416

CHAPTER 14

The Physical Challenges of Old Age

417

At age 76, Susan was vigorous and fit. She walked a mile each day. As the community college’s star pupil, she took classes three days a week. But, Susan was finding it hard to hear her professors because those young students made so much noise! Her night-vision troubles made it scary to drive home from school, especially during the dark winter months.

Susan’s doctor worried about her atherosclerosis. But it was the vision and bone problems that preoccupied Susan’s thoughts. What if she fell when walking to class, or had an accident on those curving highway exit ramps? When Susan almost backed into a truck on Main Street—in broad daylight!—she realized she had to quit school and consider giving up her car.

Four years later, at age 80, Susan was having trouble cooking and cleaning. She began to worry: “What will happen when I can’t take care of myself?” Emma, now 50 (and single), urged Susan to move in with her: “I’m buying a condo in this terrific planned community where you don’t need to drive. It has no stairs; I’ll put grab bars in the bathroom. As my adoptive mom, I’d consider it a privilege to help care for you.”

Susan politely said no. She was determined to plan for a future that did not involve burdening loved ones with her care. It was time to check out that beautiful assisted living facility that was advertised as being at the forefront of geriatric care. But after going on Shady Acres website, Susan almost had a heart attack. The average rates ($6,000 a month) were higher than at a four-star hotel! Thank the Lord for Carl’s IRA and the long-term care insurance her husband had urged her to buy at the impossibly young age of 63. Susan put her name on the waiting list—and none too soon. Six months later, she fell, breaking her hip, and could no longer live at home.

Today, Susan uses a walker. It’s hard to get dressed and use the toilet. However, when I visited her, she was surprisingly upbeat. True, life at 83 can be difficult—not simply because of a person’s physical state. The problem is the ridiculous status cliques some rude old ladies have formed. Still, the facility is wonderful. She loves the activities. Old ladies can hang onto their passions, too. The monthly lectures—covering everything from great books to politics, taught by her former community college professors—are a real joy!

What enemy is Susan battling? How does physical aging turn into disease, disability, and sometimes the need for a nursing home? This chapter offers answers to these questions and many more.

In the following pages, I’ll be exploring problems that some gerontologists (for example, Rowe & Kahn, 1998) have labeled as “unsuccessful aging,” describing what goes physically wrong during the old-old years. By now, you should realize that equating “successful aging” with walking miles at age 90 is wrong. Successful aging means drawing on what gives your life meaning to live fully, no matter how your body behaves. It is epitomized by 94-year-old Jules, described on page 401, who—although he can barely take a step without stumbling—is sensitively doing therapy and writing books.

Aging successfully means having Jules’s sense of life purpose and generative mission. But, successful aging also depends on whether the wider world offers older people the support they need to function at their best. The issue in later life is not so much being ill, but living fully in the face of chronic disease. The way people function in later life depends on their personal capacities (or nature) combined with nurture—having the right person–environment fit.

How can we engineer the right person–environment fit for older loved ones? Let’s begin our search for answers by charting the aging process itself.