14.1 Prejudice and Predictions

Same Situation, Far Apart: Agile, Balanced, and Old Not every older adult can spin wool or traverse a tight rope, like this Moroccan woman (left) and Korean man (right). Arthritic fingers or unsteady feet may render this impossible. But these two prove that stereotypes and generalities are false.

ROBERT HARDING PICTURE LIBRARY LTD/ALAMY
SEONGJOON CHO/LONELY PLANET IMAGES/GETTY IMAGES

Prejudice about late adulthood is common among people of all ages, including young children and older adults. That is a reflection of ageism, the idea that age determines who you are. Ageism can target people of any age. Why do people accept it, especially in regard to the old?

One expert contends that “there is no other group like the elderly about which we feel free to openly express stereotypes and even subtle hostility.…[M]ost of us…believe that we aren’t really expressing negative stereotypes or prejudice, but merely expressing true statements about older people when we utter our stereotypes” (Nelson, 2011). As mentioned above, even older people express these stereotypes. If an older person forgets something, he or she might claim a “senior moment,” not realizing the ageism of that reaction. When hearing an ageist phrase, such as “second childhood,” or a patronizing compliment, such as “spry” or “having all her marbles,” elders themselves miss the insult. The expert believes that a major problem is that ageism is institutionalized in our culture, evident in the media, employment, and retirement communities.

Another reason people accept ageism is that it often seems complimentary (“young lady”) or solicitous (Bugental & Hehman, 2007). However, the effects of ageism, whether benevolent or not, are insidious. They seep into the older person’s feelings of competence; the resulting self-doubt fosters anxiety, morbidity, and even mortality. As one author writes, stereotyping makes ageism “a social disease, much like racism and sexism…[causing] needless fear, waste, illness, and misery” (Palmore, 2005).

Believing the Stereotype

When families are confronted with racism or sexism, parents teach their children to recognize and counter bias, while encouraging them to be proud of who they are. However, when children believe an ageist idea, few people teach them otherwise. Later on, their longstanding prejudice is very difficult to change, undercutting their own health and intellect (Golub & Langer, 2007).

The positive and negative stereotypes that people hold can have either beneficial or detrimental effects on their own cognitive and physical development. According to stereotype embodiment theory, ageist stereotypes can

• become internalized across the life span
• operate unconsciously
• become self-referential
• influence a person’s future pathways by having psychological, behavioural, and physiological effects on him or her (Levy, 2009).

Having positive or negative age stereotypes can influence people’s actions in an unconscious way. In one study, seniors who were subliminally exposed to negative stereotypes of the elderly, later gave handwriting samples that were noticeably shaky and “senile” looking, whereas those who were exposed to positive images had handwriting that appeared confident and “wise” (Levy, 2000).

Rothermund (2005) found that people who thought of certain behaviours as characteristic of the “typical old person” tended to incorporate those characteristics into their own self-views five years later. They internalized certain age stereotypes, which then affected their behaviour.

Some studies have reported that age stereotypes create expectations that act as self-fulfilling prophecies. This can then have a direct influence on a senior’s health. For example, stereotypes that suggest cognitive decline is inevitable could influence whether seniors believe that a healthy diet can have positive effects on their future well-being, or whether any attempt to improve their health will be futile (Levy & Myers, 2004).

Ageist EldersMost people older than 70 think they are doing better than other people their age—who, they believe, have worse problems and are too self-absorbed (Cruikshank, 2009; Townsend et al., 2006). Asked how old they feel, typical 80-year-olds take a decade or more off their age (Pew Research Center, 2009). Yet if most 80-year-olds feel like they are 70, then that feeling is, in fact, typical for 80-year-olds. In this example, older people reject their own ageist stereotype of 80-year-olds, although they feel the same way most 80-year-olds actually do. This is illogical, but in an ageist culture, thinking you feel younger than your chronological age is self-protective. Indeed “feeling youthful is more strongly predictive of health than any other factors including commonly noted ones like chronological age, gender, marital status and socioeconomic status” (Barrett, 2012).

Not Yet When should aging people retire? In his younger years, Canadian actor Christopher Plummer played the lead male role, that of Baron von Trapp, in the classic movie The Sound of Music. Here, at the age of 80, he accepts an Oscar for best supporting actor for his role in the film Beginners.

DOUG PETERS/PA PHOTOS/LANDOV

Stereotype threat (discussed in Chapter 11) can be as debilitating for the aged as for other groups (Hummert, 2011). For instance, if the elderly fear they are losing their minds, that fear itself may undermine cognitive competence (Hess et al., 2009).

The effect of internalized ageism was apparent in a classic study (Levy & Langer, 1994). The researchers selected three groups. Two were chosen because they might have been less exposed to ageism: residents of China, since older people are traditionally respected and honoured there, and North Americans who had been deaf throughout their lives. The third group was composed of North Americans with typical hearing, who presumably had listened to ageist comments all their lives. In each of these three groups, half the participants were young and half were old.

Memory tests were given to everyone, six clusters in all. Elders in all three groups (Chinese, Americans who are deaf, and Americans who can hear) scored lower than their younger counterparts. This was expected; age differences are common in laboratory tests of memory.

The purpose of this study, however, was not to replicate earlier research, but to see if ageism affected memory. It did. The gap in scores between younger and older North Americans who could hear (those most exposed to ageism) was double that between younger and older North Americans who were deaf, and five times wider than the age gap in the Chinese. Ageism undercut ability, a conclusion also found in many later studies (Levy, 2009). Sadly, later studies have found that, with modernization, many Asian cultures have become more ageist than they were when this earlier research occurred (Nelson, 2011).

When older people believe that they are independent and in control of their own lives, despite the ageist assumptions of others, they are likely to be healthier—mentally, as well as physically—than other people their age. Of course, some elders need special care. If an older person struggling with a heavy bag is offered a helping hand, it might be appreciated. But do not assume help is needed.

Elders must find a way to balance knowing when to persist and do things for themselves and when to seek assistance (Lachman et al., 2011). For instance, at a restaurant, older people should feel no shame in asking a younger dinner companion to read the fine print of a menu, but that younger person should not spontaneously offer to cut the elder’s steak.

Slowing Down? Lest you think that bikes are only for children, an extensive study of five European nations (Germany, Italy, Finland, Hungary, and the Netherlands) found that 15 percent of Europeans older than 75 ride their bicycles every day (Tacken & van Lamoen, 2005). This 75-year-old man from London, England, is not letting age slow him down, either. Rather than driving to his destination, he hopped on his bike and is, in fact, travelling faster than the cars on his right, stuck in traffic.

ASHLEY COOPER/CORBIS

Ageism Leading to IllnessAgeism impairs daily life. For example, it prevents depressed older people from seeking help because they resign themselves to infirmity. Could that, as well as a greater reluctance among men than women to ask for help, be why elderly men between the ages of 85 and 89 have the highest suicide rate of any age and either gender (Statistics Canada, 2012h)?

Ageism also leads others to undermine the vitality and health of the aged. For instance, health professionals are less aggressive in treating disease in older patients, researchers testing new prescription drugs enrol few older adults (who are most likely to use those drugs), and caregivers diminish independence by helping the elderly too much (Cruikshank, 2009; Herrera et al., 2010; Peron & Ruby, 2011–2012). A lack of understanding of changing physical needs may also undermine the health of the aged. One specific example is sleep.

The day–night circadian rhythm diminishes with age: Many older people wake before dawn and are sleepy during the day. Older adults spend more time in bed, take longer to fall asleep, and wake frequently (about 10 times per night) (Ayalon & Ancoli-Israel, 2009). They also are more likely to nap. All this is normal: If they choose their own sleep schedules, elders are less likely to feel tired than are young adults. However, if ageism, which leads people to believe that the patterns of the young are ideal, results in distress over normal elderly sleep patterns, doctors might prescribe narcotics, or elders might drink alcohol to put themselves to sleep. These can overwhelm an aging body, causing heavy sleep, confusion, nausea, depression, and unsteadiness.

Ageism may also be a contributing factor to a lower level of exercise among the elderly. In Canada, only 11 percent of those aged 60 to 79 meet recommended guidelines for exercise (2½ hours a week of moderate-to-vigorous physical activity), compared with 19 percent for adults aged 18 to 39 (Statistics Canada, 2013c). Part of the reason for this low level of exercise is that many activities are geared to the young. Team sports are organized for children, teenagers, and young adults; traditional dancing assumes a balanced sex ratio (which does not exist among the elderly); many yoga, aerobic, and other classes are paced and designed for young adults; bike paths are scarce, and many bikes are designed for speed, not stability.

Added to that, self-imposed ageism leads the elderly to exercise less, which increases stiffness and reduces range of motion while impairing circulation, digestion, and thinking. Balance is decreased, necessitating a slower gait, a cane, or a walker (Newell et al., 2006). Thus, internalized as well as externalized ageism makes people sick.

None of the normal changes of senescence requires that exercise stop, although some adjustments may be needed (more walking, less sprinting). Health is protected by activity, but ageism in one’s culture, caregivers, and the elderly themselves leads to inaction, then stagnation, and then poor health. Indeed, the passive, immobile elder is at increased risk of virtually every illness.

ElderspeakPeople’s stereotypes of the elderly are evident in elderspeak, or the way they talk to the old (Nelson, 2011). Like baby talk, elderspeak uses simple and short sentences, slower talk, higher pitch, louder volume, and frequent repetition. Ironically, elderspeak reduces communication. Higher frequencies are harder for the elderly to hear, stretching out words makes comprehension worse, shouting causes stress and anxiety, and simplified vocabulary reduces the precision of language.

Destructive ProtectionSome younger adults and the media discourage the elderly from leaving home. For example, whenever an older person is robbed, raped, or assaulted, sensational headlines add to fear and, consequently, to ageism. In fact, street crime targets young not older adults (see Figure 14.1). The homicide rate (the most reliable indicator of violent crime, since reluctance to report is not an issue) of those over age 65 is one-half the rate for those aged 18 to 24 (Statistics Canada, 2013m). Telling older adults to stay home is shortsighted and prevents them from enjoying the benefits of activities outside the home.

FIGURE 14.1 Victims of Crime As people grow older, they are less likely to be crime victims. These figures come from personal interviews in which respondents were asked whether they had been the victim of a violent crime—assault, sexual assault, rape, or robbery—in the past several months. Personal interviews yield more accurate results than official crime statistics because many crimes are never reported to the police.

The Demographic Shift

Demography is the science that describes populations, including population by cohort, age, gender, or region. When certain subpopulations become significantly greater or smaller than in past years, this is a demographic shift. In an earlier era, there were 20 times more children than older people, and only 50 years ago, the world had 7 times more people under age 15 than over age 64. No longer.

The World’s Aging PopulationThe United Nations estimates that nearly 8 percent of the world’s population in 2010 was 65 or older, compared with only 2 percent a century earlier. This number is expected to double by the year 2050. Already 13 percent in the United States are that age, as are 14 percent in Canada and Australia, 20 percent in Italy, and 23 percent in Japan (United Nations, 2012).

Demographers often depict the age structure of a population as a series of stacked bars, one bar for each age group, with the bar for the youngest at the bottom and the bar for the oldest at the top. Historically, the shape was a demographic pyramid. Like a wedding cake, it was widest at the base, and each higher level was narrower than the one beneath it, for three reasons—none currently true:

1. More children were born than the replacement rate of one per adult, so each new generation had more people than the previous one.
2. Many babies died, which made the bottom bar much wider than later ones.
3. Serious illness was usually fatal, reducing the size of each older group.

Sometimes unusual events caused a deviation from this wedding-cake pattern. For example, the Great Depression and World War II reduced births. Then postwar prosperity and the soldiers’ return caused a baby boom between 1946 and 1964, just when infant survival increased. The mushrooming birth and survival rates led many demographers to predict a population explosion, with mass starvation by 2000 (Ehrlich, 1968).

That fear evaporated as new data emerged. Birth rates fell and a “green revolution” doubled the food supply. Now people worry about another demographic shift: fewer babies and more elders, affecting world health and politics (Albert & Freedman, 2010). Early death is uncommon; demographic stacks have become rectangles, not pyramids.

Same Situation, Far Apart: Keep Smiling Good humour seems to be a cause of longevity, and vice versa. This is true for both sexes, including the British men on Founder’s Day (left) and the two Indian women on an ordinary sunny day in Dwarka (right).

TIM GRAHAM/GETTY IMAGES
MITCHELL KANASHKEVICH/CORBIS

The demographic revolution is ongoing, although not yet starkly evident everywhere. Most nations still have more people under age 15 than over age 64. Worldwide, children outnumber elders more than 3 to 1. United Nations predictions for 2015 are for 1 877 551 000 people younger than 15 and 602 332 000 older than 64. Not until 2065 is the ratio projected to be 1 to 1 (United Nations, 2012).

According to Canada’s 2011 National Household Survey, the aging population (65 and older) make up 12.9 percent (4 551 535) of the population; 33.6 percent of this population are immigrants. Over 10 percent are visible minorities, with Chinese (141 650) and South Asians (130 115) the two largest visible minority senior groups (Statistics Canada, 2014d). While about 76.8 percent speak at least one of the official languages, those who do not pose additional challenges for families, communities, and health professionals, who may require translators’ assistance in order to provide adequate and meaningful care and support to the older population (Statistics Canada, 2014a).

Statistics that FrightenUnfortunately, demographic data are sometimes reported in ways designed to alarm. For instance, have you heard that people aged 80 and up are the fastest-growing age group? That is true but misleading.

In 2013 in Canada, there were more than 1.4 million people aged 80 and older. Statistics Canada (2013h) estimates that this number could more than double—to 3.3 million—by 2036. Stating the numbers this way can trigger ageist fears of a nation burdened by hungry hoards of frail and confused elders.

But stop and think. According to Statistics Canada, the Canadian population as a whole will also grow over that period, from 33.7 million to about 43.8 million. The percent of residents 80 and older will double, increasing between 2009 and 2036 from 3.8 percent to 7.5 percent (Statistics Canada, 2010d). That proportion will be far from overwhelming for the other 92.5 percent of the population.

Demographers and politicians sometimes report the dependency ratio, estimating the proportion of the population that depends on care from others. This ratio is calculated by dividing the number of dependants (defined as those under age 15 or over age 64) by the number of people in the middle, aged 15 to 64. The highest dependency ratio is in Uganda, with more than one dependant per adult (more than 1 : 1); the lowest is in Bahrain, with one dependant per three adults (1 : 3). Most nations, including Canada and the United States, have a dependency ratio of about 1 : 2 (United Nations, 2012).

But the calculation of the dependency ratio assumes that older adults are dependent. Most elders are fiercely independent; they are caregivers not care receivers. In 2007, about one in four caregivers were seniors themselves, with one-third over the age of 75 (Statistics Canada, 2008c). Only 10 percent of those over age 64 are dependent on others for basic care, and those “others” are usually relatives, not unrelated taxpayers.

Young, Old, and OldestAlmost everyone overestimates the population in nursing homes because people tend to notice only the frail, not recognizing the rest. This is a characteristic of human thought—the memorable case is thought to be typical—that feeds ageism rather than reflecting reality.

Gerontologists distinguish among the young-old, the old-old, and the oldest-old. The young-old are the largest group of older adults. They are healthy, active, financially secure, and independent. Few people notice them or realize their age. The old-old suffer some losses in body, mind, or social support, but they proudly care for themselves. Only the oldest-old are dependent, and they are the most noticeable.

Many of the young-old are aged 65 to 75, old-old 75 to 85, and oldest-old over 85, but age itself does not indicate dependency. An old-old person can be 65 or 100. For well-being and independence, attitude is more important than age (O’Rourke et al., 2010a).

Ongoing Senescence

The reality that most people over age 64 are quite capable of caring for themselves does not mean that they are unaffected by time. The processes of senescence, described in Chapter 12, continue throughout life. Good health habits slow down aging but do not stop it.

Theories of AgingWhy don’t people stay young? Hundreds of theories and thousands of scientists have sought to understand why aging occurs. To simplify, these theories can be understood in three clusters: wear and tear, genetic adaptation, and cellular aging.

The oldest, most general theory of aging is known as wear and tear. This theory contends that the body wears out, part by part, after years of use. Organ reserve and repair processes are exhausted as the decades pass (Gavrilov & Gavrilova, 2006).

Is this true? For some body parts, yes. Athletes who put repeated stress on their shoulders or knees often have chronically painful joints by middle adulthood; workers who inhale asbestos and smoke cigarettes destroy their lungs. However, many body functions benefit from use. Exercise improves heart and lung functioning; tai chi improves balance; weight training increases muscles; sexual activity stimulates the sexual-reproductive system; foods that require intestinal activity benefit the digestive system. In many ways, people are more likely to “rust out” from disuse than to wear out. Thus, although the wear-and-tear theory applies to some body parts, it does not explain aging overall.

A second cluster of theories focuses on genes (Sutphin & Kaeberlein, 2011). Humans may have a genetic clock, a mechanism in the DNA of cells that regulates life, growth, and aging. Just as genes start puberty at about age 10, genes may switch on aging. For instance, when a person is injured, aging genes spread the damage, so that an infection spreads rather than being halted and healed (Borgens & Liu-Snyder, 2012).

Evidence for genetic aging comes from premature aging. For example, children born with Hutchinson-Gilford syndrome (a genetic disease also called progeria) stop growing at about age 5 and begin to look old, with wrinkled skin and balding heads. These children die in their teens of heart diseases typically found in people five times their age.

Other genes seem to allow an extraordinarily long and healthy life. People who live far longer than the average usually have alleles that other people do not (Halaschek-Wiener et al., 2009; Sierra et al., 2009).

Hundreds of genes hasten aging of one body part or another, such as genes for hypertension or many forms of cancer. Certain alleles—SIR2, def-2, among them—directly accelerate aging and death (Finch, 2010).

Other alleles are protective. For instance, allele 2 of ApoE aids survival. Of men in their 70s, 12 percent have ApoE2, but of men older than 85, 17 percent have it. This suggests that men with allele 2 are, for some reason, more likely to survive. However, another common allele of the same gene, ApoE4, increases the risk of death by heart disease, stroke, neurocognitive disorder, and—if a person is HIV-positive—by AIDS (Kuhlmann et al., 2010).

A Trick Question How old is he? His strong muscles and body’s flexibility make him comparable to a fit 30-year-old. However, the placement of this photo should give you a clue that this man is a senior.

BRUCE LAURANCE/THE IMAGE BANK/GETTY IMAGES

Why would human genes promote human aging? Evolutionary theory provides an explanation (Hughes, 2010). Societies need young adults to produce the next generation and then need the elders to die (leaving their genes behind) so that the new generation can thrive. Thus, genetic aging may seem harsh to older individuals, but it is actually benevolent for communities.

The third cluster of theories examines cellular aging, focusing on molecules and cells (Sedivy et al., 2008). Toxic substances damage cells over time, so minor errors in copying accumulate (remember, cells replace themselves many times). Over time, imperfections proliferate. The job of the cells of the immune system is to recognize pathogens and destroy them, but the immune system weakens with age as well as with repeated stresses and infections (Wolf, 2010).

Eventually, the organism can no longer repair every cellular error, resulting in senescence. This process is first apparent in the skin, an organ that replaces itself often. The skin becomes wrinkled and rough, eventually developing “age spots” as cell rejuvenation slows down. Cellular aging also occurs inside the body, notably in cancer, which involves duplication of rogue cells. Every type of cancer becomes more common with age because the body is increasingly less able to control the cells.

Even without specific infections, healthy cells stop replicating at a certain point. This is referred to as the Hayflick limit, named after the scientist who discovered this phenomenon. Leonard Hayflick believes that the Hayflick limit, and therefore aging, is caused by a natural loss of molecular fidelity—that is, by inevitable errors in transcription as each cell reproduces itself. He believes that aging is a natural process built into the very cells of our species, affected by stress, drugs, and so on (Hayflick, 2004).

One cellular change over time occurs with telomeres—stretches of DNA at the ends of chromosomes that protect the cell’s genetic blueprint. As cells divide, telomeres get shorter. Eventually, at the Hayflick limit, the telomere is gone and cell duplication stops.

Telomere length is about the same in newborns of both sexes and all ethnic groups, but by late adulthood, telomeres are longer in women than in men, and longer in European-Americans than in African-Americans (Aviv, 2011). There are many possible explanations, but cellular aging theorists consider this one reason why women outlive men and European-Americans outlive African-Americans.

Calorie RestrictionAging slows down in most living organisms with calorie restriction, which is drastically reducing daily calories while maintaining ample vitamins, minerals, and other important nutrients. The benefits of calorie restriction have been demonstrated by research with dozens of creatures, from fruit flies to chimpanzees. Generally, compared with no restrictions, keeping non-humans on a restricted diet after puberty results in less aging and longer life (sometimes twice as long), as well as stronger hearts, less disease, and better cognition (Bendlin et al., 2011). However, specifics of diet and timing may be crucial. That may explain, for instance, why some research on monkeys finds that calorie restriction extends life, but other studies do not (Mattison et al., 2012). Much remains to be understood; calorie restriction is a fact in search of a theory, as “the molecular mechanisms by which such a simple intervention has such a stunning effect has eluded researchers for decades” (Masoro & Austad, 2011, p. xi).

Application of calorie restriction to humans is controversial. Controlled experiments with people would be unethical as well as impossible since researchers would have to find hundreds of people, half of whom would be randomly assigned to eat much less than usual, whereas the other half would eat normally. For both groups, periodic checks would ascertain whether they were sticking to their diets and would measure dozens of biomarkers in the blood, urine, heart rate, breathing, and so on.

The researchers would exclude anyone younger than 21 or potentially pregnant since undereating would be particularly harmful to them. They would warn the participants that calorie restriction reduces the sex drive, causes temporary infertility, weakens bones and muscles, affects moods, decreases energy, and probably affects other body functions.

As a result, studies of the effects of calorie restriction on humans have been limited. Researchers have studied populations from places such as Okinawa, Denmark, and Norway, where wartime brought severe calorie reduction plus healthy diets (mostly fresh vegetables). The result was a markedly lower death rate (Fontana et al., 2011). In addition, studies have been conducted with volunteers (not random participants) who choose to reduce their calories. Currently, more than 1000 North Americans belong to the Calorie Restriction Society, voluntarily eating only 1000 nutritious calories a day, none of them buttered or fried. One leader of this group is Michael Rae, from Calgary. He explained:

Preliminary data on practitioners of calorie restriction find some health improvements as a result of calorie restriction, but also find somewhat different responses than for non-humans. Scientists are trying to find some easier way—perhaps a drug or nutrient—that would achieve the same result as calorie restriction, halting genetic or cellular aging (Barzilai & Bartke, 2009; Beil, 2011).

All the theories of aging, and all the research on calorie restriction, have not led to any simple way to stop senescence. Most scientists are skeptical, not only of calorie restriction but of what people are willing to give up for a longer life. More than ever, scientists recommend exercise, a moderate diet, and staying away from harmful drugs (especially cigarettes).

Selective Optimization

Social scientists have another goal, not of adding years to life but adding life to years. One method is called selective optimization with compensation (see Chapter 12). The hope is that the elderly will compensate for any impairments of senescence and will excel (optimize) at whatever specific tasks they select. We will look at three examples: sex, driving, and the senses. All three involve personal choice, societal practices, and technological options, but here each is used to illustrate one of these three dimensions of the compensation process.

Individual Compensation: SexMost people are sexually active throughout adulthood. Some continue to have intercourse long past age 65 (see Figure 14.2) (Lindau & Gavrilova, 2010). However, on average, intercourse becomes less frequent than it was earlier, often stopping completely. Nonetheless, sexual satisfaction within long-term relationships increases past middle age (Heiman et al., 2011). How could that be?

FIGURE 14.2 Intimate Relations Older adults who consider their health good (most of them) were asked if they had had sexual intercourse within the past year. If they answered yes, they were considered sexually active. As the graph shows, more than 50 percent of adults aged 66 to 80 had had sexual intercourse. For many elders, sexual affection is expressed in many more ways than intercourse, and it continues throughout life.

Many older adults reject the idea that intercourse is the only or even the optimal measure of sexual activity. Instead, if sexual desire remains, then cuddling, kissing, caressing, and fantasizing become more important. Is that optimization, compensation, or both? Desire correlates with sexual satisfaction and quality of life in late adulthood more than frequency of intercourse does (Chao et al., 2011). Indeed, a five-nation (United States, Germany, Japan, Brazil, and Spain) study found that kissing and hugging, not intercourse, predicted happiness in long-lasting romances (Heiman et al.,2011).

The research finds that older women, more often than older men, say they have no sexual desire, and, on average, women stop intercourse earlier than men. This is primarily because of a lack of partner availability—there are more older women than older men—not biology. However, elders who feel sexual desire tend to be happier and healthier than those who do not (Ambler et al., 2012).

After divorce or death of a partner, selectivity is evident. Some of the elderly prefer to consider sex a thing of the past, some cohabit, some begin LAT (living apart together) with a new partner but without marriage or leaving their own home, and some remarry. That is selective optimization—each older person choosing whether and how to be sexual.

Social Compensation: DrivingA life-span perspective reminds us that “aging is a process, socially constructed to be a problem” (Cruikshank, 2009). The process is biological, but the problem begins in the social world. That means selective optimization with compensation is needed by families and societies, too. One example is driving. With age, sign reading takes longer, head turning is reduced, reaction time slows, and night vision worsens. The elderly compensate: Many drive slowly and avoid night driving.

Although drivers compensate, few societies do. If an older adult causes a crash, age is blamed rather than other factors, such as the law (Satariano, 2006). Laws are often lax; many jurisdictions renew licences without testing, even at age 80. If testing is required, it often focuses on knowing the rules of the road or being able to read with glasses, not on the characteristics that correlate with accidents. For instance, when vision is tested, it is usually to gauge a person’s face-front reading ability, yet peripheral vision is a stronger predictor of accidents (Johnson & Wilkinson, 2010; Wood, 2002).

Through Different Eyes These photographs depict the same scene as it would be perceived by a person with (a) normal vision, (b) cataracts, (c) glaucoma, or (d) macular degeneration.

ALL: PHOTODISC/GETTY IMAGES

Beyond more effective retesting, there are many other things that societies can do. Larger-print signs before an exit, mirrors that replace the need to turn the neck, illuminated side streets and driveways, non-glaring headlights and hazard flashes, and warnings of ice or fog ahead would reduce accidents. Well-designed cars, roads, signs, lights, tests, as well as appropriate laws and enforcement, would allow for selective optimization; competent elderly drivers could thus maintain independence, and dangerous drivers (of all ages) could be kept off the road.

Technological Compensation: The SensesEvery sense becomes slower and less sharp with each passing decade (Meisami et al., 2007). This is true for touch (particularly in the fingers), taste (particularly for sour and bitter), smell, and pain, as well as for sight and hearing. Yet in the twenty-first century, hundreds of manufactured devices compensate for sensory loss, from eyeglasses (first invented in the thirteenth century) to tiny video cameras worn on the head that connect directly to the brain, allowing people whose eyes no longer see to process images (not yet commercially available).

Only 10 percent of people of either sex over age 65 see well without glasses (see TABLE 14.1), but selective compensation allows almost everyone to use their remaining sight quite well. Changing the environment—brighter lights, large and darker print—is a simple first step. Corrective lenses and magnifying glasses can also help. For those who are totally blind, dogs, canes, and audio devices have for decades allowed mobility and cognition.

No Quitter When hearing fades, many older people avoid social interaction. Not so for this man, who wears a hearing aid that is quite discreet.

PETER CHRISTOPHER/ALAMY

Similarly, by age 90, the average man is almost deaf, as are about half of the women. For all sensory deficits, an active effort to compensate—not accept—is needed. Unfortunately, ageism leads many elders to avoid bifocals and hearing aids, squinting and mishearing, until blindness or deafness is imminent (Meisami et al., 2007).

Ageism also affects the use or non-use of technological possibilities by society. Few designers and engineers create innovations that compensate for sensory losses, although the technology is available. Look around at the built environment (stores, streets, schools, and homes); notice the print on medicine bottles; listen to the public address systems in train stations; ask why most homes have entry stairs and narrow bathrooms, why most buses and cars require a big step up to enter. Just about everything, from airplane seats to fashionable shoes, is designed for able-bodied, sensory-acute adults. Many disabilities would disappear with better design (Satariano, 2006).

Sensory loss need not lead to morbidity or senility, but without compensation, it can result in less movement and reduced intellectual stimulation. Consequently, illness increases and cognition declines as the senses become less acute.