As Time Goes By: A Look at Growing Older in the New Millennium

By Samantha Stainburn

In a recent documentary about music and aging, an elderly nursing home resident named Henry sits in a chair, still and unresponsive. But when a recreation therapist gives him an iPod to listen to, he lights up and hums along to the music. Normally mute, after his earphones are taken off, he is able to answer questions about music he likes and even sings a verse of his favorite song.

The documentary, Alive Inside, chronicles the work of Music & Memory, a New York-based nonprofit organization started by Adelphi University School of Social Work alumnus Dan Cohen, M.S.W. ’78. Mr. Cohen had a hunch that providing nursing home residents with iPods that contained songs that were specific to their lives could improve their sense of well-being. He first tested his idea at a nursing home in 2006, filling 10 iPods with music that had meaning for each resident. “I came in with iPods and a laptop,” he recalls. “I asked residents what music they liked, and I gave it to them. Then I’d come back in two weeks and say, ‘Tell me which songs to take off and which ones you really liked.’ After two or three months, every song of their 100 to 200 songs was a song they really liked.”

The impact was dramatic. “People who were not very communicative were talking more,” he says. “People who didn’t move around much were more active, and people who were depressed were happier.”

Nursing home workers also benefited from the iPod program, which Mr. Cohen expanded after receiving funding from the New York City-based Shelley & Donald Rubin Foundation. The music made the residents more willing to eat, bathe and take their medications, and nurses found it could reduce anxiety in residents with dementia. “It helps with staff morale,” Mr. Cohen says. “They work with the same person for years, and when they suddenly see this person transform and be more cooperative and engaged, they’re happier.”

Music & Memory accepts donations of both new and used iPods and has distributed iPods with personalized playlists to 1,700 seniors in 50 nursing homes in 15 states. Mr. Cohen wants no less than to make personalized music standard care in nursing homes, hospitals, hospice and home care. “I want staff to reach for the music before they reach for the drugs,” he says.

As Dan Cohen’s story demonstrates, there’s still a lot we are discovering about aging. That’s a good thing. With the 74 million people in the baby boom generation entering old age—by 2030 18 percent of America’s population will be 65 or older, according to the Pew Research Center—figuring out how to deal with the challenges of aging has never been more pressing. 

Aging is a very different experience today from what our parents and grandparents went through. To begin, people are living longer, creating a growing cohort of what gerontologists sometimes call ‘the old old’—seniors 80 years old and above. “It can become a real crisis for people who reach retirement age and haven’t thought about it,” says Bradley Zodikoff, Ph.D., an associate professor of social work at Adelphi who studies aging and caregiving. “If you retire at 65, you may have another 20 years ahead of you, so what are you going to do? You’ll get bored surfing online or playing golf.” 

While many seniors spend those additional years in good health, they may also live longer with sickness and infirmity than their grandparents would have. “It used to be, you got the flu and that killed you,” says Philip Rozario, Ph.D., an associate professor of social work at Adelphi who studies older adults. “Now when older people fall sick, they may need help for a longer time.”

Meanwhile, it’s become more difficult for families to take care of their aging relatives. “Families tended to be closer geographically back in the 1950s or ’60s, and by and large your parents would be living in the same town that you and your kids were in,” says Robert Bornstein, Ph.D., a professor at the Gordon F. Derner Institute of Advanced Psychological Studies. “So a lot of what really amounted to elder-care services were provided by your kids because they lived down the block. That’s not true anymore.”  

“Families are a lot smaller these days, so you may have one child providing care for two parents, or more, with divorce and stepparents coming into the picture,” Dr. Rozario notes. And with more women in the workforce, daughters have less time to look after their elderly relatives.

Helping older people maintain a good quality of life and a positive sense of well-being as they age is a complicated but critical task, and that motivates Adelphi faculty and alumni who study and work with aging adults.

“Reaching this state of old age—even in the face of loss and other serious challenges— creates new opportunities to reflect upon and assign meaning to our finite lives,” Dr. Zodikoff says. “Aging is experienced differently by each individual who undergoes this process, and it is informed by much more than the list of prescriptions we take. Society has an opportunity to embrace this inevitable stage of life—whatever it looks like and however we get there—as more than just a disease or a social problem to be solved.”

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Successful Aging

What is successful aging?

One widely used definition of aging successfully, based on the findings of a major MacArthur Foundation study on aging, was developed by gerontologist John W. Rowe and psychologist Robert L. Kahn in 1998. Successful agers are characterized by three things, Dr. Rowe and Dr. Kahn said: They maintain high physical and mental function, they continue to be engaged with life and they avoid disease and disability.

You can increase your chances of aging successfully by preparing physically, cognitively and emotionally for getting older, says Audrey Weiner ’73, D.S.W., president and CEO of Jewish Home Lifecare, an organization that provides a variety of aging services in New York. “Everybody has to ask themselves, ‘What am I going to do to stay strong and flexible? Yoga, tai chi, walk?’” she says. “‘To engage my mind, am I going to read, play mahjongg, go to work?’” You can also adjust your living environment to reduce the opportunities for accidents like disabling falls, she adds. “An older person can’t have a rug in their kitchen,” she says. “Put in a stall shower, since bathtubs are difficult to get in and out of.”

You may also give your physical and mental health a boost by cultivating the right type of social network, according to Katherine Fiori, Ph.D., an assistant professor at the Derner Institute who studies social relationships.

“There are essentially four basic different types of networks that we see,” she explains. “A diverse network, in which the individual—typically married with kids— has…contact with both friends and family; a friend-focused network, in which the person is of.ten widowed or not married but is engaged in a lot of activities and spends…time with friends; a family-focused network, where the person doesn’t have a lot of contact
with friends, but a lot with family; and a restricted network, where the person doesn’t have a lot of contact with friends or family, or they’re not getting the support they need from friends or family.”

Dr. Fiori’s research shows that being in a diverse or friend-focused network seems to be best overall for physical and mental health. “Being in a friend-focused network is particularly beneficial for cognitive functioning,” she notes. “We think it’s probably due to the more complex interactions and conversations you tend to have with friends compared with family.”

Dr. Fiori has found that people with family-focused networks seem to be worse off in terms of mental health, although they have relatively good levels of physical health. A potential explanation: “This close-knit family network is constantly bugging you to take your medications and go to the doctor, but family relationships tend to be more negative than friend relationships,” she observes.

Francine Conway, Ph.D., an associate professor at the Derner Institute, has studied how older adults who take care of their grandchildren handle the caregiving challenge.

“The grandparents’ personality disposition does play a role in their health outcomes,” Dr. Conway says. “If they’re able to see this as a benefit to them, then it will be.” The more optimistic grandparents she’s studied cite benefits like affection from the grandchild, having company and vicariously learning through their grand.child’s experience.

While caring for grandchildren is stressful, the good news, she notes, is there is less stigma today attached to seniors caring for grandchildren. In the past, it was often assumed that grandparents needed to pitch in because their own children were struggling with drugs or other issues. Today, it’s recognized that many grandparents step in to help their kids out financially.

What if you are not able to avoid chronic illness or disability? Dr. Rozario argues that it is still possible to age successfully. He has found that people with chronic illness often maintain a positive perception of themselves.

“People with chronic illnesses don’t necessarily think of themselves as ‘less than,’ ” he says. “They incorporate their disabling condition into their idea of who they are, and that changes their reference points. They no longer look at another healthy person as their point of reference, but someone who’s worse off than them. So, if I walk with a walker or a cane, I’m better off than the person who needs a wheelchair. And if I use a wheelchair or scooter, I’m still better off than the person who’s bed-bound.” 

While people with reduced function might not have all the abilities they had earlier in life, they are able to make adaptations that preserve their sense of well-being, Dr. Rozario says. “They may not do things they consider frivolous so they can focus on things that are meaningful for them,” he notes. “They may try to optimize what strengths they have, like exercising because it builds muscle. Or they may try to compensate for the losses by using equipment or getting someone to help them.”

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Supporting Caregivers

More adults are caring for their elders than ever before. The number of Americans looking after someone 50 or older increased by 28 percent between 2004 and 2009, according to a recent report by the National Alliance for Caregiving and the AARP.

Between 22 percent and 23 percent of adults ages 45 to 64 and 16 percent of adults over age 65 provide elder care, according to the U.S. Bureau of Labor Statistics. About 20 percent provide care daily, about 24 percent help out several times a week and 20 percent provide care once a week.

Unfortunately, caregiving has potentially negative effects on family caregivers. According to the National Alliance for Caregiving/AARP report, 23 percent of family caregivers caring for loved ones for five years or more report their own health is fair or poor. Estimates of depression in family caregivers range from 20 percent—double that of the general population—to 60 percent in some studies. 

Several Adelphi faculty members have studied how to improve the family caregiver experience.

“The entire health and aging system relies heavily on the ability of family caregivers, who oversee the treatment plan, prevent unnecessary hospitalizations and delay institutionalization,” Dr. Zodikoff observes. But the way it typically works, he says, is “the doctor comes in and says, ‘This is the treatment plan, make it happen.’” Given that caregivers know their relatives well and may have in.sights into how they behave and what they need, “family members need to be much more actively integrated into discussions about the medical treatment plan,” Dr. Zodikoff says. “Then their questions need to be answered when they are on board, because caregivers have a lot of anxiety about what they’re supposed to do and where to go if it goes wrong.”

Caregivers can benefit from a lot of emotional support, such as “someone checking in on them and telling them they’re doing a good job,” according to Dr. Rozario. Encourage family members to be “a bit more forgiving of themselves, just not taking it all on, because there’s only so much you can do,” he says. “Sometimes guilt—feeling that you could do more—can be more destructive than anything else.”

The worst thing a person taking care of an older relative can do is compartmentalize the different parts of their life, says Dr. Fiori. “Say to your employer, ‘This is what’s going on; I may need to adjust my hours,’” she urges. “Say to your siblings, spouse and kids, ‘I’m going to need your help. Maybe on Saturdays you can take Dad out to the diner.’ Try to make it a part of your life and of those around you. Tell your kids, ‘Grandma is going to need more care, and this is going to change our lifestyle.’”

A strong conviction that taking care of his mother is simply the right thing to do has helped sustain Gayden Wren, a playwright, as he’s provided care for Mary Wren, M.A. ’78, an instructor in the Adelphi English department in the late 1970s, over the past four years. Mr. Wren, who’s married, left his own home and moved into his mother’s house in 2008 to help her after she was diagnosed with Alzheimer’s. “I didn’t actually make a decision to make a huge lifestyle change,” he says. “I just was doing what needed to be done in the immediate situation. That said, if I could have foreseen how it turned out, I wouldn’t have done anything differently. My mother spent the first four years of my life caring for me. It seems fair.” Mr. Wren was able to make sure his mother stuck to a routine, including lots of walking, which grounded her, he says. This year, Mary, now 79, moved to a nursing home, and Mr. Wren moved back to his home. He believes the time he lived with her was well spent. “My mother has been basically happy for the past five years,” he says.

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The Cost of Care

Aging is expensive. Some 70 percent of people who reach age 65 will need long-term care at some point—perhaps for chronic issues like dementia, rehabilitation after an accident or to compensate for declining ability to eat, bathe and dress.

According to a 2012 Cost of Care survey conducted by Genworth Financial, the median annual cost of a home health aide for 44 hours a week is $43,472; a one-bedroom apartment in an assisted living facility is $39,600; and a private room in a nursing home that provides skilled nursing care is $81,030.

Medicare, the government’s health insurance for Americans older than 65, covers only the first 100 days of skilled nursing care. After that, patients must cover the costs on their own. Skilled nursing care can run $250 to $1,000 a day, so a person who is not wealthy enough to have hundreds of thousands of dollars in savings yet is not poor enough to qualify for Medicaid, which does pay for long-term care, will quickly wipe out their assets. If you are in a nursing home when this happens, you will not be kicked out, but you will be moved to Medicaid and lose any frills, such as a private room or cable TV.

Yet there’s no need to panic, say Adelphi’s aging experts.

“It’s not dire if you plan,” says Dr. Bornstein, who co-wrote When Someone You Love Needs Nursing Home, Assisted Living, or In-Home Care: The Complete Guide with his wife, psychologist Mary Languirand, to help people deal with this challenge. At minimum, he says, there are two steps everyone should take by the time they hit 50. “First is to have various legal documents in place regarding medical decision making,” he says. “You want to have a directive to physicians, known as a living will, stating what should happen to you when an emergency occurs, and you need to appoint someone to make medical decisions on your behalf if you become incapacitated. Second, you need to at least investigate the options for long-term care insurance.”

Long-term care insurance pays for nursing home care and can also cover in-home care, depending on the policy. The policies are not perfect; few policies cover the entire daily rate of private care. Plus they’re expensive: while rates vary along with age and amount of coverage purchased, the average annual premiums for policies sold to seniors cost about $3,500 a year.

Still, investigating long-term care insurance early is a wise idea, Dr. Bornstein says, because if you do choose to buy it, “the younger you start, the cheaper it is.” Also, if you fall ill, it may be impossible to get long-term care insurance at any price.

One method to reduce your costs in old age is to pick a lower-cost area in which to retire, Dr. Bornstein says. “The single biggest determinant of who thrives financially during retirement isn’t the amount of money in your nest egg, but where you live,” he says. “If you can’t save a million dollars, one way to have a great retirement is to not live in the New York area.” The trick is to find a less expensive location where it’s easy to get to stores and services, there are opportunities to do what you want to do in retirement and there are decent services for older people, which vary in quality from state to state, he says.

Planning ahead also increases the chances that you will live out your golden years in a place you like. Unfortunately, many people move into a nursing home during a health crisis, and may have to jump into whatever place can take them right away, Audrey Weiner notes.

“Whenever you make decisions when it’s a crisis, it’s a bad thing,” says Dr. Weiner. A better idea is to look at nursing homes and assisted living facilities before you need them, she says. “It’s really helpful if family members say, ‘I’ll take the day off tomorrow and let’s go look at apartments, then we’ll have lunch,’” she notes. “Make a nice day of it.” Some senior housing facilities even allow potential residents to try living in one of their apartments for a month to see if the facility is a good fit.

Dr. Bornstein offers a few tips on distinguishing the good nursing homes and assisted living facilities from the mediocre ones. Patient ratings and state inspection results of facilities are available on the Internet, he says. “Check them out to get a sense of the quality of each place. What you’ll find is, all facilities have problems. It’s like hospitals; there is no hospital in the world that doesn’t have sanctions actively against them at any time. The questions to ask are not whether they have problems, but whether they have serious or typical problems, and do they address them?”

Also, he observes, “the best-run facilities know how to group up the residents. Poorly run facilities will randomly put people together. There’s nothing worse than being cognitively clear and having a demented roommate. You have to go there and see.” 

While no one wants to leave a home they’ve lived in happily and independently for years, moving into a skilled nursing facility or senior community may not be as upsetting as many fear.

“Fundamentally, the really good ones are hotels,” Dr. Bornstein says. “You have to picture it like you’re living in a hotel that happens to have a lot of medical people in it. There’s a pool and golf and a dining room and the food is good. 

“For some people, it’s actually a fresh start,” he adds. “They actually appreciate the opportunity to bag all the old relationships from before. I’ve seen people who were shy and not that social move to assisted living and all of a sudden become very social people.”

Other people get creative about bringing their old lives with them. Dr. Weiner knows of four couples who decided they were going to move to the same seniors’ facility in Nassau County. “They found a new building that wasn’t far from where they all lived, and they moved in together when they were in their late 80s,” she says.

“If someone retires at 65 and lives until 95, they live for an entire other generation,” Dr. Weiner notes. “So it’s not that they’re retiring, but beginning the next phase of their life. That’s the perspective we need to put aging in today.”

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How to set up an iPod for an older person

• Find out what music they like. The key to success with setting up an iPod for someone else is to learn what music they really enjoy. Sometimes it is easy to learn; other times it’s more of a trial-and-error process.
• Take advantage of the popularity category in iTunes. When looking for the best songs from musicians or groups, give preference to songs that are the most popular.
• It is better to start with a playlist of numerous artists than one with many songs from a small number of artists.
• Print out the list of songs to help in the review process.
• Select an iPod model that takes into account the recipient’s capabilities.
• Keep improving the list. Within the first few days, ask which songs are favorites and which are so-so. Remove the so-so ones and build on the successful ones. The goal is to create a playlist where every song is a song that’s loved.

Adapted from Music & Memory’s “In-Home Patient iPod Music Therapy Setup Guide” at musicandmemory.org