Invisible older persons arise

Reading Joseph Coughlin’s The Longevity Economy. Some very interesting ideas, very interesting. He sees older persons as consumers and in a good way. The growing numbers, especially since many are baby boomers, means more change for the society. Up to this point, marketing people and tech people have pretty much ignored older persons as a group. Sure the retirement industry and the pharmaceutical industry are marketing to them, but in many cases, that is to the dependency of older persons. Coughlin sees them more as vibrant people who are fully engaged in a society that tries to ignore them despite their $8 trillion in wealth.
Mostly, Coughlin places the blame on the rampant ageism in our society, an ageism developed over a century as we, in Carroll Estes’s term, medicalized old age. We made it a separate stage of life and one that did not include a complete membership in the main society anymore.
His approach meshes with the focus of the Department of Gerontology here at VCU. Ageism, we are realizing, is the most pervasive discriminatory and belittling theme of American society. Prejudice to no other group is tolerated as much as it is regarding older persons.
But Coughlin hits this prejudice in a place that just might be able to make some changes: American business. In his opinion, they need to get with the idea that much of their future business, in so many sectors, will come from older persons. And the solutions that older persons are coming up with may disrupt existing industries and companies. For example, we know people love their homes and want to stay in them. If we can bring the services of assisted living into the home at a reasonable price (and through Uber, Instacart and other new options we can), then what will be the affect on these huge residential institutions?
In the coming weeks, I’ll be sharing more insights from this work and similar ones. In the meantime, let’s try and think more creatively about some of these ‘old age problems’ we have made.

Three issues for advocacy

Three things you need to know about aging issues this week.

First, Senator Bernie Sanders, I-Vermont, has proposed raising the cap on the amount of earnings subject to Social Security Payroll tax withholding. “If we apply the Social Security payroll tax to income above $250,000, we could immediately bring in enough revenue to the Social Security trust fund to extend it for decades and also be able to increase benefits,” he says. Currently the cap is wage income of $118,500. And it does seem unfair that middle class and lower class folks have to pay on ALL of their income while upper class folks only pay on a small portion of their income. It makes a certain sense although those paying these higher payroll taxes on their wages would not, under the current system, recoup much from changed Social Security benefits. Thus Social Security would be of even less benefit to those in the upper middle class and above. Wouldn’t you think this politically powerful group would then work to change Social Security into a means-tested program or even eliminate it? Still….

Second, Administration for Community Living issued the ‘final rule’ for the Long-Term Care Ombudsman Programs in the Federal Register. They have been working on this for years (actually, since 1975 when the program was first authorized in the Older Americans Act – 40 years or so should be perfect don’t you think?). Each state operates its ombudsman program a little differently and there is a beauty in diversity, but some consistency of approach is also helpful. After years of working with the states and other interested partners, official guidance is now available on how to operate a Long-Term Care (LTC) Ombudsman program. With the quality of Long Term Support Services still needing improvement, the demand for good LTC ombudsman can only increase. These programs are always looking for volunteers.

Third, the Senate Committee on Aging released a report on increasing the use of generics in Medicare Part D. You would think this would be a no-brainer that both parties could get behind. The Medicare Part D drug plans could do more to promote the use of generics; maybe some incentives are in order. But Medicare beneficiaries need education too so that they understand the safety and cost savings of using generic drugs. We probably need some ads on the History Channel and the Hallmark channel to counter the constant drug company ads. Oh, and then there’s the prescribers. But that’s a whole other post.

That’s it. Pick an issue. Do some advocacy!

How to Ignore Older Americans: Obama’s State of the Union Speech

Per the President, there is not much need to address issues around aging in this country. Nevermind that we are an aging society. Our changing demographics is one of the most important national (and global by the way) trends. But no need to address any issues around that.

Social Security provides the basic foundation of retirement income for older Americans. For 60% of those over the age of 65, Social Security provides a majority of income, in many cases, over 80% of income. Per the Social Security Trustees the Social Security Retirement Trust Fund (OASI) may run out in 2034. I know that is 20 years down the road and the President was looking at the next 15 years. Still this is the time to address the potential shortfall. Of course, he doesn’t want to bring this issue up. It is not one that he and the Congress are likely to find any common ground to make recommendations.

Access to health care was addressed and we have seen progress here. Ten million more Americans have access to health care. But Medicare faces a trust fund that may run out in 2030. Now this is an improvement, largely due to an improving economy, and I do give the President credit for steering us from the Bush era recession. Still, Medicare’s health spending continues to increase (some from more older persons, but mostly from more expensive health care). Something needs to be done soon. Like Social Security, changes to Medicare will require a lead time so future beneficiaries can adjust their expectations.

The President did speak to one key issue regarding older Americans – retirement. He offered a number of proposals to substantially expand workers’ access to retirement savings, mostly through new savings options through employers. More workers would be automatically enrolled in retirement savings accounts thus leading to better preparation for retirement. Although this does not benefit retired older Americans, it’s a good step in helping workers prepare for retirement in this new economy.

So Social Security and Medicare remain the ‘elephant in the room’ that we won’t discuss. The GOP Congress has opened the issue by voting to restrict transfers from the Social Security Retirement Fund to the Social Security Disability Fund. (That fund may be out of funds next year.) It’s not a good start, and the liberal side opposes it, but a change that stimulates controversy may also, one hopes, lead to a discourse that will improve Social Security and Medicare supports for all older Americans.

Walk Your Way Around This Disease

A silent disease is stalking you. It waits, unbidden, unseen. You may think I’m talking about high blood pressure. Certainly a good answer, but I’m talking today about weak bones, the precursor to osteoporosis. For women over 50, 1 out of 2 will have an osteoporosis-related fracture before they die; for men it’s one in 5.

We have about 10 million Americans who we know have osteoporosis, diagnosed. But there’s 3-4 times as many people who have lost some bone mass, who have weak bones and are at risk for the disease. And if you are over 65 and you have a hip bone fracture, chances are 1 in 5 that you’ll die within a year. What we need is a way to strengthen bones.

So what’s to be done, my Aunt May asks. She’s 80 and doesn’t go out all that much and her sister died of a hip fracture and subsequent hospitalization. The answer, unsurprisingly, is walking. Brisk walking, heck, any walking, will help strengthen your bones. That’s what I tell her. Jogging works, jumping rope works (Aunt May gives me a look when I suggest this to her. Proper ladies just don’t jump rope.) But a recent study done by the Indiana School of Medicine suggests that brisk walking is the best option of all.

Why does Aunt May love this idea? First, it’s cheap. She already has a pair of walking shoes. She calls them sneakers. So there’s no upfront costs to start walking. Second, she knows how to do it so there’s no training involved, no Tai Chi moves to learn, no yoga positions to master. Her main problem with it is that she has to get up from a very comfortable wingback chair and go outside and do it. But she’s finally agreed to walk to the end of the block and back.

I tell her she’ll feel better. The fresh air will do her good. Her neighborhood is safe. (Some aren’t and then to walk, a person needs to find a mall or a large store and walk the aisles.) She’ll meet her neighbors — not a convincing argument for my reclusive aunt. I try to convince her to visualize her bones getting denser and stronger. Finally I suggest we walk together a couple mornings a week. That gets her. I’m her favorite nephew, she says. Note: I’m her only nephew. She loves that joke.) Problem is I live 600 miles away, but I suggest that I call her in the morning of a walk day and we’ll head out at the same time and talk after we’ve finished our respective walks. She’s good with that. We’ll see how it goes. Good for us both to get out there for a walk every day. Strengthen those bones.

Teaching Gerontology and Aging Studies to 163,000

I recently watched this video of Dr. Sebastian Thrun who gave the keynote speech ( at the Sloan Consortium annual meeting. Dr. Thrun is an Artificial Intelligence researcher and educator at Stanford University. He describes his experiences changing an academic course in Artificial Intelligence from a classroom experience for 200 students to an online course. More than 163,000 people took the course. From this experience he went on to help found Udacity ( Udacity is an educational organization with the goal of bringing knowledge to more and more people.

So now I’m wondering how I can do the same for Gerontology and Aging Studies. There is such a dearth of knowledge about how best to integrate growing numbers of older people into the society, how to support people in 20-30 years of retirement, and, perhaps most importantly, how to care for those among them who need care. Most of us have had little training in caregiving. Even most health care providers know little about how aging interacts with  disease let alone how best to work with elders to keep them healthy, wealthy, and to tap their wisdom. Lots of work to do, and if anyone has ideas on how we can reach out to 160,000 in one course, please let me know.


40 Issues for an Aging Society: A Guide for Students is Live!

</strong>Just in time for the fall semester, we have <strong>40 Issues for an Aging Society: A Guide for Students</strong>. This work introduces key issues affecting older persons and important challenges for the society. It’s available as a PDF (best bet is to use the link below and save it and then open it). It’s also available in the iBookstore for the iPad. The iPad version has more interactivity and includes short videos introducing many of the topics. Best news of all – both versions are FREE. Check it out. It’s the closest thing you’ll get to a free lunch today.

We give a little background on each of the 40 topics, and discuss the implications for the society. For most issues affecting older persons there’s a lot of information out there and we offer some websites to explore (links should be good for a few months – if they don’t work, try to Google the site). We also suggest some places for more research from academic sources where the student can obtain more scholarly information about the issue. Gerontology, as everything today, is about entrepreneurship and we present some brief thoughts on which business sectors may prove opportune for a career. The final section offers thoughts on policy and political controversies that may emerge around each of the issues.

The goal of the work is to help many people learn a bit more about older persons so that they can better work with elders to build a better society and  to assist those who need it. Enjoy. Let me know your thoughts.

PDF: 40 issues for an Aging Society: A Guide for Students

Aging and Gaming

Hi, my name is Jim and I’m a computer gaming addict. I’ve just spent hours playing the new Civilization game, Civilization V: Gods and Kings. It’s a wide sweep strategy game in which you start with a small city in 4000 B.C. and build a dominant civilization through the modern era. It’s one of those ‘just one more turn’ type of games where there is always just one more exciting task to complete, battle to fight, technology to discover.

A long history of this kind of play for me. I’ve been playing strategy games since I was a kid, first board wargames, then, since the early 1990s, strategy games on the computer  when the first Civilization game and others came out. Here I am in my 60s still at it. From a Gerontology point of view, I would say that shows Atchley’s Continuity Theory at work if I ever saw it. I expect I’ll want an internet connection and a computer forever.

This blog seemed like it would be a bit risky confessional. What 60 year old is still playing computer or video games? Turns out I’m not such a weirdo after all. One quarter, 25% of gamers, are over the age of 50. The average age of a gamer is 35 which means, given the number of teenage gamers, there is a good number of older gamers driving up that average. I suspect that there are quite a few like me who are ‘early onset’ gamers who have been doing it for their whole life. And there’s a whole bunch of ‘late onset’ gamers who are discovering the joy of gaming — a good portion of the Me generation is turning into the Wii generation. I think the number of older gamers will grow and here’s why.

Older people have more time, and gaming takes hours and hours. That’s why you don’t see teenagers for days (who’s complaining?). Older people who are working less and not dealing with their children’s crises all day have more time for gaming. Second, games cost money — around $50 for most new ones, but it’s increasing and should be at $75 soon. When I was young I had to save up that $ for a new game. Now, with a much improved bank balance and not much more than one click I can buy that game and download it. Third, the mental, and, in the case of Wii type games, physical challenge, of gaming is just about right for many older people. Keeps the mind sharp in Civ V to decide whether to attack Alexander the Great’s Greek civilization or build the Stonehenge Wonder.

So I’ll keep at it. Hope you are gaming or doing something stimulating and exciting. If you do game a lot, let me know. Otherwise, I’ll see you on the gaming discussion boards. Now I need to get back to building that Stonehenge Wonder.

Sid Meier’s Civilization V: Gods & Kings is available for PC  via download from Steam and in stores.


Hurray! The Affordable Care Act was upheld.

The Affordable Care Act was upheld in all but one of its provisions. I say Hurray! It will be hard to repeal and I hope gives a boost to those who advocate for universal health care. That said, what does it mean for older persons?

First, the law makes certain prevention activities free for older persons on Medicare, such as cancer screenings and cholesterol checks and the initiation of a personalized prevention assessment and plan. This means we can catch diseases sooner for older people, treat them sooner, and help older persons lead healthier lives.

Second, the Affordable Care Act begins to close the gap in prescription drug coverage known as the “donut hole.”

Third, insurance companies cannot deny coverage for pre-existing conditions. Aside from the relief this brings to parents and grandparents of those with health conditions, this is also helpful for older persons who continue to work past 65 years of age. This is especially important in these times when older workers are seeking jobs to cover retirement fund losses. Another benefit for children and grandchildren of older persons is the clause that allows dependents under age 26 to remain on their parents’ insurance plan. What a relief to know that your grandchild has some health insurance!

Other provisions, such as the stabilization of payments to Medicare Advantage plans should help reduce the draw on Medicare funds. The Medicare Advisory Board can begin to take a look at the Medicare program and make some rational recommendations (as opposed to the Ryan budget guttings) on where money can be saved. The Medicaid provisions on Money Follows the Person were not struck down, in my understanding, so I hope the rebalancing of state long-term care funds towards a greater emphasis on home and community-based services will continue.  Finally, a number of provisions encourage pilot programs and demonstrations about how to better integrate medical care for older persons.  With the increasing number of transitions of care between providers and settings, the older person’s care can get easily mucked up. This is an urgent need and the Affordable Care Act may help find a solution.

So, again Hurray! And Hurray! And Hurray! once more. A giant leap forward for the U.S.

Is aging the same as disability? Consolidation of agencies for aging persons and persons with disabilities

We’re consolidating agencies for aging and disability services. Is this a good idea? A little background: the Administration on Aging is now part of the Administration for Community Living. The new administration agency includes the AoA, the Administration on Developmental Disabilities and the Office on Disability. Secretary of Health and Human Services, Kathleen Sibelius, offered this: “”For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new Administration for Community Living will be to help people with disabilities and older Americans live productive, satisfying lives.”In Virginia, our Department for the Aging is merging with our Department of Rehabilitative Services and some elements of the Department of Social Services to form the Department for Aging and Rehabilitative Services.

As a former Director for Programs at VDA and an Associate Professor in Gerontology here at VCU, I have mixed reactions. On the one hand, we continue to struggle against the idea that aging means disability. Look around! The overwhelming majority of our aging population is not disabled. Older persons are our political and management leaders, our artistic mentors, our rank and file workers, our professionals, our pillars of caregiving. Furthermore, we want to encourage optimal aging – a time of life of physical and mental health that allows for vibrant, continuing contributions to the society. So the answer is a resounding ‘NO’. Aging does not equal disability.

Yet, chronic disease and disability often come in a time of advanced age. It’s a time when the metabolism of age can no longer keep the disease at bay. With enough disease comes disability. Help is needed to continue to age in place in the community or in a facility. Health and social services are needed. Older persons in this situation need similar services to those needed by persons with disabilities. So the answer to the question “Are services for chronically ill older persons very similar as those needed by persons with disabilities?” The answer is a definite ‘YES’. This consolidation of approach may open doors to collaboration and efficient use of resources to allow more persons, of any age, to receive needed services.

Back to my mixed reaction. As an older person with some chronic disease, I don’t consider myself a person with a disability and I don’t need any services. The new agencies would have little meaning for me. But I remember the dilemma I had while working at Southeastern Senior Services when a 59 year old person with a disability called and asked for a ride to the doctor’s. Because the Older Americans Act serves only persons over the age of 60, we could not help him. It seemed ridiculous that for the want of a few months of age we could not serve a man in need. My hopes for the consolidation are that each person in need of services will be able to access them regardless of age. And I would also expect many of those giving the services will be over the age of 60.

Note to Candidates: Easy Fix to Social Security

If only it was a matter of rational thinking, we could fix Social Security easily. We all want Social Security to continue. Well, most of us do.

Political party dogma gets in the way. Even Republican primary voters oppose cuts to Social Security and Medicare as a way to control the budget ( Eric Cantor, the House Republican leader, can’t explain why the candidates and leaders of the party are so out of tune with the majority of Republican voters (

Ron Paul, putting on his Herbert Hoover hat, thinks the program should never have been put in place and should be eliminated. Rick Santorum wants immediate cuts. Even President Obama is on a dangerous path by temporarily foregoing Social Security payroll contributions to stimulate individual spending.

Once the Republican nominee is established we’ll see some attention to Social Security in the election of 2012. My bet is that both parties will call for reform and neither will provide details.

So let’s at least set the record straight. There are a series of steps that, taken together, would go a long way to solve the long-term solvency issues for Social Security. These would be easy to accomplish and pretty painless.

1. Raise the amount of the Social Security contribution from 12.4% to 13.4%. A 1% increase for the typical worker would mean $4 more per week from worker and employer.

2. Gradually raise the full retirement age to 70. This would be phased in with workers born after 1964. Early retirement at 62 would still be allowed, with benefits reduced more severely than at present.

3. Increase the wage limit subject to Social Security from its current level, plus adjust this upwards annually based on the general rise in wages.

4. Expand the range of years considered when computing Social Security benefits. The effect would be to slightly reduce benefits.

5. The Disability component of Social Security has the most dire solvency problems. A number of reforms have been proposed, but the program should more fully focus on the goal of getting disability claimants and recipients back to work.

Do you want to address the Social Security issues? Here’s a fun website from the American Association of Actuaries to help you play the game:

We can solve the Social Security solvency issue with very modest changes. I doubt whether any variation of this path will be taken. The rhetoric will be more about values; we will debate how much government should assist older persons in their retirement. In 1935, our society said yes. What will be the answer in the coming years?