91�ֿ�

We’re all getting older—that is, if we’re lucky. 91�ֿ� experts share their advice on how to prepare for and make the most of our golden [Flash] years.

By Lynette Lamb | Illustrations by Melissa Olson

As Baby Boomers become senior citizens—and attempt to redefine that stage life as they’ve redefined previous ones—articles and books are promising them a future of “healthy aging.” But how do we define that term? asks Gregory Smith, PhD, 91�ֿ� professor of human development and family studies. “The older we get, the more likely we are to be victims of senescence,” he says. “Biological aging is a normal process. It isn’t necessarily ‘healthy,’ but it is inevitable.”

That’s why Dr. Smith prefers the term optimal aging, which he says “implies that you are living the best quality of life that you can, given your current state of affairs.”

Yet the conundrum persists: How can we achieve that optimal life? There’s no sure-fire set of instructions, but we’ve solicited the advice of some 91�ֿ� experts, on subjects ranging from communicating to exercising, that just might help you and your loved ones reach 80 or 90 optimally.

MAKING THE MONEY LAST

Who knows how long you’ll live, but planning ahead can help you prepare for any event.

When it comes to aging well, money really can buy happiness. Of course, life is unpredictable. You could have saved millions for retirement only to die of cancer at 63. Or you might assume you won’t make it past 70, only to see your 90th birthday roll around while eking out your Social Security.

91�ֿ�’s Nadia Greenhalgh-Stanley, PhD, an associate professor of economics who studies the economics of aging, has some advice to help you plan ahead, regardless of your lifespan.

Give away money to your family tax-free while you can. Currently you can give each family member $14,000 a year tax-free. Considering the uncertainty about when you will die and how sick you will be before that, she says, it makes sense to start giving away your money now, before you have to spend it down to qualify for Medicaid.

Make housing choices ahead of time. Waiting until a crisis hits nearly always results in a situation that is worse both emotionally and financially, says Dr. Greenhalgh-Stanley.

Don’t collect Social Security any earlier than you have to. Taking your benefits before full retirement age means giving up larger monthly payments for the rest of your life.

Remember that Medicare* does not cover nursing home costs. It’s surprising how many people believe it does, says Dr. Greenhalgh-Stanley.

Modify your house to stay safe. Adding grab bars, removing throw rugs and improving lighting to prevent falls and hospitalizations will allow you to age in place longer. Some states (including Virginia, Minnesota and California) even have loan or grant programs to help elders improve their homes’ safety.

Don’t live in a food desert. In an urban area, a food desert is defined as any home located more than a mile away from a grocery store selling fresh fruit and vegetables. Many elderly people cannot drive, nor can they walk far to buy groceries—and ordering food online hasn’t caught on yet with most senior citizens. Yet obtaining adequate nutrients is critical for staying healthy at any age, says Dr. Greenhalgh-Stanley.

Buy long-term care insurance early— or not at all. Because of its high cost, long-term care insurance rarely makes financial sense for any but the wealthiest people, says Dr. Greenhalgh-Stanley. The exception is if you can buy it early enough—in your 40s or 50s—or if you can get financial assistance from an employer to cover the premium costs.

*Medicare vs. Medicaid 

Medicare is a federally sponsored health insurance program for Americans aged 65 and up and for disabled people. The cost is reasonable (around $200 to $300 a month) and is usually supplemented by a small personal health insurance policy. Medicare pays for doctor’s visits, hospital stays, prescriptions, etc., just as any other health insurance plan does. It does not pay for nursing home stays.

Medicaid is a jointly funded, federal-state health insurance program for low-income people. It covers children, the aged, blind, disabled and other people who are eligible to receive federally assisted income maintenance payments. Medicaid will pay for nursing home care but only for those people whose incomes are quite low and whose assets have been reduced to $2,000 to $3,000 in total (not including a home).

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HAVING THE TALK

How to have a conversation with your parents (or your children) about later-in-life choices—before it’s too late.

One of the most important issues as we age is to communicate with our families about a host of vital matters, such as: Where do we want to live? When should we stop driving? When do we need help in our home? How much money do we have to live on? Under what medical conditions do we want to stop fighting a disease or sign a do-not-resuscitate order?

None of these are light, breezy conversations, but they are essential, says 91�ֿ� associate professor of communication studies Mei-Chen Lin, PhD. She and some 91�ֿ� colleagues have studied the kinds of issues that stop people from having these difficult but necessary talks.

They found that less than half of adults have conversations like these with their parents, yet one thing is certain: Members of the younger generation always wish they would have discussed these issues before a tragedy or crisis with a parent forced them into making quick choices without enough information.

Baby Boomers have struggled in part because they are the first generation to have so many parents who live into their late 80s and 90s. “Experience with their parents is giving them a better idea how to talk with their children,” says Dr. Lin. Or at least she hopes so.

Following are a few of her suggestions for communicating with your parents about later-in-life choices. Then pass on your newfound wisdom to your kids. They’ll thank you for it.

Ask your parents to put their wishes on paper. This is critical in case both parents become impaired at once, and neither can pass along their wishes to offspring.

Let your parents know you have plenty of time to talk about these matters. Elders told Dr. Lin and her fellow researchers that they didn’t want to bother their busy children with this information.

Bring up housing, driving and other matters informally. See how your parents respond and don’t cover the entire conversation at once if they’re not ready to talk. 

Speak with your siblings.  Ask if they have already held these conversations with your parents, and get all siblings on the same page, if possible. The sibling who is emotionally closest to your parents should start the conversation. Others can help with resources, logistics, etc.

Research housing and transportation options. Offer that information to your parents along with alternatives, such as hiring home care, moving to a senior complex, or remodeling the home for more safety and ease.

Don’t patronize your parents. Reassure them that you are thinking about how they can best maintain their independence, not trying to take away
their freedom.

Communicate your love and care. Don’t make them feel like a burden; assure them that you’re all in this together. Help your parents understand how much making these decisions will help you and your siblings now and later on.

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RAISING THE GRANDCHILDREN

What happens when you’re ready to retire, but have to take on another round of child-rearing?

Many Americans are finding that just as retirement comes into view, they are unexpectedly raising their grandchildren. This is more common than many people realize, says Gregory Smith, PhD, 91�ֿ� professor of human development and family studies. “I wish I had a nickel for every grandparent who told me they didn’t see this coming.” 

Some are taking on a significant co-parenting role for a variety of reasons, which include parent work schedules, health concerns and military deployment. 

But about a million grandparents in the United States are taking on a custodial or skipped generation role—meaning they are raising grandchildren on a fulltime basis in their own home without involvement from birth parents (although many don’t have legal custody).

Parent substance abuse, incarceration and mental illness are some of the causes behind this upswing in custodial caregiving, says Dr. Smith, who has been researching various interventions to alleviate the psychological effects of disrupted parenting on custodial grandfamilies. 

Custodial grandmothers (who do the major share of caregiving) are at high risk for psychological distress and custodial grandchildren (who experience early life adversity) are at high risk for behavioral and emotional difficulty. 

The norm for traditional grandparenting, Dr. Smith points out, is to interact with grandchildren in an indulgent, fun-loving way and to help out occasionally with money or babysitting. That role gets tossed aside when a grandparent becomes the primary caregiver. 

In a study funded by the National Institute of Nursing Research, involving custodial grandmothers of children ages 4 to 12, Dr. Smith compared three interventions—cognitive behavioral therapy, behavioral parent training and information only support—to improve the well-being of custodial grandfamilies. The first two interventions were equally effective in reducing distress and improving parenting behaviors among grandmothers and lessening psychological difficulties among grandchildren—and more successful than the information only approach.

Dr. Smith’s most recent five-year research grant, funded by the National Institute on Aging, involves social intelligence training* for custodial grandmothers and their adolescent grandchildren, ages 12 to 18. Adolescents have been largely ignored in studies, but are at a peak period for developing social skills. Social intelligence is the ability to effectively navigate and negotiate complex social relationships and environments. “Developing and maintaining close social ties is critical to optimizing mental and physical health, whatever your age,” says Dr. Smith. 

He and another principal investigator at Arizona State University are developing an online social intelligence training program for the grandmother/grandchild dyad. 

Researchers and media reports on custodial grandparents have largely focused on the caregivers and their burdens. And while grandparents undoubtedly need support, Dr. Smith says he is equally concerned with the emotional needs of the grandchildren.

“It’s the difference between caring for and caring about ���dz���DzԱ�.”

*Help stop the cycle 

The importance of this social intelligence intervention cannot be underestimated, Dr. Smith says. “Increasing evidence over the past decade shows that early life adversity has profound effects on our later lives. It is a huge risk factor for problems throughout life, including the ability to form and maintain close interpersonal ties. In risky families, the cycles continue across generations. Social intelligence training is a form of intervention that can stop the cycle.  

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KEEPING ACTIVE

Use it or lose it. We’ve heard this expression so often we don’t really hear it anymore. 

There’s no denying that exercise is a vital component to achieving an optimal old age. A number of physiological changes occur naturally with aging, says Angela Ridgel, PhD, 91�ֿ� associate professor of exercise science and physiology—among them loss of muscle strength and balance, and a decline in sensory systems such as vision and kinesthetic sense. 

The good news is that you can combat this decline, but you’re going to have to work at it*. “Aerobic exercise increases heart rate, blood flow to the tissues, oxygen delivery to the brain,” Dr. Ridgel says. “We also know it increases neurotransmitters that help movement and cognitive processes and improve mood.”

Okay, we’re convinced. But how much exercise is enough? Dr. Ridgel, whose newest research focuses on neuro-rehabilitation with Parkinson’s disease patients, has some advice.

Resistance or weight training is necessary to offset the muscle decline that comes with aging. You can slow down and even reverse that muscle loss with a two to three times a week weight regime. Choose exercises that work large muscle groups, such as the leg press, abdominal press and back machines, and those that help you work out your upper body. You’ll be glad you did when you can rise from a chair, stand and walk for longer periods. And you don’t need heavy weights to make a difference, Dr. Ridgel says. Even five to ten pounds will do the job.

Consider high-intensity interval training. Currently an important older adult research area in Dr. Ridgel’s field, high-intensity interval training means performing five to six, 20 to 30–second bursts of very high heart rate exercise, which serves to increase blood flow and oxygen to the brain but won’t completely wear a person out, she says. Researchers speculate that this increased blood flow may improve both physical function and cognitive function.

Don’t be afraid of getting hurt while exercising. “It’s important for older adults to feel confident about their abilities,” says Dr. Ridgel. “Exercise allows you to go out into the world and face it head on. Believe me, you’ll feel so much better.” And isn’t that what we’re all hoping for?

*Work it

Aerobic exercise means more than a weekly stroll around the block. If you prefer moderate exercise—which allows you to walk or bike, for instance, while still easily holding a conversation—you need to aim for 30 minutes, five days a week. If you can handle higher intensity, such as running or playing singles tennis, aim for 30 minutes three times a week.

 

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SURVIVING THE SANDWICH YEARS

What to do when you’re caught in the middle of caring for children and older adults.

When his grandmother in Vermont got sick some years ago, Phillip Rumrill, PhD, 91�ֿ� professor and coordinator of the Rehabilitation Counseling Program and director of the Center for Disability Studies, became what he calls “an unwitting and unwilling member of the sandwich generation.” 

His grandmother was facing a long road ahead, with cancer and dementia, and Dr. Rumrill was faced with figuring out how to best support her through all of that, which drew on skills he’d learned from teaching rehabilitation counseling case management. 

After his grandmother died he decided to write—with two colleagues—a helpful manual called , which won the 2013 Gold Medal for the Family & Relationships category in Foreword Reviews’ INDIES Book of the Year Awards. 

Following is advice from Dr. Rumrill’s book.

Compile all your financial records—attorney’s contact info, will, assets, medical records, bank accounts, etc.—and keep them in one easy-to-find place. Even though you may still be middle-aged, should you suddenly get sick your family would be able to easily find insurance policies and other vital financial information.

Consult with a financial planner who specializes in eldercare issues—for yourself and your parents. Financially helping your parents can have implications for your children, though. “If you’re paying for Grandma’s assisted living, that’s less college money for them,” says Dr. Rumrill. 

Realize you may need to take a medical leave at some point to support your parents. This means making career adjustments, which tend to fall disproportionately on women, Dr. Rumrill says. Nationwide, about a third of women between ages 40 and 60 say they have had to interrupt their careers because of eldercare responsibilities.

Acknowledge that the role reversal is hard for both parties. “Our parents are our superheroes,” Dr. Rumrill says. “Watching them age requires some adjustment on our part, as well.”

Include your children in caring for elderly loved ones as much as you can. “Aging is a natural part of the human experience,” Dr. Rumrill says. “But there is a balance to this. You don’t want to overwhelm children.”

Take care of yourself if you’re the caretaker. “Don’t be afraid to ask for help,” says Dr. Rumrill. “You won’t be good to anyone if you burn out.”

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FEEDING YOUR BRAIN 

Your gut’s microbiome can help your brain function at its best.

Food and weight are fraught subjects, of course, but 91�ֿ� psychology professor John Gunstad, PhD, director of the Applied Psychology Research Center, urges older people to stay the course and take their caloric intake seriously.

Research has shown links between obesity and memory loss, he says, and as weight goes up, we’re also at greater risk for diabetes and heart disease. Interestingly, underweight people are also at greater risk for Alzheimer’s and other forms of dementia, so the best solution seems to be maintaining a healthy weight.

Dr. Gunstad’s latest research explores the relationship between the gut microbiome and brain function in older adults. There are more bacterial cells in our body than human cells, he explains, and these bacteria can have an important impact on body systems such as blood sugar and heart disease. 

“Research in animals shows that a better ratio of good to bad bacteria improves brain health*,” he says. “And we think it might work the same in humans.”

The researchers plan to check mood and memory at the beginning and end of a 90-day cycle in which some human test subjects take probiotics and others do not, to determine if probiotic capsules—standardized and safe—make a difference in brain function. By summer 2018 they hope to have some results.

In the meantime, when it comes to aging gracefully, healthily and optimally, Dr. Gunstad has some advice, but it’s nothing magical or new. “Do all the things your mother told you to do: sleep enough, eat right and exercise. Take care of the little things, and the big things will mostly take care of themselves.”

*Better Bacteria

How to achieve that better bacteria ratio? Yep, back to the good old Mediterranean diet we’ve heard about for years: fruits, vegetables, fish, olive oil, yogurt. But what if we could help our guts and brains without mainlining kale and olive oil? Dr. Gunstad and his fellow researchers are interested in that question, too. They’re in the midst of a study looking at whether taking a probiotic supplement might manipulate bacteria to improve brain function.

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EATING AS YOU AGE 

How you ate and drank in your 20s and 30s probably won’t meet your needs in your 50s and beyond. 

When it comes to improving your diet, it’s never too late to start, says , BS ’73, PhD, a nutrition professor emerita at Georgia State University, who currently provides nutrition consulting services to many food and nutrition-related groups. 

In her recently published book, , she and her coauthor translate scientific research into simple action steps for adults over 50 who want to lead active, healthy lives. 

However, it’s never too early to start either. Although many people wait until they retire to make major lifestyle changes, 30 is about the age when changes in most of our body systems begin to occur, says Dr. Rosenbloom, who specializes in sports nutrition and gerontology. “These changes happen gradually, and the good news is that aging adults can do many things to maintain good function, even at advanced ages.” 

“If you make it to age 65, statistically you have a life expectancy of 20 more years. And you want to spend them in as good health as you can. You don’t have to throw everything out of your pantry and start over. Just begin making little changes.” 

Here are some changes she recommends:

Watch out for weight creep. If you gain just two pounds a year, multiply that by 30 years and you’re saddled with 60 extra pounds. “Monitoring is important,” Dr. Rosenbloom says. “I encourage people to weigh themselves every morning—not to freak out or let the number on the scale dictate your happiness, but when you start seeing that steady increase, to put the brake on it so you maintain a healthy weight.” 

Eat regular meals and distribute protein throughout the day. Many of us tend to eat light during the day and then backload all of our calories at night, says Dr. Rosenbloom. “It’s much better for our muscle mass to be fed with good protein throughout the day.”

Choose nutrient-rich foods. As you get older, you need fewer calories, but the same (if not more)of some nutrients, including calcium, vitamin D and vitamin B12. “Be more selective about choosing foods that give you the right balance of nutrients, not just empty calories,” Dr. Rosenbloom says. “There’s less room in your diet for that pitcher of beer and basket of fried chicken wings you might have had when younger.”

Know your nutrients. Track your food/beverage intake for several days using sites like ChooseMyPlate.gov or Supertracker.usda.gov to see if you’re getting a healthy balance of nutrients; you can also download apps to find the percentage of nutrients you’ve consumed. 

“Once you know your baseline, you can make any needed adjustments,” says Dr. Rosenbloom. “For example, when it comes to calcium, you might just need to add a handful of almonds or six ounces of yogurt in the afternoon to get your calcium up to a healthy range.” 

Consider your portion sizes. Bigger isn’t always better when it comes to health. You can overeat healthy foods, too. “For example, bottled smoothies can be a good snack or meal replacement, but often the bottle contains two servings.” 

Cook at home more. Cooking is still the best way to make healthy meals. Highly processed packaged and frozen foods are often high in sodium, sugar and less healthy fats.

Be wary of the latest fad diet. “We need the nutrients in carbohydrates, proteins and fats, so having a balance of those things is important,” Dr. Rosenbloom says. “You don’t need to go on a deprivation plan; most people can’t stick with them anyway.” Unless you have some major health condition, you don’t need to be very restrictive; just make some minor adjustments and tweaks, like limiting added sugar and refined grains.

Choose a healthy eating plan. There is no best diet or food for optimal aging, says Dr. Rosenbloom. Many healthy eating plans contain a balance of the three major nutrients—carbohydrate, protein and fat—so find a plan that works best for you. In her book, she suggests you consider four dietary plans backed by science that contain a variety of healthy foods from all food groups: Dietary Approaches to Stop Hypertension (DASH), Flexitarian, Mediterranean-style and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND).

Enjoy eating and socializing. Food is an essential and enjoyable part of life. Share meals with family and friends. Experiment with new flavors and recipes. Learn to make substitutions, not sacrifices. Eat for health most of the time, but recognize that everything in moderation is fine, says Dr. Rosenbloom. You don’t have to miss out on enjoying a piece of your grandchild’s birthday cake.

Know what moderation means. Sharing a decadent dessert with your dinner companions is moderation; ordering the death-by-chocolate cake just for yourself is not. Not drinking during the week and drinking it all on Saturday night is not moderation; that is binge drinking. If you drink alcohol, moderate your intake to one or two drinks a day for men and one drink a day for women.

By The Numbers

Older American adults:

• 30% are overweight or obese
• 1 in 5 meet the recommendations for daily physical activity
• 1/3 have high blood pressure
• 1 in 4 over 60 have diabetes

See about food and fitness as we age.

Lynette Lamb is a freelance writer based in Minneapolis. Her parents are 85 and 91 years old.

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