Rich Man Poor Man

Three out of five of this year’s Forbes top 100 richest Americans were older adults 65 years and older. These affluent older Americans individually own enough capital to compare with most developing countries. But poverty is the side that we are more likely to hear when we discuss income of older adults. Income of older adults sits along a very very long continuum.  Therefore, talking about average income of older adults hides these extremes.

Most reports on income among older adults talk about poverty.  The reason is easy is to see. In a 2009 Congressional Report, Patrick Purcell reported the median income of individuals aged 65 and older as $18,208. The same report finds that one in four had incomes of less than $11,139.  It is not surprising that for 41% of elderly recipients, Social Security accounted for more than 90% of their total income. Even when older adults worked to supplement their income—the reality for 20% of individuals aged 65 and older in 2008—the median earnings of workers aged 65 to 69 were $25,000.  Clearly, Social Security on its own elevates some older adults out of poverty.

The rate of poverty among older Americans fell from 33% in 1960 to 9.7% in 2008—a rate lower than poverty rates among children under age 18 (19%) and adults aged 18 to 64 (11.7%). However, this low overall rate of poverty among older Americans is not shared by older women (unmarried and/or widowed), minorities, less educated, and adults over the age of 80.

Wealthy older adults comprise the opposite facet of this reality. The Social Security Administration Chartbook of 2008 (the most recent) reports that 23% of older adults aged 65 and older reported incomes of $50,000 or more; while 8% had incomes of more than $100,000.  There is a stark contrast between the very poor and very rich older adults.

A Pew Research study in 2009 asked a sample of adults to identify the most prevalent conflict in America. After conflicts of immigration—nearly half of respondents (47%) identified conflicts between the rich and poor as the most important social conflict. In this same survey, older adults are significantly less likely to see such conflict than those under the age of 50 (36% vs. 51%).

These contradictory worlds—extremely wealthy older Americans and their poor neighbors— highlight why some programs should address needs rather than age. Surprisingly, these two obvious extremes among older adults share a common behavior.

In the Anatomy of a Giver, Tim Stafford reports that in the United States both the poor (those making less than $20,000 per year) and the rich (those making more than $100,000 per year) give the highest percentages of their income to charity. Middle-class Americans—those making between $40,000 and $100,000 per year—donate at the lowest percentage.  Older adults are a disparate group. The older we get the more variance there is among our peers. One such measure of variance is income. We do however share at least one attribute. This attribute is our appreciation that our lasting legacy is to give back.

Sex, Romance and Relationships of Older Adults

The state of well-being among older adults does not seem to be improving. A recent AARP report compared sex and well-being in 1999, 2004, and 2009. Although overall, midlife and older adults currently have a positive outlook on life, this is less so than in 2004. Both the frequency of sexual intercourse and overall sexual satisfaction are down close to ten points since 2004.  Just over four out of ten say that they are satisfied with their sex lives, down from half in 2004. While the frequency of self-stimulation and sexual thoughts remain unchanged. Younger respondents, men, and Hispanics in general are more likely to report being satisfied.

Why should older adults report a decline in general well-being, particularly sexual experience? Several key factors influence sexual activity, including health, medications, stress, finances, and exercise. Health—as reflected by increased use of prescription medications--seems to mirror this decline in general sexual satisfaction and well-being. The most prevalent medications are for cholesterol, taken by 36 percent of all older adults—a number that has doubled since 1999. A similar increase appears in the use of blood pressure medications, which 43 percent of the older population takes--up from 36 percent in 1999. There was an increase in diagnosis of erectile dysfunction for 23 percent of men in 2009, compared to 17 percent in 2004.

Men continue to think about sex more often than women. They see it as more important to their quality of life, engage in sexual activities more often, are less satisfied without a partner, and are twice as likely as women (21 vs 11 percent) to admit to sexual activity outside of their relationship. Distinct male-female differences exist across age groups.

Men report less sexual intercourse, kissing or hugging, touching and caressing, self stimulation, oral and anal sex with increasing age (from45 to 70+).  Women—although the overall percentage is nearly half of that for men—tend to report a peak of activity at age 50-59, with hugging and kissing remaining stable over all ages.

The good news is that those who have sex at least once a week, 84 percent, are satisfied.  Those less satisfied report having sex less frequently. Half of all single and dating males report that they rarely or not at all, use protection during sex. This rate goes down to 29% for women. The statistic is still troubling, given that one in four persons with HIV/AIDS was an older adult in 2005. A fascinating paradox is the quality of life rating. Although both male and female—whether with a current or recent partner or not—show a decrease in reporting high overall quality of life since five years ago (48% from 50%), everyone expects their quality to increase in five years time, in some cases above the peak of five years ago (57%). By age 70, this optimism for the future diminishes, although one in three still report that the future appears more positive!

Sexual activity and well-being are intertwined. We should be aware of the impact that medication, stress, financial situation, and exercise have on our overall sexual health and well-being.

Falling for You

Falling is the leading cause of injury hospitalization and death among Americans aged 65 and older. Fall injuries, including hip fractures, deep bruises and head trauma, represent a growing public health problem that remains under-recognized and under-treated. Sadly, all falls are preventable.

Each year, falls occur for more than one in three (35% -40%) of older Americans who live at home. The older you are the more likely you are to fall.  In nursing homes and hospitals, rates triple (1.5 falls per bed annually). Women sustain about 80% of all hip fractures.  In 2000, the total costs of treating fall-related injuries among older Americans exceeded $19 billion. By 2020, these numbers are expected to climb to $59 billion as a consequence of the growing number of aging baby boomers.

Self-imposed activity limitations from the fear of falling affect more than half of all community-dwelling older adults, leading to increased risks for further falls, depression, social isolation, and a drastic decline in quality of life. In a study of 540 community-living adults aged 70 years and older, Jolanda van Haastregt and colleagues reported that more than half of all study participants said they fell at least once in the previous six months. More than one in four (28%) said they had severe fear of falling and severe avoidance of physical activity.

In 2009, one out of every 27 older adults aged 85 and older called 911 in San Diego County because of a fall. Falling was the fourth most common pre-hospital call, resulting in nearly one in ten of all calls (5,606 in 2009). Falls remain the leading cause of unintentional injury hospitalization for those over 55 years. In 2006 in San Diego County, two thirds of all falls occurred at home--nearly half from slipping (43%). Of these, “emergency room discharge with a fall injury” was highest for the east county cities of Lemon Grove, La Mesa and El Cajon. SANDAG projects that the older adult population for 2015 for San Diego county would be 435,805 it is expected that one in three (145,268) will fall that year. Of these, three out of four will fall a second time.

Aside from substantial medical cost, the individual cost involves more than money. Fall-related injuries are often single most common event that alter mobility and limit independent living.  Many fall injuries, such as hip fractures, increase the risk of premature death. For example, a recent survival analysis of men and women aged 50-plus years who had a hip fracture concluded that hip fractures increased all-cause mortality 5- to 8-fold during the first three months after the injury. Such negative outcomes persist over time. Life is not the same once you have had a significant fall.

Falling does not have to be a death sentence. Many of these risk factors are manageable and potentially correctable. Sensory problems and medications can be address with your health care provider. Since gait and balance problems are strong predictors of falls, yoga, exercise, and the use of assistive devices can reduce the likelihood of a fall. 

Sleep is the Best Medicine

Sleep is the best medicine. Although older adults need as many hours of sleep as younger adults—7-9 hours each night—we often hear the commonly-held but mistaken belief that you need less sleep as you age. Disruption of sleep can cause memory problems, depression, and a higher susceptibility to falls.

In the United States, insomnia is the third most common reason for a medical visit, behind only headaches and the common cold.  As sleeping patterns change for older adults—going to sleep earlier, getting up earlier and napping during the day—it becomes more difficult to fall asleep at night. Once asleep, older adults spend less time in deep sleep—rapid eye movement (REM) sleep—and are often therefore light sleepers. By themselves, even these normal changes can to disrupt sleeping patterns. More than half of older adults have a sleep disorder. The rate is higher among long-term care facility residents. Although researchers have described more than 70 sleep disorders, four disorders hold top billing.  These include insomnia, , sleep apnea, restless legs syndrome, and narcolepsy.

Among older people, women experience insomnia than men.  Insomnia—which is the most common sleep problem in adults age 60 and older—results in trouble falling and staying asleep. About 60 million Americans a year have insomnia, which tends to increase with age. It affects about 40 percent of women and 30 percent of men.

Sleep apnea is a disorder of interrupted breathing during sleep. It usually occurs in association with fat buildup or loss of muscle tone associated with aging. These changes allow the windpipe to collapse during breathing when muscles relax during sleep and is usually associated with loud snoring (though not everyone who snores has this disorder). An estimated 18 million Americans have sleep apnea.

Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD)--an unpleasant crawling, prickling, or tingling sensations in the legs and an urge to move them for relief--affects as many as 12 million Americans.  In one study, RLS and PLMD accounted for a third of the insomnia seen in patients older than age 60.

Older adults with narcolepsy have frequent "sleep attacks" at various times of the day, even if they have had normal amounts of night-time sleep. Narcolepsy affects an estimated 250,000 Americans who have attacks lasting from several seconds to more than 30 minutes. The disorder is usually hereditary, but is occasionally linked to brain damage from a head injury or neurological disease.

Disruption of sleep becomes more common  as we get older. Some clinical research now focuses on the role of melatonin in this cycle. Some serious conditions need consultation, while others just require a more disciplined approach to going to sleep.

Amanda Dew and her colleagues at the University of Pittsburgh, USA looked at one such reflection of peace of mind, sleep and how it can influence an early death. After controlling for things that can also influence death, such as age, gender, and how healthy they were, they then could predict death based on their sleep patterns. Individuals who take longer to sleep than 30 minutes were more than twice at risk of death. While those who sleep for less than 4/5th of the time while in bed were nearly twice as likely to die earlier. Even those who either dreamt too much or too little (Rapid Eye Movement sleep) were nearly twice as likely to die earlier. Sleeping just right is an important process that can promote longevity.

Follow a regular sleep schedule. Go to sleep and get up at the same time each day, even on weekends. Try to avoid napping and make an effort to get outside in the sunlight each day. Stay away from caffeine late in the day. Exercise and light meals also contribute to better sleep. You can sleep yourself to good health.


Refernces

Dew, M. A., Hoch, C. C., Buysse, D. J., Monk, T. H., Begley, A. E., Houck, P. R., ... & Reynolds III, C. F. (2003). Healthy older adults’ sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosomatic Medicine, 65(1), 63-73.

Tele-Intensive Care Units: Technology at the end of life.

Intensive Care Units (ICUs), representing a major facet of health care in U.S. hospitals, now treat six million of the sickest and oldest patients every year. One of every five older adults dies in an ICU. The Health Resources and Services Administration (HRSA)—remains the primary federal agency for improving health care access for people who are uninsured, isolated or medically vulnerable. HRSA reports that patients in acute care hospitals receive more than 18 million days of care in ICUs each year. Already costing almost one percent of U.S. gross domestic product, the demand for ICU services is projected to grow rapidly during the next decade as the older adult population increases. The ability of critically ill patients to receive adequate care depends upon a number of factors. A 2002 HRSA Report to Congress projected that there will be a shortage of highly-trained ICU physicians (known as intensivists), the other possibility to meet the demand is to see if health care efficiency can be improved.

This is where “telemedicine ICUs” come in. In Tele-ICUs an intensivist physician and four nurses in one command center can oversee the care of up to 75 patients in distant ICUs. These clinicians are aided by “smart” databases that track patients’ clinical values and alerts the local ICU staff when signs indicate a negative trend or when a change in treatment is scheduled according to protocols. The local ICUs, staffed with physicians and nurses providing direct care to patients, do not have to be intensivists.

A recent study in 2007 by Massachusetts Technology Collaborative (MTC) and the New England Healthcare Institute (NEHI) reported that Tele-ICUs saved lives. The study found other benefits. Tele-ICUs decreased mortality by 20 to 36 percent, shortened ICU stays by 30 percent, and recovered up-front investment costs in less than one year. Tele-ICUs also enabled community hospitals to care for a substantial portion of patients who would have been transferred to teaching hospitals. Retaining these patients in community hospitals saved the payers approximately $10,000 per patient. Although these outcomes may vary, Tele-ICUs are providing a reasonable way of addressing the projected cost increases of ICU care. Our investment in improving this technology merits close attention. And there are some applications that are at the forefront of technology right here in San Diego.

The Veterans Administration Desert Pacific Healthcare Network runs the Care Coordination Home Telehealth program (covering San Diego) using nurses who can provide care coordination services to up to 150 patients a day. While at a more local level, the San Diego-based Council of Community Clinics is using telemedicine to reach and serve residents of rural community clinics and health centers by using video conferencing to  provide rural residents with access to specialty clinical services and to educate and train rural healthcare providers. Although these are still at an early stage of development, it will only be a matter of time before technology will be applied to tailor health care to frail and dying older adults.

Volunteerism and Wellbeing among Older Adults

Volunteerism has long been one of America's traditions. Since Benjamin Franklin's founding of the first volunteer firefighter company in 1736 we have not looked back. Currently, promoting volunteering and civic service is a major policy agenda of President Obama's Administration. Defying the popular notion that hard economic times suppress civic participation, the number of Americans who volunteer grew last year at the fastest rate in six years. The report, released in 2010 by the Corporation for National and Community Service, says that 63.4 million adult Americans—nearly 27 percent of the population—volunteered to help charitable causes last year. That’s an increase from 2008 of roughly 1.6 million volunteers, the largest single-year jump since 2003. In total, 2009’s volunteers donated about 8.1 billion hours of service, valued at nearly $169-billion, says the report, which is based on annual and monthly surveys of roughly 100,000 Americans age 16 or older, conducted by the U.S. Census Bureau for the Bureau of Labor Statistics.

Older adults are the backbone of this tradition. Although sometimes taken for granted, without this volunteering most agency or cities cannot function at the level that they do today. To define the importance of volunteers, a unique study was undertaken in 1998. Dixon Arnett, who then headed the California Department of Aging, conducted an extensive survey to find out how many volunteers there were in all of its programs provided through some 720 separate entities.

The findings showed that throughout the state there were an incredible 67,620 volunteers. These volunteer contributed to a total of 757,120 hours. Multiplying that by California’s minimum wage at the time ($5.75/hour), the total value of those hours – per week – was $4,353,440 – an annual national value of $226,378,880 in 1998! At that time the total federal and state taxpayer-provided appropriations for these older adults programs was $159 million. With the volunteers, the federal and state governments realized a 142% return on its investment.

But the real value is far more in the giving of one’s self then in the receiving of care. A growing body of research is pointing to the social, emotional, and even physical health benefits of volunteering. A study published last year led by University of Pittsburgh researcher Fengyan Tang, found that the volunteers reported significant improvements in their mental health, along with a greater feeling of productivity, increased social activity and an overall sense that their life had improved. What’s more surprising is that the less affluent the volunteers the higher their reported benefits. In this way, all older adults are able to enhance their sense of purpose, satisfaction, and good health later in life at the same time that they give back to society. It also helps our economy. For volunteering in San Diego check out volunteer San Diego at http://www.volunteersandiego.org/ and you can also go to your local faith-based organization and other organizations including Oasis at http://www.oasisnet.org/.

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Mario Garrett, PhD, is a professor of gerontology at San Diego State University. He can be reached at mariusgarrett@yahoo.com

Homeless Older Adults

The economic downturn continues to affect older adults, as evidenced by AARP’s recent suit against the Department of Housing and Urban Development (HUD).  It’s about reverse mortgages.  AARP argues that HUD—by insisting that surviving spouses (who are not named on the mortgage) pay the full loan balance to keep their home—is pushing older adults into foreclosure. And in fact, this policy ignores HUD’s own provisions against displacing a surviving spouse.

Reverse mortgages, which pay older homeowners a regular sum against the equity in their house, were designed to shield borrowers from economic upheaval. More than a half-million people have received reverse mortgages since Congress authorized the program a quarter-century ago. Those who withdraw equity cash through this program must be at least 62 years old. Participants receive either a lump sum or monthly payments from lenders. After their death, the house is sold and the mortgage is paid off. However lenders sometimes encourage only the elder member of a couple to put his or her name on the mortgage—hence the issue with the surviving spouse having to pay-off the mortgage.

Since last year, more than 32 percent of all San Diego County homeowners with mortgages were upside-down—owing more on their mortgage than the house is valued—according to CoreLogic. During the past three years, more than 640,000 Californians have lost their homes. This statistic reflects other key indicators of economic health. The average credit card debt among adults aged 65+ was $10,235. The consequences of the burst housing market and the resulting loss of equity have resulted in one in seven older adults facing retirement with a negative net worth.  It comes as little surprise that AARP in 2008 reported that Americans aged 50 and older accounted for approximately 28 percent of all delinquencies and foreclosures.

One repercussion from these events is that over the next ten years, HUD projects a 33 percent increase in homelessness among adults over the age of 62. This was unheard of in the past. In HUD data for San Diego County in 2009, individuals aged 51 years and older occupied 28% of local emergency shelters (933) and occupied 25% of all transitional housing (1018). Two years ago, Los Angeles-based Shelter Partnership, an advocacy group, released a study showing that among Los Angeles’ homeless population, 3,000 to 4,000 are over 62 years old and more than two-thirds struggle with some disability.

In our nation’s history, homelessness has rarely been an aging issue. With social security, Medicare, and rising home equity, older adults were unlikely to be displaced. The new economy has changed that. To help the homeless San Diego has eleven agencies and you can access their contact information at http://allcare.net/s2/sd.php#shelters. If you are having trouble with your mortgage and need free unbiased advice, try San Diego Home Loan and Education Center tel: 619-624-2330. Sometimes bad things happen to good people but it is prudent to check out all options beforehand. It is important to realize that this is happening across San Diego County and that you are not alone.

Sex, Drugs and Rock & Roll

Today's older adults are the generation that created the culture of sex, drugs and rock and roll. The 1960s rallying call of that generation was best exemplified by Timothy Leary's "Turn on, tune in, drop out."  This year, the first wave of the counterculture generation becomes eligible for social security, Medicare, and discount early bird meals at the local cafeteria.

Researchers report that the baby boomers who discovered marijuana, cocaine and other drugs as young people apparently haven't given them up. All these studies refer to older adults as any adult 50 years and older.

Two new federal studies support this assertion.  Although substance abuse is more common among younger adults (aged 18 to 49), the rate of illicit drug use among older adults aged 50 to 59 increased from 2.7 percent in 2002 to 4.6 percent in 2008 and continues to climb.  This statistic comes from a new study by the Substance Abuse and Mental Health Services Administration (SAMHSA). This report indicates that 4.3 million older adults (4.7 percent) used an illicit drug in the past year. Men are more likely than women to abuse alcohol, marijuana and other illicit drugs. Male and female older adults report similar rates for abuse of prescription drugs.

The SAMHSA report also shows that there are differences between aging cohorts, with older adults using marijuana as the drug of choice, while old older adults (65 years and older) prefer prescription drugs. Additionally, many older adults use prescription and over-the-counter medications that could interact adversely with illicit drugs and may themselves have the potential for abuse. This does not include the use of legal drugs such as alcohol.

Older adults abusing drugs are more likely to end up in an emergency room. The Drug Abuse Warning Network estimates that 118,495 emergency visits involved illicit drug use by older adults in 2008. Cocaine was the most common cause of emergency room visits (63 percent), followed by heroin (27 percent), marijuana (19 percent), and illicit stimulants (5 percent). Nearly a third of these visits also involved alcohol.

Of these visits one in ten were referred to psychiatric or chemical dependency/detoxification services. It is becoming increasingly important to understand and plan for substance use prevention and treatment needs of this vulnerable population since the numbers will inevitably grow.

The number of adults over 50 with substance abuse problems is projected to double from about 2.5 million in 1999 to about 5 million in 2020. These numbers directly translate to increased demand for treatment.  According to one study by Gfroerer and colleagues, treatment for illicit drugs use for older adults is projected to increase more than 500 percent between 1995 and 2020.

Reducing and treating drug use problems among the growing older adult population requires both medical and behavioral intervention. Although older adults are less likely to abuse substances, when they do they are more likely to end up harming themselves. If you need help with substance abuse call the hotline provided by the San Diego County Adult Emergency and Crisis Mental Health at 1-800-479-3339. Turn on, tune in, drop out.  Just don’t drop dead.

Facing the Music

Carroll Pratt delivered a talk in 1950 entitled “Music as the Language of Emotion.” Gerontologists are increasingly finding how different spheres of aging—genetic, biological, psychological, and social—all interrelate. We are looking more closely at the role emotions play in mediating these different spheres. If Carroll Pratt is correct, and music is indeed the language of emotion, then we need to start examining how music relates with emotions and affects longevity.

We all know that playing or listening to music can be pleasurable. But is it also beneficial? Social and psychological researchers repeatedly find benefits in listening to music. Studies looking at how music reduces or increases stress include a classic 1993 study by JoAchim Escher in which a group of patients undergoing gastroscopy were allowed to select and listen to music during surgery, while a control group heard no music. The study showed a much-reduced rise in stress hormones—ACTH and cortisol--for the music group. It seems that music mitigates negative experience.

Apparently, rather than music by itself eliciting these changes, they are a result of how we interact with music. Whether music speaks tranquility or excitement depends on how the music is interpreted. Some music is intuitively “soothing” and “relaxing.” Martin Möckel and his colleagues at the Free University of Berlin found that meditative music was best at reducing levels of cortisol and noradrenaline, but even this effect depended on the listeners. Some listeners, especially music students, showed increased cortisol levels regardless of the type of music. It seems that these students were actively engaged in analyzing the music.

The paradox of aging also rears its complex head. Increased levels of stress hormones do not necessarily have just negative effects, but also has some benefits. Hormones can enhance muscle and skin tone for the short term and can enhance memories of events that occurred concurrently. Thus, if one wants to increase memory, music that produces transiently higher hormone levels might be beneficial, for the short term.

It could be that healthy older adults already self-select music in order to arouse or soothe their autonomic nervous system. The crucial study, conducted at Loma Linda University School of Medicine and Applied Biosystems in 2005, revealed that listening to music can turn off DNA-based switches that determine human stress response. The potential of inducing and subsequently reversing gene expression in this manner may suggest new and exciting possibilities for testing and tailoring specific treatments to an individual, rather than a group. Music and how we interact with it is seems to be a language of how we communicate with our bodies. San Diego offers many opportunities to learn how to appreciate music, or to start playing an instrument. Perhaps for some, it might be reuniting with a childhood instrument. Check out the classes at your local adult enrichment center, or call 1-800-510-2020 for the one nearest you. If music is the language of emotions, then we need to open those channels of communication.
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Mario Garrett, PhD, is a professor of gerontology at San Diego State University. He can be reached at mariusgarrett@yahoo.com.

Collecting problems: Hoarding

We have all known pack rats.  Maybe we have occasionally been guilty of stockpiling unnecessary stuff ourselves. But when this behavior starts interfering with our daily routine it becomes hoarding. Hoarding—the excessive collection of items, along with the inability to discard them—often results in cramped and unhygienic living conditions in homes, resulting in narrow pathways winding through stacks of clutter. 

Although hoarding can be found in people of any age, race, education, socio-economic status, gender or nationality—it is more prevalent in older adults.  They are unaware that their living circumstances pose a danger to themselves and to others, yet they are unable to change their behaviors on their own.

We do not know how many people are hoarders in the country because most do not seek help. Some studies estimate that two to five percent of Americans exhibit hoarding behaviors. One of the few comprehensive studies—a 2009 initiative of the Department of Aging and Adult Services and the San Francisco Mental Health Association—estimated that between 12,000 to 25,000 people in San Francisco struggle with hoarding behaviors.

People who hoard often don't see it as a problem, making treatment challenging. Not enough is known about the disease to determine whether it's an addiction or a compulsion. But intensive treatment can help people who hoard understand their behaviors and live safer, more meaningful lives.

Hoarding—also called compulsive hoarding and compulsive hoarding syndrome—can be a symptom of obsessive-compulsive disorder (OCD). Most people with OCD know that their obsessions and compulsions make no sense, but they can't ignore or stop them. Most older adults who hoard don't have other OCD-related symptoms. 

The National Institute of Mental Health reports that OCD affects about 2.2 million American adults.  The problem can be accompanied by anxiety disorders or depression. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families. The course of the disease is quite varied.

Initially, families or caregivers might approach the problem as simply an issue of cleaning up the house or apartment. But compulsive hoarding is not only a health and safety issue, it is also an expression of psychological trauma. If we don’t address the underlying problem—the reasons for hoarding—the behavior will come back within a few months.

If you suspect a hoarding situation in your neighborhood or with a family member you need to seek professional help. A comprehensive list of resources for San Diego can be accessed through telephone listings through the San Diego Boarding Task Force, which include a list of county, city, university and private agencies that treat hoarding victims and their families. The website also includes local support groups and vendors:  http://www.hoardingtaskforce.org/san-diego-hoarding-collaborative/.  Addressing the root of the problem of hoarding might resolve long standing issues, and make their lives safer and more meaningful.

Oldest Boldest

We want to retain our youth—our vigor—-for longer periods of our lives.  We should heed the lesson of Tithonus, a mythological Greek king whose lover granted him immortality but not eternal youth.  He eventually become so wrinkled and incapacitated that his lover turned him into a cicada—eternally living, but begging for death. What we seek is not just longevity but vigor, and a lot of older adults are finding it and holding on to it.

Louis Armstrong was 66-years-and-10-months-old when his career peaked with "What A Wonderful World" and "Cabaret" in 1968.  Armstrong is one of many who continued to be especially productive into older age. Numerous examples exist of artists, actors, writers and academicians who continue to produce great work at older age. A half-century ago, Harvey Lehman showed that our most creative period is between ages 33-36.  But the formula is not prescriptive, and exceptions are common.  When it comes to health and longevity, we all want to be the exception. It is not that we just want to live longer, it is that we want to live longer, healthier.

More and more older adults are breaking conventional expectations about physical barriers. In 2006, Maria del Carmen Bousada Lara gave birth to twin boys in Barcelona, Spain. Nothing remarkable about that except Lara was within a week of her 67^th birthday.  Although older adults are breaking records across the board, 2002 was a banner year. Tamae Watanabe reached the summit of Mt Everest at the age of 63. Jenny Wood-Allen completed the London Marathon at 90-years-old. James Talbot Guyer  parachuted off the 148 m (486 ft) high Perrine Bridge near Twin Falls, Idaho at age 74 years. More recently, Robert McKeague, age 80, completed the 2005 Ford Ironman World Championship. Two years later, Linda Ashmore swam the English Channel at age 60. After that, Bahadur Sherchan reached the highest point on Earth—summiting Mount Everest at the age of 76.

Thomas Perls, a gerontologist who studies centenarians, has shown that although income and education increase our survival rate to age 85, the rest of our survival is pretty much determined by genetics. We can’t do anything about that, at least for now. Still, it seems that a lot more older adults are reaching older age while they’re healthy and active.

We will see more of these "exceptions"—older adults who are not only productive in the arts and sciences, but also in sports. For some people, we might see our vigor extending to later life. But with this vigor comes responsibility. We shouldn’t believe that being healthy equates to unlimited longevity or immortality. In a way it reminds us that the best we can hope for is to die while we are healthy. Remembering the story of Tithonus, we don’t have much of a future as cicadas.