December 2004

Renewing Old Values

We are now living in an age defined by “values voters.” But one value we are not talking about enough is one of the oldest faith-based values: “Honor thy father and thy mother: that thy days may be long upon the land.”

In the past century, Americans — through better nutrition, better medical care and better social policy — have experienced a 56 percent increase in life expectancy, from 49 years to 77 years, and the means to enjoy it. Overall, older adults have the lowest poverty rate of any age group, but they also spend most of the health dollars. Almost 30 percent of Medicare spending is on those who are in the last year of their lives.

Now that Baby Boomers are helping their parents manage medicine, money and mobility, to talk about the health of older adults means talking about a variety of different values. What do we value about our parents’ or grandparents’ generation? What is the value of life as it approaches an end?

And of particular interest to us, what is the value of promoting health and preventing disability in older people when the benefits may be minimal, hard-won or short-lived?

The answers to this last question will be powerfully influenced by three A’s: ageism, affordability and accommodation.

Ageism is the prejudice against the capacities of older adults that results in assigning low priority in research funding and program implementation that could contribute to healthy aging. There is precious little research on changing the eating, smoking and physical activity patterns in older adults despite the fact that doing so often improves quality of life and moderates disability.

Affordability is the concern that promoting and maintaining health — even if we are just talking about managing simple exercise, eating habits and safety precautions — costs more than you might think and even more for older adults with fixed incomes and more acute needs. When walking shoes cost about $70 a pair and fresh fruit is a specialty food, what appear to be simple health management tasks are out of reach for many.

Accommodation is the notion that the unique requirements of older adults mean that health policy, community programs and health care delivery can be, but often are not, structured to take health promotion into account. Simple fixes like reducing the fat and salt content in congregate meals made from surplus food seem painfully obvious but practically remote.

We are not going to be able to cure “old age” with pills and procedures — nor should we — and we will have to accept that age often means some disability. But what a powerful reflection of our values it would be if we decide to do more than just treat the dying — by making it possible for them to live as well as they can for as long as they can.

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