Forever Young

We exist in an age of immortality, where we all will live active, vibrant lives well into our 90s. A nip here, a tuck there, and we’ll be back to skydiving and whitewater rafting in no time and doing it in style. Retirement is when life begins, so saddle up ladies and gentlemen, because the best years are just ahead!

At least that’s the picture a lot of clever marketers paint. As baby boomers turn 65 and enter retirement, the question is begged: Is 70 really the new 50?

According to Susan Jacoby, author of Never Say Die, not necessarily.

In Jacoby’s latest book, she takes a firm stand against the marketing of “the new old age” preferring instead to have a more realistic view of living life in the 70s, 80s and 90s.

“If it were true that 90 were the new 50, then we wouldn’t have to worry about entitlement programs, such as Social Security,” Jacoby argues. “And 70 isn’t the new 50, either.”

A writer who is no stranger to controversy, much of Jacoby’s premise is based on us having no control over our genetics, and it’s genetics that ultimately decide how active we can be in our golden years. In an article for the New York Daily News, she cites the appearance of 94-year-old Kirk Douglas at the Academy Awards – and the backlash from the media who thought it was “embarrassing” and “uncomfortable” to watch – to highlight America’s discomfort with aging.

“It’s very un-American to say that it doesn’t matter if you keep yourself healthy and eat the right foods that you can expect to be like Betty White when you’re 90. Nobody wants to hear that we can’t control certain things.”

Of the many things that can happen to us in our old age, approximately 17 percent of older Americans live in poverty. According to Jacoby, it is up to us to provide support to those who need it through programs such as Social Security and public health care programs.

“There are a lot of people who cannot save for old, old age, and there really aren’t jobs for people in their 70s,” says Jacoby.

Realistic Expectations

But is there anything we can do to prepare ourselves to be in the best position going into old age? Dr. Candy Ting with St. John Medical Center believes there is hope for us.

“Yes, it is very realistic to expect to lead an active life in your 70s, 80s and 90s,” Ting explains. “If people take care of themselves, exercise, don’t smoke and don’t let themselves become obese, then yes, they can have very vibrant lifestyles in their old age.”

Many health professionals say that how you live and take care of yourself when you’re young will impact how active your later years will be. Ting stresses the importance of maintaining social connections, which is often a factor for depression for those who are older, who have lost loved ones and become lonely. Keeping up with a social group is one way to stimulate the brain and remain motivated.

“I always believe in a three-generation family,” says Ting. “Kids need to step in and do more things with their parents – visit with them, drive them to church. That’s why retirement facilities are great for social interaction. Assisted living facilities are great because they are organized and have group activities and outings. It gives people more independence back.”

Vanessa Neal, executive director at University Village, says that you’re never too old to learn something new.

“When you stop learning or engaging, that’s really when you’re old,” she says. “We encourage our residents to be active. Some have even started to warm up to the Wii exercise system.”

As we age, the most common ailments we face are arthritis and degenerative joint diseases. Ting recommends a regular habit of exercise – whether it be walking or swimming – to keep joints from becoming stiff.

Skin cancer is another common health concern, as well as sleep deprivation and coronary heart disease.

“When people don’t go to work in the morning, they don’t feel that they have to go to bed at any particular time,” says Ting.

However, the largest health challenge facing seniors, or those that fall into the dubious category of the “old, old” 85 and over range, is dementia. According to Alz.org, one in eight people 65 and over has Alzheimer’s, while nearly half of those over 85 suffer from dementia or Alzheimer’s. Out of the top 10 leading causes of death in America, Alzheimer’s is the only one that has no cure or prevention or way to slow the disease.

“You have to keep active, and that includes mental activity,” says Ting. “The frontal lobe of the brain isn’t getting used very much. Many just don’t have the routine anymore and they’re not telling their brain to do things. Memory impairment can usually be stimulated by human interaction. Many times, people sit and watch TV – it’s not the same. The TV can’t interact with you, reach out and hug you.”

Ting also suggests reading books and incorporating brain challenges and brain teasers into daily activity. There are also medications that doctors can prescribe to assist with brain function. The trouble is that many times the early signs of dementia are overlooked. The signs can be as small as a slight change in behavior.

“Let’s say your mom always color-coordinated her clothes, matching blouse and pants. But now, mom isn’t color-coordinating her clothes. You need to be vigilant about these kinds of changes in behavior and patterns,” says Ting.

Additional signs are memory loss that disrupts daily life, confusion with time or place and mood swings. If a parent or loved one is exhibiting signs of early dementia, a doctor should see them.

It is also important to keep up with vaccines and inoculations. For those over the age of 55, Ting recommends a one-time pneumonia shot. She also suggests the shingles vaccine and yearly flu shot.

Most important, says Ting, is people’s attitudes as they age.

“I think if they accept that even though they can’t work the eight-hour day, they can still get up and have a good day. They can have someone come over and drive them to church. You may not be able to run anymore, but you can exercise in the pool. It’s when they tell themselves they can’t do these things that they really are old.”

Know Where To Go

With all the health challenges we face, access to quality medical care is also of great concern, especially now with health care reform on the horizon.

Carter Kimble with the Oklahoma Health Care Authority (OHCA), which provides medical coverage for those who qualify for dual coverage under Medicare and Medicaid, says that on the state level, the programs that they offer may have more of a group care focus.

“Right now, there are several grant opportunities to fund pilot programs on how to coordinate care for the elderly,” Kimble explains. “It’s allowing us to examine how to provide wrap around services for community partners. Typically, older patients will have several doctors – one for primary care, one for cardiology, one for their arthritis and so on. This method would group those services so that doctors are working together.”

Typically those who fall under OHCA’s program are high utilization patients. According to Kimble, these grant opportunities are not only beneficial in allowing test areas for new ways to provide health care, but they’re also beneficial for the state and taxpayer.

The current grant OHCA is utilizing is $1 million for one year. As for how the federal legislation will impact at a local level, the future is still unclear.

“I would say the big things are still in the pipes,” Kimble says. “There’s a lot of uncertainty about how this program is going to look and how much flexibility will be given to the states. One of the things that remains central is that we make sure that people have access to quality health care regardless of their ability to pay for it. That’s our goal and our mission and has been for a long time.”

Grow Old Gracefully?

Quality health care is vital to keeping on the go, but what happens when the mirror starts to become an enemy? For those with the desire and the means, you can fight off Mother Nature one wrinkle at time.

“About 30 to 35 is when we all have this epiphany,” says Pam Brewer, founder of Skin Medic in Tulsa.

“We wake up and think, ‘Holy cow, where’d my face go?’”

For Dr. James Koehler, a surgeon at Tulsa Surgical Arts, 35 also is the average age that patients begin to seek his help in lifting areas that have fallen.

“Some of the most common things we do is what people term the ‘mommy makeover.’ These patients are women have had a couple of kids, theirs breasts are drooping or their abdomen has been stretched out and they want to feel better about how they look. They’re not going to get the body they had before kids, but they’ll get close. That’s when people start doing these types of procedures and have the money to do so.”

According to Koehler, the trend he’s seeing more recently is not in terms of age, but rather in gender.

“Before you wouldn’t see very many men seeking out facial rejuvenation procedures but I’m seeing more men 55 and up,” he says. “I think that’s because people are working longer. One patient told me how he is competing with people in their 20s and 30s. He feels good, but he wants to look good as well.”

The oldest person that Koehler has performed an elective procedure on is 75. Barring any outstanding health issues, the risks for patients who are older are the same as for anyone who is going under the knife.

“Every person needs to understand you cannot freeze yourself in time,” says Koehler. “People have to accept the aging process. It all comes down to realistic expectations. You’ve got to set the expectations significantly different in older patients. The reason being that the tissue has less elasticity. Even if I get things as tight as possible, I know they’re going to have some loose skin in three months. It’s reasonable to say you’ll have a more rejuvenated look, but to say you’ll look 65 again is completely unreasonable.”

Jenny Maschino, who is also with Skin Medic, specializes in bioidentical hormone therapy. She agrees that setting the realistic expectations is key.

“What we hear a lot of times from our clients is that they don’t want to look 20, they just want to look good for their age. We can work with that. We really try to set the expectation that it’s a process – you didn’t get this way overnight, and it can’t be reversed in one session.”

The use of bioidentical hormones is becoming more and more popular among those who are looking for their own fountain of youth.

“Taking a very simplistic approach, let’s say that a woman comes to us who is very wrinkly,” says Brewer. “Very wrinkly is a big indicator of some possible estrogen deficits. And if they’re going to spend the money in the aesthetic realm of looking better, we need estrogen to produce collagen. Therefore, they kind of have to do them both if they want to get the bang for their buck.”

Both Maschino and Brewer agree that for those who want maximum results, care for their skin and health must be part of an overall lifestyle.

“If people want to spend the money on putting something in their face but the body doesn’t receive it well, then we’re fighting an up hill battle,” says Brewer. “If a patient smokes or spends a lot of time in tanning beds or outside a lot, we’re spending a lot of money trying to get you back to a more rejuvenated form and you’re fighting us the whole time.”

According to Brewer, one of the first and least expensive things to do to maintain a healthy appearance is skin care.

“Often, life gets in the way of these types of procedures. People who are having hip surgeries, knee replacements or even taking care of loved ones will put this type of medical procedure on the back burner. Luckily, there are several pathways people can take, depending on budget, to look a good as possible. One end of the spectrum is skin care, while on the opposite end is hormonal therapies and weight management. In the middle there are fillers and machines. The middle two are Hollywood. The others are necessary – skin care is necessary.”

According to Koehler, the use of fillers can also be good for maintenance as well as preventative measures against aging.

“Sometimes people will get these deep vertical lines on the brow,” he explains. “As the skin loses elasticity, those creases will become permanent. Botox won’t help you then. However, Botox done early enough will prevent creating those repetitive lines. In that capacity, Botox can be used for prevention.”

“Genetics does play a role,” adds Maschino. “What I like to focus on is what you can control. Everything else, you’ll just spin your wheels and make you mentally exhausted. If people are predisposed to being overweight, or heart disease or diabetes, you don’t just have to sit there and think ‘oh, this is what I’m stuck with.’ We know there are therapies that help with insulin resistance and lower cholesterol. We can’t stop genetics, but there are things that can help.”

“If you don’t have your health, you really don’t have anything,” adds Brewer. “It doesn’t matter what you look like, or how much money you have. It’s about balance and that’s what we try to instill in our patients.”

“You kind of have to find religion in this,” says Maschino. “You have to be willing to change how you think and feel about health. If you keep doing unhealthy things, nothing is going to change.”

“If people have this misconception about how they look, no amount of surgery is going to satisfy them,” says Koehler. “People have to be well-adjusted happy on the inside, like who they are and these are things they are doing for themselves.”

So what does the future of old age look like? Only time will tell.

Author Susan Jacoby shares what she learned in writing Never Say Die.

Oklahoma Magazine: What inspired you to write Never Say Die?
Susan Jacoby: I was getting older myself – entering my 60s. My mother was in her late 80s and was beginning to have very serious health issues. The old, old age is very different from what we’ve seen. Also, my partner had passed from early on-set Alzheimer’s.

OM: What has been the reaction to the book?
SJ: I’ve never had a book that’s had more violently mixed reactions. Women like it more than men. The old, old are mainly women, with 80 percent of the people over 80 being women. In most families, the women are the caretakers of the old, so women who are in their 50s and 60s have a better idea of what old, old age really looks like. It’s funny; the older the men are who read it, the better they like my book.

OM: What is the biggest myth marketers have told about growing old in America?
SJ: The biggest myth is it that if you live right, you’ll be young. Fifty percent over 80 have dementia. While there may be something to treat it down the line, there’s no immediate cure for dementia. Exercising, not smoking, eating healthy, these are all good things, but they don’t have an effect on Alzheimer’s. The Baby Boom generation grew up in an era that you could endlessly reinvent yourself, and the fact is you can’t fight genetics. And there are exceptions. I mean, we’d all like to be Betty White, but she’s the exception.

OM: You come from a line of long-living women. What is your biggest fear as you get older?
SJ: Alzheimer’s. I can cope with anything but Alzheimer’s is my biggest fear – losing the ability to control my own decisions. People should have their own living will and everyone should have an end-of-life care plan. If you don’t have any brain function or will have no quality of life, you need to make your wishes known. Individuals have to take responsibility.

OM: In your opinion, what is realistic when it comes to expectations about aging? In what ways can people be prepared for it?
SJ: I’m not sure anyone is ever prepared for old age. Work as long as possible. If not paid, then as an unpaid volunteer. Unless you hate where you live, rethink moving to retirement communities. Living in New York, I think this is the greatest place in the world for being old. It’s very difficult to have a life when you can’t drive a car. More and more, people are moving to places like Portland that have public transportation.

OM: Are there any positives that have come from the marketing of new old age? Is there a silver lining?
SJ: If you like delusion there is. The new old age hinges on always having a positive attitude. I don’t think anybody is any different than when they were middle aged. You don’t suddenly become wise if you’re an idiot at 40. People tend to become themselves, only more so. I don’t think there’s anything you can do but live your best life at any age.

OM: What is the moral of the story you would like your readers to take away from Never Say Die?
SJ: Don’t shoot the messenger, but there’s not a moral to the story. What I would like people to realize is that who they are now is who they will be later. There is no magic in old age, no special wisdom that comes with it. You better be searching for wisdom at 40 if you want any later.
Also, it’s important to understand that old people are entitled to the same emotions that young people are. No group of people is this injunction of an always positive attitude more forced upon than old people. Elderly people have a right to their emotions, negative as well as positive.

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