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Expanding Gerontology's Reach

By James Siberski, MS, CMC, and Carol Siberski, MS, CRmT, C-GCM

Providing information to young people on the physical, emotional, spiritual, and social changes associated with aging could help reduce their future needs for costly health care and long-term services and supports.

Agequake: Riding the Demographic Rollercoaster Shaking Business, Finance and Our World, a book written by Paul Wallace and published in 1999, investigates possible ramifications as a significant and unprecedented proportion of the human population approaches old age. This Agequake will register a metaphorical 8.5 on the Richter scale. However, the nations of the world will be shaken (pun intended) in their attempt to cope with a rapidly aging population. Who is at fault (pun intended) when countries around the world survey the societal destruction caused by far too many older individuals with no counterbalance of youth to compensate for the imbalance?

While Wallace's book focuses on business and finances, it is time to emphasize the other equally important aspects of this Agequake. The international community has known for many decades that the world population is getting older. The baby boomers, long on the radar in the United States, are now coming of age. Nonetheless, few preparations have materialized. Had we prepared, we would now have adequate numbers of geriatricians, geriatric psychiatrists, geriatric occupational therapists, physical therapists, nurses, and other medical professionals.

Adequate housing options would be available in sufficient quantity. Retirement planning would be just that: planned. In the United States, the baby boomers as a group are financially and psychosocially ill-prepared for retirement. While many made preparations, many more did not—or they prepared inadequately. At the July 2015 White House Conference on Aging, as in prior years, the major themes of the conference were retirement security, healthy aging, elder justice, and long-term services and supports.

Sharing Appropriate Knowledge
In gerontology courses, students learn that their parents prepared them to attend grade school, where they acquired the knowledge necessary to attend high school, which equipped them for employment, family responsibilities, and further education. Some attend college to pursue a career while others complete advanced training and degrees. Ideally, all will utilize what they have learned in pursuit of a successful life. In contrast, no institution teaches us about middle age, let alone old age to acquire knowledge and skills related to coping with the associated physical, emotional, spiritual, and social changes. Trial and error, articles from publications such as Prevention magazine, tips from organizations or websites, and advice from parents and grandparents provide a kernel of knowledge about aging. But an organized life plan has yet to be developed and implemented.

The life expectancy of a female born in 1900 was 48.3 years while a male's was 46.3 years. There was barely a middle age and usually no old age at all. On average, a female born in 2010 can expect to live to the age of 81 while a male's life expectancy has reached the age of 76, according to the Centers for Disease Control and Prevention. This cohort will experience aging in phases designated as the young old (aged 65 to 75), old (aged 75 to 85), and old old (over the age of 85) and will likely lack knowledge about possible cognitive changes, normal age-related changes, and many other changes associated with old age that will confront and surprise individuals or family members due to a lack of education on aging.

Most of the emphasis on aging focuses on the financial aspects. One can be financially secure and yet be ill prepared for old age. Aging is complicated; and successful aging is a lifelong challenge requiring knowledge and effort. Retirement planning should begin years before the actual event. What type of financial plan is necessary? What will fill the 40-plus hours each week with meaningful activity within the parameters of any chronic conditions such as arthritis, vision changes, or hearing limitations acquired throughout life or that result from normal aging changes or diseases of aging? How can one grow older and maintain life span, health span, and brain span for a lifetime? While it may not be difficult to practice wellness, eat healthfully, and exercise the mind and body, the question arises about the timing for an appropriate start to these practices and how often to engage in these strategies because timing is so important in the aging process.

Healthy aging requires individuals to be aware of aging pitfalls. While drinking alcohol has been shown to be beneficial, based, for example, on sex, age, and medical history, what is the appropriate quantity? Since a segment of the elderly will eventually experience mental health issues and others will bring mental illness into old age from earlier periods in their lives, how should mental health issues be managed? Many older adults take supplements. Which are beneficial? Which are potentially harmful? Which are likely to create adverse events in combination with prescription medications? How does sleep change as we age? How does menopause affect sleep and memory? The answers to these and similar questions affect healthy aging. 

For long-term services and supports, what options are available for older adults who need help?  How will the children or family members of an older adult arrange for long-distance care and support for parents or other family members? Is purchasing long term care insurance advisable, and at what point should the purchase be made? If a veteran is in need of home support or a personal care facility, will the VA assist with the costs? What are nursing home fees or is companion care the better option? What is an elder care attorney, and do all elderly individuals require such expertise? What services do the Area Agency on Aging, the Alzheimer's Association, and the American Red Cross provide? How do churches and synagogues assist their older worshipers? With regard to elder justice, where and how should suspected elder abuse be reported? Are the elderly targets for fraud and identity theft, and how often are they victimized by scams? What do the elderly need to know in order to protect themselves and receive elder justice?  

Preparing the Next Generations
Indeed, there is a great deal to consider in aging. Significant planning is critical. Numerous questions must be answered for an individual to experience a happy, productive, and healthy life that includes life span, heath span, and cognitive span. Because individuals who are currently young or early middle aged will likely experience a longer aging period, it is essential as a society, community, and country to educate individuals about what it is to age, what is involved in aging, and why it's necessary to plan for later years. By the time students reach middle school and high school, aging concepts should be introduced. This target group needs to become aware of the potential of living 20 to 25 years in retirement, become familiar with aspects of normal aging, and become educated on various diseases of aging. The target group also needs to appreciate that financial planning is important but no more so than the biopsychosocial issues of healthy aging. All the money in the world will not guarantee happiness if it is to be shared with numerous chronic diseases, some of which might have been prevented, minimized, or postponed for many years through the practice of preventive medicine. Currently school systems prepare students to live but not ways to age competently.

Aging is a subject about which students at universities and colleges need to be educated. While most of these institutions require sociology and psychology to prepare students for living in their communities, little if any emphasis is placed on gerontology, the study of aging. Many of these students, who by virtue of having attained a higher degree of education and the potential for better employment with accompanying benefits that can translate into a healthier later life in terms of brain, health, and life spans, will be providing services such as occupational therapy, physical therapy, nursing and medical care, social services, and speech therapy.

Therefore, it is imperative that these young professionals comprehend what it is to be old and how to effectively communicate with and develop rapport with the elderly. Since gerontology focuses on these topics and other vital issues that prepare individuals to work with older adults, why do universities and colleges fail to require social gerontology or aging and development courses? Why do occupational therapy, physical therapy, and nursing programs require no gerontology credits within their curricula? Should education majors be exposed to a gerontology course so that as future teachers they can prepare children in primary and secondary schools for aging? Would a gerontology course benefit the prelaw, business, or accounting majors who will interact with aging adults in legal matters, business, and finance? In fact, couldn't a gerontology course be an asset to any individual in relating to the elderly in employment and in the marketplace?

Consider the topic of those individuals who are now older adults. Geriatric care managers are contacted daily by children, relatives, employee assistance programs, and older adults themselves, seeking advice about various situations. Is placement in a nursing home needed? Where can I find and access services and support programs? My mother has Alzheimer's disease, what should I do? Had the educational process exposed the population to this stage of human development, they would likely be less anxious and better equipped to respond.

The solution to the questions posed above is the launch of educational programs designed for individuals who will be aging. That's everyone. State governments need to take a simplistic view of aging, ie, the greater number of individuals who are knowledgeable and aware of what is involved in the aging process, the more successful the aging process will be. The result will be healthier older individuals who will require less health care and fewer programs and services because knowledge of the need to plan and live life recognizing the likelihood of attaining old age can affect the life health trajectory.

The goal is to live long and die short. Living long involves a satisfactory life throughout which an individual remains engaged, with many years of good health. Dying short involves dying in a few months or a very few years, rather than experiencing five, 10, or even more years of emotional, physical, and financial pain involving expensive care, only to succumb following a lengthy ordeal. The Departments of Education could commit to providing students with a basic blueprint of aging, informing them about what to expect, choices they'll face, planning they can do, and the normal age-related changes that occur. There is no need to create a new bureaucracy or to publish a 200-plus page official document, as this goal can be achieved with minimal expense by utilizing what we already have and know.  

Those who are already old need sources of information they can access. Currently, pharmacies, grocery stores, churches, synagogues, senior centers, print media, Internet, Area Agencies on Aging, the Alzheimer's Association, and geriatric care managers can offer reliable sources of information.

Societies around the world will struggle to cope with the results of the Agequake and the "magnitude" of destruction it will leave behind in terms of crumbling social services, financial ruin, and a vast demoralized older population. Now is the time to intervene to prevent subsequent generations from an avertable crisis by educating the coming generations about available options and instilling in them the responsibility to make judicious preparations so that one day they are, to quote the Beach Boys, "pickin' up good vibrations" and not experiencing  the results of an Agequake.

— James Siberski, MS, CMC, is an assistant professor of gerontology and the director of the geriatric care management graduate certificate program at Misericordia University. He is also an adjunct faculty member at University of Scranton in Pennsylvania.

— Carol Siberski, MS, CRmT, C-GCM, is a geriatric care manager in private practice and participates in research in geriatrics and intellectual disabilities in Pennsylvania.