Everywhere you look, aging research is in the news. Every week, it seems, some new finding is reported. Some of these are helpful, and some can be confusing. Often, results of studies seem to contradict each other. Recently a team of researchers led by psychologist Charles Holahan of the University of Texas, Austin, concluded that moderate drinkers live longer, on average, than nondrinkers. What was really surprising was the finding that even heavy drinkers live longer than nondrinkers in spite of their alcohol-related health issues.19 As individuals trying to age well and live healthy lives, what are we to make of such reports? Scientists themselves aren’t sure. There was controversy about whether to even publicize the results out of concern that they could contradict decades of medical advice about the dangers of drinking.
Scientific studies of this sort look at large groups of people, trying to discern patterns and statistical significances. But doctors see patients one at a time. For them each patient is unique. What can these physicians tell us about aging well?
To help me learn more, I interviewed several doctors, among them primary care physicians, a specialist in rehabilitation medicine, a physical therapist, psychiatrists, and psychologists. These physicians aren’t researchers, but clinicians. Their patients are people they’ve known intimately for many years, if not decades. Each of these doctors taught me something valuable about the aging process; all of them together taught me that when it comes to aging, everyone is different.
One issue that interested me was the difference in how the genders experience aging. In my interviews with both men and women, I recognized some differences but didn’t know whether they were due to gender or were just individual variations. For example, Stephanie and Christina both seemed to have made a good adjustment to growing older and could speak lightheartedly about it. In contrast, Alan and Greg were both having a hard time adjusting to the changes of aging. Do women adjust more easily to aging than men?
When I posed this question to the doctors, they immediately honed in on one clear difference: Women face aging sooner and more realistically because they go through menopause. “When it comes to realizing they’re aging,” one said, “women drop off a cliff, so to speak, while men the same age either ignore the signs or notice them a lot more gradually.”
While menopausal women have a whole range of symptoms that are quite noticeable and measurable—hot flashes, loss of bone density (more than in men), diminished endurance, disturbed sleep, and mood changes—men in their fifties who are active and in good health still feel very much as they did in their thirties and forties. If they are athletic—as Alan was—they try to compete and stay in shape. When they overdo it, “weekend warrior” sports injuries occur. One M.D. told me about a fifty-two-year-old male patient of his who broke his ankle boogie-boarding at the beach with his son. At the hospital, the man told him, “You know, Doc, I finally get it. I’m not eighteen anymore.” Another male patient of middle age fell off his bike, smashed his helmet, and sustained a mild concussion. He was lucky; that injury could have killed him.
A third justified his penchant for running in races with men half his age by saying, “I’m an old Marine. If aging is going to get me, I’m not going to go quietly.”
Another gender difference is that women tend to use humor more in dealing with aging, while men—once they get past their denial—prefer serious data and hard facts. A woman doctor specializing in menopause told me that some of her patients keep a whole second closet of clothes that no longer fit them. Women who have put on weight say, “Why don’t I give all those clothes away to the cancer consignment store?” Then they answer themselves, “Well, one of these days I’ll really get serious about going to the gym, and I’ll be able to wear all those clothes again.”
Then they laugh.
When confronted by issues such as high blood pressure or cholesterol, more men than women may resort to what one doctor called the “denial saga.” “My blood pressure is fine,” the patient will say. “I had a big meal last night. That’s all.” Or he’ll say, “Oh, I drank three cups of coffee this morning just before I came into your office. This isn’t my real blood pressure.”
One patient—a highly successful man in his early sixties—came into his doctor’s office with blood pressure of 240 over 140. This is a malignant hypertension from which one can keel over and die at any time. “I tried to explain this to him,” his doctor told me, “but he shrugged it off and said he felt fine.”
So the doctor took a different tack. He asked the patient if he’d ever worked on car radiators. “Sure,” the patient said. “I’m rebuilding an old MG in my garage as we speak.” Then the doctor asked him if he’d ever seen a radiator hose burst. When the patient nodded, the doctor told him, “You’ve got radiator hoses all over your brain, and they’re all about to burst.
“And that did it,” his doctor said. “His denial dissolved before my eyes. I have a whole bag of tricks like that.”
Once a male patient “gets it,” he is likely to take the issue up as a problem to be solved, a challenge to be surmounted. “Male patients like to create charts and graphs, showing how they’re improving,” another doctor told me. “Or they’ll have a program on their smartphone that tracks calorie intake. They prove to me they’re winning. That’s fine. I want them to win.”
I also heard from the physicians I spoke with that women in their fifties and sixties often form support groups around their emerging interests—a book group, a gardening group, a hiking or bird-watching group—that can also serve as a forum in which to discuss age-related issues and problems, physical and otherwise. Men do this too—it is a good strategy for both genders—but their groups tend to be oriented more around sports, recreation, or hobbies. Men also seem to maintain their primary focus on career longer than women. Even highly successful career women enrich their lives by branching out into community service, volunteering, and local politics.
All the primary care physicians I spoke to tended to agree on these general patterns of gender differences, but they all made sure to stress that these differences are generalizations and that there is a lot of overlap in individual coping patterns and behaviors. The psychiatrists had a somewhat different take on gender differences in aging. Compared with the primary care physicians, who see all their patients regularly regardless of whether they are having problems, psychiatrists’ patients are skewed toward those who are having difficulty. A psychologist who used projective testing such as the Rorschach to diagnose and hone in on patient problems reported that without names and faces, it is hard to discern gender from test results alone.
“You’d think with all the psychological factors these tests measure, if men and women were so different the tests would spot it,” the psychologist said. “But in my experience that’s not true. I’ve come to believe that if you put aside stereotypes and cultural assumptions, when it comes to midlife problems, men and women are more similar than they are different.”
One category of aging that seems to affect both genders similarly involves loss and identity. We have seen throughout this book how many of aging’s losses are irrevocable and cannot easily be mended. In talking about such losses, people often begin by saying, “There’s no time left to…” or “I don’t have so much time left…” or “I’ve got to make the most of the time I have.” There is a poignancy and sadness to these expressions. If people’s nest eggs lost value during the crash of 2008, they may well be too old to go back into the job market and earn it back. If a close friend or relative has died, they are gone forever.
When I talked to my psychiatrist friends about losses of aging, they agreed that as we age, the loss that is often the most difficult to deal with is loss of identity. We’re always losing pieces of our identity. When we leave home and go off to college, that’s a loss of our identity as a child. When we graduate from college and leave our dorm mates behind, that’s a loss too. But when we’re young, we don’t have to work so hard to make up for those pieces of our identity that fall away. The world is always bringing new pieces to us.
No sooner do we graduate from college than we land our first job (or it used to be so before 10 percent unemployment!), with a major new identity that can make up for the sadness of leaving college life behind. When we get married, we leave behind the freedoms of single life, but we embark on an exciting new identity as a married person. When we have children, our identity becomes, in addition to our other roles, that of parent. Regarding our identity, throughout the first half of our life, loss and gain work in tandem without our noticing it much. When we are young, we expect the world to bring us new opportunities and fresh chances, and it often does; it’s part of the magic of youth.
What’s hard about the losses sustained in older age is that it’s not so easy to repair the holes they leave in our identity. When we get to “the other side of the hill,” as one psychiatrist termed it, the world doesn’t bring us the new pieces; we have to find them ourselves. After a divorce, a new marriage doesn’t automatically materialize. When we lose a job, a new job doesn’t suddenly appear at our doorstep. When we are younger, the process of identity repair runs more or less under its own steam. When we’re older, the job of identity repair is more and more up to us.
As we discussed in the chapter on elderhood, this state of affairs may be an artifact of modern life. In traditional societies, such as Native American cultures and others that still exist throughout the world, they provided elders with new roles and identities as their old ones fell away. As elders left behind their productive roles as providers and the responsibilities of parenthood, their community encouraged them to become storytellers and singers, healers, midwives, hospice workers; they became mentors to the younger adults who were themselves just taking on leadership roles. These are not jobs that the elders had to make up or concoct themselves; they were part of life.
How different for today’s elderly in our world! As we approach retirement, we’re pretty much on our own.
Dr. Houston was an air force psychiatrist in the 1970s when the military was just beginning to realize what problems retirement posed for career servicemen and women. Retirees went from a highly structured life to one with hardly any structure at all, and the subsequent problems could be severe: depression, anxiety, substance abuse, even suicide. As a result, the military developed a multiyear program of retirement preparation.
I asked Dr. Houston how he helps his own aging patients facing retirement. He replied:
If they’re already retired, I have them walk me through a week. What do they do on Monday, Tuesday, Wednesday, and so on? I ask them, Where did you go, what did you do, who did you talk to? That gives me a jumping-off point to start talking about what’s good about that and what’s missing. Are they truly enjoying their activities? Is there something they’ve always wanted to do, like take a trip or take up a hobby, that they imagine they’re now too old to do? If you won the lottery, I ask, what would you do then? I get people to think outside the box, to draw in all the resources and excitement of their hopes and dreams, and out of that build a richer identity, one that finds replacements for the losses in their life.
Dr. Houston had concluded that although older people have to do the “heavy lifting” of a postretirement life themselves, they can do it. He sees it time and again. He was optimistic and told me that for many people, the postretirement years can be the best years of their life.
Aging can be a time of increasing worry. For one thing, as we age we have more issues and people to worry about: friends, family, children, and a lifetime of important relationships, as well as obvious and perennial concerns about health, money, and security. The simple drumbeat of maintenance and paperwork—insurance forms and claims, home and auto repairs, financial reports, correspondence, e-mails, and endless filing—seems to steadily accelerate with each passing year. The longer we live, the more details there are to take care of.
And yet worry need not be an affliction. There is a side of what we call worry that is positive and can lead to solutions and insights. Dr. Eldridge talked to me about “healthy worries,” concerns that are wholesome and necessary for us to attend to. The first one, he said, is simply, Are my needs being met, and if not, why not? The second, and equally important healthy worry, is, Who’s in control of my destiny—me or someone or something else?
These, he went on to say, are worries you should pay attention to and do something about. If our needs are not being met, we eventually become angry, depressed, or both. If we don’t pay attention to these basics, that is not so good. If we dwell too much on them and start to obsess about them, that’s not good either. I said to him, “It sounds as though you are talking about a middle way.”
He nodded. “Yep,” he said. “That’s right. There has to be a middle way.”
The “middle way” is a core Buddhist teaching that has many nuances of meaning, one of which is a sense of balance or moderation. The Buddha taught that any spiritual practice is like a lute string. If it is too tight or too loose it does not make a good sound. Only when it is tuned just right can its music be heard.
Dr. Eldridge went on to explain that many people he sees are convinced that their worries defy solution simply because they don’t have enough time left to fix them. If their nest egg lost value in the crash, they’re too old now to earn it back. If their house has gone down in value, they expect they’ll be dead before it regains its value.
If people become so depressed or discouraged in the face of such difficulties that they give up, that is having the lute string too slack. If they become angry, anxious, or frantic—if their lute string is too tight—that is not productive either. For people who are discouraged, Dr. Eldridge encourages them to do something, however small. “If people are struggling with financial reverses, I ask them to look for a way to save ten dollars a month,” he said.
And for people who are obsessing on their problem to the exclusion of all else, Dr. Eldridge sends them on a trip—even if it is only a drive to the seashore and back.
In listening to Dr. Eldridge, I was reminded of one of my Buddhist teachers who liked to say, “Every breath, new chances.” The not-so-obvious corollary to this teaching is, “At all costs, keep breathing.”
Other psychiatrists echoed Dr. Eldridge’s advice. We should spend enough time worrying to identify a problem, but not so long that we begin to dwell on it. It’s preferable to move to solutions as quickly as possible. “If you worry too much for too long, your unconscious will become anxious and believe there is an immediate and impending danger,” Dr. Eldridge summed up.
Use your worry like a radar to hone in on the target, but then attack your target with a bunch of possible solutions. For example, suppose you have a bad hip. You might start dwelling on that, and pretty soon you’re thinking, “I’m not going to be able to walk, I’m not going to get around, I’ll be in one of those mobile carts, I’ll lose my strength, I won’t be able to go out.” You spin these problems into crises, and before you know it you’re anxious, you’re depressed, and you may be consulting a psychiatrist with a serious problem.
But all of that worry is just speculation. None of it may be true. Identify the problem and immediately figure out how you are going to get help, how you are going to deal with it. That’s healthy worry.
All the psychiatrists and psychologists I spoke to mentioned that one important requirement as we get older is to build a team of helpers for the different problems we encounter. When we are young we have energy and stamina with which to attack our problems alone. As older men and women, we need a team: a good doctor, a good accountant, a good financial adviser, a good plumber, electrician, car mechanic, and so on. People who have the knack of team building often enjoy creating their team; it may be harder for others, but it’s a necessity.
Just like the owner of a small business does, seek out possible team members, assess their skills and suitability, bring them in as part of your team, watch their performance, and do not trust them blindly. After Alan heard that his college friend had died suddenly, he realized—really for the first time in his life—that he needed help. He began asking around for a good therapist and began seeing one, but soon felt that it was not a good choice for him. He eventually settled on a sports psychologist. He dealt with his high blood pressure by beginning to study stress-reduction meditation and also began seeing an acupuncturist. As a track coach, Alan instinctively understood the process of team building, but it was a revelation to him that he needed to—and could successfully—build a team to help him with his life-stage needs.
The first questions I tended to ask my psychologist and psychiatrist interviewees were, “How does healthy aging look to you? What are the qualities you see?”
One quality they all spoke of was curiosity. People who are doing well with their aging have a deep interest in what is going on around them. If they’re going on a trip, they do research on the Web to learn all about their destination. If there’s a town meeting coming up to decide about the sewer system, they want to go and find out how it turns out. They’ve heard about a new restaurant from a friend and they can’t wait to try it. And when they talk about these things, there’s enthusiasm and energy in their voice. They’re engaged in their life.
People who aren’t doing so well with their aging tend to be the opposite. They tend to contract into a smaller world, one that is individual and personal. If they have illnesses or injuries, they dwell on them. If they have a problem, they worry it to death and can’t seem to talk about anything else. For them, it’s too much trouble to travel or to try out the new restaurant. They’d rather stay at home and watch TV or surf the Internet.
In the course of my interviews, I kept hearing the term “the extraordinary elderly.” These are people who seem to have beaten the odds when it comes to aging. Though they might be in their eighties or even nineties, their state of mind seems eternally young.
Earlier we met two people—Emma and Sarah—whom we might place among the extraordinary elderly. Emma, the artist with arthritis who overcame difficult health obstacles to find a different way to paint, was extraordinary in the sense that she refused to let the physical obstacles of old age defeat her. Sarah, though rather frail physically at age 105, was full of energy, with a mischievous sparkle in her eye. She seemed to love everything she saw or touched, from her ethereal weavings to the texture of the couscous and tomato salad she ate slowly, forkful by forkful, as she talked to me.
The extraordinary elderly are everywhere. Most of us know one or two—perhaps even a parent or relative—who have refused to “go gentle into that good night,” as Dylan Thomas wrote. How do they do it? I told Dr. Houston about Emma and Sarah and asked him to comment. Did he know what secret sauce such people were drinking?
“Yes,” he said, “I see these people from time to time. They all have that incredible curiosity and enthusiasm for what is going on around them. They’ll tell me they’re in the middle of a wonderful book and have to run home to find out how it ends. Even if you talk to them about dying, they’re not afraid. If anything, they’re annoyed that dying might interrupt all the fascinating things they’re doing.”
At the end of Nikos Kazantzakis’ novel Zorba the Greek, a villager describes the last words of Zorba, a man whose enthusiasm and zest for life was unparalleled.
“I’ve done heaps and heaps of things in my life, but I still did not do enough. Men like me should live a thousand years…” These were his last words. He then sat up in bed, threw back the sheets and tried to get up. We ran to prevent him…but he brushed us all roughly aside, jumped out of bed and went to the window. There, he gripped the frame, looked out far into the mountains, opened wide his eyes and began to laugh, then to whinny like a horse. It was thus, standing, with his nails dug into the window frame, that death came to him.20
The fictional Zorba could be the exemplar of all extraordinary elders. He represents those people in every country and society who defy the odds and expectations of aging’s decline with the power of their zest for life.
This contemplative exercise focuses on identity—the way we lose old pieces of our identity as we age, and the opportunity to create new identities to replace what we have lost.
This can be a pencil-and-paper exercise or a mental reflection while seated quietly in a calm, supportive environment.
Begin by asking yourself the question, In the last three, five, or ten years, what pieces of my identity have I lost? Has it been something physical: an injury, a chronic condition, an incipient illness such as high blood pressure, diabetes, or heart arrhythmia?
Is it connected to my work identity? Have I lost a job, been passed over for a promotion, recently retired, or changed professions in a way that leaves me less satisfied?
Has it had to do with financial identity? Did I lose a lot of money in the 2008 crash? Did my home go down in value? Have I had to cut into my nest egg to help a struggling adult child or other relative?
Has it been something personal? Have I recently lost a friend to death or illness? Has a longtime relationship recently ended? Have old friends drifted away or moved away?
Take an inventory of your losses of identity and tune in to the feelings that come with loss: loneliness, sadness, grief, wistfulness, even anger.
Now shift to the positive side of the ledger and ask yourself, During that same time period, what new aspects of my identity have come in to replace what I have lost? Have I taken up a new hobby or vocation? Have I launched a new business or found a new way to supplement my income? Have I started a new relationship? What have you already done to fill in the gaps and crevices that the losses of aging have brought you?
Now, as a third step, imagine new possibilities to replenish your identity that you have not yet tried or put into practice. Reach as high and as far as you can.