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Aging With Grace: America’s Next Big Challenge

 

Seaside symposium examines how communities can help residents make the most of their later years

Experts in fields ranging from public health to community design gathered in Seaside in October 2018 to confront one of the great demographic issues of our times: the aging of the American population. With the Baby Boom now becoming an Elder Boom, how can individuals — and communities — navigate this important shift?

Seaside founder Robert Davis, who turned 75 in November, had the nonprofit Seaside Institute bring together more than a dozen speakers with backgrounds in public health, architecture, planning, wellness and other fields. A two-day symposium on “Aging with Grace”— organized by the Seaside Institute’s program director, Washington, D.C. architect Dhiru Thadani — attracted approximately 55 people, mainly from Florida and nearby states.

Miami architect Andrés Duany, 68, a dominant voice in the New Urbanism movement, got the discussion under way by distinguishing between two periods of later life. One, Duany said, is “old age,” which in its initial years, when people still possess considerable energy, “has its comforts.” The other is “old old age,” a later period often marked by substantial decline and fragility.

Duany said that as they age, some people will need features such as orange doorknobs (because they have trouble seeing) or raised dishwashers (because they have trouble bending over). But, he said, many baby boomers will insist as long as possible on seeing themselves as vital individuals who “really enjoy life.” They will not respond well to overt marketing of features that bring to mind deterioration and decline.

That aging is a sensitive topic is borne out by Worman’s Mill, a 307-acre development in Frederick, Md. Since 1988, the Wormald Companies, a family-owned building firm, has been constructing the 1,497-unit community on a former farm three miles north of downtown Frederick.
Roughly half the Worman’s Mill residents are 55 or older, yet only once — in an early stage — did the company advertise the development as a “retirement community.” “That was a huge mistake,” said Robert K. Wormald Jr., a managing partner in the company. It made many people, especially younger ones, reluctant to come buy houses.

The developer soon learned to avoid describing its offerings in explicitly age-related ways. Instead, advertising emphasized first-floor master suites (popular with older couples), maintenance-free exteriors, and the fact that residents don’t have to mow the lawn or rake the leaves; the community association takes care of outdoor chores.

Sales staff extol a “lock-and-go” lifestyle (homeowners can travel without worrying about their property). This strategy appeals to seniors without saying anything about age. The symposium suggested that if “aging with grace” is become a widespread goal, it will have to be presented very discreetly — at least to people who are near the start of their retirement years.

For the “old old,” on the other hand, the afflictions that aging brings are not something that can be left undiscussed. A major challenge, many speakers averred, will be how to protect fragile individuals (many in their 80s and 90s) from a “medical-industrial complex” that intervenes too aggressively, with invasive procedures that can seem like “medical torture.”

What the Numbers Say
Speakers presented startling statistics:

  • Each day, another 11,509 Americans turn 65.
  • By 2030, between 25 and 27 percent of the population will be 65 or older.
  • By 2035, there will be more Americans 65 and older than there will be children under age 18.
  • Nationally, the fastest-growing group is people 80 and over.
  • Zero percent of Americans want to end their days in a nursing home. But 33 percent are likely to spend time there, and 24 percent will stay for more than six months.
  • The average nursing home resident receives only four visitors a month, said Dr. John McGinty, a consultant to hospitals across the country.
  • The average lifespan is 79 years, said Dr. Hillary Glenn, co-founder of the Point Washington Medical Clinic in Santa Rosa Beach. But the average “health span” — the period of being largely unhampered by disease and ailments — is considerably shorter: 63 years.
  • White Americans in their 50s have a declining life expectancy, some of it because of social isolation and economic hollowing-out, said Dr. Brendan Jackson, an Atlanta family physician who completed a residency in preventive medicine at the U.S. Centers for Disease Control.

Housing and transportation will be major concerns. “Our housing is built for able-bodied 35-year-olds,” said Leslie Spencer of AARP’s Florida office. Since the 1920s, communities and roadways have been built predominantly for automobiles. But many older people are reducing their driving, and feel cut off when no stores, parks, cafes and gathering places are within walking distance.

To promote places where people can readily participate in local life, AARP has developed online tools such as the AARP Livability Index, and has formed an AARP Network of Age-Friendly Communities, now numbering over 300. Said Dhiru Thadani: “AARP is now taking the lead on the issues that New Urbanists were talking about.”

The website SeniorLiving.org states that for people with financial means, a continuing-care retirement community (CCRC), offering independent living, assisted living and a nursing home, “may be the ideal senior living option to ‘age in place.’” Certainly that’s true in some cases.
But if a retirement community is not in a walkable town or close to a pedestrian-scale neighborhood center, can it really be ideal? Dr. Richard Jackson, professor emeritus at UCLA’s Fielding School of Public Health, recalled talking with a man who felt frustrated by his CCRC. “I can’t go for an interesting walk without getting on a jitney,” he lamented.

“Having certain chronic conditions or being isolated increases the risk” of depression, Jackson warned. “This is why keeping chronic conditions at bay [such as arthritis or limited vision whenever possible] and staying engaged are so important.”

Building More Wisely
The New Urbanist response is to build communities that bring housing, stores, restaurants, offices and other elements of daily life into close proximity. Place small parks throughout the community, connected to people’s homes by an inviting street and sidewalk network. Create a mix of sizes and types of housing so that people can stay in a community through every stage of life.

David B. Wolfe, author of “Serving the Ageless Market,” among other books, believed that the elderly — even those in assisted living — would be happier if their housing were in a townlike setting. He worked with Robert K. Wormald Sr. to ensure that Worman’s Mill would be walkable for seniors. Now, seven years after Wolfe’s death at 78, his vision is coming to fruition: the final element of Worman’s Mill, a village center, is under construction.

The 171 apartments in the village center are reserved for people 55 and older and 62 and older. Some of the units will be in the second and third floors of a building containing retail at street level. All 171 will be close to three restaurants, a bakery, a nail salon, an investment office and a convenience store/delicatessen that will have tables where people can sit. There will be an assortment of places to meet friends.
“The village center has always been envisioned as intergenerational,” said Edward Wormald, a managing partner who is overseeing the center’s construction. He expects people to walk, bike, or drive to the center from throughout the larger development.

The apartments will accommodate people who — on move-in day or at some future date—need assistance. Residents can obtain whatever services they require — hair-dressing, housekeeping, shopping, dog-walking, diabetic management, help with medications, meal preparation. They will pay for services a la carte. That’s much less expensive than moving to “assisted-living facilities with huge entry fees and huge rents,” Robert Wormald observed.

The center’s final element will be a building that resembles a hotel and offers some hotel-like services. Operated by Sage, an assisted-living company based in the Philadelphia area, it will contain 69 units intended for people who need daily nursing care or other assistance. Whenever they’re up to it, those residents will be free to circulate through the village center.

The four-story building also will contain rooms for 20 “memory-care” patients — individuals with Alzheimer’s Disease or other forms of dementia. The hope, said Robert Wormald, is that that people who have lived in Worman’s Mill for years will be able to stay in the community, even after fully independent living has become impossible. Friends will be close enough to visit frequently.

Humanizing Intimidating Institutions
If the average nursing home resident gets only four visitors a month, and even those visits don’t last long, as Dr. McGinty said, part of the reason may be the off-putting character of most nursing homes. “Nobody wants to be there or to visit a nursing home,” said McGinty, a part-time Seaside resident who led hospitals in Kenosha, Wisconsin, and Columbus, Indiana, before launching a healthcare consulting firm.

Duany offered a design concept aimed at breaking down the scale of a nursing home and making it more homelike. He showed sketches that his firm, DPZ, generated in 2009 for the “Lifelong Communities” initiative of the Atlanta Regional Commission. The nursing home’s perimeter would be made up of diminutive cottages, each containing a living room (including a tiny kitchen), a bedroom, and a bathroom, plus a small garden court.

A visitor, instead of having to pass through an institutional lobby, would walk through a garden gate and knock on the cottage door. The unit’s domestic feel might overcome the resistance of visitors and patients alike. At the rear of each row of cottages would be a wide corridor that the staff, based in the main building, would use to enter the cottages and provide services.

Helping People Stay at Home
Many elders would prefer to remain in their own homes rather than move into an assisted-living complex. Fortunately, in recent years, there’s been a surge in the number of service providers who make house calls. This is making it easier for people to stay in their homes.

Allied with this trend, more than 200 grassroots groups, known as “villages,” have sprung up to put neighbors in touch with these paid service-providers — and with volunteers and other neighbors. A pioneer in this movement is Beacon Hill Village (BHV), a nonprofit organization in Boston. Founded in 2002 to serve people who are 50 or older, the organization first focused on Beacon Hill but has since expanded to serve seven other core Boston neighborhoods.

“We have a small cadre of paid drivers” who transport residents to the airport and other destinations, BHV Executive Director Laura Connors told me. Window washers, visiting podiatrists, repair people, home care providers—all sorts of workers and professionals are identified through BHV and hired to meet residents’ needs.

BHV also organizes volunteers, who donate time to help their neighbors. Strengthening the community and reducing isolation are among the village’s goals. Connors noted, “We organize many cultural, educational and well-being types of activities.”

The cost? To support a staff of three full-time and three part-time employees, Beacon Hill Village members pay annual dues of $675 per person or $975 per household. Across the country, though, the cost of joining a village varies widely, depending on the village’s location and whether there’s a paid staff. “If it’s a volunteer-run organization in the suburbs, it might be closer to $100,” Connors said.

The Village to Village Network, a national organization that helps groups get started, says the village movement has gained a foothold in 45 states and the District of Columbia. More than 150 villages are in development.

Beacon Hill residents formed their village “so they could live out their lives where they know their neighbors,” Seaside’s Robert Davis emphasized. It’s an alternative to becoming uprooted by moving to a geographically remote retirement community.

Last summer he began talking with Susan Davis, who had headed the Sacred Hearth Health System in Pensacola, about establishing a source of services for older residents of communities along Highway 30A, including Seaside and Rosemary Beach. “There is such fragmentation of services, and you have to be knowledgeable about how to access them,” Susan Davis (unrelated to Robert) said.

The organization they’re contemplating would help guide people through the thicket of what’s available. Services could be “integrated with a wellness program, diet, exercise, meditation, entertainment and education,” Robert Davis said.

What Can an Individual do?
Part of the symposium headed into a more personal realm: How individuals can improve their own health and well-being, no matter where they live. Dr. Hillary Glenn observed that many diseases of aging are really diseases of chronic inflammation. In her own case, she was told by physicians that her severe rheumatoid arthritis could be fought with infusions — six a year at $36,000 a piece.

“I couldn’t afford that,” Glenn said. “The country can’t afford that.” Therefore she looked at lower-cost, more natural methods, such as yoga and Tai Chi. She found that “95 percent of all illnesses are caused or worsened by stress.” Learning to actively relax became a priority. She came to see food as something that can activate a painful genetic predisposition or turn those genetic influences off.

Elizabeth Trapp, a registered dietitian, castigated the “standard American diet” and urged people to shift to “a plant-based diet high in fiber and phytonutrients.” She told of positive results from an anti-inflammation diet. Dr. C. Jon Raley, a chiropractic doctor in Andalusia, Ala., urged everyone to sit less because excessive sitting causes or exacerbates physical problems and is harmful to the brain as well.

Marie Boularand, naturopath, psycho-bio therapist, and founder of the Biodecoding Institute, argued that “diseases are logical and intelligent.” By her reckoning, a disease is the body’s way of responding to “a past trauma that we failed to heal.” Delve deeper to identify the buried trauma and resolve it, and the disease may vanish, she suggested. “The symptom is the roadmap to healing ourselves.”

Dr. Prudence Farrow Bruns of Santa Rosa Beach, a teacher of Transcendental Meditation (TM), said baby boomers grew up in “a very difficult time” — during the Cold War and after two world wars and the development of the hydrogen bomb — so it’s not surprising that they had a quest for self-expression and were “not going to go the way the world told us.” This propelled some to undertake an inward search, said Bruns. Her own search sent her to India to study with Maharishi Mahesh Yogi, and led John Lennon, who was in India for the same reason, to write the Beatles song “Dear Prudence.”

Bruns praised Transcendental Meditation for having “a balancing effect on the busy mind,” observing, “If you can be quiet and still … you can be in control.” As evidence of TM’s effectiveness, she cited a study showing that people who started practicing TM at age 65 saw their spending on physicians go down, while those who didn’t practice TM saw their use of doctors, and their medical spending, rise. “There was a remarkable drop in expenses for those in TM,” she said.

A decline in stroke, heart attack and death among practitioners of TM has also been identified, Bruns said. “When we talk about aging gracefully,” she proposed, “it is a mental state.”

Dr. Peter C. Brown, professor emeritus of philosophy at Mercer University, urged people to examine their belief systems and seek “true human excellence.” A person’s philosophical outlook affects how well he or she will deal with aging, Brown suggested. More than one speaker recommended Daniel Klein’s book “Travels with Epicurus: A Journey to a Greek Island in Search of a Fulfilled Life,” which draws on philosophers from Epicurus to Sartre and offers advice on how to live well in old age.

At symposium’s end, it was up to each participant to sort through the speakers’ disparate ideas and reach conclusions. Whatever argument one agreed with or dissented from, the overall thrust was clear: aging gracefully is something each individual can strive for, but the quest goes better if you’re part of a community.

Philip Langdon is author of “Within Walking Distance: Creating Livable Communities for All,” published by Island Press.

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