In her book “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life,” Louise Aronson, a geriatrician and a professor of medicine at the University of California, San Francisco, examines Americans’ fraught relationship to the aging process, from our enthusiasm for supposed anti-aging cures to our troubled health-care system and the persistence of ageism among employers. Too often, Aronson argues, people over the age of sixty-five are viewed as a single group—one whose needs and desires and humanity are given short shrift, particularly within a medical system that is ostensibly centered around the needs of the elderly.
Questions about the place of the elderly in American society have become especially pertinent in our current political moment. On Inauguration Day, 2021, a septuagenarian—Donald Trump, Joe Biden, or Bernie Sanders—will almost certainly be sworn into the office of the Presidency.
To discuss the perceived and real effects of aging, I recently spoke by phone with Aronson. During our conversation, which has been edited for length and clarity, we discussed why so many Americans over sixty-five are entering the workforce, whether the Presidency is the wrong job for someone over seventy, and why we tend to view older Americans as a single, distinct group.
Your book is very sympathetic to the realities of aging, as it should be. But what have you made of the fact that our next President is likely going to be seventy-four, seventy-eight, or seventy-nine when he is sworn into office? And how should we think about that as citizens?
What a lovely question. I guess I would see it as the most visible part of a national trend, which is that, for the last several years, by far the fastest-growing segments of the American workforce, and this comes from the Bureau of Labor Statistics, have been people age sixty-five and up. That includes two groups, and, actually, they parse it a bit, even though I complain in my book that we often don’t parse it. One is ages sixty-five to seventy-four, and one is ages seventy-five and up. The relative increases are four to five times higher than the increases in workforce gains in people in their thirties, forties, and fifties. So it’s really this new phenomenon, which has come after a slight lag.
When we set Social Security and retirement in our sixties, the average age of death was about sixty-two. And now the average age at death is seventy-nine, with huge variation according to gender and race. The leading [Presidential] candidates are all white, which gives them a mortality advantage, as does the fact that they’re all educated. So people their age very routinely live into their eighties. And, actually, a man at age seventy-five has on average eleven to eleven and a half years of additional life, most likely, the vast majority of which are healthy.
To take a step back from the Presidency, how do you view this workplace trend?
I think it’s a good trend for a variety of reasons. One is that society simultaneously is quite ageist about, say, “Isn’t it time to retire?,” or “That person’s over the hill,” or not hiring, or all those hiring pull-down menus where they might not include a variety of birthdays of people who could be perfectly competent for the job. I speak to a lot of people in companies where they’re, like, “But maybe they won’t last very long.” And they don’t consider the youth equivalent, which is that most younger people now switch jobs really often.
I’m digressing, but we can’t have a society that simultaneously discriminates on the basis of age and doesn’t hire or phases people out on the basis of age, and then complains about older people as a burden. You can’t have it both ways. You can’t say, “Oh, you’re not fiscally contributing,” and then, “We’re not going to let you fiscally contribute.” That is short of productive—economic and societal hypocrisy, basically.
One of the reasons I called the book “Elderhood” was because I really wanted to emphasize the fact that modern old age—the old age that evolved over the twentieth century, when we moved from an average lifespan of forty-nine to seventy-nine—is colossal, that elderhood has become like childhood and adulthood. It is a phase of life that lasts decades and includes a huge diversity of people and functional abilities. So we easily accept that a neonate, infant, and toddler are children, just as teen-agers are children. And those are pretty different-looking animals. Similarly, we have a twenty-year-old in our household, and we’re in our mid-to-later fifties, and those are pretty different, too. You could argue a little less so, but, the further along I get, the more I’m aware of the differences.
So how old are you? I know it’s a rude question, but, in this case—
No, no. Fifty-six.
I’m thirty-seven, just so we’re all honest and on the record.
I did search you, to get the sense of who I was talking to. I find I actually sometimes do get different questions depending on how old the person is.
So, while we all talk about our twenties or thirties as being so different from each other, you’re saying the difference between sixties and seventies, or seventies and eighties, and eighties and nineties, are actually huge?
Exactly. A fascinating thing has happened in geriatrics just in the last decade, which is that we now sometimes take care of two generations. I’ve had patients in their hundreds where their kids are in their seventies or eighties. And I routinely have people in their eighties and nineties who have kids in their sixties or seventies. So it’s really becoming multi-generational, because of the vast numbers of people living so many more years, and we need to acknowledge that those people are different. Different decades, no matter how old or young you are, are all very different, and that’s part of life’s excitement. We keep moving forward.
Do you have some broad way of thinking about different ages or stages of elderhood?
I think one of the problems with old age is that we all begin young. So it all seems very old and foreign to us. There have been some subcategories. A psychologist, Bernice Neugarten, named the stages Young Old, Old, and Old Old, and that was roughly sixty-five to seventy-four, seventy-five to eighty-four, and then eighty-five up. We do have increasing numbers of centenarians, so that is a broad range. But one could argue that the sixty-five-to-seventy-four range, except for the most disadvantaged—and there are all these structural things that contribute to that, like stress and poverty—is a blurred line in medicine. Are you more like an adult? Are you more like an elder? And either can be true. And, as you get into seventies-to-eighties, there still is a range, but there are more people who are going to resemble the older people.
We got sidetracked, but can you say more about why you think it is good for older people to stay in the workforce?
One is that the economic burden goes down. The longer you work, the less likely you are to be the so-called burden. But perhaps more important is that health and quality of life go up when people keep working. I should also qualify that to use the word “work” broadly. We tend not to count traditionally female things, like caregiving, although we’re seeing increasing grandparents participating. But there are many ways in which you can contribute to your family or your community. People who have lots of wealth may be doing volunteer jobs—that’s still work. But we know unequivocally that people who keep working maintain higher levels of physical function and cognitive function. They just tend to be healthier. It probably relates to this growing database on purpose and health, and optimism and health. If you’re doing something that feels like it has purpose or meaning—although these are things we actually often intentionally strip old people of—then you have a reason to get up.
You seem bullish on this idea that people continuing in the workforce or returning to the workforce can be really helpful for their health and happiness. After the financial crisis, a lot of people were forced back into the workforce, and some of the jobs were really hard physically. So how dependent is this question on the type of jobs older people are doing, and their own financial situations?
I think all those things are relevant. I think there are certain sorts of jobs you can keep doing, absent dementia, obviously, and other ones that definitely become harder. We got retirement in the twentieth century because people noticed that on factory lines men who were about forty or forty-five were slower. Now we are talking about people running for President who are almost twice that age. I like to think of this phase in human history as the evolution of a new life stage. It has always been there, but there haven’t been enough people, and the social situations weren’t such that it was named. The best analogue I can think of is adolescence, which was not a life phase until more or less a hundred and fifty years ago. This is a new phase, too, and it may be that some people love their jobs and are physically or cognitively able to keep doing them. That tends to be a little class-related, too, because you are more likely to get to do what you want if you are more educated and have more opportunities.
So, certain things, like hard physical labor? No. But, travelling the country, I routinely am picked up by people in their seventies and sometimes eighties doing their next jobs. Sometimes they have taken a pay cut, but they get to supplement their income—they have something to do every day. A lot of them say, “I chose to do this because I love talking to people and I meet all these interesting people all day long,” which is part of why I am a doctor. You get to meet other sorts of people.
But, if retirement is going away, with fewer pensions, then we have to acknowledge for a certain number of people, and certainly for people who have done really hard physical labor, the new job may have to be different because people’s bodies change. Are there other ways to keep people engaged? And we haven’t really addressed that explicitly. Right now a lot of people do piecemeal work, and sometimes that is enough to add to what they are making already if they have some pension or Social Security. Richer people always have more options.
How do all of these perhaps positive things factor into something like having an older person hold the job of the Presidency?
So, that is clearly a high-risk occupation, as many are. On the other hand, my understanding of the campaign trail is that that’s pretty brutal, too, right? It’s sleep disturbance and travel and performing, and so it might be that that serves as a physical, cognitive stress test, in the cardiac sense.
Does it concern me there might be some accelerated aging with the demands of the Presidency? Absolutely. Do I think that means we can’t entertain it? No, I don’t think the fact that there may well be some stress-related accelerated aging from this job necessarily means that anybody in their seventies should be ruled out as a Presidential candidate. And, I guess, if we’re being really scientific about it, the fact is, we don’t know yet. And there haven’t been enough Presidents to do a study, and we’ve never had ones in this age group, really.
I don’t think our current occupant is a good example of really anything, as far as that goes.
I so profoundly agree. Yes.
Putting Trump aside, when I look at Biden or Sanders, I occasionally think they seem old and somewhat fragile. And I’m not a doctor. I’m explaining how I feel, and how I think a lot of voters feel. Voters don’t want to discriminate against older people. I certainly don’t think that Biden or Sanders is incapable of being a good President or doing the job, but it does make me anxious, and I’m curious what you think of that response.
I think lots of us feel that way. I feel that way sometimes, and then I catch myself, because it’s a normal human reaction that’s also been really pushed onto us. So, yes, being older increases your risk for all sorts of things. Yes, being older makes you appear frail, but that’s also because we have this standard for human beings in which the adult is superior and everything else is a variation. This is actually explicit in medical curricula, where young people, old people, and brown people, i.e., most of this planet’s inhabitants, are considered so-called special populations. So we’re accustomed to having this norm. You lose muscle mass starting in your thirties. Things change. So, yeah, so they are different, and they looked a little more fragile, but, again, it’s not really a sprint. And do we really know scientifically that that makes a difference? No, but we do know plenty of people are doing all kinds of other stressful work into their eighties, and also that being President should be a team sport. It’s about the ability to use good judgment to surround yourself with really good, competent people and manage them.
That’s very quaint.
But I agree. Sometimes you look and you think, Ah, is this a mistake? And then, with Sanders, there’s the issue of the heart attack, which I think is a big deal.
Why is it a big deal?
If you are a healthy seventy-five-year-old, your life expectancy is higher and your chances of adverse health events are lower than those of a person in their seventies who’s recently had a heart attack. Sanders also has not released all of his records. We know he’s got two stents, but which vessels were blocked makes a difference. There are blood vessels where, if it goes badly, you can die pretty quickly or be gravely impaired. And there are other ones where you’ve got more time and we can intervene. Now, he did make it, but we shouldn’t have to guess. There is this trend led by our famous President about not releasing your records, and it’s a shame in so many ways.
Side by side with this Presidential race is this coronavirus outbreak that is going to disproportionately impact older people. Do you think this will have a huge psychological impact on older Americans, or are they already consumed with health concerns in ways that younger people might not grasp?
I think we don’t yet know just how much it’s going to wipe out certain segments of the population that do seem to be higher-risk. So I guess one of the things for younger people to remember is that, with your every decision, action, priority, you are creating your own future. Because, barring an early death, you will become old, even though it seems inconceivable to you now. So we need to be thinking about this not in terms of, like, Oh, it’s wiping out these old people who didn’t matter anyway, but it might be fundamentally changing who and what we are as a species, too.
So, yeah, you may not get sick, but are you washing your hands a lot, because maybe you love your parents or your grandparents or your boss or any of the people over fifty-five where the risk seems to be increasing? Think about it as important for all of us.
Do you ever get nervous watching these aging candidates go around shaking everyone’s hands?
Well, that’s interesting. I guess I should be. We have been doing the elbow-bump here, and I think it might behoove them and maybe the entire country for them to start doing something like that.
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How Old Is Too Old to Work? - The New Yorker
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