”How many years of beauty do I have left?” she asks me.
How many more do you want?
Here. Here is 34. Here is 50.
When you are 80 years old and your beauty rises in ways your cells cannot even imagine now and your wild bones grow luminous and ripe, having carried the weight of a passionate life.
When your hair is aflame with winter and you have decades of learning and leaving and loving sewn into the corners of your eyes and your children come home to find their own history in your face.
When you know what it feels like to fail ferociously and have gained the capacity to rise and rise and rise again.
When you can make your tea on a quiet and ridiculously lonely afternoon and still have a song in your heart Queen owl wings beating beneath the cotton of your sweater.
Because your beauty began there beneath the sweater and the skin, remember?
This is when I will take you into my arms and coo YOU BRAVE AND GLORIOUS THING you’ve come so far.
Navigating Aging focuses on medical issues and advice associated with aging and end-of-life care, helping America’s 45 million seniors and their families navigate the health care system.
To contact Judith Graham with a question or comment, click here.
Society gives short shrift to older age. This distinct phase of life doesn’t get the same attention that’s devoted to childhood. And the special characteristics of people in their 60s, 70s, 80s and beyond are poorly understood.
Medicine reflects this narrow-mindedness. In medical school, physicians learn that people in the prime of life are “normal” and scant time is spent studying aging. In practice, doctors too often fail to appreciate older adults’ unique needs or to tailor treatments appropriately.
Imagine a better way. Older adults would be seen as “different than,” not “less than.” The phases of later life would be mapped and expertise in aging would be valued, not discounted.
With the growth of the elder population, it’s time for this to happen, argues Dr. Louise Aronson, a geriatrician and professor of medicine at the University of California-San Francisco, in her new book, “Elderhood.”
It’s an in-depth, unusually frank exploration of biases that distort society’s view of old age and that shape dysfunctional health policies and medical practices.
In an interview, edited for clarity and length, Aronson elaborated on these themes
Q: How do you define ”elderhood”?
Elderhood is the third major phase of life, which follows childhood and adulthood and lasts for 20 to 40 years, depending on how long we live.
Medicine pretends that this part of life isn’t really different from young adulthood or middle age. But it is. And that needs a lot more recognition than it currently gets.
Q: Does elderhood have distinct stages?
It’s not like the stages of child development — being a baby, a toddler, school-age, a teenager — which occur in a predictable sequence at about the same age for almost everybody.
People age differently — in different ways and at different rates. Sometimes people skip stages. Or they move from an earlier stage to a later stage but then move back again.
Let’s say someone in their 70s with cancer gets really aggressive treatment for a year. Before, this person was vital and robust. Now, he’s gaunt and frail. But say the treatment works and this man starts eating healthily, exercising and getting lots of help from a supportive social network. In another year, he may feel and look much better, as if time had rolled backwards.
Q: What might the stages of elderhood look like for a healthy older person?
In their 60s and 70s, people’s joints may start to give them trouble. Their skin changes. Their hearing and eyesight deteriorate. They begin to lose muscle mass. Your brain still works, but your processing speed is slower.
In your 80s and above, you start to develop more stiffness. You’re more likely to fall or have trouble with continence or sleeping or cognition — the so-called geriatric syndromes. You begin to change how you do what you do to compensate.
Because bodies alter with aging, your response to treatment changes. Take a common disease like diabetes. The risks of tight blood sugar control become higher and the benefits become lower as people move into this “old old” stage. But many doctors aren’t aware of the evidence or don’t follow it.
Q: You’ve launched an elderhood clinic at UCSF. What do you do there?
I see anyone over age 60 in every stage of health. Last week, my youngest patient was 62 and my oldest was 102.
I’ve been focusing on what I call the five P’s. First, the whole person — not the disease — is my foremost concern.
Prevention comes next. Evidence shows that you can increase the strength and decrease the frailty of people through age 100. The more unfit you are, the greater the benefits from even a small amount of exercise. And yet, doctors don’t routinely prescribe exercise. I do that.
It’s really clear that purpose, the third P, makes a huge difference in health and wellness. So, I ask people, “What are your goals and values? What makes you happy? What is it you are doing that you like best or you wish you were doing that you’re not doing anymore?” And then I try to help them make that happen.
Many people haven’t established priorities, the fourth P. Recently, I saw a man in his 70s who’s had HIV/AIDS for a long time and who assumed he would die decades ago. He had never planned for growing older or done advance care planning. It terrified him. But now he’s thinking about what it means to be an old man and what his priorities are, something he’s finally willing to let me help him with.
Perspective is the fifth P. When I work on this with people, I ask, “Let’s figure out a way for you to keep doing the things that are important to you. Do you need new skills? Do you need to change your environment? Do you need to do a bit of both?”
Perspective is about how people see themselves in older age. Are you willing to adapt and compensate for some of the ways you’ve changed? This isn’t easy by any means, but I think most people can get there if we give them the right support.
Dr. Louise Aronson(ANNA KUPERBERG PHOTOGRAPHY)
Q: You’re very forthright in the book about ageism in medicine. How common is that?
Do you know the famous anecdote about the 97-year-old man with the painful left knee? He goes to a doctor who takes a history and does an exam. There’s no sign of trauma, and the doctor says, “Hey, the knee is 97 years old. What do you expect?” And the patient says, “But my right knee is 97 and it doesn’t hurt a bit.”
That’s ageism: dismissing an older person’s concerns simply because the person is old. It happens all the time.
On the research side, traditionally, older adults have been excluded from clinical trials, although that’s changing. In medical education, only a tiny part of the curriculum is devoted to older adults, although in hospitals and outpatient clinics they account for a very significant share of patients.
The consequence is that most physicians have little or no specific training in the anatomy, physiology, pharmacology and special conditions and circumstances of old age — though we know that old people are the ones most likely to be harmed by hospital care and medications.
Q: What does ageism look like on the ground?
Recently, a distressed geriatrician colleague told me a story about grand rounds at a major medical center where the case of a very complex older patient brought in from a nursing home was presented. [Grand rounds are meetings where doctors discuss interesting or difficult cases.]
When it was time for comments, one of the leaders of the medical service stood up and said, “I have a solution to this case. We just need to have nursing homes be 100 miles away from our hospitals.” And the crowd laughed.
Basically, he was saying: We don’t want to see old people; they’re a waste of our time and money. If someone had said this about women or people of color or LGBTQ people, there would have been outrage. In this case, there was none. It makes you want to cry.
Q: What can people do if they encounter this from a doctor?
If you put someone on the defensive, you won’t get anywhere.
You have to say in the gentlest, friendliest way possible, “I picked you for my physician because I know you’re a wonderful doctor. But I have to admit, I’m pretty disappointed by what you just said, because it felt to me that you were discounting me. I’d really like a different approach.”
Doctors are human beings, and we live in a super ageist society. They may have unconscious biases, but they may not be malicious. So, give them some time to think about what you said. If after some time they don’t respond, you should definitely change doctors.
Q: Do you see signs of positive change?
Absolutely. There’s a much larger social conversation around aging than there was five years ago. And that is making its way to the health system.
Surgeons are thinking more and more about evaluating and preparing older adults before surgery and the different kind of care they need after. Anesthesiologists are thinking more about delirium, which has short-term and long-term impact on older adults’ brains. And neurologists are thinking more about the experience of illness as well as the pathophysiology and imaging of it.
Then you have the age-friendly health system movement, which is unquestionably a step in the right direction. And a whole host of startups that could make various types of care more convenient and that could, if they succeed, end up benefiting older people.
Conscious aging not only acknowledges that we get older but celebrates it.
Posted May 14, 2019
You may not have noticed, but a backlash against the negative ways in which aging is perceived in America is in the works. More and more baby boomers are embracing the idea of “conscious aging,” a reaction against the silliness and futility of anti-aging. For the last century or so, we have been a youth-obsessed society in which we have done everything we can to deny the reality of aging (and dying, for that matter). Rather than try to overlook the simple truth that people get older, conscious aging not only acknowledges that fact but celebrates it, turning the whole idea on its head. Conscious aging is not only a positive thing for individuals to do but a means of creating a healthier, less ageist society. By “aging consciously, we will naturally begin to manifest those qualities that our society needs in order to survive,” the spiritual guide Ram Dass wrote in his Still Here: Embracing Aging, Changing, and Dying (a reference to his earlier classic Be Here Now), those qualities being “sustainability, justice, patience and reflection.”
The Conscious Aging Alliance (CAA), a network of several organizations committed to an empowering vision of later life, offers the definitive explanation of the concept: “Conscious aging is a perspective that sees aging as a life stage full of potential for purpose, growth, and service to community, and as a path toward realizing that potential. Our beliefs, about what is possible for us, and the intentions that spring from them, hold great power in shaping who we become. A great many baby boomers, as well as those further along in years, are hearing an inner call to age consciously, and are seeking support in responding to that call.”
As the CAA correctly explains it, conscious aging is steeped in the truism that over the course of thousands of years, many civilizations venerated those who had lived the longest, a practice that was viewed as important to the health of the whole society. Older people were termed “elders”- individuals assigned the key task of serving as mentors to younger people. Elders also were responsible for reciting the narratives that related the story and central beliefs of the society in order to ensure the wellbeing of future generations. Elders were seen as having evolved into a position of individual completeness so that they could act as role models for their community. Despite widespread ageism, the CAA continues, there is nonetheless a primal human drive to permit the “inner elder” to surface. Encouraging this to happen is the essential mission of conscious aging. “This is the work that can lead to wholeness and fulfillment as we age, in whatever circumstances life presents us,” the CAA concludes, a worthwhile effort.
Another organization actively promoting the cause of conscious aging is the Institute of Noetic Sciences (INS). Established by astronaut Edgar Mitchell (after having what he described as a “peak experience” while in space on the Apollo 14 mission), the INS is a “nonprofit organization dedicated to supporting individual and collective transformation through consciousness research, transformative learning, and engaging a global community in the realization of our human potential.” (“Noetic” is Greek for “inner or intuitive knowing.”) The goal of the INS is nothing less than to “create a shift in consciousness worldwide- where people recognize that we are all part of an interconnected whole and are inspired to take action to help humanity and the planet thrive.” Part of the INS’s charter is to train facilitators to lead Conscious Aging Workshops as a means of fostering spiritual, emotional, and psychological growth among those in their third phase of life. To that point, the INS has recognized nine actions to help older individuals fully embrace being alive:
“Reflect on your worldview, beliefs, stereotypes, and assumptions, and ask how might they be limiting you or holding you back
Reframe your inner talk by making internal, critical messages more positive and self-compassionate
Shift your perspective away from the popular media that shape the dominant view of aging and find opportunities to find joy and goodness
Practice mindful attention by bringing your attention toward greater self-awareness
Set intentions by asking yourself, ‘What matters most? and ‘What values do I want to adhere to?’
Build new habits by challenging your brain with new learnings, exploring new activities, or doing something new every day
Find guidance by connecting with others offering a way of living into new patterns and behaviors
Move from I to We in order to add joy and purpose to your actions
Recognize that death makes life possible.”
With getting older as natural and universal experience as can be, conscious aging is destined to gain cultural currency in the years ahead as America and the rest of the world become appreciably grayer.
While many in Hollywood may be seeking a fountain of youth, Carrie Ann Inaba believes true beauty starts from within.
During Wednesday’s episode of The Talk, the Dancing with the Stars judge, who is featured in PEOPLE’s 2019 Beautiful Issue alongside her cat Mimi, opened up about gracefully aging — and why beauty transcends the exterior.
Sitting alongside her co-hosts and PEOPLE staff editor Melody Chiu, Inaba said that “it’s such an honor to be included in this magazine” as a photo of herself and her cat, which is showcased in this week’s issue of PEOPLE, displayed on the screen.
Carrie Ann Inaba MIKE ROSENTHAL
“The best part though is that’s Mimi. Mimi is the star. She’s my rescue cat. She was found on the streets. Her ears cut off because she was part of one of those feral — you know where they rescue them and put them back on the street and spay them and neuter them?” she shared about the photo with her black feline. “She’s just an amazing cat and it’s such a great honor to be there featuring Mimi. I’m just her background.”
Chiu explained during the table talk that the Beautiful Issue celebrates “inner beauty” and “women who are making an impact in the world,” noting cover star Jennifer Garner.
“What’s so great about this issue is it’s about celebrating the inside beauty as opposed to just the exterior beauty. And I really do believe that,” Inaba said later during the discussion.
For more on Carrie Ann Inaba and her cat Mimi, pick up The Beautiful Issue of PEOPLE, on newsstands Friday.
“As you get older, the thing that happens is, I’ve noticed I appreciate people’s beauty by what you see in their eyes — like the joy or the courage or the bravery, or when you’re sitting next to them and you feel their compassion or their warmth or their spirit of determination,” she continued.
Added Inaba: “To me that’s beauty, so I think people do get more beautiful as they get older.”
