February 4, 2011

NEVER SAY DIE

The Myth and Marketing of the New Old Age

By Susan Jacoby

Pantheon. 332 pp. $27.95

If old age isn't for sissies, then neither is Susan Jacoby's tough-minded, painful-to-read and important book, which demolishes popular myths that we can "cure" the "disease" of aging and knocks the "g" right out of the golden years. Forget about those dreams of dropping dead on the tennis court, or in a lover's arms, at age 95. Such happy endings could happen to us, but the odds are great that they won't, in spite of how frisky we currently feel and in spite of our dedication to a vegetable-eating, non-smoking, moderate-drinking, daily-exercising life style.

Instead, if we live long enough to join the ranks of what are called the "old old"- the late 80s and the 90s and beyond - we are likely to become (choose several of the following) socially useless, financially strapped, physically disabled, mentally impaired, desperately lonely and demeaningly dependent. But even if we have already previewed the miseries lying ahead by having seen our parents' sorry decline, we might be tempted to tell ourselves that their fate need not be ours, tempted to believe that by the time we reach their age, 90 will be "the new fifty."

Jacoby, who tended her lover through Alzheimer's disease and watched her spunky grandmother, almost 100, grieve because she could no longer do "most of the things that had given her life meaning," has no illusions about what she regards as the dubious blessings of longevity. Indeed, she is enraged by the self-help gurus and the drug companies who merrily market an age-defying old age, where octo- and nonagenarians are touted as flourishing teachers, composers, skydivers, or as richly blessed with the "wisdom of old age." These exceptions can be admired, but they aren't how most stories will end.

Jacoby grants that, in the past, older women and men were the victims of negative stereotypes and too readily devalued and dismissed. But she sees the reversal in attitude over the last 40 years as a misleading and damaging correction, with the "hucksters of longevity" purveying the untruth that no one need fear growing old anymore because science - any day now - is going to fix whatever it is that ails us.

Not so, says Jacoby, supporting her arguments eloquently and persuasively with historical, sociological, scientific and economic research. For, contrary to all the media hype, age is not just a number. Almost half of Americans living past age 85 will suffer from Alzheimer's. Fifty percent will wind up in a nursing home. And only 25 percent of Americans living past age 65 have annual incomes of over $33,667. Furthermore, by the year 2030 some 70 million Americans will be older than 65, making up 20 percent of the population, compared with 13 percent today. And among that 70 million will be 8.5 million people over age 85, the over-85ers being the fastest growing part of our population.

Thanks to advances in medicine, we are living longer and better - up to a point. But unless we are genetically blessed, we cannot expect to indefinitely escape the degenerative, chronic and irreversible diseases of advanced old age. And unless we are economically blessed, we may not be able to afford it, either.

Jacoby is well aware that some - many, I suspect - will object to her grim view and will question why she so passionately insists on debunking the myth of a healthier, happier, vastly improved "new old age." In response, she cites the late, great gerontologist Robert Butler, first director of the Institute on Aging, who cautioned, "I'd love nothing more than to wake up one morning and read a newspaper article announcing a cure for Alzheimer's. But we have to plan for aging as it is - not as it might be if a magic potion appears. . . ." Jacoby adds, "Only when we abandon the fantasy of beating old age . . . will we be able to develop more humane ways of caring" for the oldest members of our society.

Jacoby recommends a number of social policy changes - more accessible and affordable housing for old people, public subsidies for home-care services that would allow many more of them to remain in their homes - that could significantly improve the life of the elderly. She also has some words of advice for those who are, or will be, the old old. Don't retire to one of those car-dependent resort communities; live instead in a city where you can get where you want to go even via a wheelchair or a walker. Do some kind of useful work - paid or volunteer - as long as you can. Don't feel that aging successfully requires you to be a serene, above-it-all, smiley-faced optimist. If what you really are is a "discontented work in progress," go for it. And, if you can do so, find some pleasure in the world as it actually is, without counting on the imminent triumphs of science to allow you to be skydiving in your 90s.

Judith Viorst's most recent book is "Unexpectedly Eighty and Other Adaptations."