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AGING HORIZONS BULLETIN
March/April 2007
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Interview: Harvard Professor Envisions Good Old Age Nurtured in Community
Study: How Older Widowers Adjust to New Life
Survey: Boomers Count Midlife Blessings
Study: Older Single Women Happy and Socially Productive
Interview: In Search of Beauty in Later Life
Roundup: Celebrating 60; Creating Age-Friendly Cities; Who Needs Facelifts?
Interview: Harvard Professor Envisions Good Old Age Nurtured in Community
Dr. Muriel Gillick is a practising physician, expert gerontologist, and associate professor
in the department of ambulatory care and prevention of Harvard Medical School.
She is the author of several books, including Tangled Minds: Understanding Alzheimer’s
Disease and Other Dementias. Her 2006 work, The Denial of Aging: Perpetual Youth,
Eternal Life, and Other Dangerous Fantasies (Harvard University Press), urges readers
to accept the inevitability of aging, embrace its possibilities, and create community
structures to support the aging population.
I reached Dr. Gillick in Boston, Massachusetts.
Ruth Dempsey: In The Denial of Aging, you argue: “Despite my vitamin and
exercise regimens, I am likely one day to find myself sick or frail. Better I come to
terms with this reality now.” Why is this message important?
Muriel Gillick: I worry that if we deny the realities of old age we will squander our
resources on ineffective but costly screening tests. We will waste our resources on
ultimately futile but expensive treatment near the end of life, leaving us insufficient funds
for a beneficial cure.
I am concerned that if we assume Alzheimer’s disease will be cured and disability
abolished in the near future, we will have no incentive to develop long term care facilities
that focus on enabling residents to lead satisfying lives despite their disabilities.
And I’m afraid that if we assume diet and exercise will prevent chronic disease, we will
fail to look for better models of care for chronic disease. We will not bother to overhaul
our medical system so that it provides incentives to physicians and hospitals to improve
the care of chronic illness.
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RD: You emphasize evidence-based medicine. What is it, and how is it likely to
affect me?
MG: Evidenced-based medicine is an approach to medical care that rests on scientific
studies. Instead of simply assuming that tests or treatments will produce the desired
result, we don’t prescribe those interventions unless we have sound evidence that they
work.
If your physician adheres to these precepts, he or she will not prescribe something for you
without good data indicating that it makes sense. This means that you will not get
treatments you may read about in the popular press that sound like a good idea but have
not been tested. It means you will not be subjected to treatments that are useless but have
worrisome side effects. It also means that what seems desirable treatment one year may
turn out not to be advisable the following year when there is new data.
RD: You recommend a brand of intermediate care for frail older people. Can you
give me an example? Why is this type of care important?
MG: Many people – including physicians – tend to think that there are only two
approaches to medical care: maximally aggressive treatment (whatever devices, drugs, or
operations are relevant for your condition) or hospice type care, care that is focused
exclusively on comfort. In fact, there are often options in between these two extremes.
A frail older person with a heart attack might be perfectly willing to have a cardiac stent
placed to keep his narrowed coronary artery open (a procedure done while you are awake
and requiring typically a day or two in the hospital), but not willing to undergo open heart
surgery, a riskier procedure with a longer recovery period.
It’s important to consider such options so as to avoid over-treatment, which often results
in side effects and complications that you might strenuously wish to avoid, and also to
avoid under-treatment – being deprived of potentially life-prolonging or quality of life
enhancing therapy.
RD: Making end-of-life decisions can be complicated for both patient and family.
Can you give me some guidelines?
MG: It’s critical to have open conversations with your family members and your
physician about your overall goals. You may not know whether or in what circumstances
you might want to have cardiopulmonary resuscitation or be on a ventilator. But you may
be able to talk about what is important to you – is it living as long as possible, no matter
what? Is it retaining whatever independence you have in areas such as walking, hearing,
and seeing? Or is it just being as comfortable as possible?
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Explain your views to your family and your physician, who can then help translate these
goals into practice. Also choose one person to speak for you – to be your surrogate or
health care proxy – in case you are too sick to speak for yourself.
RD: In the book, Ruth Schatz, 93, is suffering from dementia. She is also stuck with
a high-powered defibrillator that keeps going off. What can be done?
MG: Whenever an older person develops a new medical problem, it’s important to think
about how to address that problem in the context of the whole person, not just his heart or
his kidney or whatever is failing right now. A person who develops heart problems and
has progressive dementia may warrant a very different approach from a vigorous older
person with the same heart problem. Typically primary care physicians or geriatricians
are better at dealing with this sort of issue than specialists.
It’s also important to review the overall situation periodically – drugs or devices that
make sense for someone at a particular point in time may no longer make sense later.
They should be discontinued or turned off if they are no longer serving the original
purpose.
RD: You consider community essential for a good old age. Will you please
elaborate?
MG: One of the greatest challenges in dealing with older individuals is to help them find
meaning in their lives. Typically they are finished with child-rearing and have retired
from their occupations. They may simply feel superannuated.
The ways most people find meaning are through participation in something larger than
themselves, in their community. They need to find ways to give to that community,
whether it’s through tutoring elementary school children or providing advice to out-ofwork executives or teaching English as a foreign language to new immigrants.
But for older people to find such opportunities, the community needs to make them
available. Transportation for older individuals will have to be provided. Part-time work
needs to be acceptable. Only if society recognizes its responsibility towards the elderly
will the elderly be able to give to the surrounding society.
RD: You say, “A good old age is within our grasp. But we must reach in the right
direction.” Can you please explain?
MG: There are three or four things to keep in mind.
First, we need to change our personal behaviour. I said we shouldn’t put our faith in
exercise, but that doesn’t mean we shouldn’t do what little we can to stay limber.
Exercise markedly decreases risk of heart disease, the leading cause of death in people
over 65. Exercise can help prevent obesity, increasingly recognized as epidemic. And
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people who stay fit tend to stay self-sufficient. They can carry groceries and go up the
stairs.
We should keep moving but probably shouldn’t make so many geographic moves.
Cultivating relationships with family and friends mitigates against loneliness. It also has
effects on health – social contacts influence the rate of recovery from a heart attack, a
stroke, or a hip fracture. Finally, social engagement can help delay the onset of dementia
and minimize its impact.
Second, in the realm of preventive medicine, we need to stop obsessing about things that
no longer matter, resisting the impulse to request Pap smears and prostate specific antigen
tests, and start paying attention to new areas that do matter. Falling and breaking a hip
presents a far greater threat to independence and happiness at age 85 than does cervical
cancer. We also need to consider intermediate care not just aggressive care or hospice.
Also, it’s important to give people tools to help them change their behaviour. For
example, we need to have some kind of continuing health education for older people. We
may need prolific peddling points to encourage exercise – something like frequent flyer
miles. We could have password protected sign-in sites with exercise bikes. At approved
weigh-in centres, we could get points for achieving exercise and weight goals that could
be used toward purchase of medications or other medical services not covered by
insurance.
Third, institutional changes are also imperative. Nursing homes need to be more residentcentered. There are models of care that let residents decide when they will get up, what
they will do.
As well, assisted-living facilities have to allow for negotiated risk. Diabetics may not
want tight control of their blood sugar if it means forgoing the few pleasures in their
lives. The facility shouldn’t be penalized for serving sweets, provided residents have a
choice and make an informed decision. A wobbly person may not want to use a walker,
even if she risks falling. Again, the facility shouldn’t be penalized for falls, provided
residents are offered physical therapy, encouraged to use walkers, and they declined
based on understanding of risks and benefits.
Study: How Older Widowers Adjust to New Life
What is the experience of widowhood for older men?
How do they adapt to their new lives?
These were some of the questions the researchers set out to answer to fill a long-standing
gap in the research on older widowers.
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The study involved interviews with 51 men, aged 58 to 104, scattered throughout 10
states in the United States and in two Canadian provinces. The men came from diverse
cultural and religious backgrounds. They were mainly middle-class, although many had
started out poor. Most were widowed at least two years.
The study’s researchers, Alinde Moore and Dorothy Stratton, are faculty members of
Ashland University in Ohio. Moore is chair of the department of psychology, and
Stratton is chair of the department of social work. The researchers published their
findings in Resilient Widowers (Prometheus Books).
Becoming a Widower
Participants had difficulty sleeping and some lost interest in food following the death of
spouses. Others battled depression and feelings of regret. “The experience of widowhood
is a highly individualized process of grieving, adjustment, and self-definition,” according
to researchers.
Adapting to New Life
Men, who cared for ailing wives, appeared to gain in resiliency by having time to deal
with their loss and learn household skills. Sudden deaths, on the other hand, were very
traumatic, leaving a man at least temporary immobilized. This was especially true for
younger men, who felt that in addition to losing their wives, they lost the future.
Following the death of a spouse, some men spent more time alone, others quickly turned
to new relationships, while others were too cautious and tearful to make new friends. Still
others got involved in community projects.
Adult children provided the most support for fathers. However, contact between the
widowed men and children varied widely, from daily to almost never.
Some men found support from siblings. A few from male friends. Others by participating
in church activities, social groups, and volunteer work. A few men had very little support.
Most of the men found comfort in their religion. Very few attended bereavement groups.
Most felt they had at least some control over their lives.
For example, “Clarence”, 93, who lived alone, established a comfortable daily routine.
He kept up with current events, spoke very little of health problems, and looked forward
to each day and special events, such as his daughter’s visits.
Overall, many of the men adapted quite positively to the loss of spouses, yet in all cases,
the researchers noted “ an underlying traumatic residue.”
Remarriage
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And what of the current belief older men remarry quickly and that remarriage resolves
their grief? At best, the evidence is mixed.
According to a 1976 study, only one-quarter of widowers over 65 remarry, however,
those who remarry do so more quickly than women who remarry. The men tend to marry
a widow close to them in age and someone they already know.
In the current study, only 17 of the 51 men remarried – the youngest at age of 54 and the
oldest at age 81. Not all married immediately after being widowed, but many did marry
within a short period.
Other study participants chose not to remarry, despite feelings of loneliness. This was due
mainly to age, health condition, or devotion to deceased wife or independent spirit. As
“Daniel” noted, “I am good company for myself”.
According to the researchers, first wives are not replaced, but the role of wife is filled by
another person.
The study found almost every man had a “current woman” in his life. Sometimes the
woman was a new wife, daughter, daughter-in-law, granddaughter, sister or niece. In
other cases, the woman is a neighbour, a woman from the man’s church, or a dating
companion.
Advice to Other Men:
When asked what advice they would give to other men, who may someday face
widowhood, participants offered the following suggestions:
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Make sure your finances are in order and able to cover expenses.
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Have wills made and trusts arranged.
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Learn to cook and do household chores.
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Do things you both want to do.
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Fulfill the wife’s needs in illness.
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Help her disperse the possessions she values.
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Cherish the moments with her.
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Never give up.
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Survey: Boomers Count Midlife Blessings
When Canadian Peggy Edwards and her co-authors sat down to write The Juggling Act:
The Healthy Boomer’s Guide to Achieving Balance in Midlife (McClelland & Stewart),
they launched The Healthy Boomer Midlife Survey to help them get the lay of the land.
Results showed respondents struggling to achieve a sense of life balance but counting
their blessings.
The survey was based on 500 questionnaires sent to men and women born between 1946
and 1964. The survey included detailed questions about relationships, work, income,
lifestyle and appearance, retirement, spirituality, and dying. The questions were followed
up with telephone interviews. Most of the respondents came from middle-income
backgrounds and had at least a high school education.
When asked, “Now that you are in midlife, what gives you the most joy in life?”
respondents gave the following top six answers:
1. Loving relationships: spending time with my partner and other family members.
2. Being part of the growth and development of my children and grandchildren.
3. Interacting and laughing with friends and pets.
4. Enjoying the simple things of life: reading in bed in a flannel nightie, going to the
beach, watching the sun go down, enjoying martinis, taking time to enjoy sewing,
meditating, travel, adventures.
5. Mastery and growth: using my talents, getting things done, accomplishing things
at work, learning new things.
6. Helping others, volunteering and making a difference in others’ lives.
Study: Older Single Women Happy and Socially Productive
Older single women are satisfied with their lives and are socially productive, a new study
reports. The researchers also found singleness runs in families.
The study involved 24 never-married heterosexual women from across the United States.
The mostly white women had a median age of 46 years and earned more than $35,000
annually.
Participants responded to a questionnaire, which asked about their values, family role
models, personal accomplishments, work, life satisfaction, social networks, and events
that contributed to their singleness.
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The researchers also asked respondents about criteria for a husband, social pressures to
marry, and the reasons to marry now.
The study, led by Tandace McDill of the University of Guadalajara, appeared in the
Journal of Women & Aging, Vol. 18 (3) 2006.
Life Satisfaction
A high percentage of the women (81 per cent) said they were satisfied with their lives.
Similarly, 80 per cent report personal growth and freedom as a result of their single
status. The women scored average or high on standardized tests for self-esteem.
McDill’s group found the women create their own “family structures” as adults. A
substantial percentage indicate they most value friends (48 per cent) and family (52 per
cent). They see fostering relationships as an important part of aging well. The women
often attribute their singleness to “having not met the right person”.
Social Productivity
More than half of the group (57 per cent) view independence and a successful career as
accomplishments. They report that career success, ability to travel, and personal growth
contribute to their feelings of happiness.
Most of the women (65 per cent) suffered no societal stigma as a result of their single
status. “This may be due to their own positive attitude toward their singleness,” the
researchers noted.
Singleness Runs in Families
A high percentage (85 per cent) of the women grew up with a strong, positive female role
model in their families, often the mother. As well, the women often have siblings or other
single relatives – for example, 42 per cent had siblings who never married, and 42 per
cent grew up with only one parent.
Despite the reports of life satisfaction, more than half of the women (76 per cent) said
they would consider marriage now for companionship, financial support, and being in
another closer relationship. But 62 per cent feared the loss of freedom and independence
if they married.
The researchers conclude: “. . . marriage may not be as vital to women’s overall life
satisfaction as previously perceived.”
Interview: In Search of Beauty in Later Life
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Dr. Laura Hurd Clarke is an award-winning researcher at the University of British
Columbia. She carries out research with older women on body image, health and the
aging experience. Currently, she is investigating older women’s use and experience of
non-surgical cosmetic procedures.
I reached Dr. Hurd Clarke in Vancouver.
Ruth Dempsey: What sparked your interest in aging? Were older people important
in your life when you were growing up?
Laura Hurd Clarke: I grew up in a family where my grandparents were a central part of
my life. They are dynamic, creative, vital, strong, and loving individuals who have had a
prominent influence on my life.
Up until very recently, I had the good fortune of having three living grandparents.
Considering I’m in my mid-30s, this is very fortunate indeed. My two living
grandmothers are both in their 90s and I share close, loving relationships with both of
them.
The importance of extended family and older relatives is something I intend to pass on to
my own children – my three-year-old son and my daughter, born in January. My son and
my daughter have four living grandparents, and four living great grandparents. We
frequently get the four generations together and we enjoy each other’s company
enormously.
Undoubtedly, the richness I gained from being part of a family that values close
intergenerational relationships sparked my interest in aging generally, and ageism more
specifically.
RD: In one study, you interviewed women aged 61 to 92 about body image. What
did you learn?
LH: I can sum the findings up in four main points:
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Women over the age of 60 are concerned about their appearances. They often feel
dissatisfied with their bodies, similar to their younger counterparts.
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Weight is a source of dissatisfaction for many older women. While the women I
interviewed who were under the age of 80 tended to want to lose weight, those
women who were over the age of 90 tended to want to gain weight.
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Health tends to replace appearance as a priority in women’s lives, in the face of
illness and loss of physical abilities.
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Older women’s concept of physical attractiveness is often different from their
younger counterparts. Many of today’s older women grew up with female media
personalities who had more voluptuous bodies than today’s Hollywood actresses.
Many of the women I interviewed suggested that they, too, preferred more
rounded, soft female bodies to that of the ultra skinny ideal, common today.
RD: The research suggests the majority of women of all ages feel dissatisfied with
their bodies. How do older women cope with the pressure to conform to current
beauty standards?
LH: Well, that’s a complex question.
Some women feel very dissatisfied about their bodies and their appearances. These
women may choose to seek out surgical and non-surgical cosmetic procedures in order to
maintain a more youthful appearance. They argue that failure to use youth-enhancing
products such as hair dye, make-up, or non-surgical and surgical procedures put them at
risk of being invisible in a youth and appearance-obsessed society. At the same time, they
want their enhanced appearances to be viewed as the result of graceful aging and good
genes.
In contrast, some women resist current beauty standards in which attractiveness is
equated with young thin bodies rather than voluptuousness. These women suggest an
alternative beauty ideal that is reminiscent of Marilyn Munroe, who was a curvy size 14.
Similarly, some women argue their wrinkles are badges of honour and signs of lives welllived rather than something to be fought against and remedied with products like Botox
and injectable fillers like Restylane, Artecol, Hylaform, or Perlane.
Finally, some women talk about the importance of inner beauty and argue that even if one
is beautiful on the outside, one cannot be truly attractive if one lacks personal character,
integrity, compassion, and serenity.
RD: The beauty industry focuses on appearance and chronology. This would appear
to set us up as victims of age. Is that right?
LH: Yes, I would agree. If less than five per cent of us approximate today’s thin, toned,
youthful beauty ideal, and the beauty we see in the media is largely the product of
Photoshop, make-up, and other forms of digital artifice, the majority of us will be found
wanting and undesirable.
The question is, are we really willing to accept these notions of beauty and social
currency? What about things like experience, integrity, intelligence, or alternative visions
of physical and personal attractiveness?
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RD: More than 30 years ago, literary critic Susan Sontag argued society has a
double standard of aging, judging older women less attractive than older men. Is
this true today?
LH: Yes, I think so. Thus, women lose social currency as they age while men can be
distinguished and handsome, if not sexy, in later life. Evidence of this can be seen all
around us. For example, look at Hollywood movies. We see many examples of leading
older men who star against young, beautiful women but we rarely see older women in
sexy roles.
Similarly, if you look at the beauty industries – women continue to be the primary
consumers of beauty products. Indeed, 90 per cent of individuals who get cosmetic
surgeries and non-surgical procedures are women.
RD: Is demand for cosmetic surgery on the upswing?
LH: Canadian Statistics are not available. But the demand has increased astronomically,
according to The American Society for Aesthetic Plastic Surgery (ASAPS).
The ASAPS statistics indicate that since 1997 cosmetic surgeries have increased by 119
per cent, while non-surgical cosmetic procedures have increased by 726 per cent. Nonsurgical cosmetic procedures such as Botox injections, injectable fillers, chemical peels
and laser skin treatments have eclipsed surgical procedures. Thus, 455,489 liposuction
procedures were performed in 2004 in the United Sates compared to 3,294,782 Botox
injections.
Interestingly, the main consumers are women aged 35 to 50.
RD: Finally, have the stories you hear about beauty and later life changed?
LH: Well, yes and no. Recently, some of the baby boomers have been talking about how
they are aging differently from their parents. They see themselves as younger in both
behaviour and appearance than previous generations. They talk about wanting to stay
young. They see themselves as a powerful force for social change, for example, in
redefining aging.
At the same time, the stories I have been hearing over the past decade have stayed
remarkably the same. Women often talk about feeling invisible as they age. They talk
about wanting to have the bodies they had when they were younger. They express
dissatisfaction with their appearances, usually in relation to their weight.
Finally, women’s feelings about their bodies are often fraught with contradictions and
tensions as they struggle to live in a society that emphasizes appearance while
simultaneously not entirely accepting or liking the emphasis.
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I hope that in the future the stories will change – that men and women will increasingly
challenge and resist current standards of physical attractiveness and redefine how we
view aging.
I hope we will embrace the fact that bodies are evolving entities that change over time
and that these changes are to be celebrated rather than disparaged and feared. And I hope,
as a society, we come to place more value on aging and later life, as a result.
ROUNDUP
CELEBRATING 60: No! I Don’t Want to Join a Book Club is a fictional account of a
woman's 60th year. British author Virginia Ironside tells the story of Marie Sharp, a
retired art teacher divorced with one son and one cat. She is thrilled to be turning 60 and
eagerly looks forward to old age.
“The real pleasure about approaching 60 is that so many things are impossible,” says
Sharp. “I’ve been feeling guilty about not learning another language for most of my adult
life. At last I find that now, being old, I don’t have to! There aren’t enough years left to
speak it. It’d be pointless.”
Men are on Marie’s impossible list, or so she says. But not grandparenthood. When
Marie suddenly becomes a granny, it feels like, “The carpet had been pulled from under
my feet, and had sent me cascading into a golden cavern, as if all the happiness that I had
found it so difficult to garner throughout my whole life had been waiting behind the door,
which had suddenly opened, letting it burst out all at once.”
CREATING AGE-FRIENDLY CITIES: The World Health Organization (WHO) is
establishing guidelines to support the development of age- friendly cities and
communities.
The new guidelines will identify factors that enable older persons to age actively – that is,
“to live in security, enjoy good health and continue to participate fully in society.”
The WHO will work with older persons, community leaders and experts to identify the
major physical and social barriers to active aging. The results will be compiled into
practical Age-Friendly City guidelines for use by cities around the world.
Age-friendly communities prove a boon for people of all ages, improving air and water
quality, promoting caring relationships between generations and providing secure and
friendly community spaces for all.
WHO NEEDS FACELIFTS? At Scotland’s Royal Edinburgh Hospital a study of 3,500
people who looked younger than their actual ages found that having sex three times a
week seemed to take seven to 12 years off their appearance. Having more sex than this
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did not compound the benefits, however, and casual sex seems to speed the aging
process.
Source: Health Magazine (June 2001).
Editor’s Note: We welcome your feedback. Write to us with your comments and
suggestions. R.D.
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