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Aging at a Turning Point in the 21st Century
EDITORIAL Aging at a Turning Point in the 21st Century Gene D. Cohen, M.D., Ph.D.
Copyright 䉷 2000 American Association for Geriatric Psychiatry
Am J Geriatr Psychiatry 8:1, Winter 2000
T
he study of aging is at a new turning point with the arrival of the 21st century. At the crux of the transition is a fundamental shift of focus adding attention to potential to that of problems in later life. But before looking at emerging developments, let us look first at the nature of change during the last quarter of the 20th century. In the early 1970s, few showed any academic or research curiosity about issues of aging. Most viewed aging as an area of little promise and less interest. Then, new findings and hypotheses (e.g., a cholinergic deficit in Alzheimer’s disease) appeared that helped launch a new orientation focused on identifying which changes in later life represented those of aging as opposed to illness. A major transition was occurring where many age-associated decrements that had historically been greeted with nihilism were now being reevaluated as potentially modifiable problems. A “new frontier” feeling emerged that fueled the growth of a new research infrastructure addressing issues of aging. In 1975, at the start of the fourth quarter of the 20th century, the National Institute on Aging appointed its first director. The Center for Studies of Mental Health and Aging at the National Institute of Mental Health was established, and the Geriatric Research, Education, and Clinical Centers (GRECC) Program of the Department of Veterans Affairs was launched. The focus on problems associated with aging was a major conceptual leap. The idea of human potential in later life, though, had not entered the realm of intellectual consciousness with any real presence. It was not until the late 1980s and early 1990s that studies on normal or healthy aging, mounted with magnitude and influenced by concepts of health promotion and preventive medicine, finally entered the domain of aging. Papers were being published on preserved skills in later life, successful aging, and productive aging. The change that was occurring here was the view that serious problems did not have to accompany aging, that they might be prevented or at least delayed. The concept that health and mental functioning in later life could be reasonably maintained entered popular thinking and the laboratory with increased energy. The new juncture we have reached upon entering the 21st century is one in which we move beyond studies of what aging is to what is possible with aging. We have moved from a time not that long ago when aging was seen as synonymous with senility, to one in which a glimpse of human potential has entered the cultural radar screen. Finally, we are ready to talk about what is possible, not just despite aging, but because of it. There is no denying the problems that do accompany aging. But what has been universally denied is the potential. The ultimate expression of that potential is creativity. Creativity has always been there with aging, but many have not recognized or searched for it in themselves in later life because society has so denied, trivialized, or maligned it with advancing years.
1
Editorial The importance of understanding potential in relation to aging is profound, because doing so will not only enable older people to access latent skills and talents in later life, but will challenge younger age-groups to think about what is possible in their later years in a different way. If potential in later life is denied, then we do not plan or prepare for it. With awareness of it, our sense of opportunity, challenge, and responsibility to ourselves is altered in a positive way. The mental health ramifications are profound. We already see this change in relation to physical exercise. As we have begun to notice people who are aging well physically, we have grown more interested in physical fitness as younger adults. In the past, when we were more influenced by negative myths of aging, we focused mainly on the diseases and disabilities of older adults. All of this contributed to our negative views of aging and denial of it. In denying aging, people did not prepare for it. But with the changing image of what is possible as we age, we have a growing sense that we can and should do something to help make the possibility of a healthy and fruitful old age even more likely. Today we recognize the benefit of exercise at all ages for long-term health gains. In the same way, now that we recognize that preventive health strategies can help keep us healthier longer and make us more resilient in the face of illness, we seek those options and find a growing array of choices in the marketplace. Now that we see how attention to mental health problems can save lives and lead to more productive and satisfying years of life, mental health treatments have become increasingly common choices for families and individuals. We are on the cusp of a similar phenomenon relating to human potential in later life. Focus on the “boomers” for a moment. There are approximately 75 million “baby boomers” in the United States who were born between 1946 and 1964. Most social observers emphasize the boomers’ potential influence in terms of their numbers, their potential political impact, and, at times, their sense of entitlement. But there is a larger psychological issue as work here. The boomers are the first major population group that has grown up with positive images of aging. Many of their parents have aged well physically, mentally, socially, and financially. They are the first major population group that has looked beyond stereotypes to glimpse what is possible in later life. Much of this change is unconscious, but it is real, and it is powerful. They are not denying the existence of old age, but instead experience a new awareness of what can and should be in later life. Once we have this awareness, our whole orientation toward aging begins to change. If it can be good, people are more motivated to give it every chance to be so. Again, this awareness fundamentally affects one’s sense of personal opportunity and empowerment. But the boomers are not going to just want later life to be
2
Am J Geriatr Psychiatry 8:1, Winter 2000
Editorial OK—like the rest of their experiences, they are going to want it to be special. More and more older adult models out there are showing it can be just that—particularly in relation to the expression of human potential. The old negative views of aging stifled individual motivation and short-circuited social policy deliberations that could improve individual and societal access to what is possible with advancing years. We need to peel away all the negative myths and stereotypes that have erected so many obstacles to seeing what we are truly capable of accomplishing in the second half of our lives. When we do, we will witness a new wave of progress in treating and preventing problems in later life and in promoting health and human potential with aging. For age is opportunity no less Than youth itself, though in another dress, And as the evening twilight fades away The sky is filled with stars, invisible by day. —from Morituri Salutamus H. W. Longfellow, age 68
Am J Geriatr Psychiatry 8:1, Winter 2000
3
Copyright 䉷 2000 American Association for Geriatric Psychiatry
Am J Geriatr Psychiatry 8:1, Winter 2000
T
he study of aging is at a new turning point with the arrival of the 21st century. At the crux of the transition is a fundamental shift of focus adding attention to potential to that of problems in later life. But before looking at emerging developments, let us look first at the nature of change during the last quarter of the 20th century. In the early 1970s, few showed any academic or research curiosity about issues of aging. Most viewed aging as an area of little promise and less interest. Then, new findings and hypotheses (e.g., a cholinergic deficit in Alzheimer’s disease) appeared that helped launch a new orientation focused on identifying which changes in later life represented those of aging as opposed to illness. A major transition was occurring where many age-associated decrements that had historically been greeted with nihilism were now being reevaluated as potentially modifiable problems. A “new frontier” feeling emerged that fueled the growth of a new research infrastructure addressing issues of aging. In 1975, at the start of the fourth quarter of the 20th century, the National Institute on Aging appointed its first director. The Center for Studies of Mental Health and Aging at the National Institute of Mental Health was established, and the Geriatric Research, Education, and Clinical Centers (GRECC) Program of the Department of Veterans Affairs was launched. The focus on problems associated with aging was a major conceptual leap. The idea of human potential in later life, though, had not entered the realm of intellectual consciousness with any real presence. It was not until the late 1980s and early 1990s that studies on normal or healthy aging, mounted with magnitude and influenced by concepts of health promotion and preventive medicine, finally entered the domain of aging. Papers were being published on preserved skills in later life, successful aging, and productive aging. The change that was occurring here was the view that serious problems did not have to accompany aging, that they might be prevented or at least delayed. The concept that health and mental functioning in later life could be reasonably maintained entered popular thinking and the laboratory with increased energy. The new juncture we have reached upon entering the 21st century is one in which we move beyond studies of what aging is to what is possible with aging. We have moved from a time not that long ago when aging was seen as synonymous with senility, to one in which a glimpse of human potential has entered the cultural radar screen. Finally, we are ready to talk about what is possible, not just despite aging, but because of it. There is no denying the problems that do accompany aging. But what has been universally denied is the potential. The ultimate expression of that potential is creativity. Creativity has always been there with aging, but many have not recognized or searched for it in themselves in later life because society has so denied, trivialized, or maligned it with advancing years.
1
Editorial The importance of understanding potential in relation to aging is profound, because doing so will not only enable older people to access latent skills and talents in later life, but will challenge younger age-groups to think about what is possible in their later years in a different way. If potential in later life is denied, then we do not plan or prepare for it. With awareness of it, our sense of opportunity, challenge, and responsibility to ourselves is altered in a positive way. The mental health ramifications are profound. We already see this change in relation to physical exercise. As we have begun to notice people who are aging well physically, we have grown more interested in physical fitness as younger adults. In the past, when we were more influenced by negative myths of aging, we focused mainly on the diseases and disabilities of older adults. All of this contributed to our negative views of aging and denial of it. In denying aging, people did not prepare for it. But with the changing image of what is possible as we age, we have a growing sense that we can and should do something to help make the possibility of a healthy and fruitful old age even more likely. Today we recognize the benefit of exercise at all ages for long-term health gains. In the same way, now that we recognize that preventive health strategies can help keep us healthier longer and make us more resilient in the face of illness, we seek those options and find a growing array of choices in the marketplace. Now that we see how attention to mental health problems can save lives and lead to more productive and satisfying years of life, mental health treatments have become increasingly common choices for families and individuals. We are on the cusp of a similar phenomenon relating to human potential in later life. Focus on the “boomers” for a moment. There are approximately 75 million “baby boomers” in the United States who were born between 1946 and 1964. Most social observers emphasize the boomers’ potential influence in terms of their numbers, their potential political impact, and, at times, their sense of entitlement. But there is a larger psychological issue as work here. The boomers are the first major population group that has grown up with positive images of aging. Many of their parents have aged well physically, mentally, socially, and financially. They are the first major population group that has looked beyond stereotypes to glimpse what is possible in later life. Much of this change is unconscious, but it is real, and it is powerful. They are not denying the existence of old age, but instead experience a new awareness of what can and should be in later life. Once we have this awareness, our whole orientation toward aging begins to change. If it can be good, people are more motivated to give it every chance to be so. Again, this awareness fundamentally affects one’s sense of personal opportunity and empowerment. But the boomers are not going to just want later life to be
2
Am J Geriatr Psychiatry 8:1, Winter 2000
Editorial OK—like the rest of their experiences, they are going to want it to be special. More and more older adult models out there are showing it can be just that—particularly in relation to the expression of human potential. The old negative views of aging stifled individual motivation and short-circuited social policy deliberations that could improve individual and societal access to what is possible with advancing years. We need to peel away all the negative myths and stereotypes that have erected so many obstacles to seeing what we are truly capable of accomplishing in the second half of our lives. When we do, we will witness a new wave of progress in treating and preventing problems in later life and in promoting health and human potential with aging. For age is opportunity no less Than youth itself, though in another dress, And as the evening twilight fades away The sky is filled with stars, invisible by day. —from Morituri Salutamus H. W. Longfellow, age 68
Am J Geriatr Psychiatry 8:1, Winter 2000
3