The End of Old Age

Typical assumptions about aging have an unconscious but significant influence on how people actually age.

Science has no known cure for aging, and examples of longevity can defy explanation. Long-lived elders usually experience a combination of regular physical exercise; close communities and families; and diets focusing largely on fruits, vegetables and healthy oils. Their vigor and activity keep them engaged.

“Aging brings wisdom that is essential to the unity and progress of both the spirit and the community, and one forsakes it at his or her own peril.”

Many people argue against prolonging old age. Some make the moral argument that space is necessary for the next generation. Others point to the pain and discomfort of old age. Medical ethicist Ezekiel Emanuel wrote passionately in his article “Why I Hope to Die at 75” about the personal limitations of old age. He explained that “living too long is also a loss” because it concludes a vibrant life with a focus on pain. He proposes refusing medical treatment. With many in the 85-and-older population suffering from neurocognitive disorders, Emanuel’s repulsion for old age seems logical to many observers.

The stereotype embodiment theory describes how people internalize stereotypes about aging.

Psychologist Becca Levy’s stereotype embodiment theory describes how people internalize oversimplified images of aging. Such stereotypes have a pernicious, unconscious but significant influence on how people age. Psychologist Laura Carstensen’s socioemotional selectivity theory views aging as a response to seeing death approach. As life becomes more important, people often choose to participate in emotionally meaningful activities and relationships.

“All the knowledge, experience, maturity, perspective, balance and wisdom bequeathed by age…enable you to look back with such keen vision on your life.”

Famed psychologist Erik Erikson presented eight stages of life, of which old age constituted only one. In his lexicon, tension defined the eighth stage, as people struggled to reflect with pride on lives well-lived but also experienced anxiety about everything they failed to accomplish. Eventually, Erikson and his wife, Joan, added a ninth stage that describes a period of enfeeblement, frailty, doubt and insecurity.

The brain has many adaptive attributes.

If life is measured in terms of physical ability, then age appears as a downward spiral. MRIs indicate a steady reduction of brain tissue beginning in early middle age and accelerating after age 60.

“A geropause refers to a downward shift or even a moratorium on pursuing and developing new interests, skills, relationships, roles or life circumstances.”

Age makes distractions more difficult to manage, and that leads people to choose more carefully where to put their attention. This narrowing is a natural response to an influx of information. It enhances “fluid intelligence,” the skills that relate to reasoning, solving problems and recognizing patterns.

The brain is capable of adapting in many ways. “Brain reserve” describes the “number, density and connectivity of neurons” that contribute to the intelligence, skills and experiences people use to support normal functioning even as the brain goes through age-related losses. The scaffolding theory of aging and cognition (STAC) developed by cognitive scientists Denise Park and Patricia

Reuter-Lorenz describes how older brains develop additional neural networks to complete assignments. Young people may do the same tasks using smaller areas of their brains, but that doesn’t mean they are doing a better job.

Compensation-related utilization of neural circuits (CRUNCH) describes how older brains send work to other parts of the brain in order to fulfill demanding tasks. Older people use both sides of their brain to complete tasks, an attribute called hemispheric asymmetry reduction in older adults (HAROLD).

Aging offers five core strengths that correlate to older people’s roles as “savant, sage, curator, creator and seer.”

Aging offers five core strengths: “knowledge, judgment, empathy, creativity and insight” that correlate to five roles older people may fill:

• Savant – People who fulfill this role teach others on the basis of their lifetime of knowledge.
• Sage – Those in this role use their wisdom to deliberate and offer judgment on complicated situations. They are unafraid to redesign “long-held emotions, values and goals.”
• Curator – These elders show empathy and connect with others through caring.
• Creator – Artists and makers in this role may manifest great creativity and produce their most profound works by mixing significant aspects of their pasts with the present.
• Seer – People who fulfill this role forecast the possibilities of the future. Insightful and introspective, they often act as spiritual leaders.

An “age point” occurs when life changes.

When life disrupts the values, standards and beliefs someone has embraced until that moment, an age-point process begins. Resolving an age point leads to developing new abilities for those who are willing to forego prior ways of doing things and to adjust to a new situation.

These transitional age points can occur at any time of life, and they unfold in four stages:

1. “Event” – Things change. An experience transforms how you think or feel.
2. “Suspension” – Akin to a shock, the period of suspension occurs when your mind can’t understand what has happened or how it could. A negative suspension cultivates confusion and emotional strain. A positive suspension lets go of old ideas about how things work to make room for new possibilities.
3. “Reckoning” – People spend this period weighing the cost of change as they face decisions about how to fit new realities into old relationships and patterns. They recognize your limitations, weaknesses and faults. Previous strengths no longer function, and they must adapt to move forward. People may undergo a crisis of faith as they experience personal and intellectual reconfiguring.
4. “Resolution” – Acceptance allows altered beliefs and new behaviors to help elders navigate the new phase of life. A positive resolution grants them a more flexible approach to life.

“Geropause” is the stagnation that often occurs in response to an age point.

“Menopause” and “andropause” refer to periods of hormonal and physical alterations. These come with psychological shifts as people face the first major signs of aging; often, this affects their choices and lifestyles. Geropause addresses the stagnation that can occur in response to an age point. During geropause, people stop pursuing fun activities and learning new things. They resist new relationships or interests. Physical fear or loss of an important social role can stymie personal development.

“In neglecting to preserve and enrich an aging life, whether our own or that of others, we send a message that life only has meaning when we are happy, comfortable and independent.”

An “active geropause” arises from a deliberate choice to step back – for example, to retire. Some people may stop participating in an important activity, whether it’s skiing or volunteering. A “passive geropause” stems from loss of abilities, convictions or opportunities. For example, withdrawal is common when eyesight diminishes and people can no longer drive. Losing faith in meaningful religious or political beliefs may set someone adrift. Reduced income may force people to leave clubs or activities. An “inhibited geropause” stems from external blocks. An argument with colleagues can lead to refusing to participate in the local game league. Fears about driving at night can limit social interactions.

People may refuse to recognize their changed circumstances or seek solutions. Geropause often leads to being bored and inactive, but people can find creative solutions through personal growth. This requires a choice to no longer yearn for what once was. People who are aging must make peace with a changed world and participate in it. The pain of physical rehabilitation or psychological development makes many people avoid the effort to overcome geropause, but being stuck in it is worse.  

Purpose is pivotal to life satisfaction; this remains true at the end of life.

Purpose comes from providing a positive contribution. The ancient Greek philosophers regarded achieving eudaimonia – when the soul experiences harmony with the practical requirements of life – as one of the highest human endeavors. The Japanese term ikigai refers to the general philosophy of having fully developed reasons for living that a person aspires to embody.

 ”We cannot forget our past, but often must tap into it for strength and inspiration.”

Societal expectations that older people should recede from life increase the difficulty of maintaining purpose, which stems from the desire to serve the world and yourself.

Your “age culture” provides references for continuing to thrive by leading a meaningful life.

Gerontologists Paul and Margret Baltes recommend cultivating activities that are extensions of your current skills or lifestyles, are nearby or easily available, and are meaningful.

“The accumulating products of our aging self represent a rich tapestry of abilities, interests, experiences, relationships and commitments that can be described as our age culture.”

Creative aging includes overlapping “human potential phases” to reflect that adult development doesn’t occur within strict age parameters. What geriatric psychiatrist Gene Cohen calls a “midlife re-evaluation phase” may begin in the second half of your 30s and last through your mid-60s. He suggests that you may evaluate your choices and seek improvements by calling upon “quest energy.” You may next experience what Cohen terms a “liberation phase” that continues into your mid-70s, when a sudden urgency arises to try things that were previously unthinkable.

Retirement can make this freedom possible, even as family or friends find this new activity disturbing and try to limit it. The “summing-up phase” occurs from the late 60s into the 90s, when you want to contribute to the world. The “encore phase” begins in the 70s and lasts until the end of life, as you affirm and commemorate your life choices.

Positive models help those who are aging begin to embrace the idea that people can thrive even as they get older. The artist Matisse exemplified this idea. During World War II, Matisse suffered from many ailments and became wheelchair-bound. He was unable to stand and paint. His assistant, Lydia Delectorskaya, gave him brightly colored paper and scissors. He cut undulating shapes and instructed her where to pin them on colored canvases. These works celebrated his desire to thrive – even amid the pain of his physical ailments – at the end of his long, successful life as a prodigious painter.

Pioneering modern dancer Martha Graham faced a similar challenge at the end of her dancing career. Unable to fathom a life away from her art, she transformed herself into one of history’s greatest choreographers.

“Re-aging” is a five-step process of coming to value the aging process and its creative potential: Affirm your wisdom, identify your resilience, create an action plan, consider your legacy and celebrate your life.

No one can give another person purpose, so having an action plan provides steps an older person can follow to discover the elements of a meaningful path. For those who think all is well, an action plan provides guidance for future challenges. For those feeling trapped by a physical or mental problem, an action plan reveals opportunities, though some may require accepting help or changing long-held personal attributes. For those who are in the final stage of life, an action plan provides a vision to help their relatives and friends recognize the dignity and wisdom of the moment.

An action plan begins by recognizing your age culture. Ask three questions to unpack your core principles: “Who was I? Who am I? Who will I be?” The answers provide references for continuing to thrive and to lead a meaningful life. Re-aging calls for valuing the aging process and recognizing its creative potential.

“Certain kinds of mental skills even improve with age, such as the ability to solve a problem based on experience and the integration of information, a quality best defined as wisdom.”

The five steps of the re-aging process are:

1. Affirm your current store of wisdom – Reflect on how you played each of the five roles (savant, sage, curator, creator and seer) across your life. What knowledge and experience did you share as a savant? How did you, as a sage, help people make decisions and recognize important values? What engagements with your communities reflected your care and concern for others? Where were you most creative? How did you offer spiritual or philosophical guidance?
2. Identify your resilience – Examine your age points to detect what resources served you in the past and which behaviors helped you overcome challenges.
3. Reinvent yourself – Create an “age imperative action plan” based on each of the five roles. Ask how you currently fulfill each role and how you will fill each role in the future.
4. Reflect on your legacy – Consider how you want your life to affect your family, your immediate community and the greater world. Examine what contributions you made and still can make to recognize the meaning you continue to cultivate in your life.
5. Celebrate your life – You probably held celebrations for every other important passage, so create a ceremony to symbolize this time. Within that ceremony, devise your own rituals to honor the life you have lived and are living.

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About the Author

Geriatric psychiatrist Marc Agronin, MD, is the author of How We Age. He is the senior vice president for Behavioral Health and the chief medical officer for MIND Institute at Miami Jewish Health.