridge et al. 1996; Stuck etal. 1999).

On the positive side, one factor that could lead to healthier aging among Baby Boomers compared to the current elderly is the changing life circumstances of childhood and adulthood. It appears that neurobiological circumstances in old age may be shaped in part by experiences during early, critical periods of brain development, and that many changes in function during aging show variability related to these early life experiences. That is, childhood diseases, nutritional deficiency, poverty, and lack of education might be contributing to what is now viewed as normal aging. Childhood health problems have been linked to a variety of morbidities later in life, including arthritis, cardiovascular conditions, and cancer, even when socioeconomic status is controlled for ( Blackwell 2001). According to the Barker hypothesis, prenatal conditions can have a large effect on health in later life as well, with poor nutrition in utero related to increased cardiovascular disease, diabetes, and other ailments in later life ( Barker 1995). Many elderly alive today matured during the two world wars and the long depression period, when malnutrition and vitamin deficiencies were still common. The Baby Boom cohort, by contrast, grew up among much better health, economic, nutritional, and educational conditions. Because of antibiotics and immunizations they will have been largely untouched by the ravages of childhood disease.

Education is also strongly correlated with psychological function, health behaviors, and biological conditions ( Kubzsansky et al. 1998). Persons who are not high school graduates are at almost twice the risk for experiencing declines in functional abilities in older adulthood. It is encouraging that national trends in educational attainment among the elderly are so positive, with future cohorts having completed many more years of schooling than the current elderly. However, even older adults without much formal education can benefit from programs and activities that keep their minds supple and active.

Trends in healthy behaviors are not as encouraging as the socioeconomic statistics. National trends in healthy behavior have been mixed, with stagnation in exercise, increases in obesity, and decreases in smoking. In 1997, only one-half of all 65- to 74-year-olds and one third of all people aged 75 and older engaged in any leisure time physical activity each week. Twenty-four percent of people aged 60 and older are obese and current obesity trends among younger cohorts indicate that this number will only increase ( U.S. Department of Health and Human Services 2000). Obesity is a risk factor in the elderly for arthritis, lung dysfunction, hypertension, diabetes, cardiovascular disease, and certain forms of cancer ( Kotz, Billington, and Levine 1999).

Although many suspect that rising obesity rates will increase overall medical costs, it is unknown what effect this will have on long-term care expenditures. Analysis of mortality statistics indicates that obesity has a much larger effect on life expectancy at younger than older ages, but future generations of elderly are likely to have a much higher rate of obesity than current generations. Also, the health implications are unknown for overweight elderly who have been overweight for much of their adult lives ( Kotz, Billington, and Levine 1999).

What can be done to change these trends? A sophisticated social marketing campaign might increase awareness and change attitudes about eating and exercising. In the past, successful such efforts made progress in increasing awareness about cardiovascular health risks and the importance of cholesterol monitoring and control of hypertension ( Shea and Basch 1990; Dustan, Roccella, and Garrison 1996). Better pharmaceutical agents that help control obesity also are likely to be developed in the coming years.

Communities need to provide more and better opportunities for health promotion for older adults. In 1997, only 12 percent of adults aged 65 years and older participated in one or more organized health promotion activities ( U.S. Department of Health and Human Services 2000). Many communities also do not offer activity-friendly environments that encourage seniors to walk or engage in other physical activity.

On a positive note, many researchers have shown that it is possible to reach old age in a healthy condition; those with healthy habits have a very good chance of reaching old age without disability ( Vita, Terry, Hubert, and Fries 1998) and without accruing large health care costs ( Schauffler, D'Agostino, and Kannel 1993; Daviglus, et al. 1998).

Efforts to Nurture Strong Interpersonal Relationships

Although research has shown that the lack of social relationships is a major risk factor for poor health, as significant as smoking or inactivity, few direct interventions to work on this issue have emerged. Studies suggest that mortality rates rise sharply at low levels of social connection, with death more than twice as likely compared to people with adequate social relationships ( Berkman and Syme 1979). Good social connections also affect mental health and cognition as well. One study found that persons who had no social ties were twice as likely to experience cognitive decline compared to those persons with five or six social ties ( Bassuk, Glass, and Berkman 1999). The 1986 General Social Survey indicated that twenty percent of the elderly (6.4 million people) are so socially isolated their health is at risk. Two million of them have no social network at all. Clearly, these elderly are at high risk for unhealthy aging.

Opportunities for healthy aging currently are highly related to social and economic status. The inequalities that exist in society translate into health inequalities. Receiving health insurance for the first time at age 65 will not eliminate the impact of years without insurance. Poor dental care as a child leads to lifelong increased susceptibility to many types of infection. Recent research has shown that lifetime differences in social and economic circumstances affect differences in mortality up to age 89 years ( Kubzsansky et al. 1998). Although research indicates that as a whole the elderly will be much better off in 2030 than they are today, closer examination reveals a significant minority of elderly-disproportionately women and minorities-in 2030 who could be left behind.

Recharging the Concept of Family and the Value of Seniors in American Culture

The fourth challenge related to meeting the long-term care needs of an aging population is quite intangible and is dependent on culture rather than public policy. The idea of elders as an economic burden or as frail and weak is a twentieth-century construct. An interesting book by Thomas Cole traces the history of society's views on aging ( Cole 1992). In ages when death struck randomly and evenly at all ages, people did not focus so much on a birth to death, linear view of life. And, agrarian economies where the young, the middle-aged, and the old all play productive roles enhanced the sense of the value of all ages.

So, in past eras life was viewed more as a circle-the Lion King image. But, since the Victorian Age and especially during the twentieth century, as more people have lived to old age, the linear interpretation of the life cycle has become dominant. The past century's improvements in medical and economic conditions for older people have been accompanied by cultural isolation and a change in the conception of old age. Old age has been removed from its once spiritual location in the journey of life to being redefined as a medical problem.

Perhaps it is time to rethink the value of aging and the positive aspects of aging and to adopt a cultural view captured by the imagery of the "Long Late Afternoon of Life." While it is difficult to change "culture" per se and the way elders are viewed in society, there are practical steps communities, employers, and individuals can begin to take to prepare for a society with greater numbers of healthy elders.

First, it is worth reassessing the responsibilities and assets of elders. All ages need roles in life. According to Erik Erikson, the hallmark of successful late-life development is the capacity to be generative and to pass on to future generations what one has learned from life. Marc Freedman has called the elderly "America's one growing resource" and views the aging of the population as an opportunity to be seized ( Freedman 1999). More than half of all elderly volunteer their time. In the past few decades with the creation of National Senior Service Corps, the Foster Grandparent program, and the Faith in Action initiative, more opportunities than ever are available to elderly who want to contribute to their communities.

Half a million people age fifty and older have gone back to college ( Riley 1998). Firms are integrating workforces through programs of "unretirement" or by hiring retirees as temps, consultants, and part-time workers. Surveys suggest that the 60-year trend of a decreasing number of elderly working has reversed itself as Baby Boomers reconsider their financial needs for retirement as well as how they want to spend more than a third of their adult life. In 2000, the percentage of elderly who worked, nearly 13 percent, was higher than it had been in 20 years ( Walsh 2001). The young elderly (people in their 60s) have reported increased ability to work, with a 24 percent drop in the inability to work at this age; the percentage of elderly unable to work at age 65 in 1982 was higher than the percentage unable to work at age 67 in 1993 ( Crimmins, Reynolds, and Saito 1999). Most forecasters project this trend to continue as more elderly work longer for economic, social, and personal reasons, employers become more flexible and aware of the needs and benefits of older workers, and the labor market remains tight, with a smaller number of available younger workers.

Since the sheer size and energy of the Baby Boom generation has led to other dramatic social shifts, some experts see hope that a new imagery for aging is possible. A growing interest in "age integration"-a process that takes advantage of the broadened range of accumulated "life course" experiences in society-has occurred over the last few decades. In an age-integrated society, changes made to bring older people into the mainstream could simultaneously enlarge personal opportunities and relieve many other people who are in their middle years of the work-family "crunch" ( Uhlenberg 2000; Riley 1998).

Actual physical integration between the generations can take place too. Although some towns have seen a trend toward "senior-only" housing, others are exploring options in integrated apartment buildings. Surveys have shown that most older people prefer a mixed-age neighborhood over one restricted to people their own age. Some community centers are integrating senior centers with child-care centers, facilitating cross-age interaction and at the same time conserving space and resources.

Cultural change also is possible, in terms of one-to-one relationships. Baby Boomers have made an art of enjoying and taking pride in everything about caring for children; some even go so far as managing to almost "enjoy" paying $30,000 annually for college tuition. The needed cultural shift is for children and communities to find more enjoyment and pride in providing for the care of parents and neighbors.

The simple message-and the intangible goal-is to recognize the give and take of all parts of society. Anyone who has spent time caring for an elderly friend or relative recognizes that in the end, caregivers receive far more than they give in the relationship. Everyone benefits when the elderly can be integrated fully into a caring society.

Notes

¹ Based on average life expectancy of 17 additional years at age 65, out-of-pocket prescription drug costs of approximately $400 a year (with 5 percent annual increases over inflation), out-of-pocket medical care costs of $900 a year, and uncovered insurance premiums costs of $1,000 a year, and average life long-term care costs.

² The ADLs include eating, bathing, dressing, toileting, transfers, and continence. The IADLs include light housework, laundry, meal preparation, transportation, grocery shopping, telephoning, and medical and money management.

³ According to demographic projections, the ratios continue to moderately worsen between 2030 and 2050 as Baby Boomers reach very old ages.

⁴ The Lewin-LTC model used in this paper uses relatively conservative assumptions about declines in disability over the next thirty years and assumes that the average amount of time spent in disability before death will remain the same even as the age of death rises. Thus, disability will decrease at an average annual rate, depending on age, of between 0.5 and 0.6 percent-mirroring the social security trustees assumptions for declines in mortality-and keeping the percentage of elderly in the community who are disabled in 2030 at approximately the same level as in 2000: around 5 percent.

⁵ In this paper, Lee and Skinner outline the major caveats in making projections of health care needs, mortality, and disability, the lack of consensus in interpretation of data, the need for stronger modeling strategies, and what would be necessary for more robust, long-term predictive power.

⁶ All comparisons were done using 2000 dollars, with projected inflation adjustments. (Knickman, Snell, and Hunt).

⁷Tim Smeeding coined the term "Tweeners" ( Smeeding 1986) and Smeeding and Holden have considered their problems in earlier papers ( Smeeding and Holden 1990).

⁸The $150,000 amount is used to define a long-term shock because this amount would be needed to support a three-year nursing home stay in many parts of the country. To calculate "current income" we include income over a three-year period since most nursing home stays are less than three years, but many last more than one year. Thus, including only one year of current income might have understated resources available for long-term care. Income includes earnings, social security income, pensions, other annuities, and investment incomes. If a person is single, it is assumed the long-term care resources available include income over three years plus liquid assets. The long-term care resources available to a person who is part of a couple is three times income, minus $16,000 a year for the spouse plus liquid assets, minus the half the liquid assets of $120,000, whichever is smaller. Thus, long term care resources for a couple = 3[MAX (0, income-$16,0001)] + (liquid assets − [MIN (1/2 liquid assets, $120,000)]).

⁹ The Long-term Care Financing Model simulates the utilization and financing of long-term care services for elderly individuals through 2050 using national data. The two principal components of the model are the Pension and Retirement Income Simulation Model (PRISM) and the Long-term Care Financing Model. The PRISM simulates future demographic characteristics, labor force participation, income and assets of the elderly. The Long-term Care Financing Model simulates disability, admission to and use of institutional and home and community-based care, and methods of financing long-term care services. The model uses a Monte Carlo simulation methodology. The current version of the model is the second major revision of the model that was developed jointly by Lewin-ICF and the Brookings Institution in 1986.

In almost all cases, PRISM uses the Intermediate assumptions from the 1999 Social Security Trustees' Report. The PRISM models income from social security, private and public employee retirement plans, Individual Retirement Accounts, Keogh accounts, earnings, assets, and the Supplemental Security Income program. Aggregate changes in wage levels are assumed to increase at the rate assumed in the Intermediate category of the 1999 Trustees' Report. In general, average wages are assumed to grow by 0.9-1.0 percentage points in excess of the inflation rate in each year after 1998. The PRISM simulates mortality, disability, childbearing, and changes in marital status. Mortality rates vary by age, gender, disability status, years since becoming disabled, and race (black versus nonblack).

In the Long-term Care Financing Model, disabled individuals age 65 and older are defined as those who are unable to conduct at least one instrumental activity of daily living or unable to conduct at least any one of five activities of daily living. The disability prevalence rates used in the model were calculated using data from the 1994 National Long-term Care Survey (NLTCS) while assuming that the overall period during which an individual is likely to have a disability will remain stable. Taking an intermediate view of long-term disability prevalence rates, it assumes that disability will decrease at an average annual rateof between 0.5 and 0.6 percent-mirroring the social security trustees' assumptions for declines in mortality-depending on age. This rate isapproximately one-half the 1.2 percent per year declines in disability estimated by Manton based on the 1982 and 1994 NLTCS (Alecxih, L. B., J. Corea, and R. Foreman, 2000. "Long-term Care Financing Model: Model Assumptions [Draft]," The Lewin Group.)

¹⁰ It is very difficult to know how fast long-term care costs will inflate over a thirty-year period. On the other hand, if labor becomes more productive in the general economy, service costs could inflate at faster rates than average because productivity gains in the service sector often lag average gains in the economy. However, over the next thirty years it is possible that new technologies and new service strategies could improve the efficiency of the long-term care sector. The assumption of 1 percent inflation above average inflation seems like a moderately-but not unreasonably- optimistic guess.

¹¹ The grounds for mandatory savings would be based on the following type of thinking: (a) people miscalculate the importance of saving for long-term care, and (b) if individuals fail to save, the costs of long-term care become a social burden. This logic motivates a wide range of regulatory behavior ranging from social security to mandatory automobile insurance.

¹²Some have feared that as life expectancy increases, the time spent in poor health will correspondingly rise. Recent data does not seem to support these fears. Average life expectancy at age 85 was six years in 1980, and, by 1997, had increased by less than four months ( U.S. Census Bureau 2000). Declines in disability, however, appear to be quite significant.

References

Barker DJ. "Fetal Origins of Coronary Heart Disease" British Medical Journal. 1995;311:171-4. [[PMC free article] [PubMed] Google Scholar]

Bayer A, Harper L. Fixing to Stay: A National Survey on Housing and Home Modification Issues. 2000. American Association of Retired Persons.

Curran S, McLanahan S, Knab J. "Does Remarriage Expand Perceptions of Kinship Support among the Elderly?" Social Force. In review. [[PMC free article] [PubMed] Google Scholar]

Dey AN. "Characteristics of Elderly Nursing Home Residents: Data from the 1995 National Nursing Home Survey". Hyattsville, MD: National Center for Health Statistics; 1997. Advance data from [Vital and Health Statistics, no. 289. [PubMed] Google Scholar]

Freedman VA, Martin LG. "Contribution of Chronic Conditions to Aggregate Changes in Old-Age Functioning" American Journal of Public Health. 2000;90(November):1755-60. [[PMC free article] [PubMed] Google Scholar]

Health Care Financing Administration. "National Health Expenditures by Type of Service and Source of Funds: Calendar Years 1960-98" 2000. [December 2000]. Available at http://www.hcfa.gov/stats/nhe-oact/

Human Genome Project Budget, Human Genome Project Information webpage. Available at http://www.ornl.gov/hgmis/project/budget.html.

Knickman JR, Snell EK, Hunt KA. "How Many Elderly Will Be Able to Afford Uncovered Health and Long-Term Care Services: Projections to the Year 2030" Working paper, The Robert Wood Johnson Foundation, Princeton, New Jersey.

Lubitz J, Greenberg LG, Gorina Y, Wartzman L, Gibson D. "Three Decades of Health Care Use by the Elderly, 1965-1998" Health Affairs. 2001;(March/April):19-46. [[PubMed] Google Scholar]

Manton KG, Gu X. "Changes in the Prevalence of Chronic Disability in the United States Black and Non-black Population above Age 65 from 1982 to 1999". Proceedings of the National Academy of Science USA May 8.2001. [[PMC free article] [PubMed] Google Scholar]

Manton KG, Corder L, Stallard E. "Chronic Disability Trends in Elderly United States Populations: 1982-1994". Proceedings of the National Academy of Science USA; 1997. pp. 2593-8. [[PMC free article] [PubMed] Google Scholar]

McCall N, Mangle S, Bauer E, Knickman J. "Factors Important in the Purchase of Partnership Long-Term Care Insurance" Health Services Research. 1998;33(2, Pt 1):187-203. [[PMC free article] [PubMed] Google Scholar]

Riley MW. "The Hidden Age Revolution: Emergent Integration of All Ages" 1998. Syracuse University, policy brief no.12.

Singer B, Manton K. "The Effects of Health Changes on Projections of Health Service Needs for the Elderly Population of the United States". Proceedings of the National Academy of Science; 1998. pp. 15618-22. [[PMC free article] [PubMed] Google Scholar]

Waidmann TA, Manton KG. "International Evidence on Disability Trends among the Elderly" 1998. Office of Disability, Aging, and Long-Term Care Policy Department of Health and Human Services. Available at http://www.aspe.os.dhhs.gov/daltcp/reports/trends.htm.

Walsh MW. "Reversing Decades-Long Trend, Americans Retiring Later in Life" New York Times. 2001:1. February 26, section A. [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

# data[].attributes.attachment_link.title
The 2030 Problem: Caring for Aging Baby Boomers

# data[].attributes.attachment_link.description
To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages.A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the ...

# data[].attributes.body
I agree with Sabina. I was suprised that most answers were just numbers. I see aging as something with the body and not with numbers.
Aaliyah Afzal

# data[].attributes.body
Hochschild talks about how the people in the United States are being politically divided. The First few pages of this book talks about the issues Hochschild sees and how she doesn’t understand the political beliefs of people she meets even if they are on the same things. He sets out to Louisiana to help find the missing link of his understanding. In this book, it also talks about the differences between the political parties over the years and what they have believed in the past years. 

The Great Paradox is inspired by Thomas Franks book called What’s the Matter with Kansas?. The extreme example that was given of the paradox is Louisiana. The two years that were recorded in this book showed how many kids learned and that the school system isn’t the best in this state. Out of the 50 states it has ranked on the bottom 10 states. It also has the poorest health in the nation. Just by itself it receives 40% of its budget from federal programs. One of the things that’s also talked about in this topic is insurance for the elderly. This one case caught my eye a man lovingly divorced his wife who suffered a severely disabling disease to make her eligible for Medicaid. Some people had elderly parents lacking private long-term care insurance and also declared indigent in order to enable them to receive Medicaid. It kind of mad me a little upset because doesn’t matter what age you hit, you’ll have a problem with health insurances. In my family, most of us have had trouble in the past with insurance and had limited things that we needed and impossible for insurance to cover. Most insurance won’t cover certain things even when you switch insurances. 

# data[].attributes.body
That's an interesting article!
I would have thought as we grow older, we become closer to the people we know, but I forgot that sometimes our friends move away or die. It really is important to continue to make friends as we age.
-David Cocker

# data[].attributes.headline
Respond to Meredith H The ending of the Journey game is very beautiful.  I think that Luke's death scene in The Last Jedi is one  of the most peaceful I've seen. 

# data[].attributes.subject
Respond to Meredith H The ending of the Journey game is very beautiful.  I think that Luke's death scene in The Last Jedi is one  of the most peaceful I've seen. 

# data[].attributes.body
-Vanessa M.

# data[].attributes.headline
The gender pay gap is the reason why women receive less Social Security than men

# data[].attributes.subject
The gender pay gap is the reason why women receive less Social Security than men

# data[].attributes.body
-Vanessa M.

# data[].attributes.attachment_link.title
The Gender Pay Gap Haunts Women in Retirement Too

# data[].attributes.attachment_link.description
Women's retirement income is stretched thinner than men's because they earn less and live longer.

# data[].attributes.body
As Corrinne Stiles said age can be just a number. I believe this is so true in todays world. I have a grandfather who is 92 and plays 9 holes of golf and a grandmother who can walk longer and faster than me at the age of 90. One thing they both do that they say that keeps them "young" is to get out of bed each morning and do something that makes you smile. I hope to one day be 90 and feel better than I did in my teens.
-Kathryn Roedell

# data[].attributes.body
I have seen the whole movie and I honestly thought it was such an amazing Idea of giving seniors a hobby or a sense of place. I also noticed in the film how it showed the difference in generations such as they way they dress for work and their work ethic. I believe having programs like senior interns is a wonderful Idea because it can help boost moral.
-Kathryn Roedell

# data[].attributes.headline
Reply to 3 generations Under One Roof By Shannon Fobbs.

# data[].attributes.subject
Reply to 3 generations Under One Roof By Shannon Fobbs.

# data[].attributes.body
Hi Shannon,

A very intresting read which brings forward the revival of multigenerational families sharing the same living space. Though this concept seems new to the avarage American family today. It has been well documented that Families did share the living space in the USA as a budding nation. Also this is a common lifestyle for people in Asia and with increasing migration from that part of the world to the USA, people are getting comfortable with the Multigenerational Living under one roof once again.

Sabina Shaikh

# data[].attributes.body
Wow that was great list of items that everyone should add to their diets. I have heard of the benefits of Green Tea but Rooibos Tea was new to me. Thank you for the article.

-Shannon Fobbs

# data[].attributes.body
51 million Americans live in multigenerational homes. Is it right for your family?

by Sally Abrahms, AARP Bulletin, April 2013

Have you noticed more people around your neighborhood? That long-gone college grad is back across the street, and Grandma's moved in, too. The older couple next door has a full house — their son, his wife and two kids. The ranch a few doors down was just bought — jointly — by adult children and their parents.

Three generations under one roof, known as multigenerational housing, is here to stay.

This is an interesting article. Please click the link below to continue reading:

https://www.aarp.org/home-family/friends-family/info-04-2013/three-generations-household-american-family.html

Shannon Fobbs

# data[].attributes.body
Hi Dorothea,
Aging is nothing but a slowing of metabolic functions in a Human Body. This process has nothing to do with numbers. A person starts to get old once the ability to preform tasks which were done earlier with ease start to seem difficult to accomplish.
Sabina Shaikh

# data[].attributes.headline
Positive results of music therapy used in treatment of Alzheimers and Dementia patients demonstrated by MUSIC & MEMORY, a non profit organization that brings personalized music into the lives of the elderly or infirm through digital music technology, vastly improving quality of life.

# data[].attributes.subject
Positive results of music therapy used in treatment of Alzheimers and Dementia patients demonstrated by MUSIC & MEMORY, a non profit organization that brings personalized music into the lives of the elderly or infirm through digital music technology, vastly improving quality of life.

# data[].attributes.body
Sabina Shaikh

# data[].attributes.attachment_link.title
(original) Man In Nursing Home Reacts To Hearing Music From His Era

# data[].attributes.headline
Old people have some advantages to learn new things including language.

# data[].attributes.subject
Old people have some advantages to learn new things including language.

# data[].attributes.body
-Azusa Yoshimura

# data[].attributes.attachment_link.description
The brain's neuroplasticity decreases with age, but this shouldn't put off older learners - they do have some advantages

# data[].attributes.headline
Good article about relationship between grand parents and their grandkids

# data[].attributes.subject
Good article about relationship between grand parents and their grandkids

# data[].attributes.body
-Azusa Yoshimura

# data[].attributes.attachment_link.readable_text
parenting
No matter how much you love your grandkids, raising them comes with many challenges as well as rewards. These guidelines can help you succeed at parenting the second time around.

The challenges of grandparents raising grandchildren

As grandparents, we usually have the benefit of interacting with our grandkids on a level that is once removed from the day-to-day responsibilities of parents. For many of us, grandparenting means a weekend together every now and then, an afternoon play date, an evening babysitting, a summer vacation, or chats on the phone and email exchanges here and there. But when life circumstances change-through divorce, the death of parents, or changes to a parent's work or school-related responsibilities, for example-it often falls to grandparents to assume full- or part-time responsibility for their grandchildren.

Also known as "kinship care," a growing number of grandparents are now taking on the parenting role for their grandchildren, thus foregoing the traditional grandparent/grandchild relationship. This often means giving up your leisure time, the option of traveling, and many other aspects of your independence. Instead, you once again take on responsibility for the day-to-day maintenance of a home, schedules, meals, homework, and play dates. And if it was tragic circumstances that required you to step into the role of a parent, you'll face many other stress factors, such as coping with your own and your grandchildren's grief.

But raising your grandchildren, while challenging, can also be incredibly rewarding. Yes, you may have to deal with colicky babies or moody teenagers, but you'll also experience a much greater connection to your grandchild's world, including their school and leisure activities. You may also find yourself rolling back the years, rejuvenated by the constant companionship of much younger people. And you can derive immense satisfaction from providing your grandchildren with a safe, nurturing, and structured home environment in which to grow and feel loved.

Exploring your rights as a grandparent

Some circumstances make it necessary for grandparents to seek legal help. If there's been a divorce, death of one parent, estrangement, or the suspicion that your grandchildren are undergoing neglect or abuse, you may need to consult a lawyer or advocacy group to clarify your legal rights and ensure access to your grandchildren

Grandparents raising grandchildren tip 1: Acknowledge your feelings

The prospect of raising grandchildren is bound to trigger a range of emotions. Positive emotions, like the love you feel for your grandchildren, the joy in seeing them learn and grow, and relief at giving them a stable environment, are easy to acknowledge. It's more difficult to admit to feelings such as resentment, guilt, or fear.

It's important to acknowledge and accept what you're feeling, both positive and negative. Don't beat yourself up over your doubts and misgivings. It's only natural to feel some ambivalence about childrearing at a time when you expected your responsibilities to be dwindling. These feelings don't mean that you don't love your grandchildren.

What you may feel

Stress and worry - If you've been used to the occasional visit from a grandchild, being back in the saddle full time can feel stressful and overwhelming. You may worry about how you will handle the additional responsibilities and what will happen to the grandkids if something happens to you.
[Read: How to Stop Worrying]
Anger or resentment - You may feel anger or resentment toward the grandchild's parents for leaving you with the responsibility of caring for their child. Or you might be resentful of other friends who are enjoying the retirement you once envisioned.

Guilt - You may feel guilty and responsible for your child's failures as a parent, second-guessing and regretting your own mistakes when you were first parenting.

Grief - There are many losses that come with taking in your grandkids, including the loss of your independence and the easier role of "grandparent," rather than the primary caregiver. You may also be grieving for your child and the difficulties that have led to this situation.

When you start to feel overwhelmed...

Remember that while you may not have the energy you did when you were younger, you do have the wisdom that only comes with experience-an advantage that can make a huge difference in your grandchild's life. Unlike first-time parents, you've done this before and learned from your mistakes. Don't underestimate what you have to offer!

With over 25,000 licensed counselors, BetterHelp has a therapist that fits your needs. It's easy, affordable, and convenient.

Online-Therapy.com is a complete toolbox of support, when you need it, on your schedule. It only takes a few minutes to sign up.

Teen Counseling is an online therapy service for teens and young adults. Connect with your counselor by video, phone, or chat.

Tip 2: Take care of yourself

You probably weren't expecting to be raising kids again at this stage in your life. At times, the physical, emotional, and financial demands may feel overwhelming. That's why it's vitally important that you take care of yourself and get the support you need.

When you're preoccupied with the daily demands of raising grandkids, it's easy to let your own needs fall by the wayside. But taking care of yourself is a necessity, not a luxury. You can't be a good caretaker when you're overwhelmed, exhausted, and emotionally depleted. In order to keep up with your grandkids, you need to be calm, centered, and focused. Looking after your own mental and physical health is how you get there.
[Read: Aging Well]
A healthy you means healthy grandchildren. If you don't take care of your health, you won't be able to take care of your grandchildren, either. Make it a priority to eat nutritious meals, exercise regularly, and get adequate sleep. Don't let doctor's appointments or medication refills slide.

Hobbies and relaxation are not luxuries. Carving out time for rest and relaxation is essential to avoid burnout and depression. Use your "me time" to really nurture yourself. Rather than zoning out in front of the TV (which won't revive you), choose activities that trigger the relaxation response, such as deep breathing, yoga, or meditation.

It's okay to lean on your grandkids for help. Kids are smarter and more capable than we often give them credit for. Even young children can pick up after themselves and help out around the house. Helping out will also make your grandkids feel good.

Support makes all the difference

Studies show that grandparents who cope well with the added stress of raising grandchildren are those who seek out others for support.

Find someone you can talk to about what you're going through. This will give you a chance to work through your feelings and reach an acceptance of the situation. If you deny or ignore these feelings, they will come out in other ways and may affect your relationship with your grandkids.

Look for support groups for grandparents raising grandchildren. Support groups or even phone support can be very helpful in this journey, and it's a good start for making friends in similar situations. Hearing from people who have been there can help both uplift your spirits and give you concrete suggestions for your situation.

Reach out in your community for childcare help. If you are a member of a church, synagogue or other religious organization, you may be able to ask around for available babysitters. Try asking at a library storytime, chatting up other parents at the playground, finding out if any neighbors have a reliable teen available to babysit, or if other parents are interested in a babysitting swap.

Connect with parents with children. Even if you feel like you are from a different generation, the joys and tribulations of raising children can quickly form common bonds. It may take time, but forging friendships with parents of similar aged children can offer camaraderie and help on navigating the maze of issues facing children today.

Tip 3: Realize your grandkids will have mixed feelings too

Moving to a new home is never easy, even in the best of circumstances. When children are dealing with the loss of regular contact with their parent or parents, the move is even harder. It will take some time for your grandchildren to adjust, and in the meantime, they may act especially contrary and difficult. And if the children have suffered from emotional neglect, trauma, or abuse, those wounds will not disappear just because they are now in a safe place. They will need time to heal.

Your grandkids may resent being separated from their parent and wish to return, even if their home situation was dangerous or abusive. Don't take this personally. The parent-child bond is powerful. Even if the children are old enough to understand that they're better off with you, they will still miss their parent and struggle with feelings of abandonment.

Your grandkids' feelings may come out in many ways, including behavior. They may lash out with aggressive or inappropriate behavior, or they may withdraw and push you away.

No matter their behavior, your grandkids need your comfort and support. If you start to get angry or upset, put yourself in their head. Picture what they've been through, and the confusion, mistrust, and fear they're probably feeling.

Remember that children often act out in a safe place. While it may feel like your grandchildren don't love or appreciate you sometimes, their behavior actually means they feel safe enough to express frightening emotions.

When grandkids first arrive, they may be on their best behavior. Don't be too discouraged if, after a brief "honeymoon" phase, they start to act out. This doesn't necessarily mean you're doing a bad job. As mentioned previously, this can be a sign that they finally feel secure enough to vent their true feelings.

Tip 4: Focus on creating a stable environment

While it will take your grandkids time to adjust to their new living arrangement, there are steps you can take to make the transition easier. Above all, your grandchildren need to feel secure. Children thrive in an environment that is stable and predictable.

Establish a routine. Routines and schedules help make a child's world feel safe. Set a schedule for mealtimes and bedtimes. Create special rituals that you and your grandchildren can share on weekends or when getting ready for bed.

Encourage their input in their new home. Let your grandkids help pack and move in their belongings to the extent that they're able for their age. Encourage them to decorate their new room and arrange it as they'd like. Having some control will make the adjustment easier.

Set clear, age-appropriate house rules and enforce them consistently. Children feel more secure when they know what to expect. Loving boundaries tell the child that he or she is safe and protected.

Make sure that each grandchild has a private space. If grandchildren are sharing a bedroom, get creative: use a divider to partition off a private area in a bigger room, erect a playhouse in the backyard, or set up a tent in the family room.

Offer your time and attention. You can be a consistent, reassuring presence for your grandkids. Try to make time to interact with them at the beginning of the day, when they come home from school, and before bed.

Tip 5: Encourage open and honest communication

Communicating openly and honestly with your grandchildren is one of the best things you can do to help them cope with their new situation. It's especially important to take the time to really listen to your grandkids. In this difficult time, they need an adult they can go to with their questions, concerns, and feelings.
[Read: Effective Communication]
Plan regular times when you sit and talk to each other, free from TV, phones, games, and other distractions.

Encourage your grandchildren to talk about their feelings, both good and bad. Try to listen without judging or dismissing their feelings.

Help your grandkids learn to identify their emotions. For example, if your grandchild seems upset, you might say, "You look sad. Is something bothering you?"

Young children communicate through play. Young children may not be able to verbalize how they feel, but will express themselves through their play.

It's okay to say, "I don't know." You don't have to have an answer for everything. If you don't know when mommy's coming home, for example, be honest about it. Don't evade the question or lie.

How much should you tell young grandchildren?

When deciding what to tell your grandchildren about the situation, it's important to consider their age and developmental skills. The following tips may help:

Avoid telling the child too much. Many children are simply too young to understand the whole story. When grandparents tell a young child all of the details of the situation, they may create more harm than good. Too much information can be confusing, scary, and overwhelming for the child.

Avoid telling the child too little or nothing at all. Kids are smart. They will pick up tidbits about their situation, even if the details are not discussed directly. If children learn about what's going on from someone else, they could feel hurt, deceived, and confused. They may avoid asking you questions or talking to you about other important concerns because they think certain topics are "off limits."

Never twist the facts or lie to the child. Even very young children know the difference between the truth and a lie. They often piece together information, but then are afraid to talk about the truth. Some people may twist the facts in an effort to protect the child. But that approach often backfires. When children are told untruths about a situation, they may become very confused, angry, and hurt. The best strategy is to be honest with your grandchildren, at their level of understanding. Your grandchildren will learn the importance of trust and honesty in relationships.

Source: Grandparents Raising Grandchildren, University of Wisconsin-Extension

It is not always possible for children to remain in contact with their parents, and at times, it may not be in a child's best interest. But in general, it is healthy for your grandchildren to maintain relationships with their parents, especially if they may live with them again. If meeting in person isn't possible, you can encourage contact in other ways, including phone calls, video chats, cards and letters, and email.

Making visits with parents as smooth as possible

Don't put your grandchild in the middle. Try to set aside any feelings of anger or disappointment you have toward your grandchild's parent. Avoid venting issues or saying critical things about the parent in front of your grandchild. And don't make your grandchild feel guilty about spending time with their parent. This can be confusing and distressing for the child.

Communicate and cooperate with your grandchild's parent. Do what you can to smooth the relationship and make the parent feel a part of the child's life. Share information about the child's school, hobbies, and friends. Make sure the parent has the child's schedule and contact information.

Make visits part of your grandchild's routine. Contact with parents will be less stressful for children if they know what to expect. If possible, plan visits well in advance and put them on a regular schedule. Talk with the parent ahead of time, so everyone's expectations for the visit are clear. It's best if both parents and grandparents enforce the same rules.

Be sensitive to your grandchild's feelings. It's important to talk with your grandchild about how they feel about parental contact. Even when kids are looking forward to a visit or call, it can bring up many feelings, including uncertainty and nervousness. Kids may worry that their parent doesn't love them anymore, or that they won't have anything to talk about. Be there to reassure them.

Help your grandchild deal with disappointment. Sometimes, visits don't go well or the parent doesn't show up. Vent to a friend if you need to, but avoid the temptation to say angry or hurtful things about the parent in front of your grandchild, as this won't make him or her feel better. Instead, talk with your grandchild about what happened and how they feel about it.
Authors: Melinda Smith, M.A. and Jeanne Segal, Ph.D.

Grandparents Raising Grandchildren - If you are just starting to care for your grandchild, this guide will help you find your way. Covers legal issues, family challenges, and how to find support. (AARP)

Grandparents Raising Grandchildren Series - Articles covering topics such as reasons for your grandchild's misbehavior and ways to build strong families. (University of Florida IFAS Extension)
Finding support
In the U.S.: State Fact Sheets - Find resources for grandparents raising grandchildren in your state. (AARP)

In the UK: Advice for kinship carers - Advice, support, and a helpline for grandparents raising grandchildren in the UK. (Grandparents Plus)

In Australia: Grandparents - Links - Regional and national support resources for grandparents in Australia, including a helpline. (Family Court of Australia)

# data[].attributes.attachment_link.description
parenting As grandparents, we usually have the benefit of interacting with our grandkids on a level that is once removed from the day-to-day responsibilities of parents. For many of us, grandparenting means a weekend together every now and then, an afternoon play date, an evening babysitting, a summer vacation, or chats on the phone and email exchanges here and there.

# data[].attributes.body
This video shows us that age can be number.
-Corrinne Stiles

# data[].attributes.attachment_link.title
The 77 Year Old Ballet Dancer Sharing Seven Decades Of Experience | Amazing Humans

# data[].attributes.body
It was an interesting article. I think if there is more education for doctors on how to combat the stereotypes they have with the elderly it should help move

# data[].attributes.body
I think these signs and symptoms are very helpful to people going through demetia, whether it be a family member or themselves. Perhaps f people caught the sign sooner, more could be done to help.
-Emily Brockley

# data[].attributes.body
This was really interesting! I always thought dementia was something that just happened. Perhaps I need to start some sudoku.
-Emily Brockley

# data[].attributes.body
I thought this was an interesting article done by the American Psychological Organisation. It has a lot of details on the effects of ageism among the elderly.
-Emily Brockley

# data[].attributes.attachment_link.description
Geropsychologists are striving to stop negative age stereotypes and meet the growing mental health needs of older adults.

# data[].attributes.headline
Here is a really interesting research paper on how peer pressure changes through age groups.

# data[].attributes.subject
Here is a really interesting research paper on how peer pressure changes through age groups.

# data[].attributes.body
-Jordan Schauberger

# data[].attributes.headline
This is a great article on the development of friendships as people age.

# data[].attributes.subject
This is a great article on the development of friendships as people age.

# data[].attributes.body
- Jordan Schauberger

# data[].attributes.attachment_link.readable_text
"We need to catch up soon!"

In the hierarchy of relationships, friendships are at the bottom. Romantic partners, parents, children-all these come first.

This is true in life, and in science, where relationship research tends to focus on couples and families. When Emily Langan, an associate communication professor at Wheaton College, goes to conferences for the International Association of Relationship Researchers, she says, "friendship is the smallest cluster there. Sometimes it's a panel, if that."

Friendships are unique relationships because unlike family relationships, we choose to enter into them. And unlike other voluntary bonds, such as marriages and romantic relationships, they lack a formal structure. You wouldn't go months without speaking with or seeing your significant other (hopefully), but you might go that long without contacting a friend.

Still, survey upon survey upon survey shows how important people's friends are to their happiness. And though friendships tend to change as people age, there is some consistency in what people want from them.

"I've listened to someone as young as 14 and someone as old as 100 talk about their close friends, and [there are] three expectations of a close friend that I hear people describing and valuing across the entire life course," says William Rawlins, the Stocker Professor of Interpersonal Communication at Ohio University. "Somebody to talk to, someone to depend on, and someone to enjoy. These expectations remain the same, but the circumstances under which they're accomplished change."

The voluntary nature of friendship makes it subject to life's whims in a way that more formal relationships aren't. In adulthood, as people grow up and go away, friendships are the relationships most likely to take a hit. You're stuck with your family, and you'll prioritize your spouse. But where once you could run over to Jonny's house at a moment's notice and see if he could come out to play, now you have to ask Jonny if he has a couple hours to get a drink in two weeks.
The voluntary nature of friendship makes it subject to life's whims in a way other relationships aren't.
The beautiful, special thing about friendship, that friends are friends because they want to be, that they choose each other, is "a double agent," Langan says, "because I can choose to get in, and I can choose to get out."

Throughout life, from grade school to the retirement home, friendship continues to confer health benefits, both mental and physical. But as life accelerates, people's priorities and responsibilities shift, and friendships are affected, for better or, often, sadly, for worse.

The saga of adult friendship starts off well enough. "I think young adulthood is the golden age for forming friendships," Rawlins says. "Especially for people who have the privilege and the blessing of being able to go to college."

During young adulthood, friendships become more complex and meaningful. In childhood, friends are mostly other kids who are fun to play with; in adolescence, there's a lot more self-disclosure and support between friends, but adolescents are still discovering their identity, and learning what it means to be intimate. Their friendships help them do that.

But "in adolescence, people have a really tractable self," Rawlins says. "They'll change." How many band T-shirts from Hot Topic end up sadly crumpled at the bottom of dresser drawers because the owners' friends said the band was lame? The world may never know. By young adulthood, people are usually a little more secure in themselves, more likely to seek out friends who share their values on the important things, and let the little things be.

To go along with their newly sophisticated approach to friendship, young adults also have time to devote to their friends. According to the Encyclopedia of Human Relationships, many young adults spend 10 to 25 hours a week with friends, and the 2014 American Time Use Survey found that people ages 20 to 24 spent the most time per day socializing on average of any age group.

College is an environment that facilitates this, with keggers and close quarters, but even young adults who don't go to college are less likely to have some of the responsibilities that can take away from time with friends, such as marriage, or caring for children or older parents.

Friendship networks are naturally denser, too, in youth, when most of the people you meet go to your school or live in your town. As people move for school, work, and family, networks spread out. Moving out of town for college gives some people their first taste of this distancing. In a longitudinal study that followed pairs of best friends over 19 years, a team led by Andrew Ledbetter, an associate communications-studies professor at Texas Christian University, found that participants had moved an average of 5.8 times during that period.

"I think that's just kind of a part of life in the very mobile and high-level transportation- and communication-technology society that we have," Ledbetter says. "We don't think about how that's damaging the social fabric of our lives."

We aren't obligated to our friends the way we are to our romantic partners, our jobs, and our families. We'll be sad to go, but go we will. This is one of the inherent tensions of friendships, which Rawlins calls "the freedom to be independent and the freedom to be dependent."

"Where are you situated?" Rawlins asks me, in the course of explaining this tension. "Washington, D.C.," I tell him.

"Where'd you go to college?"

"Chicago."

"Okay, so you're in Chicago, and you have close friends there. You say 'Ah, I've got this great opportunity in Washington ...' and [your friend] goes, 'Julie, you gotta take that!' [She's] essentially saying, 'You're free to go. Go there, do that, but if you need me, I'll be here for you.'"

I wish he wouldn't use me as an example. It makes me sad.

As people enter middle age, they tend to have more demands on their time, many of them more pressing than friendship. After all, it's easier to put off catching up with a friend than it is to skip your kid's play or an important business trip. The ideal of people's expectations for friendship is always in tension with the reality of their lives, Rawlins says.

"The real bittersweet aspect is young adulthood begins with all this time for friendship, and friendship just having this exuberant, profound importance for figuring out who you are and what's next," Rawlins says. "And you find at the end of young adulthood, now you don't have time for the very people who helped you make all these decisions."

The time is poured, largely, into jobs and families. Not everyone gets married or has kids, of course, but even those who stay single are likely to see their friendships affected by others' couplings. "The largest drop-off in friends in the life course occurs when people get married," Rawlins says. "And that's kind of ironic, because at the [wedding], people invite both of their sets of friends, so it's kind of this last wonderful and dramatic gathering of both people's friends, but then it drops off."

In a set of interviews he did in 1994 with middle-aged Americans about their friendships, Rawlins wrote that "an almost tangible irony permeated these [adults'] discussions of close or 'real' friendship." They defined friendship as "being there" for one another, but reported that they rarely had time to spend with their most valued friends, whether because of circumstances, or the age-old problem of good intentions and bad follow-through: "Friends who lived within striking distance of each other found that ... scheduling opportunities to spend or share some time together was essential," Rawlins writes. "Several mentioned, however, that these occasions often were talked about more than they were accomplished."

As they move through life, people make and keep friends in different ways. Some are independent, make friends wherever they go, and may have more friendly acquaintances than deep friendships. Others are discerning, meaning they have a few best friends they stay close with over the years, but the deep investment means that the loss of one of those friends would be devastating. The most flexible are the acquisitive-people who stay in touch with old friends, but continue to make new ones as they move through the world.

Rawlins says that any new friends people might make in middle age are likely to be grafted onto other kinds of relationships-as with co-workers, or parents of their children's friends-because it's easier for time-strapped adults to make friends when they already have an excuse to spend time together. As a result, the "making friends" skill can atrophy. "[In a study we did,] we asked people to tell us the story of the last person they became friends with, how they transitioned from acquaintance to friend," Langan says. "It was interesting that people kind of struggled."

But if you plot busyness across the life course, it makes a parabola. The tasks that take up our time taper in old age. Once people retire and their kids have grown up, there seems to be more time for the shared-living kind of friendship again. People tend to reconnect with old friends whom they've lost touch with. And it seems more urgent to spend time with them-according to socio-emotional selectivity theory, toward the end of life, people begin prioritizing experiences that will make them happiest in the moment, including spending time with close friends and family.

And some people do manage to stay friends for life, or at least for a sizable chunk of life. But what predicts who will last through the maelstrom of middle age and be there for the silver age of friendship?

Whether people hold onto their old friends or grow apart seems to come down to dedication and communication. In Ledbetter's longitudinal study of best friends, the number of months that friends reported being close in 1983 predicted whether they were still close in 2002, suggesting that the more you've invested in a friendship already, the more likely you are to keep it going. Other research has found that people need to feel like they are getting as much out of the friendship as they are putting in, and that that equity can predict a friendship's continued success.

Hanging out with a set of lifelong best friends can be annoying, because the years of inside jokes and references often make their communication unintelligible to outsiders. But this sort of shared language is part of what makes friendships last. In the longitudinal study, the researchers were also able to predict friends' future closeness by how well they performed on a word-guessing game in 1983. (The game was similar to Taboo, in that one partner gave clues about a word without actually saying it, while the other guessed.)

"Such communication skill and mutual understanding may help friends successfully transition through life changes that threaten friendship stability," the study reads. Friends don't necessarily need to communicate often, or intricately, just similarly.

Of course, people can communicate with friends in more ways than ever, and media multiplexity theory suggests that the more platforms through which friends communicate-texting and emailing, sending each other funny Snapchats and links on Facebook, and seeing each other in person-the stronger their friendship is. "If we only have the Facebook tie, that's probably a friendship that's in greater jeopardy of not surviving into the future," Ledbetter says.

Though you would think we would all know better by now than to draw a hard line between online relationships and "real" relationships, Langan says her students still use "real" to mean "in-person."

There are four main levels of maintaining a relationship, and digital communication works better for some than for others. The first is just keeping a relationship alive at all, just to keep it in existence. Saying "Happy birthday" on Facebook, liking a friend's tweet-these are the life-support machines of friendship. They keep it breathing, but mechanically.

Next is keeping a relationship at a stable level of closeness. "I think you can do that online too," Langan says. "Because the platforms are broad enough in terms of being able to write a message, being able to send some support comments if necessary." It's sometimes possible to repair a relationship online too (another maintenance level), depending on how badly it was broken-getting back in touch with someone, or sending a heartfelt apology email.

"But then when you get to the next level, which is: Can I make it a satisfying relationship? That's I think where the line starts to break down," Langan says. "Because what happens often is people think of satisfying relationships as being more than an online presence."

Social media makes it possible to maintain more friendships, but more shallowly. And it can also keep relationships on life support that would (and maybe should) otherwise have died out.

"The fact that Tommy, who I knew when I was 5, is still on my Facebook feed is bizarre to me," Langan says. "I don't have any connection to Tommy's current life, and going back 25 years ago, I wouldn't. Tommy would be a memory to me. Like, I seriously have not seen Tommy in 35 years. Why would I care that Tommy's son just got accepted to Notre Dame? Yay for him! He's relatively a stranger to me. But in the current era of mediated relationships, those relationships never have to time out."

By middle age, people have likely accumulated many friends from different jobs, different cities, and different activities, who don't know one another at all. These friendships fall into three categories: active, dormant, and commemorative. Friendships are active if you are in touch regularly; you could call on them for emotional support and it wouldn't be weird; if you pretty much know what's going on with their lives at this moment. A dormant friendship has history; maybe you haven't spoken in a while, but you still think of that person as a friend. You'd be happy to hear from them, and if you were in their city, you'd definitely meet up.

A commemorative friend is not someone you expect to hear from, or see, maybe ever again. But they were important to you at an earlier time in your life, and you think of them fondly for that reason, and still consider them a friend.

Facebook makes things weird by keeping these friends continually in your peripheral vision. It violates what I'll call the camp-friend rule of commemorative friendships: No matter how close you were with your best friend from summer camp, it is always awkward to try to stay in touch when school starts again. Because your camp self is not your school self, and it dilutes the magic of the memory a little to try to attempt a pale imitation of what you had.

The same goes for friends you see only online. If you never see your friends in person, you're not really sharing experiences so much as just keeping each other updated on your separate lives. It becomes a relationship based on storytelling rather than shared living-not bad, just not the same.

"This is one thing I really want to tell you," Rawlins says. "Friendships are always susceptible to circumstances. If you think of all the things we have to do-we have to work, we have to take care of our kids, or our parents-friends choose to do things for each other, so we can put them off. They fall through the cracks."

After young adulthood, he says, the reasons that friends stop being friends are usually circumstantial-due to things outside of the relationship itself. One of the findings from Langan's "friendship rules" study was that "adults feel the need to be more polite in their friendships," she says. "We don't feel like, in adulthood, we can demand very much of our friends. It's unfair; they've got other stuff going on. So we stop expecting as much, which to me is kind of a sad thing, that we walk away from that." For the sake of being polite.

But the things that make friendship fragile also make it flexible. Rawlins's interviewees tended to think of their friendships as continuous, even if they went through long periods in which they were out of touch. This is a fairly sunny view-you wouldn't assume you were still on good terms with your parents if you hadn't heard from them in months. But the default assumption with friends is that you're still friends.

"That is how friendships continue, because people are living up to each other's expectations. And if we have relaxed expectations for each other, or we've even suspended expectations, there's a sense in which we realize that," Rawlins says. "A summer when you're 10, three months is one-thirtieth of your life. When you're 30, what is it? It feels like the blink of an eye."

Perhaps friends are more willing to forgive long lapses in communication because they're feeling life's velocity acutely too. It's sad, sure, that we stop relying on our friends as much when we grow up, but it allows for a different kind of relationship, based on a mutual understanding of each other's human limitations. It's not ideal, but it's real, as Rawlins might say. Friendship is a relationship with no strings attached except the ones you choose to tie, one that's just about being there, as best as you can.

# data[].attributes.attachment_link.title
How Friendships Change When You Become an Adult

# data[].attributes.attachment_link.description
"We need to catch up soon!" In the hierarchy of relationships, friendships are at the bottom. Romantic partners, parents, children-all these come first. This is true in life, and in science, where relationship research tends to focus on couples and families.

# data[].attributes.body
The 3 stages to living longer are very interesting. I learned something interesting in this video and since i am getting married in about 5 months i am really looking forward to living longer because i believe i have the right spouse!!
-Natalie Andronic

# data[].attributes.body
Definition of aging?
DISAGREE
This is a good example of opinion as it does not give us data and facts.  I do not agree that aging for some is getting old.  Grey hair does not mean a failure or is a disease.  In current research that was presented at IAGG in SF last summer, they feel that the person who will live to 120 years old have already been born.  Check out the Buck Institute.  Age does not cause Alzhemier's and regardless of genetics not everyone who has a genetic capacity are struck by this disease.  This video has some facts but it does not tell the full story.
Prof G
Thanks for sharing to teach each of us to really examine if there is any data behind something found on the web.

# data[].attributes.attachment_link.title
Why do our bodies age? - Monica Menesini

# data[].attributes.body
Hi Justina! What a great clip on ageism that ill have to check out. It is very interesting how this is becoming more and more common and to see how it is unfolded in real life. I work in a work force where I am the youngest and I am constantly called out for it!
- Jakari Simmons

# data[].attributes.body
Oh my goodness! That was scary and creepy all at the same time! I've never seen that film, but if that's how we perceive living forever would like, count me out! It looks like a great movie I might check out!
- Jakari Simmons

# data[].attributes.headline
I always thought about "The Intern" as nothing but a comedy with some good actors/actresses in it. I never thought about how it deals with agesim in the workplace. When I watched the trailer again I can definitely see those aspects. Interesting post!

# data[].attributes.subject
I always thought about "The Intern" as nothing but a comedy with some good actors/actresses in it. I never thought about how it deals with agesim in the workplace. When I watched the trailer again I can definitely see those aspects. Interesting post!

# data[].attributes.body
-Mia Leisten

# data[].attributes.body
I love what one of the "old" guys said. "When you start stopping, that's when you start getting old." What a great mentality!

David Cocker

# data[].attributes.body
Live Your Life And Forget Your Age.
I like this very much!
-Maryna Kavalenka

# data[].attributes.body
I found a fun website that talks about food that will "keep you young forever". It was just funny and interesting to read.
-Maryna Kavalenka

# data[].attributes.attachment_link.readable_text
Add these superfoods to your shopping list and you'll never feel old.

My father was a very old man when he died.

Not chronologically. He was only 52-almost 40 years younger than Tony Bennett is, and Tony continues to make records and tour the country performing to this day. But because he was morbidly obese and ate terribly, my father's old age came at a very young age.
Also, don't miss: 5 Easy Tips for Losing Weight In Your 40s.
Thanks to him, I've spent my life battling the forces of weight gain and aging-both for myself, and for those out there like me who wish to live lives filled with health, youth and the freedom that comes with them.Having a flat belly, a limber body, and a strong heart-not to mention the bright smile, firm skin and full hair that come with youth-will keep you free to pursue your dreams, or to start over in a new life, no matter what your age.

Each of the foods on this list is packed with one or more crucial age-reversing nutrients; not just the vitamins and minerals you're already aware of, but lesser-known (and utterly crucial) nutrients with names you might not have heard before, including healthy fats, hard-to-find antioxidants like elegiac acid, and youth-preserving compounds like nitric oxide.

And while I can't guarantee that the foods on this list will have you keeping up with Lady Gaga at age 90, they will certainly keep you looking and feeling vibrant for decades to come.

These slimy shellfish may not be proven to make you feel frisky, but science says they'll help ward off age-related muscle loss and protect your peepers. In addition to being a great source of muscle-protective protein, oysters are also a prime source of zinc. "This mineral helps convert vitamin A, a vital nutrient for eye health, into a usable form and transport it through blood, says Chip Goehring, Board President of the American Macular Degeneration Foundation (AMDF). "Recent studies also suggest that zinc can slow the progression of macular degeneration," he adds.

Okinawa, an island off mainland Japan, is home to more centenarians than anywhere else in the world. In fact, about 7 out of every 10,000 citizens live to blow out 100 birthday candles! What do they all have in common? They drink green tea every day-and it's likely one of the reasons they live so long, say experts. Researchers from the Norwich BioScience Institutes recently discovered that the polyphenols, a type of micronutrient in green tea, blocks something called VEGF, a signaling molecule in the body that triggers plaque buildup in the arteries that can lead to heart attacks, stroke and vascular disease. The life-extending brew may also ward off wrinkles by fighting inflammation and improving the skin's elasticity, keeping you young both inside and out.

If you couldn't already tell, we're big fans of the brew. In fact, we love it so much, we created the The 17-Day Green Tea Diet!

And speaking of anthocyanins, grapes are filled with them, too. In addition to their arthritis-fighting properties, they also help boost collagen in the retina, which protects the eyes against age-related macular degeneration.

Grey hair is beautiful when it's age-appropriate, but for folks who start to salt-and-pepper before they've finished life's main course, it can make them feel old before their time. One cause of early graying: a lack of copper. A study in the journal Biological Trace Elemental Research found prematurely graying individuals had significantly lower copper levels than a control group. Your body requires copper to produce pigment for your skin and hair, and shiitake mushrooms are one of the best dietary sources. Just a half cup provides 71 percent of your recommended daily intake of copper-and for only 40 calories!

Good news, cheddar lovers: Your favorite food may help you maintain your smile into late life. As we age, our smile tends to lose its shine. Though it's a hard fate to avoid, you can lessen the appearance of yellowing by keeping your mouth's pH levels in check. One study in the journal General Dentistry of people who didn't brush their teeth for 48 hours found snacking on cheddar cheese raised their mouths' pH to freshly brushed levels. Like cavities, discoloration is increased when you have an acidic environment in your mouth. Plus, compounds in the cheese that adhere to tooth enamel, like a white strip, help to fend off acid.

We know you've never had a problem with occasional engine failure, but if you've heard it happened to a friend - cough - the reason may be a low level of vitamin B12. A recent report from Harvard University highlighted a study that has linked low levels of B12 to erectile dysfunction. Although an exact causal link hasn't been determined, the B vitamin is used by every system in the body, particularly in cell metabolism and the production of blood - two essential factors in getting and keeping a quality erection. The boner-boosting bivalves are also high in L-arginine, an amino acid that converts to nitric oxide (NO), the Marvin Gaye of naturally occurring gasses: It causes blood vessels to relax and facilitate blood flow, helping you get and stay hard. In fact, NO is so powerful it's used medically to treat erectile dysfunction.

Puffy, dark circles under the eyes often become worse with each passing birthday-and being dehydrated make matters even worse. Salty foods, alcohol, hot weather and not drinking enough water can strip your body of moisture and create inflammation, which results in the Rocket Raccoon complexion. To replenish your body, cut up some citrus fruits (rind included), soak them in a pitcher of ice water and drink copiously. The citrus not only improves the water's flavor, but the rinds contain a powerful anti-inflammatory compound called de-limonene, which helps the liver flush toxins from the body, according to the World Health Organization.

Among those 65 and older, one out of five falls causes a serious injury like a broken bone, according to the Centers for Disease Control and Prevention. Though you've likely heard that sipping milk can help keep your bones strong and healthy, so can grapefruit juice, say Texas A&M University researchers. Studies show that the juice can improve bone density and slow the rate of bone loss. Juice a fresh grapefruit or eat one whole to reap the benefits.

Packed with bone-building calcium and skeletal-strengthening vitamin D, sardines are an oft-overlooked way to prevent osteoporosis and keep your body strong for life. Though they aren't exactly easy to stomach, they're one of the best sources of dairy-free calcium out there.
Look for varieties canned with the bones, which are soft and completely edible. Sorry, that's non-negotiable. The bones are where all the calcium comes from! So although it may seem hard to swallow, this is the variety you've got to consume if you want to reap the benefits. Toss the fish into a bed of leafy greens with tomato, cucumber, olives, feta and red wine vinegar. The combo makes for a tasty, Mediterranean-inspired dish.

Of all the nuts at the bar to go home with, which will prove best for your ticker? The walnut, researchers say. Ironically, or perhaps Mother Nature's way of giving us a hint, heart-shaped walnuts are brimming in antioxidants and omega-3 fatty acids that can significantly reduce the risk of heart disease-an umbrella term that refers to a number of deadly complications including heart attack and stroke. The most comprehensive review of clinical trials on nut consumption in relation to cardiovascular disease showed consuming just one ounce of walnuts five or more times a week-about a handful every day-can slash heart disease risk by nearly 40 percent.

More than five million Americans are estimated to have Alzheimer's disease-a number that's expected to nearly triple by 2050 if there are no significant medical breakthroughs, according to the Alzheimer's Association. There's a genetic basis to Alzheimer's, and if the disease runs in your family, it's especially important to make changes to your lifestyle to minimize your risk. Just adding more blueberries to your diet can help. Rich in antioxidants that give them their purple or deep red color, the berries protect cells from damage by changing the way neurons in the brain communicate and reducing the accumulation of protein clumps most frequently seen in Alzheimer's. In one study, older adults who supplemented with blueberry juice for just 12 weeks scored higher on memory tests than those receiving a placebo. Researchers have found the same thing in animals: Those fed blueberries experience significantly less brain cell loss when exposed to oxidative stress like that experienced by people suffering a neurodegenerative disease.

Living a high-stress life is a good recipe for aging. Aside from making you look older (hello, facial wrinkles), stress can make you feel older by zapping your energy levels. Chronic stress also increases the odds you'll develop an illness that can further speed the aging process. To counteract the stress-pumping cortisol, make yourself a cup of rooibos tea. The plant is rich in a flavonoid called Aspalathin that's been shown to reduce stress hormones that trigger hunger and fat storage and are linked to hypertension, metabolic syndrome, cardiovascular disease, insulin resistance and type 2 diabetes. The drink is also a good source of polyphenols that help protect the skin from premature aging.

Not only will swapping refined grains like white bread and pasta for whole grains help you trim down, giving you a more youthful figure, it will help keep your skin looking younger. Refined grains cause blood sugar to soar, which speeds up the formation of wrinkles. How? When you eat a refined carbohydrate, the body converts the sugar to glucose, a nutrient that damages collagen and other wrinkle-fighting protein.

It may be green and leafy, but spinach is no nutritional wallflower. This noted muscle builder is a rich source of plant-based omega-3s and folate, which help reduce the risk of heart disease, stroke, and osteoporosis. Bonus: Folate also increases blood flow to the nether regions, helping to protect you against age-related sexual issues. Aim for 1 cup fresh spinach or 1/2 cup cooked per day.

As we age, it's common for the skin to lose its natural golden glow. Thankfully, though, it's possible to regain your youthful luster without exposing your skin to UV rays. In fact, a diet rich in fruits and vegetables have been shown to create a healthier, and more attractive, golden glow than the sun, according to a Journal Evolution and Human Behaviour study. Researchers found that people who ate more portions of red and orange fruits and vegetables per day had a more sun-kissed complexion than those who didn't consume as much-the result of disease-fighting compounds called carotenoids that give those plants their colors. Few foods are as rich in the beauty stuff than sweet potatoes; just half a medium potato with the skin provides 200 percent of your daily recommended intake.

New research has found that the reason melanoma rates are so low in regions like the Mediterranean-where going topless on the beach is all part of the summertime fun-has to do with the Mediterranean diet. Foods high in antioxidants, particularly deeply colored fruits and vegetables, can help fight the oxidizing effect of UV rays. One study in the British Journal of Dermatology found participants who ate five tablespoons of tomato paste (a highly concentrated form of fresh tomatoes) daily showed 33 percent more protection against sunburn than a control group. And tomatoes work double duty to boost beauty: While the carotenoids and antioxidants help the body fight off oxidation that ages skin cells, they also boost pro-collagen-a molecule that gives skin its taut, youthful structure.

Various cultures claim yogurt as their own creation, but the 2,000-year-old food's health benefits are not disputed: Fermentation spawns hundreds of millions of probiotic organisms that serve as reinforcements to the battalions of beneficial bacteria in your body. That helps boost your immune system and provides protection against cancer. Not all yogurts are probiotic, though, so make sure the label says "live and active cultures." Aim for 1 cup of the calcium and protein-rich goop a day.

Most red, yellow, or orange vegetables and fruits are spiked with carotenoids-fat-soluble compounds that are associated with a reduction in a wide range of cancers, as well as reduced risk and severity of inflammatory conditions like rheumatoid arthritis-but none are as easy to prepare, or have as low a caloric density, as carrots. Aim for 1/2 cup a day.

If you or your partner have ever suffered from erectile dysfunction (a common side effect of aging), try adding this "natural Viagra" to your shopping list. The powerful antioxidant agents in pomegranate arils and juice can help reverse oxidative damage to the vascular system, according to researchers. This condition-what nutritionist Oz Garcia, Ph.D., calls "natural rusting"-plays a major role in the ability to achieve and maintain erections. Perhaps this is why some theologians believe the pomegranate-and not the apple-was the forbidden fruit in the Garden of Eden.

There aren't many things that are a better choice for on-the-go snacking than apples. One medium-size fruit is packed with four grams of soluble fiber-17 percent of the Daily Value (DV). "This is important for colon health and controlling blood sugar levels," says Elson Haas, M.D., author of Staying Healthy with Nutrition. Bonus: Red apples also contain a compound called quercetin that may keep arthritis and its associated pain at bay.

Fatty fish, like tuna, wild salmon, mackerel and sardines, contain high levels of omega-3 fatty acids, nutrients that have been proven to lower overall mortality risk by up to 27 percent and decrease the odds of dying from heart disease by about 35 percent. They also offer many anti-aging benefits. Eating a few servings of fatty fish each week have been shown to help guard against Alzheimer's disease and help reduce joint pain and stiffness by suppressing the production of enzymes that erode cartilage.

If going up and down the stairs isn't as easy as it once was, or your back is always a little bit achy, it's likely due to inflammation. In fact, most age-related diseases (like obesity, heart disease, and cancer) and discomforts are the result of inflammation. To ease your aches and pains, add tart cherries to your diet. They're a good source of anthocyanins, antioxidant compounds that block inflammation-causing enzymes.

Though there are many sources of bone-strengthening calcium, none are as easy for the body to absorb as vitamin-D fortified dairy products like milk, cheese and yogurt. (The vitamin D helps the body use the calcium). Aim for three servings a day to ward off osteoporosis and brittle bones later in life.

Getting older can be a pain-literally. As we age, the aches and pains in our joints become all the more common. But thankfully, eating this delicious fruit can help. Blackberries contain antioxidant compounds called anthocyanins that fight inflammation. They're also a good source of ellagic acid, another antioxidant that helps fight inflammation which exacerbates joint pain.

Thanks for their high vitamin K content, noshing on leafy vegetables like kale, collards and mustard greens can help ward slow cognitive decline, according to new research that reviewed the diets of nearly 1,000 participants. In fact, the researchers discovered that people who ate one to two servings of the greens daily had the cognitive ability of a person 11 years younger than those who consumed none.

# data[].attributes.attachment_link.title
25 Foods That'll Keep You Young Forever | Best Life

# data[].attributes.attachment_link.description
Add these superfoods to your shopping list and you'll never feel old. My father was a very old man when he died. Not chronologically. He was only 52-almost 40 years younger than Tony Bennett is, and Tony continues to make records and tour the country performing to this day.

# data[].attributes.body
This entire film can be watched on Amazon Prime, but the trailer gives a great idea of the ageism that older people face when attempting to return to the workforce, which they're having to do more and more often.
- Justina Sharp

# data[].attributes.body
Europe has an opposite problem to the United States in terms of it's aging population - they're not going to have anyone left to work! - Justina Sharp

# data[].attributes.attachment_link.readable_text
It might be a new year, but it sure isn't a new Europe yet.

Just over a week ago, InvestorPlace editor Jeff Reeves reminded us that, while we have plenty of other things to worry about, we shouldn't leave good ol' Europe off our radars. The eurozone might not have crumbled last year, but the country still faces debt woes, unrest and a recession.

Some numbers that prove the trouble is far from over: Negative growth forecasts and not-so-hot manufacturing data, to name a few.

In coming years, though, we aren't just facing some of the same old problems across the pond, but a new old problem. Namely, Europe is getting .... well, old.

I've touched on the issue of demographics a couple times in the last few weeks, first pointing to it as a potential growth factor for emerging market Mexico, then as a bad sign for the slowing growth market of China. For Europe, things don't look so good either; here, it's the icing on top of what's already one big mess.

The accompanying chart shows the dependency ratio (dependent vs. working population) of six countries in the European Union: France, Germany, Italy, Ireland, Greece and Spain. (Countries with the oldest populations are expected to be found within the EU.)

Click to Enlarge
As you can see, the proportion of the population that is young or elderly is on its way up for all countries - and has been, in some cases, for a couple decades.

While birth rates remain low in EU nations, the region's once-large working population has been aging. In Germany - often thought of as the EU's saving grace - the dependency ratio bottomed out in 1985 at 44. That means a whopping 66% of the country was working age at that point and now, a large chunk of that group is getting older and won't be working anymore.

As a result, Germany's dependency ratio (red) has increased by 20% since then. By 2025, it's expected to increase another 19% and, for the decade after that, it's expected to climb even more rapidly. By 2035, the proportion of Germany's population that is not working is expected to be nearly double what it was a half-century before.

Things are the worst in the near- and short-term for France (dark blue); its dependency ratio already is 60 and is expected to remain the highest until 2025, when Germany's problem picks up the pace. Spain (orange) and Italy (green) also have some steep slopes to keep an eye on down the road, with Spain projected to have the highest peak after several decades.

These are just estimates - and there are years for changes to be made. The Wall Street Journal recently noted, for example, that many countries already are working to ease the burden. Still, the European Commission projected that age-related spending would reach 25% of European Union gross domestic product by 2033, but instead reached it in 2010 because of the recession.

This a huge red flag considering that, as was the case with China, a problem for Europe is more than just a problem for Europe. Jeff pointed out the weakness for retailers, but it's broader than that - 10% of S&P companies' sales come from Europe, with plenty of them even more exposed. General Electric (NYSE: GE) gets better than a quarter of revenue from across the pond, while Coca-Cola (NYSE: KO) isn't far behind; McDonald's (NYSE: MCD) and Starbucks (NASDAQ: SBUX) are plenty exposed, too.

An aging population might be the last thing Europe - and the companies depending on the region - needs right now. But like it or not, that's what's coming.

Investors should take note.
As of this writing, Alyssa Oursler did not hold a position in any of the aforementioned securities.

# data[].attributes.attachment_link.title
Europe's Newest Problem: Getting Old | InvestorPlace

# data[].attributes.attachment_link.description
It might be a new year, but it sure isn't a new Europe yet. Just over a week ago, InvestorPlace editor Jeff Reeves reminded us that, while we have plenty of other things to worry about, we shouldn't leave good ol' Europe off our radars.

# data[].attributes.headline
10 Early Signs and Symptoms of Alzheighmers

# data[].attributes.subject
10 Early Signs and Symptoms of Alzheighmers

# data[].attributes.body
-Claire Schachtely

# data[].attributes.attachment_link.readable_text
Memory loss that disrupts daily life may be a symptom of Alzheimer's or other dementia. Alzheimer's is a brain disease that causes a slow decline in memory, thinking and reasoning skills. There are 10 warning signs and symptoms. If you notice any of them, don't ignore them. Schedule an appointment with your doctor.

Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What's a typical age-related change?
Making occasional errors when balancing a checkbook.

The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone

What's a typical age-related change?
Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

# data[].attributes.attachment_link.title
10 Early Signs and Symptoms of Alzheimer's

# data[].attributes.attachment_link.description
Memory loss that disrupts daily life may be a symptom of Alzheimer's or other dementia. Alzheimer's is a brain disease that causes a slow decline in memory, thinking and reasoning skills. There are 10 warning signs and symptoms. If you notice any of them, don't ignore them. Schedule an appointment with your doctor.

# data[].attributes.body
US National Library of Medicine
National Institutes of Health

-Claire Schachtely

# data[].attributes.attachment_link.readable_text
Physicians now commonly advise older adults to engage in mentally stimulating activity as a way of reducing their risk of dementia. Indeed, the recommendation is often followed by the acknowledgment that evidence of benefit is still lacking, but "it can't hurt." What could possibly be the problem with older adults spending their time doing crossword puzzles and anagrams, completing figural logic puzzles, or testing their reaction time on a computer? In certain respects, there is no problem. Patients will probably improve at the targeted skills, and may feel good-particularly if the activity is both challenging and successfully completed.

But can it hurt? Possibly. There are two ways that encouraging mental activity programs might do more harm than good. First, they may offer false hope. Second, individuals who do develop dementia might be blamed for their condition. When heavy smokers get lung cancer, they are sometimes seen as having contributed to their own fates. People with Alzheimer disease might similarly be viewed as having brought it on themselves through failure to exercise their brains.

What Does the Evidence Show?

Three types of evidence are cited to support the idea that mental exercise can improve one's chances of escaping Alzheimer disease.

Epidemiological studies

Having more years of education has been shown to be related to a lower prevalence of Alzheimer disease in cross-sectional, population-based studies [1] and to a lower incidence of Alzheimer disease in cohorts followed longitudinally [2]. Typically, the risk of Alzheimer disease is two to four times higher in those who have fewer years of education, as compared to those who have more years of education. Other epidemiological studies, albeit with less consistency, have suggested that those who engage in more leisure activities, especially activities that are mentally stimulating, have a lower prevalence and incidence of Alzheimer disease [ 3, 4]. Additionally, longitudinal studies have found that older adults without dementia who participate in more intellectually challenging daily activities show less decline over time on various tests of cognitive performance [5].

In epidemiological studies, people cannot be randomly assigned to different levels of education, or to different kinds and levels of participation in leisure activities. Consequently, researchers must try to identify confounders and take them into account analytically. However, uncertainties remain. Both education and leisure activities are imperfect measures of mental exercise. For instance, leisure activities represent a combination of influences. Not only is there mental activation, but there may also be broader health effects, including stress reduction and improved vascular health-both of which may contribute to reducing dementia risk [6]. It could also be that a third factor, such as intelligence, leads to greater levels of education (and more engagement in cognitively stimulating activities), and independently, to lower risk of dementia. Research in Scotland, for example, showed that IQ test scores at age 11 were predictive of future dementia risk [7].

Another problem with these epidemiological studies is that reverse causation could be involved-in other words, that incipient dementia could be causing reduced engagement in leisure activities, although some prospective studies have been particularly attentive to controlling for this possibility [8]. Clinical trials are needed to test the hypotheses that emerge from the best epidemiological research. Moreover, because the onset of Alzheimer disease can be hard to pinpoint, and early changes may occur years before the disease is diagnosed, conclusions must be based on large samples, followed over a long period of time.

Randomized clinical trials

Many studies support the possibility of enhancing memory and other cognitive performance, or of slowing cognitive decline in older adults without dementia [9]. The most effective programs teach mnemonic strategies, provide practice, and give supportive feedback. Mnemonic strategies include the organization of items into meaningful groups, the use of imagery, and the method of loci (visualizing items to be remembered in a sequence of specific, well-learned locations). Comprehensive programs can also include: encouraging memory aids (such as appointment books), teaching relaxation techniques, and providing instruction about memory changes in normal aging. However, improvements are not found in all studies. When improvements are found, they are often modest, may not be maintained over time, and do not generalize beyond the skill being trained. Often, the subjective gains rival the objective ones; for example, participants do tend to report fewer complaints about their memory.

These limitations are evident in one of the largest randomized controlled trials of cognitive training with older adults, a large, multisite study named ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) [10]. Participants were assigned to receive training in one of three cognitive skills: memory, reasoning, or speed of processing. Tests of cognitive abilities given immediately after training showed large improvements on the particular cognitive skill on which the individual had been trained, but no transfer to the other two cognitive domains. Additionally, for the control group that received no training, simply taking the test battery at pre-test led to improvement on the post-test. The effects of training were maintained over a two-year follow-up. However, the cognitive training program had no significant effect on measures of everyday functioning. Finally, for participants in ACTIVE or in other memory training programs, it remains unknown whether eventual rates of Alzheimer disease will be reduced.

Neurobiology studies

The third type of evidence suggesting that mental exercise may help to prevent Alzheimer disease comes from neurobiology studies that show greater brain complexity in those with higher levels of mental activity. Many such studies, done with animals, show greater neural complexity after having been exposed to an enriched environment that provides lots of stimulation, for example by including wheels, tunnels, toys, and gnawing sticks [11]. One human study with magnetic resonance spectroscopy showed changes in the hippocampus in elderly memory training participants compared to controls [12]. Another report found changes on positron emission tomography scanning following two weeks of a comprehensive memory program that included memory training, special diet, physical exercise, and stress reduction [13].

Mental Exercise and Cognitive Reserve

The concept of cognitive reserve is often used to explain why education and mental stimulation are beneficial. The term cognitive reserve is sometimes taken to refer directly to brain size or to synaptic density in the cortex. At other times, cognitive reserve is defined as the ability to compensate for acquired brain pathology. This definition encompasses coping skills as well as recruitment of other brain areas, with cognitive reserve thus accounting for individual differences in severity of cognitive dysfunction when there are pathological neural changes. People with a higher level of education have greater cognitive reserve. In some studies, education or occupation are even used as proxy measures of cognitive reserve, while others are beginning to measure neural substrates that correspond to reserve [14].

Taken together, the evidence is very suggestive that having greater cognitive reserve is related to a reduced risk of Alzheimer disease. But the evidence that mental exercise per se can increase cognitive reserve and stave off dementia is weaker. Epidemiological studies suggest that individual differences in cognitive reserve may actually be lifelong. In addition, people with greater cognitive reserve may choose mentally stimulating leisure activities and jobs, leading to a chicken-and-egg dilemma for the interpretation of the relationship between mentally stimulating activities in adulthood and dementia risk. Cognitive training has demonstrable effects on performance, on views of self, and on brain function-but the results are very specific to the skills that are trained, and it is as yet entirely unknown whether there is any effect on when or whether an individual develops Alzheimer disease. Further, the types of skills taught by practicing mental puzzles may be less helpful in everyday life than more prosaic "tricks," such as concentrating, or taking notes, or putting objects in the same place each time so that they won't be lost.

Conclusion

So far, we have little evidence that mental practice will help prevent the development of dementia. We have better evidence that good brain health is multiply determined, that brain development early in life matters, and that genetic influences are of great importance in accounting for individual differences in cognitive reserve and in explaining who develops Alzheimer disease and who does not. At least half of the explanation for individual differences in susceptibility to Alzheimer disease is genetic, although the genes involved have not yet been completely discovered [15]. The balance of the explanation lies in environmental influences and behavioral health practices, alone or in interaction with genetic factors.

For older adults, health practices that could influence the brain include sound nutrition, sufficient sleep, stress management, treatment of mood or anxiety disorders, good vascular health, physical exercise, and avoidance of head trauma. But there is no convincing evidence that memory practice and other cognitively stimulating activities are sufficient to prevent Alzheimer disease; it is not just a case of "use it or lose it."

References

Ott A, Breteler MM, van Harskamp F, Claus JJ, van der Cammen TJ, et al. Prevalence of Alzheimer's disease and vascular dementia: Association with education. The Rotterdam study. [PMC free article]

Scarmeas N, Levy G, Tang MX, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's disease. Neurology. 2001;57:2236-2242. [PMC free article]

Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, et al. Effects of cognitive training interventions with older adults: A randomized controlled trial. JAMA. 2002;288:2271-2281. [PMC free article]

Diamond M. Enriching heredity: The impact of the environment on the anatomy of the brain. London: Collier MacMillan; 1988. 191 pp.

Small G. The memory prescription. New York: Hyperion; 2004. 368 pp.

# data[].attributes.attachment_link.title
Educating the Brain to Avoid Dementia: Can Mental Exercise Prevent Alzheimer Disease?

# data[].attributes.attachment_link.description
Physicians now commonly advise older adults to engage in mentally stimulating activity as a way of reducing their risk of dementia. Indeed, the recommendation is often followed by the acknowledgment that evidence of benefit is still lacking, but "it can't hurt."

# data[].attributes.body
Some role models

Dorothea Bell

# data[].attributes.attachment_link.title
'The Secrets Of Successful Aging' on ViewPure

# data[].attributes.attachment_link.description
101-year-old Irving Olson is an active and accomplished photographer, a quick wit-and exactly the kind of older person researchers want to study to learn the secrets of aging well.\n\nProducer: Gisela Telis\nVideographer: Bob Lindberg \nEditor: Steve Bayless

# data[].attributes.body
Personal experiences change our point of view

Dorothea Bell

# data[].attributes.attachment_link.title
Millennials Show Us What ‘Old’ Looks Like | Disrupt Aging

# data[].attributes.body
Anyone who's played the game will know why this is here. The game is often interpreted as a metaphor for death. The ending is beautiful - even if the video doesn't interest you, the music is worth a listen!

- Meredith H

# data[].attributes.attachment_link.description
SPOILER ALERT: Do not watch this video if you haven't reached the ending to this game. If you have played the game and know what's about to happen... then: This is a let's play of "Journey" on the PS4, developed by Thatgamecompany and published by Sony Computer Entertainment!

# data[].attributes.body
I remember watching Death Becomes Her years ago! Pretty funny movie, but there are some silly assumptions about what living forever would look like. Their heads pop off and they keep talking!

- Meredith H

# data[].attributes.headline
Great movie that really hits home for me why you would not want to live forever

# data[].attributes.subject
Great movie that really hits home for me why you would not want to live forever

# data[].attributes.body
from Professor Gustafson