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Ashton Applewhite

Turn “Dress Like a 100-Year-Old Day” into action against ageism

Dress Like a 100-Year-Old Day first bleeped onto my radar a few years ago, when someone submitted a picture to my Yo, Is This Ageist? blog.  It showed a little kid hunched over a toy walker and sporting a gray wig and fake glasses. All this regalia, along with fake wrinkles and drab duds and fake canes, is available in party and costume shops as the 100th day of school approaches. Once an opportunity to teach elementary-school kids about the number 100, the day has devolved into a bizarre dress-up ritual that equates old age with disability and little more. The timing matters too. Much research shows that attitudes toward aging, like attitudes towards race and gender, start to form during these impressionable early years.


Just as schools celebrate the achievements of African Americans during Black History Month and of women on National Women’s Day, how about turning the 100th day of school into an event that “inoculates [children] against ageism,” as Jill Vitale-Aussen of the Eden Alternative suggests in this scathing blog postDress Like a 100-Year-Old Day: A Call to Action, a new campaign spearheaded by the Eden Alternative, Pioneer Network, and Leading Age—three organizations at the forefront of culture change around aging—aims  to do exactly that.

Use the campaign’s great graphic any way you like. Download their Call to Action Letter_to_Educators, discuss it with teachers and parents and school officials, ask senior centers and retirement homes to make this a powerful opportunity to engage with local schools—and insist on change. Or as a less restrained commenter put it, “Let’s turn this obscenity into an opportunity . . . yell, scream, protest if your child’s school is participating in one of these events!”  Movements need direct actions, and this one has fantastic potential for a movement against ageism.

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In addition to the Call to Action Letter_to Educators, here are some other resources to share with teachers. You’ll find them, and lots of other stuff, on Old School, our newly-launched clearinghouse of anti-ageism resources.




Old School is now in session!

Movements need people. (That would be you). Movements need purpose (To make the world a better place in which to grow old. And, while we’re at it, to be young, or have a disability, or be queer or non-rich or non-white.) And movements need tools. That’s why, in collaboration with age activists Kyrie Carpenter and Ryan Backer, I’ve launched Old School, a clearinghouse of free, vetted, anti-ageism resources: books and blogs, workshops and PowerPoints, organizations and advocates.

Check it out, and tell us what you think. (It’s in beta; more features coming very soon.)  

Spread the word. Follow Old School on social media–on Twitter, on Facebook, and on Instagram–tell the world about it, and help it grow. 

Send us stuff. If you have an ageism-related resource — not  about positive aging or  productive aging or conscious aging or  healthy aging, or creative aging – but explicitly focused on ageism — submit it to Old School using our online form. You name the resource, you own it, you link it to your organization or services; we make it available for free. 

We built Old School to educate people about ageism and help dismantle it though individual and collective political action. It’s an ongoing collaboration, and will only realize its potential with help from people like you and organizations like yours. We hope you’ll like it, use it, and help it grow.


Who’s going to create a better narrative of old age in America?

Most Americans aren’t optimistic about getting older, and think the source of the problem is aging itself. So do most policy wonks, framing population aging as a set of choices about how to care for an avalanche of “frail and needy elderly.” MIT’s Joseph F. Coughlin and I don’t share that myopia. His latest book, The Longevity Economy, is packed with big ideas about the “dramatic-yet-predictable” effects of the new longevity, which we think presents a remarkable opportunity to build a better old age. We also know that what stands between us and this brighter future is the culture itself. But he’s putting his faith in corporations to “do the right thing” while I envision a very different engine of change.

Coughlin founded the MIT AgeLab, which “applies consumer-centered systems . . . to catalyze innovation across business markets,” so it’s not surprising that his approach to the longevity boom is market-driven. “It’s as though a whole new continent were rising out of the sea, filled with more than a billion air-breathing consumers just begging for products that fulfill their demands,” he writes. Soon, he predicts, “the world’s most advanced economies will evolve around the needs, wants, and whims of grandparents.” The products and technologies that emerge to meet those needs won’t just be highly profitable. By improving the quality of life of older Americans in countless yet-to-be-imagined ways, the book predicts, they will enlarge and enrich the way we experience old age itself. It’s a bold proposition, and it’s also misguided.

What stands between us and this better old age?

Why are companies failing to “wake up, smell the Ensure”—which, Coughlin points out, is pretty much Soylent marketed to olders—and start courting older consumers with all the fervor they currently lavish on millennials?” Because of “our very idea of old age [emphasis mine], which is socially constructed, historically contingent and deeply flawed.”  “Socially constructed,” as I often say, is sociology-speak for “we make it up,” and we’re in synch when Coughlin declares “Old age is made up” [emphasis his].

Not made up like a fun game, made up like a shared delusion. Call it a “collective case of blindness” as Coughlin does. Call it “implicit bias—prejudice so deeply ingrained that you might not even know you harbor it—against older people is the norm across age groups,” as he also describes it. Call it “ageism,” as I do, and why Coughlin fails to is beyond me;  the word barely appears in The Longevity Economy. But although our approaches differ, we agree on the heart of the problem: an ageist culture that confines olders to the margins of society and sanctions only the blandest of “age appropriate” behaviors: relaxing, volunteering, grandparenting, and falling apart.

Who’s going to drive the necessary social change?

Not olders themselves, Coughlin writes, “because their ability to picture new, better ways to live is utterly constrained by our current, pernicious narrative.” The drivers, he says, will be the corporate visionaries who understand that olders aspire to the same stuff as everyone else does—work, romance, purpose, imagine that!—and create the products that enable those aspirations. “By building a vision of late life that is more than just a miserable version of middle age, companies won’t just be minting money . . . they’ll also be creating a cultural environment that values the contributions of older adults.” The result will create a virtuous circle: by enriching and enlarging our vision of late life, better products will bring it about.

I love Coughlin’s vision of “a new narrative of possibility in old age,” but I don’t think it’s going to emerge from the business community. Corporations can speed social change, and they can definitely commodify it, turning sisterhood into grrl power into the Spice Girls, for example. But they exist to profit, not provoke, and it’s easy to monetize fear and insecurity. Who says wrinkles are ugly? The multi-billion-dollar anti-aging skincare industry. Who says perimenopause and “low T” and mild cognitive impairment are medical conditions? The trillion-dollar pharmaceutical industry. Why would corporations be instrumental in overturning prejudices from which they profit on this scale?

So I stumble over Coughlin’s belief that “More than any other factor, this new story [of old age] will be built on the testimony of longevity-economy products.” Really? A seismic cultural shift driven by consumer behavior? The longevity economy will bequeath us lists of service providers and garages full of tools and toys. But olders want to downsize, and products will have to be both indispensable and affordable in order to reach a mass market.  More importantly, products alone cannot transform the world in which we use them. For-profit ventures aren’t in the better-life-for-everyone business because the masses lack the disposable income to power wholesale culture change. If the goal is to go beyond meeting older people’s basic needs—to support growth and voice and visibility for all, lifelong—how do we develop the rituals, roles, and institutions that will be essential to achieving that goal? Why would we trust the private sector to start operating in the interests of the entire cohort, not just those in the 9.9%? (See this piece in The Atlantic about the “new American aristocracy.”)

A consumer revolution requires a social revolution.

We know that as time grows shorter, purpose becomes an ever-higher priority. As Coughlin observes, “Culture helps determine what older people find meaningful. And that raises a question: can . . . new, socially permissible routes to meaning open up?” Of course they can: look at the effect of the women’s movement on women’s lives around the world! Whether global or local, whether revolutionary or reactionary, social movements challenge our notion of what’s “normal,” equitable, and possible, and in the process transform society. The technology- and consumption-driven revolution described in The Longevity Economy cannot take place without a mass movement to raise awareness of ageism and to end it.

Changing the culture is hard, and it involves struggle. That struggle doesn’t start in a shopping cart, whether online or at Walmart. It starts between our ears, with the uncomfortable task of confronting our own, largely unconscious, age bias. It’s internalized ageism that keeps olders away from senior centers “because of all the old people there—I’m not like them.” (That and the fact that an ageist society doesn’t fund adequate, attractive, age-integrated gathering places.) Paired with ableism, ageism keeps olders from using walkers or wheelchairs because of the stigma, even when it means never leaving home. The same toxic combo scares off potential subscribers to the Village-to-Village aging-in-place movement, as Coughlin observes, because of “a serious perception barrier preventing people—even those evidently quite happy to join a service explicitly for older adults—from seeing themselves in a club designed to provide care for its oldest and frailest.”

Those “perception barriers” are based on fear and shame, the grotesque notion that to age is to fail. We’re going to stay mired in age shame until we take off our collective blinders and acknowledge, out loud and together, what we know to be true: that age enriches us. We’re not going to put these fears in perspective—to acknowledge, for example, that aging well and living with disability can and do coexist—without a shift in cultural values. That won’t happen without mass political action that provokes society-wide upheaval, because the dominant culture will push back hard, as it does against anything that threatens the status quo. A shift in consumer behavior isn’t going to do it. We need people in the streets, not waiting for the free market to rescue us or carry the ball.

From the personal to the political. (And back. And back again…)

Change begins with consciousness-raising, the tool that catalyzed the women’s movement. (Here’s a link to Who Me, Ageist? A Guide to Starting A Consciousness-Raising Group.) Women came together in the 1970s, compared stories, and realized that the obstacles they were facing—not getting heard, or hired, or respected—weren’t personal misfortunes but widely shared political problems that required collective action. Social change occurs only as we take that awareness out into the world and directly and explicitly confront the ageism that diminishes and segregates older Americans in every arena.

“The new, bespoke narrative of old age will emerge organically from our jobs as consumers. It will fit like a tailored suit,” Coughlin writes. Corporations are indeed going to do well by those of us who can afford tailors. There will be robots to hoist and help us, lovely communities to shield us from isolation, implants to enhance our senses (thank you, brand new cornea)—but only for those of us who can afford them. We can’t achieve equity without addressing the ways in which age intersects with race, class and gender. The movement needs to be much broader in order to bring about the richer and better old age that  we all hope to lives long enough to enjoy.

Who gets this better old age?

Coughlin does acknowledge, almost in passing, that “we’re staring at a possible future in which the gift of extra years of life is diverted straight to the wealthiest people in the world,” Possible? In a historic and shameful reversal, lifespans in the U.S. are in decline, largely among poor white women. A 2017 report by the United Nations found growing numbers of Americans living in extreme poverty. The engine of that disparity is unfettered capitalism. The modern welfare state was born in response to that disparity, lifting millions out of poverty in the wake of the Great Depression. That safety net has since been shrunk, and all the cuts that late-stage capitalism requires in order to stay viable, including the current tax bill, promise to shred it further.

Capitalism is at best indifferent to the welfare of vulnerable populations, and more typically hostile to it. Pitting “disposable workers” against each other keeps salaries low, and the less economically productive people at both ends of the age spectrum are especially at risk. Gender disadvantages. Companies continue to pay women less than men and promote them less often, because it helps the bottom line and because they can still get away with it. Racism and homophobia also enter in. Older workers of color are most at risk for unemployment, with older African American men twice as likely to be unemployed as older white men, and LBGT olders fare even worse. Corporations are no more going to fix ageism than they’re going to fix racism or sexism.

Closing the inequality gap and moving towards age equity means “changing the fundamental rules of old age,” Coughlin writes. I couldn’t agree more, and technology and innovation will indeed help older Americans stay healthy and connected. But at best his proposal is a subset of the solution. At worst it’s a band-aid on the gaping wound of deep economic inequality and a dangerous distraction from the radical action necessary to catalyze real social change. A better life for older people means valuing human beings lifelong, independent of their ability to consume or produce. That’s a better world for everyone, only a grassroots social movement will bring it about, and it is underway.

What’s with the benevolent stereotyping of older workers?

This guest post is by Ruth Ginzberg, 65, the Sr. I.T. Procurement Specialist at the University of Wisconsin System.  She has an allegedly useless humanities degree in Philosophy with a concentration in Ethics, and an advanced technical degree in Information Systems Security.

I keep trying to figure out why so many articles about older workers as valuable resources, and older individuals outside of work as valuable members of the community, still make me grouchy.

I think it’s because they still promote stereotypes, just perhaps slightly more positive stereotypes than those that depict us as all in the throes of decline, disability, dementia and death.

The wise, kindly, nurturing grandmotherly and grandfatherly stereotypes often featured in such pieces may describe some older individuals, but let’s not forget that many older individuals don’t fit, and don’t want to fit, into those kinds of roles in their workplaces or communities either.

Older individuals don’t lose our ability to analyze, problem solve, direct others, invent, create, design, develop, manage people and resources, lead initiatives, complete projects and accept feedback (including both positive and negative feedback) that helps us  grow to the next level. This is true whether or not we are “retired.”

Not all older workers are repositories of “institutional memory.” Some older workers have only worked for their current employers for several years themselves, and are still learning the business (and in need of as much training, mentoring and professional development as are younger workers with only a few years in their current roles).

Some older individuals are more comfortable analyzing, synthesizing, designing, engineering, building, and testing solutions to tricky problems than they are reading children’s books to toddlers or gardening with middle schoolers.

Some older individuals have talents they’ve not yet had the time or energy to develop, and cherish the opportunity to develop them later in life. Some older individuals discover talents they never knew they had before.

Most older individuals probably don’t want to play the role of stereotypical characters in somebody else’s script.

Even stereotypes that on the surface appear to be positive often are not.  They still pigeonhole multi-dimensional human beings by reducing them to one-dimensional caricatures  The problem is that the invoked stereotype, viewed close up, interferes with the ability to see older individuals’ many other talents and skills.

We can’t just replace negative stereotypes with more positive stereotypes and believe our work is done.  We need to push this transformation to the next level

Age self-stereotyping (aka internalized ageism): it’s insidious and harmful.

This guest post is by Louise Pendry, a Senior Lecturer in Psychology at the University of Exeter in the UK.  She’s delighted to be combining her work on online communities, stereotyping and prejudice, with her long-standing personal interest in and (more recently) her lived experience of women and ageing. Currently she is exploring how online communities can help support and empower women as they grow older. You can reach her at or find her on Instagram as silverserenity4.

I like to think I’ve got a pretty good attitude to growing older. I’m genuinely enjoying my life post-50. But recently, I hit a roadblock to my progress here, and that roadblock is me, or more precisely, how I sometimes think about me. That’s what I want to share with you.

As a psychology lecturer, I teach a class on stereotyping. Mostly I focus on how we stereotype other people, but lately I’ve started to look at what happens when we stereotype ourselves, especially when we do so on the basis of age (internalised ageism). I like to start each class with concrete examples of the topic I want to tell my students about to make it real. This is easy when it comes to stereotyping other groups (e.g., black males shot in error by police). But this SELF-stereotyping angle was less obvious. I was struggling to find a vivid, relevant illustration. Little did I realise that I’d do something – actually in the class itself – that would give my students a perfect real-life example.

Here’s what happened. It was the week before my planned session on age stereotyping. Part of the class involves students giving presentations on research articles. This is my cue to sit down and grade their efforts. The room layout was cramped and necessitated me clambering (tripping!) around the AV equipment, before climbing inelegantly over a desk to reach a seat. All of this was achieved with much stumbling and huffing and puffing on my part. Trying to make light of it, I smiled and said “Ha! I’m not the woman I was!” Cue much laughing. At the end of class, a student approached me about her presentation the following week, ironically on an article about age self-stereotyping. “You know, you just demonstrated what that article called ‘internalised ageism’,” she said. And she was right. I had used a common negative stereotype about ageing (declining physical fitness) to explain my behaviour and it was more than likely not justified. Actually anyone would have struggled to reach their seat in that classroom, young or old.

Thinking this was just an aberrant moment on my part, I tried not to worry. But as I started to think about it, I realised this was not an isolated episode. I’ve certainly found myself joking about an unfortunate “senior moment” when I’ve mislaid my glasses and can’t recall where. Where’s the harm in that? We all do it, right? Really though, what I’m doing here when I make this kind of humorous self-deprecating remark is classifying a behaviour I’ve performed as proof that my memory’s going and furthermore, highlighting it’s because of a negative and enduring part of the elderly stereotype: forgetful. I’ve pigeonholed myself, written myself off. This memory lapse could be a sign of impending Alzheimers but it’s more likely to signify that my life is way too busy. It could happen to anyone AT ANY AGE if they had as much going on as I often do. Or it could be down to menopausal brain fog (annoying but not necessarily permanent). Minor deteriorations in cognitive function can certainly happen as we age, but that doesn’t mean every slight memory lapse is a sign of serious cognitive decline.

Perhaps you think I’m over-reacting. You might think, “Good grief, where’s your sense of humour?” Now don’t get me wrong, I like a laugh as much as anyone. But here I think it might be an issue because such self-stereotyping can have important consequences for us. Research by Becca Levy and colleagues has shown that when we THINK of old as negative, we can start to FEEL old and may even ACT in a way that confirms negative elderly stereotypes.  And that can basically hijack our best efforts to age positively. What does this mean? Well, translated into everyday life, it suggests that the unconscious age self-stereotypes we hold and express (“I left my phone in the fridge, I’m having yet another senior moment!”) affect how well we approach and perform associated tasks in future (“My memory is clearly ****ed. How will I ever remember everything on my to-do list today?”). We become our own self-fulfilling prophecy.

Now I’m aware, I’m going to try to catch myself in the act when I do this, and maybe respond differently. It’s early days yet, but I would say I’m noticing this tendency more in myself and others. I met a friend for coffee recently and we were chatting about her job, and whether she wanted to apply for a new role with more responsibility. “I just don’t feel I’m mentally up to it any more,” she confessed, “I’m too old.” Mindful of all I’ve said above, I replied, “If you really don’t fancy it, that’s up to you. But if you do feel it’s not for you, is it down to your age? Remember, you moved jobs two years ago from one in which you had control over your daily routine to one which has you running around, at the beck and call of others. In your current role, you often feel overwhelmed, and that might be colouring your mindset, making you doubt your abilities. It might not be your age.” “Louise,” she replied, “you would never have said that before, you’d just have agreed with me.” And she’s right, I would have.

I’m not saying there aren’t some downsides to growing older, simply that there may be many explanations for the things we do as we grow older that are not irrevocably tied to age. Pausing to reflect on these alternatives might allow us to reappraise our achievements and move forward with this phase of our lives more positively, be that bit more resilient. As Becca Levy says: “…as all humans age, they should be aware of their own implicit negative views of their group and consciously develop an identity with old age and its positive attributes, using these to compensate for the ill effects of automatic ageism.” Reader, I’m on it!

two honors from the art world

Five years ago I got a speaking invitation from Maura O’Malley, co-founder of Lifetime Arts, a nonprofit that was creating professional arts programs for olders long before “creative aging” was a thing. (Google it now.) Last night they celebrated their tenth anniversary at a gorgeous gala in NYC, honoring Aroha Philanthropy’s Ellen Michelson for her visionary leadership and me with their inaugural Game Changer Award. (That’s Ellen below on the right—no, we didn’t coordinate our dresses—and Maura in the middle.)


One thing I turn out to be good at is recognizing my people when I encounter them, and the Lifetime Arts crew are definitely among them. They were the first organization to support me, and the first people in the creative aging field to understand that confronting ageism is central to their mission. As I said in my very short acceptance speech, “Artists like you are taking this change out into the world.” I’m grateful.

I also heard last week from San Francisco’s Yerba Buena Center for the Arts that I had been selected for their YBCA 100 list. “We believe that any major political or social change first requires a cultural movement. The YBCA 100 celebrates the 100 people, organizations, and movements that are using their platform to shift culture,” they write. “This year we continue to highlight cultural provocateurs and innovators from the Bay Area and around the globe. Welcome to a list that includes alumni such as activist Alicia Garza (2016), journalist Jose Antonio Vargas (2017), and filmmaker Boots Riley (2017).” Cultural provocateur! What an honor, and what fantastic company to be keeping.  


left; with my kids, Luke and Morgan, at the Lifetime Arts gala; right, thanking John Leland, friend and author of Happiness is A Choice You Make, who introduced me.

Not “old enough to die,” old enough to choose wisely

Note: if you’re new to my work, do check out the links, which explain or expand upon some key ideas.

Author and activist Barbara Ehrenreich has long been one of my heroes, and I imagine an affinity in our fondness for myth-busting. In her new book, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, she describes herself as an “amateur sociologist,” and I thought, “Aha, me too!” But although I was a staff writer for a science museum for twenty years, Ehrenreich’s Ph.D. in cellular immunology leaves me in the dust. She brings deep medical expertise to her latest subject: the American delusion that we can evade aging, even death itself, via right doctoring, right acting, and right thinking. (Her previous book, Bright-Sided, skewered Americans’ outsized faith in positive thinking; here’s my take on it.)

I couldn’t agree more with the book’s exposition of the damage done by our reluctance to acknowledge aging and mortality. Age denial is where ageism takes root, and it’s fed at every turn by a culture that frames aging as failure and natural transitions as disease. Shame and fear create markets, capitalism always needs new markets, and healthcare is big business. Age denial not only fosters ageism, it makes a good death less likely. Pretending we’re not getting older, not to mention mortal, makes it harder to embark on the necessary conversations about what we think we’ll want when the time comes. It also leads us to squander resources on costly but ineffective tests and treatments, especially towards the end. Most of Natural Causes is a detailed takedown of those tests and treatments, from mammograms to mindfulness: “preventive medicine” that Ehrenreich the biologist exposes as medically useless and ethically problematic. Fitness nuts live no longer than the rest of us. Placebos work, even when people know they’re being given a placebo. There’s no evidence that meditation is more effective than an hour spent doing anything calming. Most medical screenings—for breast, colon, and prostate cancer, for example, along with annual physicals—also fail the evidence-based test.

At 76, Ehrenreich is calling it quits on all that. She declines longevity for its own sake, and demands that we forsake the illusion that we’re in charge of our biological destinies.  “If anything, I hope this book will encourage you to rethink the project of personal control over your body and mind. We would all like to live longer and healthier lives; the question is how much of our lives should be devoted to this project, when we all, or at least most of us, have other, often more consequential things to do,” she writes.  One of the reasons Ehrenreich can afford this argument is that she’s a longtime gym rat, and I’d argue that staying reasonably fit is consequential. We know physical activity forestalls both physical and cognitive decline, improving quality of life. But the way we grow old is governed by a whole range of variables—including environment, personality, and genes, compounded by class, gender, race, luck, and the churnings of the global economy—over which we have varying degrees of control. Available only to the well-off, the illusion of control dumps all responsibility onto the individual, conflates luck with virtue, demands optimism without end, and shames when we inevitably fall short.

I do, however, take serious issue with the ageist way in which Ehrenreich frames her central argument. Rather than falling into the anti-aging or “successful aging “ camps, she explains, “I had a different reaction to aging: I gradually came to realize that I was old enough to die [emphasis hers].” Ehrenreich isn’t saying that humans come with an expiration date, pointing out mordantly that the military judges people to be old enough to face mortal danger at age eighteen. The title of her book comes from a phrase used in obituaries when the deceased is over 70: a death from “natural causes.” This raises no eyebrows, as she points out, and it shouldn’t. The death of a young person is indeed harder to bear than that of an octogenarian, because youngers have experienced less of what life has to offer and because the rest of us are robbed of the chance to witness and share those experiences.

That doesn’t make it OK to reduce aging to illness. “Even the most ebullient of the elderly eventually comes to realize aging is above all an accumulation of disabilities,” writes Ehrenreich. Above all?  Hardly! Growing old also brings self-knowledge, better mental health, even liberation, and is a period of ongoing growth and development, especially for those with meaningful roles and social supports. Even the most frightened and unenlightened know that despite the loss of cartilage and comrades, aging is different—and way better—than the way it’s portrayed in the culture.

Nor is it acceptable to suggest that olders are useless and disposable. Noting that the hallmark diseases of aging (atherosclerosis, arthritis, Alzheimer’s disease, diabetes, and osteoporosis) are all autoimmune disorders, Ehrenreich proposes that instead of asking why the body attacks itself, a better question might be:

“Why shouldn’t it happen? The survival of an older person is of no evolutionary consequence, since that person can no longer reproduce, unless one wants to argue for the role of grandparents in prolonging the lives of their descendants. It might even, in a Darwinian sense, be better to remove the elderly before they can use up any more resources that might otherwise go to the young. . . . And this perspective may be particularly attractive at a time, like now, when the dominant discourse on aging focuses on the deleterious economic effects of largely aging populations. If we didn’t have inflammatory diseases to get the job done, we might have to turn to euthanasia.” 

Yikes! The premise that population aging will bankrupt society is economically and ethically flawed. Ehrenreich has been a lifelong activist on behalf of the less visible and privileged, yet here she buttresses ageism’s ugliest premise: as people move through life, they lose value as human beings.

The fact that the “dominant discourse” on aging is so negative and one-sided—so ageist, in other words—is what makes it so urgent and important to challenge age bias. The conversation is anything but neutral, especially around “living too long.” An ageist culture casts the “end of life problem” in terms of increasing numbers of old people who inconveniently refuse to die, when the underlying issue is the changing nature of healthcare: the plethora of profitable, often legally mandated, high-tech medical interventions the book decries. Whose interests are in play besides those of the patient, and who is her advocate if she needs one? It’s not a particularly radical leap to conceive of assisted suicide and euthanasia as a form of discrimination against the old, the ill, the disabled, and those who are no longer economically productive, cloaked in the rhetoric of compassion. In an ageist and capitalist society, the line between “right to die” and “duty to die” can get blurry alarmingly fast.

“Ideally, the determination of when one is old enough to die should be a personal decision, based on a judgment of the likely benefits, if any, of medical care and—just as important at a certain age—how we choose to spend the time that remains to us,” writes Ehrenreich. But the right to self-determination is important at any age. It’s ageism and ableism that make the old and ill seem less entitled to it, and cutthroat capitalism that sanctions their abandonment. Small wonder that it’s become commonplace to hear even healthy, middle-aged people wondering whether the ethical alternative to “living too long” will be to commit suicide—not because they’re sick, or broke, or have no one to take care of them, but simply because they’ve grown old. That is internalized ageism of the deadliest sort. At any age and in any condition, a person has the right to want to stay alive.

“Once I realized I was old enough to die, I decided that I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life,” writes Ehrenreich. I’d tweak her credo:  replace “old enough to die” with “old enough to know better” or “old enough to choose wisely.” It’s not that she’s eager to call it quits, which very few of us do, but that she’s wise enough to spend her days doing what she likes. “As the time that remains to me shrinks, each month and day becomes too precious to spend in windowless waiting rooms and under the cold scrutiny of machines. Being old enough to die is an achievement, not a defeat, and the freedom it brings is worth celebrating.” Liberation from the specter of a long, costly, agonizing exit hooked up to machines is real, and this book liberates.

Ehrenreich is consciously opting for quality of life, which for her means a life as free of doctors and hospitals as possible. For the record, an ageist society grossly underestimates the quality of life of the very old. The bull looks different. Also for the record, much of the care doctors offer patients with terminal conditions is futile, and most doctors would themselves decline it. The medicalization of aging does make what Ehrenreich calls “the truly sinister possibility” more likely:  “for many of us, all the little measures we take to remain fit—all the deprivations and exertions—will only lead to a longer chance to live with crippling and humiliating disabilities.” But it’s stigma—ageism and ableism again—that make disability humiliating. And there’s a big difference between taking reasonably good care of yourself and giving yourself over to a life defined by doctoring.

Each of us will have to decide when to abstain or indulge, whether to be scanned or scoped, and how to cope with the consequences. I had every inch of me examined last summer, when I turned 65 and went on Medicare. That was before I’d read Natural Causes. When the next decision point arises, will I have the courage and clarity to forego tests or treatment? Will I break with my privileged demographic, buck my doctor’s advice, brave my family’s disapproval? Will I be not “old enough” but wise enough? I don’t know yet.

Not all of us will make the same choices, and none of us know what we will want at the end. But postponing those reckonings—not dealing with aging and its inevitable end—robs us of calm and content all the way along. I’m glad that growing hospice and palliative care movements are making it easier for more of us to forsake the futile pursuit of immortality, and hope the trend signals a growing cultural willingness to come to terms with the transitions ahead. What better way to maintain the upward trajectory of the U-curve of happiness—along with progress towards a world where ageism is as unacceptable as every other form of prejudice.