Book The End of Old Age

Living a Longer, More Purposeful Life

Marc E. Agronin MD
Da Capo Press, 2018
Recommendation
Marc Agronin, a leading geriatric psychiatrist, provides a new way to think about the aging
process. Describing the brain science of aging, Agronin explains how certain turning points
encourage the elderly to shrink from life. He presents a pathway to resilience and explains
why many older people choose to stagnate. Agronin shares a wealth of personal experiences
and offers an action plan to help readers rethink old age. In a culture that idealizes
youth, Agronin offers insights into what society loses by rejecting the possibilities that people
continue to develop in old age. He helps you reconsider basic assumptions about aging and
shows older readers how much more is left for them to do and discover.

Take-Aways
• Typical assumptions about aging have an unconscious but significant influence on
how people actually age.
• The stereotype embodiment theory describes how people internalize stereotypes about
aging.
• The brain has many adaptive attributes.
• Aging offers five core strengths that correlate to older people’s roles as “savant, sage,
curator, creator and seer.”
• An “age point” occurs when life changes.
• “Geropause” is the stagnation that often occurs in response to an age point.
• Purpose is pivotal to life satisfaction, which remains true at the end of life.
• Your “age culture” provides references for continuing to thrive by leading a
meaningful life.
• “Re-aging” is a five-step process of coming to value the aging process and its creative
potential: Affirm your wisdom, identify your resilience, create an action plan,
consider your legacy and celebrate your life.

Summary
Typical assumptions about aging have an unconscious but significant
influence on how people actually age.

Science has no known cure for aging, and examples of longevity can defy explanation. Long-
lived elders usually experience a combination of regular physical exercise; close communities
and families; and diets focusing largely on fruits, vegetables and healthy oils. Their vigor and
activity keep them engaged.

“Aging brings wisdom that is essential to the unity and progress of both the spirit and the
community, and one forsakes it at his or her own peril.”
Many people argue against prolonging old age. Some make the moral argument that space is
necessary for the next generation. Others point to the pain and discomfort of old age. Medical
ethicist Ezekiel Emanuel wrote passionately in his article “Why I Hope to Die at 75” about
the personal limitations of old age. He explained that “living too long is also a loss” because
it concludes a vibrant life with a focus on pain. He proposes refusing medical treatment. With
many in the 85-and-older population suffering from neurocognitive disorders, Emanuel’s
repulsion for old age seems logical to many observers.

The stereotype embodiment theory describes how people internalize

stereotypes about aging.

Psychologist Becca Levy’s stereotype embodiment theory describes how people internalize
oversimplified images of aging. Such stereotypes have a pernicious, unconscious but
significant influence on how people age. Psychologist Laura Carstensen’s socioemotional
selectivity theory views aging as a response to seeing death approach. As life becomes more
important, people often choose to participate in emotionally meaningful activities and
relationships.

“All the knowledge, experience, maturity, perspective, balance and wisdom bequeathed by
age…enable you to look back with such keen vision on your life.”

Famed psychologist Erik Erikson presented eight stages of life, of which old age constituted
only one. In his lexicon, tension defined the eighth stage, as people struggled to reflect with
pride on lives well-lived but also experienced anxiety about everything they failed to
accomplish. Eventually, Erikson and his wife, Joan, added a ninth stage that describes a
period of enfeeblement, frailty, doubt and insecurity.

The brain has many adaptive attributes.

If life is measured in terms of physical ability, then age appears as a downward spiral. MRIs
indicate a steady reduction of brain tissue beginning in early middle age and accelerating
after age 60.

“A geropause refers to a downward shift or even a moratorium on pursuing and developing

new interests, skills, relationships, roles or life circumstances.”

Age makes distractions more difficult to manage, and that leads people to choose more
carefully where to put their attention. This narrowing is a natural response to an influx of
information. It enhances “fluid intelligence,” the skills that relate to reasoning, solving
problems and recognizing patterns.

The brain is capable of adapting in many ways. “Brain reserve” describes the “number,
density and connectivity of neurons” that contribute to the intelligence, skills and
experiences people use to support normal functioning even as the brain goes through age-
related losses. The scaffolding theory of aging and cognition (STAC) developed by cognitive
scientists Denise Park and Patricia
Reuter-Lorenz describes how older brains develop additional neural networks to complete
assignments. Young people may do the same tasks using smaller areas of their brains, but that
doesn’t mean they are doing a better job.
Compensation-related utilization of neural circuits (CRUNCH) describes how older brains
send work to other parts of the brain in order to fulfill demanding tasks. Older people use
both sides of their brain to complete tasks, an attribute called hemispheric asymmetry
reduction in older adults (HAROLD).

Aging offers five core strengths that correlate to older people’s roles as
“savant, sage, curator, creator and seer.”

Aging offers five core strengths: “knowledge, judgment, empathy, creativity and insight”
that correlate to five roles older people may fill:

• Savant – People who fulfill this role teach others on the basis of their lifetime of
knowledge.
• Sage – Those in this role use their wisdom to deliberate and offer judgment on
complicated situations. They are unafraid to redesign “long-held emotions, values and
goals.”
• Curator – These elders show empathy and connect with others through caring.
• Creator – Artists and makers in this role may manifest great creativity
and produce their most profound works by mixing significant aspects of their pasts
with the present.
• Seer – People who fulfill this role forecast the possibilities of the future. Insightful
and introspective, they often act as spiritual leaders.

An “age point” occurs when life changes.

When life disrupts the values, standards and beliefs someone has embraced until that
moment, an age-point process begins. Resolving an age point leads to developing new
abilities for those who are willing to forego prior ways of doing things and to adjust to a new
situation.

These transitional age points can occur at any time of life, and they unfold in four stages:

1. “Event” – Things change. An experience transforms how you think or feel.

2. “Suspension” – Akin to a shock, the period of suspension occurs when your mind
can’t understand what has happened or how it could. A negative suspension cultivates
confusion and emotional strain. A positive suspension lets go of old ideas about how
things work to make room for new possibilities.
3. “Reckoning” – People spend this period weighing the cost of change as they face
decisions about how to fit new realities into old relationships and patterns.
They recognize your limitations, weaknesses and faults. Previous strengths no longer
function, and they must adapt to move forward. People may undergo a crisis of faith
as they experience personal and intellectual reconfiguring.
4. “Resolution” – Acceptance allows altered beliefs and new behaviors to help
elders navigate the new phase of life. A positive resolution grants them a more
flexible approach to life.

“Geropause” is the stagnation that often occurs in response to an age point.

“Menopause” and “andropause” refer to periods of hormonal and physical alterations. These
come with psychological shifts as people face the first major signs of aging; often, this affects
their choices and lifestyles. Geropause addresses the stagnation that can occur in response to
an age point. During geropause, people stop pursuing fun activities and learning new things.
They resist new relationships or interests. Physical fear or loss of an important social role can
stymie personal development.

“In neglecting to preserve and enrich an aging life, whether our own or that of others, we
send a message that life only has meaning when we are happy, comfortable and
independent.”

An “active geropause” arises from a deliberate choice to step back – for example, to retire.
Some people may stop participating in an important activity, whether it’s skiing or
volunteering. A “passive geropause” stems from loss of abilities, convictions or
opportunities. For example, withdrawal is common when eyesight diminishes and people can
no longer drive. Losing faith in meaningful religious or political beliefs may set someone
adrift. Reduced income may force people to leave clubs or activities. An “inhibited
geropause” stems from external blocks. An argument with colleagues can lead to refusing to
participate in the local game league. Fears about driving at night can limit social interactions.

People may refuse to recognize their changed circumstances or seek solutions. Geropause
often leads to being bored and inactive, but people can find creative solutions through
personal growth. This requires a choice to no longer yearn for what once was. People who are
aging must make peace with a changed world and participate in it. The pain of physical
rehabilitation or psychological development makes many people avoid the effort to overcome
geropause, but being stuck in it is worse.

Purpose is pivotal to life satisfaction; this remains true at the end of life.

Purpose comes from providing a positive contribution. The ancient Greek philosophers
regarded achieving eudaimonia – when the soul experiences harmony with the practical
requirements of life – as one of the highest human endeavors. The Japanese term ikigai refers
to the general philosophy of having fully developed reasons for living that a person aspires to
embody.

”We cannot forget our past, but often must tap into it for strength and inspiration.”

Societal expectations that older people should recede from life increase the difficulty of
maintaining purpose, which stems from the desire to serve the world and yourself.

Your “age culture” provides references for continuing to thrive by leading a

meaningful life.

Gerontologists Paul and Margret Baltes recommend cultivating activities that are extensions
of your current skills or lifestyles, are nearby or easily available, and are meaningful.

“The accumulating products of our aging self represent a rich tapestry of abilities, interests,
experiences, relationships and commitments that can be described as our age culture.”
Creative aging includes overlapping “human potential phases” to reflect that adult
development doesn’t occur within strict age parameters. What geriatric psychiatrist Gene
Cohen calls a “midlife re-evaluation phase” may begin in the second half of your 30s and last
through your mid-60s. He suggests that you may evaluate your choices and seek
improvements by calling upon “quest energy.” You may next experience what Cohen terms a
“liberation phase” that continues into your mid-70s, when a sudden urgency arises to try
things that were previously unthinkable.

Retirement can make this freedom possible, even as family or friends find this new activity
disturbing and try to limit it. The “summing-up phase” occurs from the late 60s into the 90s,
when you want to contribute to the world. The “encore phase” begins in the 70s and lasts
until the end of life, as you affirm and commemorate your life choices.

Positive models help those who are aging begin to embrace the idea that people can thrive
even as they get older. The artist Matisse exemplified this idea. During World War II,
Matisse suffered from many ailments and became wheelchair-bound. He was unable to stand
and paint. His assistant, Lydia Delectorskaya, gave him brightly colored paper and scissors.
He cut undulating shapes and instructed her where to pin them on colored canvases. These
works celebrated his desire to thrive – even amid the pain of his physical ailments – at the
end of his long, successful life as a prodigious painter.

Pioneering modern dancer Martha Graham faced a similar challenge at the end of her dancing
career. Unable to fathom a life away from her art, she transformed herself into one of
history’s greatest choreographers.

“Re-aging” is a five-step process of coming to value the aging process and its
creative potential: Affirm your wisdom, identify your resilience, create an
action plan, consider your legacy and celebrate your life.

No one can give another person purpose, so having an action plan provides steps an older
person can follow to discover the elements of a meaningful path. For those who think all is
well, an action plan provides guidance for future challenges. For those feeling trapped by a
physical or mental problem, an action plan reveals opportunities, though some may require
accepting help or changing long-held personal attributes. For those who are in the final stage
of life, an action plan provides a vision to help their relatives and friends recognize the
dignity and wisdom of the moment.

An action plan begins by recognizing your age culture. Ask three questions to unpack your
core principles: “Who was I? Who am I? Who will I be?” The answers provide references for
continuing to thrive and to lead a meaningful life. Re-aging calls for valuing the aging
process and recognizing its creative potential.

“Certain kinds of mental skills even improve with age, such as the ability to solve a problem
based on experience and the integration of information, a quality best defined as wisdom.”

The five steps of the re-aging process are:

1. Affirm your current store of wisdom – Reflect on how you played each of the five
roles (savant, sage, curator, creator and seer) across your life. What knowledge and
experience did you share as a savant? How did you, as a sage, help people make
 decisions and recognize important values? What engagements with your communities
reflected your care and concern for others? Where were you most creative? How did
you offer spiritual or philosophical guidance?
2. Identify your resilience – Examine your age points to detect what resources served
you in the past and which behaviors helped you overcome challenges.
3. Reinvent yourself – Create an “age imperative action plan” based on each of the five
roles. Ask how you currently fulfill each role and how you will fill each role in the
future.
4. Reflect on your legacy – Consider how you want your life to affect your family, your
immediate community and the greater world. Examine what contributions you made
and still can make to recognize the meaning you continue to cultivate in your life.
5. Celebrate your life – You probably held celebrations for every other important
passage, so create a ceremony to symbolize this time. Within that ceremony, devise
your own rituals to honor the life you have lived and are living.

About the Author

Geriatric psychiatrist Marc Agronin, MD, is the author of How We Age. He is the senior vice
president for Behavioral Health and the chief medical officer for MIND Institute at Miami
Jewish Health.