This project began 11 years ago as a project about people over 80 who work. Upbeat! Inspirational! Safe! I didn’t realize it at the time, but the project epitomized an approach that has dominated gerontology since the 1980s: “successful aging”— also known as “active,” “healthy,” or “productive” aging. For most of human history, aging was seen as a natural process largely beyond our control. Enter the “successful aging” model, which posits something close to the opposite: eat right, stay fit, choose well, have a good attitude, be “productive,” and we can craft the old age we want. The model emerged to counter to the prevailing narrative of aging as loss and decline alone, and it’s deeply appealing.
Something about this way of thinking made me uneasy, and I was lucky to get a gentle course correction early on from geriatrician Robert Butler, the inventor of the term ageism and one of the older workers I interviewed. “If you get up in the morning and get yourself dressed, you’re being productive,” he told me. Or, as I put it more bluntly years later, “If you wake up in the morning, you’re aging successfully.” As I came to realize, healthy behaviors and “can-do” strategies are terrific, but they can’t hold aging at bay—nor is that something we should aspire to. An active, healthy 65 is still 65, not “the new 50.” Imagining otherwise is denial—a high-end version that overlooks the very important role of socioeconomic class, along with race, gender, and just plain luck, in shaping how “successfully” we age. It leaves behind those who aren’t wealthy or healthy enough to age the “right” way, and it feeds the denial in which ageism takes root.
The model is problematic in lots of other ways as well, as I learned from reading Successful Aging as a Contemporary Obsession: Global Perspectives, a new collection of essays edited by Sarah Lamb. In the introduction, Lamb points out a central irony: although “successful aging” came into being to counter aging’s negative image, this hyperpositive way of thinking “is, in ways that can be hard to recognize, in some respects profoundly ageist—resting on a deep North American cultural discomfort with aging, old age, and being old.” To age “successfully” is essentially to not age—to stop the clock—despite the fact that very few of us are going to drop dead without experiencing some kind of diminishment, whether physical, cognitive, or social. As Lamb writes, glossing over those normal transitions not only makes it all the harder to learn from and adapt to them, it sets us up to fail.
In any case why should aging be something to succeed or fail at? That’s the why-didn’t-I-think-of-it question posed by Toni Calasanti and Neal King in the book’s first essay. We don’t talk about successful infancy or “teenagehood” or adulthood, after all, and understand that those life stages come with both pros and cons. “No other stages are treated as if they had no value unique to them, as if no positives resulted from entry into those stages, or as if we needed to justify their existence by minimizing what is unique to them,” they observe. Why should later life be the exception? Calasanti and King also argue that urging people to take responsibility for their own aging ignores the inequities that give rise to ageism in the first place. “It does not confront the notion that old age is worse than middle age, that old people should find ways to be more like their younger selves, [and upholds] other life stages as the models against which elders will be assessed.” In other words, the successful aging model leaves ageism unchallenged or contributes to it.
What else is problematic about “successful aging”?
It’s classist. Because aging “successfully” requires education, leisure, passports, and access to good healthcare and nutrition and exercise—all of which are expensive—it overlooks social inequalities. Successful agers are assertive patient-consumers, upholding their civic duty by taking good care of themselves! The emphasis on personal responsibility dovetails with neoliberal and very American ideals of self-governance and independence. This relieves the state of responsibility, which in turn makes it less likely that the less well-off will receive the public support that make it possible to age well—or even to age at all.
I knew about this class bias, but hadn’t given any thought to how it plays out in the arena of caregiving. In an essay about older Chicagoans, Elena D. Buch writes, “Efforts to promote successful aging that focus on increasing self-determination and independence implicitly prioritize the well-being of vulnerable older adults over the well-being of their also-vulnerable care workers, strengthening existing social hierarchies based on race, class, and gender.” Oof.
it’s ableist. The successful aging model assumes that olders are healthy and just have to stay that way. There are no canes or wheelchairs in sight. Where does that leave those with chronic conditions, or with a disability, whose numbers inevitably increase with age? An essay by Jessica Robbins Ruszkowski describes Poland’s Universities of the Third Age, a popular educational and social institution in Europe that promotes active aging. Because illness would mean entering the Fourth Age (dependence and decrepitude), “The concept of the Third Age thus makes illness unthinkable.” The result is exclusion, instead of inclusive visions of aging that “go beyond binary constructions of activity and passivity, success and failure, productivity and unproductivity, and health and illness,” Ruszkowski writes. As an alternative, what if funding weren’t restricted to “programs focusing on active aging as such, but toward ensuring that people have the ability to support whatever kinds of social activity they find meaningful?”
As Janelle S. Taylor writes in an essay about friendship in the face of dementia, the conventional “successful aging” narrative requires stopping the clock: achieving physical, cognitive and social stasis. This presupposes an “entire social world … in which other people are also not aging in complicated ways alongside one,” and in which it makes sense to step away from friends who become incapacitated. Do so and we forfeit participation in what Taylor calls a “moral laboratory.” Those who hang in “describe friendship after dementia that is capable of changing rather than simply enduring; and they describe dementia as an impetus for personal and interpersonal transformations that can involve learning, growth, and unexpected gifts in addition to very real experiences of sadness and loss.”
It’s shame-inducing. If we’re responsible for the way we age yet unable to control its course, aging becomes a source of shame and embarrassment. As Abigail T. Brooks writes in an essay about why North American women have cosmetic surgery, this “can give rise to the blaming and shaming of olders for simply being and growing old and for failing to do anything about it.” We experience natural physical transitions as betrayal. It’s an embarrassment, or worse—a moral or political failure—if the trajectory changes, as in the case of a high-achieving, active woman in her 70s who experienced her cancer diagnosis as a personal failure.
It perpetuates gender stereotypes: The advertisements and products that promote “successful aging” “reinforce white, middle-class heterosexist norms of male performance and female beauty,” writes Lamb. Women are supposed to focus on maintaining beauty and men on their capacity to perform, whether in bed or at the gym, which reinforces active and passive stereotypes—desire on the part of men, desirability for women. “Successful aging” “means accepting that how you look (i.e. having a youthful appearance) matters,” writes Brooks. This requires both taking personal responsibility and engaging in hard work, although the women she studied didn’t describe it as work. Those who rejected this equation of youth with beauty and appearance with value—hard work in itself—“reap rewards as they forge new relationships to their aging bodies and as they realize new avenues for self-expression outside of the body altogether.”
It medicalizes the aging process. In an essay about selling youthful sexuality as “successful aging,” Emily Wentzell defines “lifestyle drugs” as “pharmaceutical treatments—rangeing from baldness cures to eyelash lengtheners—that cause social distress rather than physical harm.” The emotional relief the treatments provide is real, she observes but the sources of that pain are not medical conditions but social expectations for how bodies should be—expectations that advertising and medical practice aggressively promote. “So, rather than questioning or challenging cultural expectations, people who cannot meet them increasingly turn to pills that will change their bodies,” writes Wentzell, which is dangerous, increases healthcare costs, and promotes unrealistic expectations, once again setting us up to fail as these strategies inevitably fall short.
Viagra exemplifies this trend, which, Wentzell notes, has “a range of social consequences.” While it counters the damaging stereotype that olders should not be sexual, it promotes a narrow vision of what connotes “healthy” sex and suggests that people should want to have sex the same way throughout their lives. She found a very different attitude in the working-class Mexican men she studied, who perceived erectile dysfunction drugs as dangerous and even absurd, and were content to shift from “macho masculinities” to “being faithful, caring, and emotionally present for their families.” Many of their wives experienced the transition as “a beautiful change.” Wentzell ends the essay with an appeal to question Euro-American ideas of aging as a pathology. “We can fight against this trend by basing our ideas of successful aging on people’s diverse and culturally specific social needs, rather than on the expectation that healthy aging means ‘staying as young as possible’ for everyone, everywhere.”
it’s ethnocentric – The prevailing successful aging model is deeply linked to deeply American cultural ideals about productivity, independence, and control over our bodies and our futures, even in old age. Anna I. Corwin’s study of Catholic nuns describes a very different value system. The nuns ceded control and agency to the Divine, which helped them accept changes with equanimity; they valued interdependence over independence; and they saw “being good” as more important “doing good,” so retiring or becoming disabled carried no stigma. As a group, Catholic nuns are happier, healthier, and have fewer cases of Alzheimer’s.
A “new paradigm for well-being across the life course” proposed by Meika Loe likewise “emphasizes learning to ‘be’ in a culture of doing.” She calls it Comfortable Aging. This model requires interdependency, is about accepting vulnerability and limitations, and involves coming to terms with mortality. “While we can fail at being ‘successful’ or ‘productive,’ personal comfort is subjectively defined and attainable,” Loe points out. “Importantly, most structural issues linked to Comfortable Aging are non-age-specific—social respect, affordable housing, community-oriented neighborhoods, access to transportation, dependable services, and care that honors all stages in the lifecycle—these are universal needs.” In other words, a society in which it’s OK to age comfortably is one that supports all its members all along the life course.
Another valuable aspect of Successful Aging as a Contemporary Obsession is its global perspective. Many in the majority world find these ultrapositive images of aging unrealistic and counterproductive. Lamb has done extensive fieldwork in West Bengal, where, far from being idealized, “too much independence is commonly regarded as the worst thing that can befall one in old age.” More than 80% of India’s 65+ population live with their families, embodying “a relationship of lifelong intergenerational reciprocity.” There’s nothing demeaning about receiving care and support of all kinds, including with toileting. Imagine that!
As Lamb points out, we have much to learn about aging well from some Buddhist, Hindu and Catholic ways of thinking, which “highlight transience as a fundamental part of being human” rather than denying or stigmatizing the changes that accompany us along the life course. “Can we not accept signs of aging—even if they include declines, vulnerabilities, and ephemerality—as in some ways a meaningful part of life?” Lamb asks. “Shouldn’t it be possible to regard old age and death not as intolerable outrages, nor as failures of medicine and self, but rather as inevitable facets of life, defining in part what it is to be human?” That less “successful” world would be a better one for all: less fear-filled, more communitarian, and more open to the transcendent possibilities of life itself.