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Deborah Carr, "Aging in America" (U California Press, 2023)
00:56:03
An interview with Deborah Carr
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- [00:00]
Rachel Pagonis
Hello everybody.
- [00:01]
Marshall Po
This is Marshall Po. I'm the founder of the New Books Network, and if you're listening to this podcast on the New Books Network, I bet you like to read. I know that I do. That's why I founded the New Books Network. So as readers, we need to know what to read. And I have a podcast to recommend for you. That being the Proofread podcast, do you have a goal to read more this year? How about a goal to read more of what you love and less of what you don't? The Proofread podcast is here to help you. Hosted by Casey and Tyler, two English professors and avid readers with busy lives, Proofread helps you decide what books are worth spending your precious time on and what books aren't. They have 15 minute episodes that give you everything you need to know about a book to decide if you should read it or skip it. They offer a brief synopsis, there's fun and witty commentary, and there are no spoilers and no sponsored reviews. Life's too short to read a bad book, so subscribe to the Proofread podcast today. And by the way, there's a new season coming soon.
- [00:59]
Deborah Carr
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- [01:32]
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- [01:36]
Deborah Carr
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- [01:56]
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- [02:00]
Marshall Po
Welcome to the New Books Network.
- [02:04]
Rachel Pagonis
Hello everyone, and welcome back to New Books in Medicine, a podcast channel on the New Books Network. I'm Rachel Pagonis and I'm your host for this episode. Today I'm speaking with Professor Deborah Carr about her new book, Aging in America, published by the University of California Press. The this year, 2023. Deborah Carr is Professor of Sociology and Director of the center of Innovation and Social Science at Boston University. She's published more than 100 articles and chapters, as well as several books, among them Golden Years, Social Inequality in Later Life and Worried How Stress Hurts Us and How to Bounce Back. She was editor in chief of the Journal of Gerontology Social Sciences and is principal investigator of the National Longitudinal Survey of Youth, 1979. She's also a fellow of the Gerontological Society of America, a member of the Honorary Sociological Research association, and the recipient of the 2022 Matilda White Riley Distinguished Scholar Award of the ASA Aging and Life Course section. Debbie, welcome to the show.
- [03:07]
Deborah Carr
Thank you for inviting me on.
- [03:10]
Rachel Pagonis
I'm really excited to have you here. And to begin, would you tell us a bit about your own background? And I'm particularly interested, too, in what prompted you to write Aging in America at this time.
- [03:21]
Deborah Carr
Sure. Well, I'm a sociologist, and for almost all of my career I've studied aging, and there are not a lot of sociologists who study aging. But I think it's one of the most important questions facing society today. How can we meet the needs of the large and growing population, age 65 plus? I think it's one of the few life stages that everyone will experience at some point if we're fortunate enough. And so we really need to understand what helps people to age well and how we as a society can meet the needs of an aging population. So I've been doing this work for a very long time, and I've done a lot of research on topics like end of life and older adult marriages and physical and mental health. So this is what I had done for about 20 years. And then I wrote the book when the editor of the series at University of California Press me about writing a book called Aging in America. And I jumped at the chance because it was really a great opportunity for me to put in one place all the studies that I've read and all the work that I've done on my own in one place, really, to give a portrait of who are older adults in the 21st century and what will aging look like for future generations, such as Generation X and the millennials that follow them.
- [04:41]
Rachel Pagonis
Yes. That's, to me, kind of a scary question, thinking of the millennials and the Xers becoming the old people and maybe I should say the older people and what will they be like? I wanted to ask you, you mentioned 65 and up, and that's a number that is usually used when we say older adults. But is that what we're talking about, people 65 and up? It is.
- [05:02]
Deborah Carr
And for the most part, statistics that are generated by the federal government, for instance, which I rely on heavily do look at 65 plus as old age. But as I point out in the book, age is more than just a number. You know that cliche people age at different paces. So those people who didn't have the privilege of going to college or who work in blue collar jobs that have a lot of wear and tear on the body, they might have an older body at a much younger age. Whereas those people who have had the privilege of higher education who do white collar sedentary work might not experience any physical health symptoms until they're 75 or 80. So even though statistically old age refers to those age 65 + in the United States, in the book, I really delve into this pattern or phenomena whereby age means very different things based on one's social location.
- [05:57]
Rachel Pagonis
Yeah, that's really interesting. I suppose there's two things as well. Which is one is that society may View Anyone is 65 and older, old, you know, regardless, you may be perceived as that way. Whereas the individual, as you say, someone younger may be actually biologically old rather than chronologically. Or somebody much older may be quite young biologically.
- [06:23]
Deborah Carr
Absolutely. And that's part of the reason why when we think about social policies that work well or less well, this is one of those factors that matters, right, that retirement age historically has been 65 for younger cohorts. For my cohort, for instance, Generation X, we can't pull our full Social Security benefits until 67, for instance. But those hard, fast policies and benefits that are key to age have problems in some ways because people have very different needs, as I had just mentioned.
- [06:56]
Rachel Pagonis
Hmm. Yeah. Well, let's start with the book. And the book itself gives, as you said, a really wide ranging look at the different components and aspects of aging. And it's also written in an accessible style. And by that I mean it's more descriptive than theoretical. So it's great to read. Who do you want it to reach? Who needs to understand the phenomenon of aging in America?
- [07:20]
Deborah Carr
Great. Well, as most authors would say, everyone. But for the most part, realistically, I think the readership is probably undergraduate students, graduate students, and maybe social work or public policy. Those students whose career interests or whose academic background really requires a knowledge of aging. But I'm not being facetious when I say this is a book I think that everybody should read. As I mentioned earlier, our population is old and getting older, and one in five Americans will be an older adult in the very near future. And that is more than at any point in history. So I believe that people working in any profession from law to business to medicine to long term care, really needs to understand why our population is getting older and what we can do to meet the needs of older adults. And any individual, for that matter, who has a family, who has an older grandparent, or who is a caregiver to an aging spouse. I think the book has information for them as well that could be really helpful at a practical level.
- [08:31]
Rachel Pagonis
That raises another question for me as just who is it then that's making? So of course there is the government making policies, but who else is determining what. What will happen with older people? What. What is the protocol? What? I don't know. I suppose how they age, where they live, what. What kinds of benefits and things they have access to or education or jobs they have access to.
- [08:59]
Deborah Carr
Yeah, that's a great question. I mean, kind of things like Social Security benefits or Medicare, that is done at the federal level. But when you think about even more seemingly simple things like supports and services, that does happen at a much more local level. So does a city have a van that drives older adults to medical appointments or grocery stores, for instance? Or what kind of benefits do employers provide to their workers who might need to take time off to care for an aging spouse or an aging parent? Those are things that people really need to think about. And then in terms of everyday life, for instance, we know that ageism is rampant. We know that people make jokes about older adults. We know that they can be snide or curt in interacting with older adults. For instance, in customer service, if you have a customer who's moving a little bit more slowly, for instance, or is a little bit less adept at using their computer, I think those professions as well need to think about, if not a formal policy, at least training for helping them to interact with older adults in a way that meets their needs and that is respectful and appropriate.
- [10:13]
Rachel Pagonis
So chapter one, this is really interesting, begins with a historical perspective on aging. And you write that in 1795, Thomas Paine imagined a national old age pension program such that older adults could, and I'm quoting here, live without wretchedness and go decently out of the world. But as you write, nothing like Payne's vision was enacted until the Social Security Act of 1935. What was life like for older American adults in the interim? Was it wretched?
- [10:46]
Deborah Carr
It was wretched for many. And that chapter, honestly, was one of my most favorite to write because I'm not a historian and I learned a lot in learning about just how difficult old age was in earlier areas. And in truth, there were fewer Older people during those earlier time periods, about 4% of the U.S. population, as opposed to closer to 14% today. But because there wasn't a federal safety net, responsibility for older people overwhelmingly was with their families. Because older people didn't work, especially if they had frail bodies, they didn't have pensions. And so most relied on their relatives. They either lived with their children or they got financial support from their children. But if they didn't have family or if they had family that wouldn't provide for them, they did live in institutions such as poor houses. And a lot was written about the poor houses or alms houses in prior eras. And it was older adults who essentially had been left behind and they co resided in those homes with unemployed people, those who had substance use issues. So for many it was a quite wretched existence, especially those who had no social ties to help support them.
- [12:08]
Rachel Pagonis
And could you clear something up about ages there as well? Because I know of course life expectancy was a lot less than, but there was a lot of childhood death. So were there still a large number of people who were getting to, let's say, 60s, 70s, even 80s, you know, despite the fact that there were a lot of people who died, you know, women in childbirth or children or men in war for that matter?
- [12:31]
Deborah Carr
Yeah, that's a great point and thank you for pointing that out. There were indeed older people. And in 1900, 1910, about 4% of the population was over age 65. And life expectancy was much lower back then, but it was because, as you mentioned, infants and children were dying. So if you think about we take an average of how long people live, and if you have a lot of people dying at age 0 or 1 due to infant mortality, that pulls down the overall life expectancy. But those people who did manage to survive through childhood illness and infant death, they could live to age 60, 70, 80. And look at photos from that era. Right. You'll certainly see pictures of older adults. So people did indeed survive until old age, even though the obstacles to surviving were much higher then.
- [13:26]
Rachel Pagonis
Yeah. And so, you know, we talked about Social Security Act of 1935 and there was that. And then I know a bit about the history of Medicare, which was passed in 1965. Can you say what were the impact of those two acts on older adulthood?
- [13:43]
Deborah Carr
It was life changing in many ways. And even though there are still critiques people could raise against Social Security today, it really did lift millions of people above poverty. And during the early stages, those first few decades of Social Security, from the 1930s to the 60s there was still a quite high poverty rate, but that diminished once those benefits were increased. But if you look at the poverty rate data, for instance, the proportion who live beneath the federal poverty line among older adults, it was about a third, about 30%, prior to the onset of expanding Social Security, and now it's down to about 10%. So it really had a dramatic impact, allowing older adults to live on their own and not to live with their families, to avoid the quote, unquote poor house and really to be able to afford a much better quality of life than they had in prior decades.
- [14:41]
Rachel Pagonis
Wow, that makes me wonder if that's helped lead to, you know, kind of a social phenomenon, which is older people living on their own, you know, continuing to live independently, but maybe also experiencing more loneliness because they're no longer living with younger generations.
- [14:57]
Deborah Carr
Yeah, you're absolutely right. I think the capacity to live alone can be, you know, a double edged sword. Most older adults today, they do want to live on their own. They love their children, but they want what some people have termed intimacy at a distance. You want to be near your children, but not in their home. But as you mentioned, that raises important issues. A lot of older adults today, especially those who live in older homes, find that their homes are not appropriate for aging bodies, for instance. So they do struggle when they physically live on their own. And as the pandemic showed us in a very dramatic way, we do have high rates of social isolation and loneliness among older adults, especially those who live on their own or who might not be adept at using things like zoom to communicate with people outside of their home. So you are right that independence does come at a cost.
- [15:53]
Rachel Pagonis
Okay. And I think we'll probably get into that a little bit more later, but still in chapter one here, and it gets into more contemporary perspectives. And you mentioned something called the epidemiologic transition, which refers to a period when infectious diseases became mostly curable and chronic diseases started to be the leading causes of death in the US Instead. And you describe two theoretical responses to this transition as people began to live longer. The first was disengagement theory, and then later there was activity theory. And I'll say that both of them to me seem kind of simplistic now, but they do speak to how older adults were perceived in the middle of the 20th century. So would you briefly describe what those two theories say and what also they posited for older adults?
- [16:44]
Deborah Carr
Yes. These two theories, disengagement theory and activity theory, came out in the 1960s, and they were really among the first Academic theories of aging, in part because older adults were relatively rarer right in the past, but they also were an afterthought at some level. And those two theories, when you hear them today, they do sound simplistic, and one in particular sounds very outdated. But they did give a lens for thinking about older adults and how to meet their needs. So the first theory, called disengagement theory, was generated in the early 1960s, and its intent was good, even though its interpretation maybe might lead to unwise interventions. It basically said that as we get older, kind of the best thing to do for older adults and society is to help those older adults recede from their social roles, spend their time kind of thinking, pondering, being introspective, and preparing for what was certainly an imminent death. And the rationale for that was one, if you let older adults kind of pull out of their roles, such as work and intensive family activities, for instance, it would give them peace and take that kind of pressure off them. But then secondarily, you would open up those roles for other people. So if you kind of nudge older workers out of the labor force, what you're doing is opening door for younger workers to hold that role. So that was the theory, but the data really don't provide tremendous support for that. And that led to the generation of activity theory, which essentially posits the opposite. It says it's not that giving up social roles allows older adults to have emotional peace and well being, but rather allowing them to be engaged and active on their own terms. So providing activities for older adults, whether it's volunteering experiences or trips to Atlantic City, on the bus, playing bingo, which we know used to be a big activity for older people, or remaining engaged as kind of a matriarch or patriarch of the family, that kind of engagement was viewed as the way to help people to age well, Even though that sounds very good. And activity theory is something that you can see see as informing policies and practices like having adult daycare centers and community centers for older adults. You can see that there also is a disadvantage. This giving older people an activity might not be their preferred activity. So, for instance, saying we're all going to take the bus to Atlantic City or we're all going to watch this movie together, that might not be something the older adult wants. If someone's kind of a quiet loner, they might prefer to read. If there's someone who likes to be physically engaged, it might be exercise class. And so activity theory then has been refined through the years to lead to this recommendation that Activity is good, provided it's an activity that an older person likes and wants to engage in. You know, at 65 or 85, we're just an older version of our younger self, and many of our preferences and hobbies stay with us all that time.
- [20:05]
Rachel Pagonis
Hmm. That. Yeah. I mean, it seems to me, like, I guess you said it's kind of evolved. It seems like activity theory still exists because I see a lot of things like bingo for older people and the bus trips where I live. You know, you go into the post office and there's posters on the wall about a bus trip, too. We don't have Atlantic City here in England, but, you know, similar things to the coast and in Europe there. I don't know if you have it in the States. The University of the Third Age.
- [20:34]
Deborah Carr
We do, actually. We have a lot of different ones. There's Olli. There's kind of the Osher Lifelong Learning Institute. There's something that used to be called Elder Hostel, which has now been rebranded. But it takes older adults on trips where they learn, and those are actually really fantastic. And I think the important thing is multiple options so that older adults, like younger people, have a menu from which they can choose those activities or trips that best align with their preferences and interests.
- [21:06]
Rachel Pagonis
So then I'd like to follow up the same way the chapter does. You give two contemporary perspectives on aging. One is the life course paradigm, and the second is cumulative inequality perspectives. So could you tell us what are these two perspectives and how do they inform our understanding of older adulthood now? Sure.
- [21:27]
Deborah Carr
These two perspectives share one important theme. And the theme is that what our old age is like is a consequence of all the experiences we've had prior, even dating back to birth. And one thing I often say when I lecture on aging is that the benefits and disadvantages of old age don't instantly crop up on one's 65th birthday. Really, they're that end result of the accumulation of experiences that we've had throughout our lives. And so that kind of general theme that I just mentioned is at the core of the life course paradigm, and that says that we have a range of experiences dating back to birth, having to do with our family relationships, our personality, the benefits or disadvantages that we face, and all of those experience kind of lay the course for what happens in to us in later life. And what happens to us at 65 in many ways depends on what kind of job we had at 40, what kind of education we obtained by the time we were 21. And so it's really important Also from a kind of a policy and a health care perspective, because it suggests that giving people economic benefits at 65 or giving them health care access 66 at age 65 is too little, too late. It recognizes that you need to do interventions in terms of early childhood education, the opportunity to go to college, access to health care at much earlier ages if we want people to age well. So that's kind of the big picture summary of life course paradigm. And it's really helpful because even at an individual level, it helps you to think about what you're doing at age 20 or 30 and how that might bear on what your retirement years are like. So that's the life course paradigm. Then the cumulative advantage and disadvantages theory kind of take that theme, but then add another layer to it. And they basically argue that we accumulate advantages and disadvantages over time such that whatever differences we might see among people who were younger just amplify and widen over time. And so let's say, for instance, you have two people who are young, who are classmates, maybe in elementary school, one has the good fortune of going to college. And so then they have a good job with healthcare benefits, white collar work, they marry well, they own a home. And so you can see it's like a rolling stone collecting boss, right? This individual collects more and more advantages over the life course, but it allows them to have a happy, healthy, wealthy retirement at the other end, their classmate might drop out of high school, have a job that doesn't provide health care, that takes real wear and tear on the body. Their stress might threaten their marriage. And so again, in the other direction, disadvantage or adversity begets further adversity, leading to, again, a more difficult old age. So that's kind of the crux of the model. And it's really important because it helps us to understand what why do some people live to 85 and some live to 60? Why do some retire on a yacht and others barely can afford their medication and live in a small one room or studio apartment? And again, it goes back to early life exposures and how the good and the bad essentially accumulate over time.
- [24:57]
Rachel Pagonis
Well, that's interesting. So what does that tell us about what policies should be in place in older age for people who have had, let's say, not many advantages throughout their life? And that's clear.
- [25:11]
Deborah Carr
Yeah, that's a good question. I guess one thing I just want to kind of revisit is that these theories are not deterministic, right? If you grow up in a family that has, who lives in poverty for instance, or if you have an early life health condition, it increases your risk. But it's not a foregone conclusion that you will continue to face adversity for exactly the reason you just mentioned. There are ways that institutions and policies can help intervene. One might be more support for college financial aid, for instance, right. Loan forgiveness, so more students can go to college, even if they come from disadvantaged economic backgrounds. Because we know that college does provide a realm of resources that help people to age successfully in terms of having better quality jobs and jobs with health insurance the other. And this might sound alien to you living in the uk, but we don't have socialized health care in the United States. And lower income people often do not have health insurance. They do not have access to preventative care or the medications they need, even in younger ages. So I think from a policy perspective, if we did more to ensure that people of all ages, of all economic backgrounds, have access to high quality preventative and curative care, that will help them to age well. Also, environmental interventions, we know that some neighborhoods are less safe. In lower income neighborhoods, it's much more difficult to find healthy, affordable foods. So there are a whole realm of ways that there can be interventions at younger ages to stop that accumulation of disadvantage, to help people either kind of get a second chance in their hopes of aging well, or to help at least minimize some of these disparities that we see in survival and then, well, being in later life.
- [27:04]
Rachel Pagonis
Well, so let's get into who are older adults today? And that's the name of chapter two. And it is a fascinating question. So I'll ask you, Debbie, who are older adults today? And in the book, there's all these fascinating demographic details, which we don't have time to go into all of them. But could you summarize some trends, maybe?
- [27:25]
Deborah Carr
Sure. Older adults are diverse and becoming more diverse with each cohort. So I think that's one important lesson. Older adults, in the general snapshot, there are people over age 65. But even within that, there's a lot of age diversity. So as we talked about earlier, people are living longer and longer. So the two most rapidly growing groups of older adults are who we call the oldest old, those who are 85 and older, and centenarians, those who are 100 and older. So over time, it's not just that we have more old people, but we have more older people in those latter two categories, those who are much older. And those are really the groups that have a greater number of health concerns, including cognitive health. So we have age Diversity. And I think that's really important because someone who's 65, they have very little in common with someone who's 100. And so that makes us think that we can't have a one size fits all mindset when it comes to the older population. And we really need to think about these different needs that people have based on again, whether they're 65 or 66 versus 100. Another thing about older adults, it's kind of a persistent trigger trend from the population level that most people don't see going away anytime soon is older adults in the US are overwhelmingly female. And anyone who has ever visited a long term care facility will notice that they see lots of women. And that's in part because women live on average anywhere between five and seven years longer than men for a realm of reasons. But the population definitely skews more female. And that also raises some issues about the particular needs that older women might have, including that are economic. Another characteristic that we see is that the older adult population is getting more and more educated with each generation. And so it was very rare again for our grandparents or great grandparents generations to graduate high school. Today it's very common to have graduated college. And that means that they have greater health literacy, lower rates of smoking, a whole collection of behaviors that tend to be more healthy. And that's something that we see with this rising level of education across generations. Then finally, one last one I'll mention is that we have with each generation, older adults are becoming more racially and ethnically diverse. That has to do with a range of different explanations. One is immigration, right, Immigration patterns, where we have rising proportions of older adults who are of Latino or Asian ethnicity. The proportion of older adults that are black is pretty stable over time, but that's yet another dimension that we see kind of the ethnic and racial and immigrant composition of who older adults are. So those were just a couple stats to throw out to you. And I won't go on too long because it gets tedious, but I'm happy to follow up on any of those or add some other ones.
- [30:35]
Rachel Pagonis
Yeah, sure. So I'll follow up in one area you mentioned the increasing diversity, but you also have several graphs in that chapter showing that people of different races and ethnicities on average have different shorter or longer lifespans with white, well, not even white women. So I want to ask you about this, the Hispanic paradox. Why is it that people of Latino or Latina heritage seem to live longer on average than anyone else in the.
- [31:04]
Deborah Carr
US that's the million dollar question. This is something that researchers have written about at length. And the Hispanic Paradox Why is it a paradox? We know that there is racial inequality in the United States, there is xenophobia, there is structural racism, and Hispanics on average have less education and income and less fewer opportunities for high paying jobs relative to white. But be that as it may, they are not dying on average, particularly younger. And so that's what that Hispanic paradox is. How is it in this context of systemic racism and xenophobia do we see that there's not a really clear gap in life expectancy? And there are a lot of different answers. The two main ones that are generated is one is that Latino immigrants in particular maintain healthier diet at some level than native born Americans. One trend that's interesting is each generation that Latinos are in the United States, their health behaviors get worse because they start eating American unhealthy foods like potato chips rather than rice and beans for instance. That's one argument that's given this change in diet. The other is a methodological issue that has to do with selection. One of the arguments is that those who come to the US are healthiest at the outset because migrating is physically difficult and so that way you're getting on average a healthier migraine at the get go. Then the other is that those who are unhealthy might return back to their home country to die. And so as a result these aggregate level life expectancy statistics wouldn't take them into consideration. So it's a really large literature. Some the explanations have to do with kind of lifestyle and the other have to do with these methodological details. So good, so good, so good.
- [33:03]
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- [33:36]
Rachel Pagonis
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- [33:58]
Rachel Pagonis
Well, that's very interesting because the first place my mind would go is, well, people who immigrate here from particularly Central American countries or they may have come from very traumatic circumstances. And so they might arrive here unhealthily and be less expected. But you're saying the ones that got here are actually the ones who survived that?
- [34:21]
Deborah Carr
Yes. And I think a big question that I raised throughout the book is kind of this. I write about people who are currently older adults, but what will it look like for future generations and if the reason for migration changes over time? You're absolutely right. Those who are fleeing oppression and violence, refugees might have a very different later life health profile than those who came here for economic opportunity or family reunification. Kind of these less traumatic reasons and reasons that really have to do with upward mobility and kind of pursuing a better life, but not in the context of violence and aggression.
- [35:03]
Rachel Pagonis
I'm going to ask you one question which is totally throwing it out there, but this is always something that's that I've wondered about. Do you have any explanation for why Supreme Court justices in the United States seem to live so long? It seems like at least some of them would die earlier. What? So do you have any.
- [35:25]
Deborah Carr
That's a great. I won't say anything political, but I could. I think it actually is kind of going back to cumulative advantage theory that even though the Supreme Court is becoming more diverse over time, all of them have something in common. They all have four year degrees from quite prestigious universities. They all have law degrees. They have had economic resources throughout their adult lives. They have benefits. They have had the fortune of living a lifestyle surrounded by other people with those benefits. So I suspect it has a lot to do with their economic position and their education and living in communities that have high quality housing and good path to walk on. So I would attribute it largely to their education and income. Also, they're very well integrated socially. Right. And we know that our social relationships, the belief that you matter, keeping engaged intellectually, all of these psychosocial factors as well help people to live longer lives. So I suspect that's part of it. They just had a whole bunch of advantages even before they became Supreme Court justices.
- [36:41]
Rachel Pagonis
Yeah. Well, that's really interesting. And what I always thought was maybe it's because they have such a strong sense of mission in life. In particular, I think of Ruth Bader Ginsburg who, you know, survived three types of cancer and the death of her husband and but stayed very active and dedicated to the Supreme Court. But maybe that's just my mind thinking.
- [37:05]
Deborah Carr
That'S There is something to that. You're absolutely right. I've been focused on kind of structural factors like education and income, as most sociologists do. But you're absolutely right. There's a whole body research generated largely by psychologists that does identify these other more spiritual or interpersonal or psychological factors. I mean, in Ruth Bader Ginsburg's case, we all know that she could plank. Right. And so she was really dedicated to physical fitness. She had a real clear sense of purpose. And there is data showing that having a high sense of purpose is linked with longer lifespan. Another trait that's linked with longer lifespan is people who hold positive versus negative views about old age. So if someone believes that old age is linked with just death and demise, then that leads to behaviors that kind of hasten death and demise. And there's a psychologist named Becca Levy who's written about this at great length. Those people who believe that you continue to kind of grow in old age and who act on that do live longer. So there is something about optimism, positive regard, engagement that do lead to longer lifespans, in part because it triggers some of these very healthy behaviors, seeking out social support and all the kind of soft factors outside of money that help people to live a longer life.
- [38:32]
Rachel Pagonis
Oh, yeah, I can see how it's all connected there. Yeah. So, okay, let's go back to something that came up before, which is loneliness and isolation, and also the difference in women, the longevity of women versus men. So in chapter three, you bring up five common challenges among older adults, including loneliness and social isolation. And you brought up this statistic that jumped out at me. And it says, in 2018, 70% of men, which is 46% of women ages 65 and older were currently married. And among those ages 85 and older, 60% of men, but just 17% of women are married. And that raises the question for me. Do older men and women experience loneliness and isolation differentially?
- [39:25]
Deborah Carr
Yeah, that's a great question. They do. And most older people want someone in their life. It just differs who that person is. And so exactly as you pointed out, men are much more likely than women to be married at older ages. And partly it's because, you know, men tend to be the one who dies first in a marriage, something we touched on earlier. And so widowed women tend to kind of live on on their own. Also, men are more likely to remarry upon divorce or widowhood, in part because some would argue they have a greater need for a kid caretaker. Right. Than women do. But also, men tend to prefer a younger woman and so they have a larger pool, whereas, you know, an 80 year old woman will have far fewer options should she choose to remarry. So that's kind of one thing going on in the background. Men and women are actually cohabiting outside of marriage, even in old agers at ever rising numbers. So that's one other kind of resource they have against the social isolation. But in short, men tend to seek out romantic partners as their source of emotional support and their hedge against loneliness. So that's either their wife or a new spouse or a no romantic partner. Women who are alone and unmarried may not necessarily be lonely because they turn to their children very often. They turn to their friends, who often are also widowed, other members of their community. So men and women use different strategies for filling out their social worlds, but they also do have high rates of loneliness, even regardless of whether they're partnered. As many as one in three married older adults who are married say they're lonely. I think it has to do with gender differences and kind of communication style and how much one needs a confidant, a helpmate, and someone with whom to enjoy life.
- [41:28]
Rachel Pagonis
I wonder if there's any evidence as far as those one in three older adults who say they're lonely within a marriage, what percent are men and what percent are women?
- [41:38]
Deborah Carr
Women tend to be a little more lonely in marriage than men. And I think it's in part having to do with, again, communication style. Women are just socialized on average to engage more in conversation and to ask more questions and offer up emotional support. So that's one reason. The other is that oftentimes the loneliness is reported in couples where one has a significant physical or cognitive or mental health concern. And that's another big issue. If you are caregiving for a spouse with dementia or with a major health condition that is just, you know, kind of debilitating. It's a lot more difficult to engage in social activities, to have those fun conversations that you once had, because the relationship dynamic shifts. It goes from being spouses and peers and equals to one who is the caregiver and one who's the care provider, which can lead to a very different emotional dynamic.
- [42:36]
Rachel Pagonis
Yeah, well, that's interesting. So, yeah, you mentioned people caregiving to a partner who is unwell. And health and well being, of course, are huge areas of concern for people as they age. So just going back to the epidemiologic transition, what are now the main chronic conditions that affect older adults and what impact do they have on disability and longevity?
- [43:02]
Deborah Carr
Yeah, that's a great Question. Very few people today are dying very suddenly. The leading causes of death are heart disease and cancer. And Covid did crack the top three for older adults over the past couple of years. But that may kind of diminish, we hope. And then behind, heart disease and cancer tends to be lung related diseases like copd, chronic obstructive pulmonary disorder. And those are all chronic diseases, which means that you can live with them for 10, 20, 30 years with some compromised well being, some compromised capacity to get around. So they really have outsized impacts on older adults quality of life. You might need a caregiver, you might need long term care, you might need to use assistive devices, for instance. And we have greater medical technologies today that allow people to take medications and get a lot of these conditions under control. But they still do have an impact on everyday life because we can live with these things for very long time periods. And so those are the more physical ones. But then obviously the another one that is a major, major strain on older adults is rising rates of Alzheimer's dementia, which is debilitating. People can live with it for a very long time, and it has a tremendous impact on the individual and their families because it just changes everything, including relationships.
- [44:32]
Rachel Pagonis
Yeah. And those rising rates of Alzheimer's and dementia, is that because there are more older people now or is there some other reason?
- [44:39]
Deborah Carr
That's the main reason, because we have more and more people not just who are older, but who are those two oldest groups I mentioned earlier, 85 plus and 100 plus. And even though there's a stereotype that old age is synonymous with cognitive decline and senility, if you look at the data, the rates of cognitive impairment and dementia really do not start to increase starkly until after 85. Right. It's about 35% of those who are currently 85 plus. And so it does have on average, that later age of onset.
- [45:15]
Rachel Pagonis
Yeah, I think that's just from when I talk to people, that's sort of the one, the thing that they most don't want to see to come to.
- [45:24]
Deborah Carr
Absolutely. And some of my research outside of this book focuses on end of life issues and how we think about death and dying. And in vignette studies, when you kind of present older adults with this question of what would be less tolerable to you, living with physical pain or living with a lack of recognition of the world around you, people are far less likely to want to live with severe cognitive impairment. Most people feel they can withstand the physical pain, but if they ever become incapable of communicating with others, that's the point at which they start thinking about, you know, not wanting to live anymore.
- [46:03]
Rachel Pagonis
Yeah. And I suppose this brings up a whole other can of worms we don't have to open, but, you know, in Europe there's assisted dying, which someone could choose if they have unbearable physical pain, but it's not something that you really can choose if you have to. Your dementia.
- [46:18]
Deborah Carr
Yeah, exactly. Because one of the criteria for being able to make that request is being, you know, quote, sound mind. Right. And in dementia, there's the belief that someone doesn't have decision making capacity. So you're absolutely right. It's a huge can of words. Politically, ethically, religiously.
- [46:38]
Rachel Pagonis
Yes. Yeah. So let's go to something more positive then. I love the way the book ends with a discussion of how older adults, rather than being seen as a burden, can be perceived as what you call a global resource. So what can older adults uniquely offer to society? And how might we all benefit from embracing this perspective? Sure.
- [46:59]
Deborah Carr
Older adults can bring so much. And so whenever someone reads an article about the gray tsunami, Right, this kind of doom and gloom portrait, we need to keep in mind that older adults bring so much first. They are among the largest volunteer labor force in the United States, and I suspect in Europe as well, contributing, you know, tens of thousands of hours each year in roles like museum docents and school volunteers. So many, many are giving back to society, many are caregivers to grandchildren. So older adults are clearly contributing, but at other levels, they're a lifeline. Right. They are our source of memory, our source of history, our source of culture. And if people would kind of open their ears and listen to the stories of older adults, they provide this wonderful lens into history, history and to culture. Right. From days past. So I think there's a lot we can learn from older adults. We know that wisdom increases with age. And so listening to older adults for their perspective, for their deeply earned knowledge, that can be really a benefit to all of us.
- [48:10]
Rachel Pagonis
And what about caregiving? Because they may also be taking care of grandchildren or providing money to children in some cases.
- [48:19]
Deborah Carr
Definitely. So older adults, often, for families that face a lot of economic adversity, they can be the custodial caregiver. We see rising numbers of older adults who are the main caregiver for a grandchild, often because that child in the middle generation has faced adversity either in terms of opioid addiction or incarceration or other mental health concerns. And the grandparents are really, really stepping up in some communities and providing just a really important service. Also providing economic resources for their children and grandchildren. We see rising numbers of older adults, for instance, taking on, you know, parts of college tuition for their grandchildren. So there are clear economic contributions that older adults make. And so I think that's really something important. So I'm glad you raised that. And then the final point that I often make is sometimes people will sit back and say, why are we giving all this money to Social Security and, you know, Medicare? Why are we giving money to older people? And trying to kind of spark this generational debate. But it's important to recognize that families are interconnected. So if older adults are receiving financial support, that means that they don't need to, to rely on the younger family members or they'll have resources that they can share with the younger generation, or they'll have the good health that's needed to be able to care for grandchildren or children or spouses. So investments in older people are not a zero sum game. And they do in fact, help the generations that are younger than them within their own families and beyond.
- [49:58]
Rachel Pagonis
Yeah, that all makes a lot of sense. And I'm thinking too that society is very lucky to have so much unpaid work that is done by older adults because they may have left the paying workforce and be doing work that arguably should be remunerate. Remunerated. But it's not, because there are. Yeah. Anyway, I'll let you speak.
- [50:23]
Deborah Carr
Oh, I'm sorry. Yeah, absolutely. I mean, just thinking, in the United States, people should think about who do they see when they go to vote at elections? Who, who are the volunteers at elections? Almost uniformly persons of the retirement age or if you go to museums, and you do raise an important question, why aren't they paid? And there are actually some federal programs in the US and you're probably more generous about this in Europe that are subsidized volunteer programs. So just as we have, you know, the Peace Corps in the United States, we do have these different volunteering cores. One that focuses on kind of helping kids in school, and the other is visiting older adults who are actually in poorer health. And this volunteer force, they are, they earn a stipend for doing so. It's not a large stipend, but it's kind of enough that it helps older adults who are just at or above the poverty line have a little bit more money to make it worth your while to do this kind of social engagement.
- [51:20]
Rachel Pagonis
Yeah, and it seems like both in the states where I'm originally from, and also in the UK where there's an absence of government funded programs that's where these volunteers, who are very often retired people, step in. And really there should be enough funding for these programs, but there isn't. And it's kind of, you know, society is able to fall back on these volunteers because they now have the free time to do it.
- [51:50]
Deborah Carr
Yeah, absolutely. Think about kind of public schools as one example, that are in some areas in particular are woefully underfunded. And some of these volunteering programs that place older adults in the class who are helping reading tutoring, for instance. They really are filling a very important need.
- [52:09]
Rachel Pagonis
Yeah, well, it's all really interesting and I agree with you. Everybody should read this book. But, Debbie, so I'd like to ask you too, before we go, what are you working on now?
- [52:22]
Deborah Carr
Yeah, a couple of projects. One new paper that will be coming out is actually a new area for me. And I think actually this is such a pressing social concern, but it's looking at climate change and aging. And we know that climate change is real and the planet is getting warmer and warmer. And one thing that I'm looking at with some colleagues is how does climate change and increasing temperatures align with population aging? Because we know that older people are much more vulnerable to heat extremes. Right. If you have heart disease, diabetes, that heat can be really difficult for you. Some medications make you really vulnerable to heat. And what we find is that there are pockets of the United States and worldwide where the population is aging most rapidly and temperatures are increasing most starkly. And so we identify what we call hotspots, these places where it's a perfect storm of growing number of older people who are sensitive to heat and rising temperatures. And it really, we think, provides an important map to identify those parts of the world where you can have lots of older adults who are dependent on healthcare, who might need more medical assistance on those really hot days. And so our conclusion is that any kind of climate change policy needs to consider the distinctive needs that older adults have because the impacts of heat are much more dire for them. So that's one new project I have that I think is important and timely.
- [53:58]
Rachel Pagonis
Well, it's a whole other aspect of climate justice.
- [54:01]
Deborah Carr
Absolutely. And it's not to take away from the fact that we know that lower income neighborhoods have fewer trees, for instance, and less air conditioning. But for older adults, they do also have these very distinctive demands or strains on them that makes it a lot harder to deal with these rising number of temperature extremes.
- [54:20]
Rachel Pagonis
Yes. And I know in Europe, whenever there's a heat wave, you hear about very large numbers of older people dying. And also I remember after one of the hurricanes, I don't remember which one, in Florida, and power was knocked out of some of the care homes, nursing homes, and. And there were old people who died there because of the heat.
- [54:40]
Deborah Carr
Exactly. We actually referenced them in this paper. Yeah, absolutely. That long term care facilities, they need to be sufficiently resourced so that they have appropriate generators in place because older adults who require the air conditioning to help them cope with the heat, in many cases they are on ventilators and have these other needs for power. And so this happens. And if you look at the disasters, everything from hurricanes, Superstorm Sandy to the heat wave in Europe, the people who die are overwhelmingly older adults, either because their bodies are less well equipped for withstanding heat, or they have mobility issues that make it harder to evacuate. Or getting back to the isolation, as we talked about earlier, some of the people who suffered most in some of these hurricanes were those who were isolated and they didn't have anybody to help them to evacuate. They had nowhere to go. So it really is just a dramatically sad and important question that we need to deal with this society beyond the US Right. Because Europe is there as well.
- [55:47]
Rachel Pagonis
Yeah. Well, look forward to reading that research when it comes out. And I'd like to remind everyone, the book is called Aging in America from University of California Press by Deborah Carr. And Debbie, thank you so much for speaking with us today.
- [56:02]
Deborah Carr
Oh, thank you. It's been my pleasure. Experience the sequel everyone's been waiting for. With Sideline 2 intercepted, join Drayton and Dallas as they navigate the challenges of calling college life while trying to stay true to themselves and each other. Catch all the drama and watch Sideline 2 Intercepted, starring Noah Beck and Sienna Agudong for free on Tubi this Thanksgiving.