1 Setting the Stage

One of the most famous journeys in US history was made by the Corps of Discovery under the command of Meriwether Lewis and William Clark. But before their expedition to the Pacific Northwest could begin, they had to make a great many preparations. The explorers had to secure supplies to meet every conceivable need, such as food, tents, clothing, and medicine. In addition, Lewis, as the group’s leader, had to familiarize himself with a wide range of subjects such as astronomy, botany, navigation, and surveying. His mastery of these disciplines helped to ensure the expedition’s success when facing the unknown.

In a similar way, in this first chapter, we review a variety of topics that are important to keep in mind when thinking about language and adult development. These topics, while diverse, are of fundamental importance and will set the stage for discussing the interaction between language and aging in later chapters.

Language by Design

Psychologists seem to be stagestruck. In fact, stage theories of development have so permeated our culture that it may seem natural to believe that people pass through different stages as a normal part of getting older. But whether or not such an assessment is accurate has a great deal to do with how we study changes across the life span.

In stage theories, certain identifiable characteristics describe the passage from one stage to another. Consider the work of the developmental psychologist Jean Piaget. He was interested in how children’s thought processes changed as they grew. For Piaget, children in the first stage of his cognitive theory do not understand that objects exist in the world when the object is out of sight.

Here’s an example of how the presence or absence of object permanence could be measured. Imagine a young child sitting in front of a circular train set. A train is running on the track, and in one of the cars is a large plastic dinosaur. At one point the train enters a tunnel. When the train exits the tunnel, the dinosaur has been replaced by a teddy bear. This would surprise those of us who possess a sense of object permanence. If a train enters a tunnel carrying a dinosaur, then we expect it to exit the tunnel with the same dinosaur. Therefore children who show surprise at this strange turn of events could be said to have achieved object permanence.

If we compare a group of younger children to a group of older children within Piaget’s first stage, we would expect to find that the younger children are not consistently surprised by the switch from a dinosaur and teddy bear, whereas the older ones are. This kind of comparison is an example of a cross-sectional study. Cross-sectional studies compare people at different ages performing a particular task. When people at different ages show differences in a task, we can reasonably assume that those differences reflect different points of development. Many studies that compare younger and older adults are cross-sectional in design. The methodology of such studies naturally leads to results that emphasize discontinuity and abrupt transitions. In other words, conclusions drawn from cross-sectional designs can offer support for the idea of discrete stages in development.

Instead of recruiting groups of different ages, however, one could simply track the performance of the same individuals over time. Such longitudinal studies are more likely to show gradual changes and continuity. However, these types of studies are difficult to conduct. For one thing, they require the ongoing participation of the subjects, who may move away or decide not to continue their involvement. These studies are also expensive and, most significantly, can take years or decades to complete. For all these reasons, researchers use longitudinal studies less commonly than cross-sectional studies.

Here’s an example of why this matters. If we went to an elementary school and measured the heights of children in kindergarten through grade five, we would find that children in different grades have different average heights. A graph of these differences might look like a set of steps. But if we measured the heights of children consistently every few months over the six-year span, we’d see a gradual change in their heights. A graph of these results would look more like a gently upward-sloping line.

Researchers can make use of a techinque that fuses these two approaches. It is called a cross-sequential design. In cross-sequential designs, different people at different ages are measured (as in a cross-sectional study), but the same people are also tracked for a short period (as in a longitudinal study). Studies that use cross-sequential designs are not as common as longitudinal and cross-sectional studies. However, they illustrate the importance of thinking about distinct stages of development as likely resulting from more gradual processes.

Comparing Apples to Oranges

Just as we saw in the last section, researchers can also use cross-sectional studies to compare the abilities of younger and older adults. At first blush, it seems like this should be a straightforward enterprise. Younger and older adults could be recruited and given a battery of tests to complete under controlled laboratory conditions. The performance of the two groups could then be compared to see if any statistically significant (i.e., reliable) differences exist in the cognitive abilities of the two groups. And while this procedure does seem straightforward, the reality is more complex. It turns out that younger and older adults differ on a variety of dimensions, not just their age. As a result, determining which factors are responsible for any differences in performance is often difficult.

Imagine a cognitive aging study conducted in the United States in the year 2015. Researchers recruited participants who were about age twenty-five (the younger group) and about seventy-five (the older group). The groups thus had a fifty-year difference in age, but did they vary systematically in other ways?

To begin with, it is likely that they differed in the number of years of formal education they had attained. Participants in the younger group would be more likely to have had at least some higher education under their collective belts, whereas the older group were of college age in the early 1960s—a time when fewer people attended college. In 2015, 65 percent of adults aged 25 to 34 had attended at least some college, whereas only 50 percent of adults age 65 and over had done so.1 Therefore, if our sample of younger and older adults was typical, then the participants varied by educational attainment as well as by age.

The type of education was probably quite different as well. Our younger group would have started elementary school in the mid-1990s, just as the internet was taking the world by storm. As a result, they are “digital natives” for whom the internet has always been part of their lives. For the older group, the online world didn’t exist until they were in their mid-fifties. They are “digital immigrants” who may use the internet and all that it offers, but the web hasn’t always been a pervasive part of their lives.²

And younger people are simply smarter than older people—at least if we equate intelligence with performance on an IQ test. It’s important to realize that intelligence is a relative attribute, since we have no absolute measure of a person’s intellect. When we say that someone has “average” intelligence, we mean that their measured IQ is about 100. Intelligence tests are carefully constructed and standardized so that the median performance ends up at that nice, even number. The problem is that people have been getting better on such tests over time. For example, the Wechsler Intelligence Scale for Children (WISC) has been restandardized four times since it was developed in 1949. This has been necessary because average performance kept improving, at a rate of about three IQ points per decade in the United States.³ Therefore revisions of the test have been designed to be a bit more difficult so as to maintain the average score at 100.

This phenomenon is called the Flynn effect, after James Flynn, who documented large gains in IQ over a forty-five-year period in the United States,⁴ and then in more than a dozen other countries.⁵ Although the Flynn effect seems quite real, researchers have put forth varied explanations for what might be causing it. As we have already seen, younger people tend to have more education than their elders. However, research has also suggested that parental literacy, changes in family structure, and improvement in nutrition and health may all play a role.⁶ Researchers also debate whether the Flynn effect is continuing⁷ or even reversing.⁸ For our purposes, it’s enough to note that it represents yet another way that younger and older adults may differ besides chronological age.

Older adults also differ from younger adults in that they are … well, older! Although aging does not cause cancer or cardiovascular disease, declines in a person’s health can also lead to cognitive decline. But this would not mean that the cause of the decline was age per se. Rather, the cause would be the underlying disease state. Although researchers may want to recruit only older adults without any known cognitive impairment, they cannot always be sure. For example, although most people never develop dementia, the longer one lives, the more likely it is to occur. For people who do develop dementia, the cognitive consequences may show up years before a diagnosis is made. And the procedures that researchers use to screen for dementia may not be sensitive enough to pick up these early declines. As a result, studies that purportedly consist of older participants without cognitive problems may actually contain individuals who are in the early stages of cognitive decline.⁹

Let’s consider another issue. If you are an older adult who is completing a battery of cognitive tests in a lab, you might well be worried about your performance in a way that simply isn’t comparable to younger adults. You are well aware of the negative stereotypes regarding the memory abilities of older adults. You may recall recent occasions when you weren’t able to think of a word you were searching for. You might begin to worry that the tests you are taking will objectively document your cognitive decline. These concerns may increase your anxiety and cause you to perform poorly. For younger adults, however, the memory and perceptual tasks might seem more like a video game and arouse no anxiety.

This example illustrates a general phenomenon called stereotype threat, which was first documented by the social psychologists Claude Steele and Joshua Aronson. They gave black and white participants a difficult test of verbal ability. One condition emphasized that the test results would reflect one’s intellectual ability. In other conditions, the test was described as either not diagnostic of ability or simply a challenging exercise. Steele and Aronson predicted that believing the test measured intellect would activate negative stereotypes for the black, but not the white, subjects. The results were consistent with that hypothesis. Black participants performed worse than white participants in the stereotype threat condition, but about the same as the white participants in the nonthreatening conditions.¹⁰

Researchers have observed stereotype threat in older adults as well. When a task was described as requiring memorization, older adults displayed higher levels of stereotype threat than younger participants.¹¹ Stereotype threat in older adults may be moderated by a variety of factors. Thomas Hess and his colleagues found that participants in their sixties were more affected by stereotype threat than those in their seventies. In addition, stereotype threat was also higher for participants who had more education.¹² Presumably, adults in their sixties are just beginning to confront memory decline, and because educational attainment depends on memorization, any perceived decline would be more concerning.

Education, intelligence, and stereotype threat are just three of the ways, besides chronological age, that younger and older people differ. We should keep such confounding factors in mind when interpreting the results of cross-sectional research studies on language and aging.

Components of Cognition

After reaching a certain point in life, we all begin to experience the effects of aging on our bodies. Joint and muscle stiffness, a slower metabolism, and declines in endurance are all too common as we get older. But the brain undergoes changes as well, and this affects a number of cognitive systems. Let’s begin by reviewing some of the cognitive processes that are affected by aging.

At a general level, evidence points to a decline in how quickly our cognitive processes operate. This is referred to as a decline in processing speed.13 This slowing has a detrimental effect on functioning for a wide variety of cognitive tasks, such as visual matching (identifying similar objects) and visual search (comparing two pictures for differences),¹⁴ to name just two.

Memory also seems to change over time. But different types of memory change differently. For example, let’s compare short-term memory and working memory, which share similarities but are in fact different. Short-term memory can be thought of as the ability to maintain items in conscious awareness, such as a telephone number, a list of words, or a set of directions. The size of short-term memory doesn’t change greatly with age. However, this is not true for working memory, which involves transforming the information in some way, such as recalling a list of words in reverse order. The ability of working memory to perform such transformations shows age-related declines.¹⁵

Another aspect of cognitive processing is called executive function, which coordinates a range of cognitive activities such as memory, perception, attention, decision making, and language. If cognitive processes are likened to members of an orchestra, then executive function serves as the conductor. Many aspects of executive function have been studied, and these aspects typically show declines across the adult life span.

For example, one important role of executive function is inhibitory control. This refers to the ability to attend to one thing while ignoring another. Anyone who drives a car is familiar with deciding what requires attention and what can be ignored. Noticing children who are playing catch by the side of the road could require a sudden shift in attention, whereas a barn on the side of the road would not and could be safely ignored. An example of a laboratory task that assesses inhibitory control is the Stroop task, in which participants are asked to name the colors that words are printed in. However, the words themselves are color names, such as the word “red” printed in blue ink. The automatic recognition of the word “red” interferes with subjects’ ability to rapidly provide the correct response (in this case, “blue”). If inhibitory control is affected by age, then we would expect older adults to do worse on the Stroop task, and they do.¹⁶

Another role of executive function involves switching rapidly between two different tasks, such as writing a memo and scanning email as it arrives on a computer screen. Most people believe that they are good at dealing with such multitasking, but in fact each attentional switch incurs further processing costs. And as you may have guessed by now, older adults experience more disruption in task switching than do those who are younger.¹⁷

Such cognitive declines give us legitimate cause for concern. However, one should keep in mind several caveats to prevent drawing overly pessimistic conclusions about the mental faculties of older adults. One of these is that people are highly variable in their susceptibility to the effects of cognitive aging. For example, researchers who followed a set of older adults over a six-year period found considerable individual differences: some participants showed significant declines, whereas others changed hardly at all.¹⁸ And though many people in their sixties and early seventies believe they are experiencing significant cognitive decline, research suggests that meaningful changes don’t become common until after age seventy-five.¹⁹

Another important issue to keep in mind is that we know less about what happens to our language abilities during middle age. To some degree, this is a consequence of how research is typically conducted. Experimenters need participants to study, and so language research is often carried out using so-called convenience samples, such as schoolchildren or college students. Researchers at the other end of the age spectrum have often drafted retired college alumni and nursing home residents into their studies. However, assuming an eighty-year life span, about half our lives is spent between the end of our formal education and retirement. Consequently, we know much less about language during middle adulthood (age range: 25–65). This “missing middle” problem makes it more difficult to tell a complete story about how language changes across the adult life span.

One final caveat: age-related cognitive decline can be offset in a variety of ways. These include cognitive and physical activity, social engagement, and proper nutrition.²⁰ Some training regimens for older adults, such as working-memory exercises, also appear to confer some benefits.²¹

So far, we have only considered outcomes linked to healthy cognitive aging. Other outcomes can have a far greater negative impact. A variety of brain diseases and neurocognitive disorders, collectively referred to as dementia, can have a devastating effect on a person’s ability to think, reason, and remember. Although Alzheimer’s disease is the most common form, there are many others as well, such as vascular dementia and Lewy body dementia. The cruelty of such disorders is that they strip away not only a person’s cognitive abilities but also their personality and sense of self.

The decline into dementia is typically not a sudden one. Many individuals go through a transitional state during which they may be identified as having mild cognitive impairment (MCI). Doctors make this diagnosis when someone experiences mental difficulties that do not interfere with daily living. A variety of tools for assessing MCI have been developed. One commonly employed battery is the Mini-mental State Examination (MMSE), which clinicians use to assess whether someone is experiencing garden-variety forgetfulness and occasional lapses in judgment or something more serious.²² MCI may or may not progress to dementia. In addition, we should note that many other conditions can mimic symptoms of dementia, including depression, stroke, urinary tract infections, brain tumors, head injury, and alcohol abuse.

Doctors today cannot definitively diagnose Alzheimer’s disease while a person is alive. An autopsy of the brain is necessary to detect the telltale amyloid plaques and neurofibrillary tangles that are characteristic of the disorder. However, the presence of such plaques and tangles does not mean that someone exhibited signs of the disease when she was alive. In some cases, it appears that protective factors prevent the physiological changes in the brain from manifesting themselves as a loss of cognitive function. Researchers use the term cognitive reserve to refer to the sparing of cognitive abilities.

As an example, imagine you wanted to fly a rocket ship to the moon. You would probably make sure you had lots of extra fuel. That way, even if you went off course, you’d still have enough to get there. Cognitive reserve works in this way as well. Some people seem to have extra cognitive capacity that helps them function, even when their brains show neuronal degeneration.

A number of factors seem to correlate with increased cognitive reserve. These include higher educational and occupational attainment as well as participating in a wide range of different leisure activities.²³ And such protective factors also seem to be beneficial in the case of other causes of dementia, such as Parkinson’s disease.²⁴

Finally, we should stress that dementia is not an inevitable consequence of aging. A majority of people will experience normal aging—and normal cognitive decline—without the devastating cognitive effects of dementia. And the incidence of dementia may in fact be declining as educational levels rise and the rate of stroke is reduced.²⁵

The Compensation of Language

When the ripe fruit falls

its sweetness distills and trickles away into the veins of the earth.

When fulfilled people die

the essential oil of their experience enters

the veins of living space, and adds a glisten

to the atom, to the body of immortal chaos.

For space is alive

and it stirs like a swan

whose feathers glisten

silky with the oil of distilled experience.

—D. H. Lawrence, “When the Ripe Fruit Falls”

What does it mean to age well? This is a difficult question to answer because it raises another question that must be answered first: what is the goal of aging? One potential answer could be to live as long as possible. But is outliving one’s friends and family a worthy goal?

Maria Carney, a physician who specializes in gerontology and palliative care, estimates that 20 percent of Americans are elder orphans.26 As the baby boom generation continues to age, this number is likely to grow. Carney and her colleagues define elder orphans as “aged, community-dwelling individuals who are socially and/or physically isolated, without an available known family member or designated surrogate or caregiver.”²⁷ Sadly, these solo agers²⁸ are at an increased risk for untreated physical ailments, psychological problems, and in some cases elder abuse.²⁹ Although the needs of this group are beginning to be addressed, it seems clear that we should not define success solely by the number of candles on a cake.

Paul and Margret Baltes propose an alternative way to think about what it means to age successfully. Their approach measures success as the ability to adapt to the inevitable changes that come with aging by “forming a coalition between the human mind and society to outwit the limits of biological constraints in old age.”³⁰

The Baltes’s approach posits that successful aging is the result of maximizing the gains and minimizing the losses of aging through a process of selective optimization with compensation (SOC). In other words, successful agers are those who select appropriate goals for themselves, find ways to optimize their own personal capabilities, and use external compensatory mechanisms to help achieve their goals. Defining successful aging as successful adaptation allows people to decide for themselves their own standard of success. In this way, SOC “enables people to master their goals despite, or perhaps even because of, losses and increasing vulnerabilities.”³¹

Consider an example of how selective optimization with compensation worked for the artist who illustrated this book. Enkhtur Bayarsaikhan lives in Ulaanbaatar and grew up in the Mongolian countryside. He did not study English in school. Later he realized that his success as an artist was limited because he could not communicate with potential clients from other countries. But trying to learn English as an adult while working was a daunting task. And although he didn’t know about SOC, he used its concepts to accomplish his goal.

First, he was careful to select an appropriate level of instruction. He found a school where other adults were also beginning English students and where he could arrange his classes around his work. Next, he optimized his English-language skills not only by going to class but also by seeking out extracurricular opportunities to practice. One way he did this was by taking advantage of the US Embassy’s American Corner. There he was able to read English-language books and listen to presentations by native speakers. Finally, he compensated for his lack of fluency by always carrying a pad and pencil with him. When talking with English speakers, if the conversation reached an impasse, he could communicate by drawing pictures. These drawings later served as triggers for remembering his new vocabulary words.

Selective optimization with compensation can also serve as a roadmap for adults when they notice declines in certain abilities. For example, as processing speeds slow down, a person might start taking more time to solve a crossword puzzle. But since vocabulary size typically increases with age, the same person could choose more difficult puzzles to solve. In fact, it might be worth the trade-off. Finishing difficult puzzles slowly might be more satisfying than racing through easy ones. More practice would be one way to optimize crossword puzzle ability, and the New York Times also offers a tutorial that could help improve skills in this area.³² Finally, a cruciverbalist having difficulty coming up with answers to clues could compensate by keeping a crossword puzzle dictionary close at hand. Regardless of the task, therefore, selective optimization with compensation is one way to maintain a sense of accomplishment.

The appropriateness of the word “success” when it comes to aging has been called into question.33 Using a word like success makes it seem like the variables that impact aging are all under a person’s control, which is obviously not true. Moreover, claiming that there is a successful way to age could lead to blaming others for any perceived failure to do so. In addition, not all researchers who study aging would operationalize success the same way.³⁴ Inconsistencies in defining success might lead to ambiguity regarding what it means to succeed. Nevertheless, as we look at the impact of aging on language (and vice versa), we will point out examples of language helping us to select, optimize, and compensate for declines in cognitive and perceptual systems. Specifically, we now turn our attention to the changes in vision and hearing that can undermine the comprehension and production of language.

Notes

1. Had done so: Camille L. Ryan and Kurt Bauman, “Educational Attainment in the United States,” United States Census, March 2016, https://www.census.gov/content/dam/Census/library/publications/2016/demo/p20-578.pdf.

2. Part of their lives: Marc Prensky, “Digital Natives, Digital Immigrants, Part 1,” On the Horizon 9, no. 2 (2001): 1–6.

3. Lisa H. Trahan et al., “The Flynn Effect: A Meta-analysis,” Psychological Bulletin 140, no. 5 (2014): 1332–1360.

4. James R. Flynn, “The Mean IQ of Americans: Massive Gains 1932 to 1978,” Psychological Bulletin 95, no. 1 (1984): 29–51.

5. A dozen other countries: James R. Flynn, “Massive IQ Gains in 14 Nations: What IQ Tests Really Measure,” Psychological Bulletin 101, no. 2 (1987): 171–191.

6. All play a role: Tamara C. Daley et al., “IQ on the Rise: The Flynn Effect in Rural Kenyan Children,” Psychological Science 14, no. 3 (2003): 215–219.

7. Effect is continuing: Jon Martin Sundet, Dag G. Barlaug, and Tore M. Torjussen, “The End of the Flynn Effect? A Study of Secular Trends in Mean Intelligence Test Scores of Norwegian Conscripts during Half a Century,” Intelligence 32, no. 4 (2004): 349–362.

8. Or even reversing: Thomas W. Teasdale and David R. Owen, “Secular Declines in Cognitive Test Scores: A Reversal of the Flynn Effect,” Intelligence 36, no. 2 (2008): 121–126.

9. Cognitive decline: Wendy Johnson, Matt McGue, and Ian J. Deary, “Normative Cognitive Aging,” in Behavior Genetics of Cognition across the Lifespan, ed. Deborah Finkel and Chandra A. Reynolds (New York: Springer, 2014), 135–167.

10. Nonthreatening conditions: Claude M. Steele and Joshua Aronson, “Stereotype Threat and the Intellectual Test Performance of African Americans,” Journal of Personality and Social Psychology 69, no. 5 (1995): 797–811.

11. Than younger participants: Alison L. Chasteen et al., “How Feelings of Stereotype Threat Influence Older Adults’ Memory Performance,” Experimental Aging Research 31, no. 3 (2005): 235–260.

12. With more education: Thomas M. Hess, Joey T. Hinson, and Elizabeth A. Hodges, “Moderators of and Mechanisms Underlying Stereotype Threat Effects on Older Adults’ Memory Performance,” Experimental Aging Research 35, no. 2 (2009): 153–177.

13. Decline in processing speed: Timothy A. Salthouse, “The Processing-Speed Theory of Adult Age Differences in Cognition,” Psychological Review 103, no. 3 (1996): 403–428.

14. Comparing two pictures: Lori L. Veiel, Martha Storandt, and Richard A. Abrams, “Visual Search for Change in Older Adults,” Psychology and Aging 21, no. 4 (2006): 754–762.

15. Age-related declines: Kara L. Bopp and Paul Verhaeghen, “Aging and Verbal Memory Span: A Meta-analysis,” Journals of Gerontology Series B: Psychological Sciences and Social Sciences 60, no. 5 (2005): P223–P233.

16. And they do: Robert West and Claude Alain, “Age-Related Decline in Inhibitory Control Contributes to the Increased Stroop Effect Observed in Older Adults,” Psychophysiology 37, no. 2 (2000): 179–189.

17. Those who are younger: Jutta Kray and Ulman Lindenberger, “Adult Age Differences in Task Switching,” Psychology and Aging 15, no. 1 (2000): 126–147.

18. Hardly at all: David F. Hultsch et al., Memory Change in the Aged (Cambridge: Cambridge University Press, 1998).

19. After age seventy-five: Brent J. Small, Roger A. Dixon, and John J. McArdle, “Tracking Cognition-Health Changes from 55 to 95 Years of Age,” Journals of Gerontology Series B: Psychological Sciences and Social Sciences 66, suppl. 1 (2011): i153–i161.

20. And proper nutrition: Kristine N. Williams and Susan Kemper, “Interventions to Reduce Cognitive Decline in Aging,” Journal of Psychosocial Nursing and Mental Health Services 48, no. 5 (2010): 42–51; Pamela Greenwood and Raja Parasuraman, Nurturing the Older Brain and Mind (Cambridge, MA: MIT Press, 2012).

21. Confer some benefits: Barbara Carretti et al., “Gains in Language Comprehension Relating to Working Memory Training in Healthy Older Adults,” International Journal of Geriatric Psychiatry 28, no. 5 (2013): 539–546.

22. Something more serious: Rónán O’Caoimh, Suzanne Timmons, and D. William Molloy, “Screening for Mild Cognitive Impairment: Comparison of ‘MCI Specific’ Screening Instruments,” Journal of Alzheimer’s Disease 51, no. 2 (2016): 619–629.

23. Different leisure activities: Yaakov Stern, “Cognitive Reserve in Ageing and Alzheimer’s Disease,” Lancet Neurology 11, no. 11 (2012): 1006–1012.

24. Parkinson’s disease: John V. Hindle et al., “The Effects of Cognitive Reserve and Lifestyle on Cognition and Dementia in Parkinson’s Disease—a Longitudinal Cohort Study,” International Journal of Geriatric Psychiatry 31, no. 1 (2016): 13–23.

25. Stroke is reduced: Eric B. Larson, Kristine Yaffe, and Kenneth M. Langa, “New Insights into the Dementia Epidemic,” New England Journal of Medicine 369, no. 24 (2013): 2275–2277.

26. Are elder orphans: Christina Ianzito, “Elder Orphans: How to Plan for Aging without a Family Caregiver,” AARP, 2017, https://www.aarp.org/caregiving/basics/info-2017/tips-aging-alone.html.

27. Designated surrogate or caregiver: Maria T. Carney et al., “Elder Orphans Hiding in Plain Sight: A Growing Vulnerable Population,” Current Gerontology and Geriatrics Research, article ID 4723250 (2016): 1; italics in original.

28. These solo agers: Sara Z. Geber, “Are You Ready for Solo Agers and Elder Orphans?” American Society on Aging, December 27, 2017, http://www.asaging.org/blog/are-you-ready-solo-agers-and-elder-orphans.

29. Elder abuse: Jed Montayre, Jasmine Montayre, and Sandra Thaggard, “The Elder Orphan in Healthcare Settings: An Integrative Review,” Journal of Population Ageing (2018), https://doi.org/10.1007/s12062-018-9222-x.

30. Constraints in old age: Paul B. Baltes and Margret M. Baltes, “Psychological Perspectives on Successful Aging: The Model of Selective Optimization with Compensation,” in Successful Aging: Perspectives from the Behavioral Sciences, ed. Paul Baltes and Margret Baltes (Cambridge: Cambridge University Press, 1990), 27.

31. Increasing vulnerabilities: Margret M. Baltes and Laura L. Carstensen, “The Process of Successful Ageing,” Ageing and Society 16, no. 4 (1996): 405.

32. In this area: Deb Amlen, “How to Solve the New York Times Crossword,” https://www.nytimes.com/guides/crosswords/how-to-solve-a-crossword-puzzle.

33. Called into question: Stephen Katz and Toni Calasanti, “Critical Perspectives on Successful Aging: Does It ‘Appeal More Than It Illuminates’?” Gerontologist 55, no. 1 (2014): 26–33.

34. The same way: Theodore D. Cosco et al., “Operational Definitions of Successful Aging: A Systematic Review,” International Psychogeriatrics 26, no. 3 (2014): 373–381.