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Southeast Advocacy Center for Elder Rights

www.sacfer.org

Sage Communities

21st Century Sage Communities

Developed by SACFER -

The Southeast Advocacy Center for Elder Rights

825 Runyan Drive, Chattanooga, TN

423-875-6723


INTRODUCTION

Recent political rhetoric about "pulling the plug on Granny" brings to the forefront a major issue that is not yet being addressed in the battles over changes to America's health care system.  The idea that health care services should be denied to "Granny" because she is old or that "Granny" is using up too many medical resources in the last six months of life misses the most important element of this debate:  Why should age make a difference? Underlying these positions is an implied assumption that older people have less value, so they should just sign up for hospice and get out of the way so that health care resources can be used by younger people who have more value.  Progressive, twenty-first century promoters of Sageism are recognizing and actively addressing issues of Ageism in our society.  This will result in a change in the type of health care services being offered and utilized by elders.  It will reduce elder frailty levels, significantly improve their independence, maximize their potential, and dramatically reduce health care costs in the process.  Tackling the attitudes and beliefs associated with Ageism will also change how society values and utilizes the Third Phase of Life, creating vital opportunities for our progress as a nation.

BACKGROUND

Ageism refers to negative attitudes and behavior toward those of advanced age simply because they are old.  The most widely accepted definition of Ageism is "prejudice and discrimination against older people based on the belief that aging makes people less attractive, intelligent, sexual, and productive" (Achley and Macaronis). In this country, once a person is categorized as "elderly," the non-elderly are likely to apply a host of negative stereotypes
to the aged, assume attitude and value differences, and expect that the elderly have very different economic and social interests than they do. (Greenberg) Strong evidence of Ageism can be found in all segments of society from the party shops that equate advanced age with mental and physical disability, and then make fun of it, to the absence of older characters depicted as smart, wise, and highly competent on television and in the movies.

The presence of Ageism in the health care system, however, has a particularly potent effect.  It reduces elders' potential and significantly drives up the costs of care.  Researchers have found that Ageism in the wider society is also present in both health policy and clinical medicine. (Bowling)  Others believe that health care professionals may be even more susceptible than the general public "to the ageist assumptions that aging and disease go hand-in-hand." (Green, et. al.)  This prevents early recognition and treatment of debilitating disorders because they are ignored as "simply due to old age." (Patupathi)  It also prevents careful examination of why elders are utilizing the health care resources they consume.  This masks the need to ask the question, "Is there a better approach to care that would prevent debilitating problems, compress the period of frailty and the end of life, and reduce the costs of care in the process?"

Ageism is also reflected in society's pervasive expectation that one should retire at age 65, because the future of the organization lies with the young.  Researchers suggest that the idea of "golden years" of retirement, recreation, and leisure mask the more sinister attitude that the needs of the young are more important and that older people are too rigid, slow, or sick to make and important contribution. (McCann) As a society, we have recognized the goals of the First Phase of Life as a time for education and to find a life partner.  In the Second Phase of Life, we typically have the expectation to raise a family and develop a career.  Ageist attitudes, however, have contributed to seeing little meaning and purpose for the Third Phase of Life.  Philosophers and sacred texts have identified Wisdom as the potential fruit of advanced age.  Noted psychologist, Abraham Maslow recognized life, itself, as a process of developmental steps, culminating in the potential for "self-actualization." (Maslow)

Religious teachings tell us that in life we are to increasingly become shaped and molded in the image of God. (Zondervan) Cultural anthropologists believe that the large number of people of advanced age about to be present in the world have the potential to use their collective wisdom to significantly advance the species. (Evans)  Failure as a society to understand the purpose of the Third Phase of Life, with the failure to have resources available to help support and maximize this stage of development, denies the potential of both the individual and the society.

Researchers have clearly documented that Ageism has a negative impact on how health care is delivered, how resources are utilized, and how elders are able to realize their potential.   Throughout the nation there are service providers and demonstration projects showing the positive results that can be achieved when Ageist approaches are overcome. (Greenberg)  Older adults can achieve the objectives of Gerontology:  independence, control of their lives, and a quality life of meaning and purpose.  Because Ageism is so prevalent in every part of society, reaping the potential results that can occur when Ageist attitudes and practices are eliminated requires an integrated and coordinated effort of all the stakeholders working together to achieve the important results that are possible.   

With 78 million Baby Boomers moving into their Third Phase of Life, the opportunity and the need are greater than ever before.  Having played a major role in improving civil rights for minorities and well as rights and opportunities for women, they are uniquely equipped to champion a change in how we view and live out the Third Phase of Life, overcoming the effects of Ageism in the process.  Those over the age of 65, known as the Greatest Generation, have very different characteristics, as a group, from the Baby Boomers who are about to follow them into advanced age.  The Greatest Generation is led by the "GIs" those who were the active participants in World War II.  The tail end of the Greatest Generation, those who were still children during the war, have been labeled as "Silents" by generational marketers because they essentially followed the lead of those ahead of them. (Yankelvich) 

The Greatest Generation deeply believed, and continue to believe in conforming to whatever is expected of them.  They trust those in authority, simply doing as they are directed.  They have always wanted to fit in, "keep up with the Jones," and "not-rock-the-boat," (Yankelvich). Consequently, when given the Ageist message by those in their company that they are too old to make a meaningful contribution, they are likely to believe it.  When told by well-meaning but prejudiced representatives of their church that they need to rest and leave the leadership to those younger, they believe it.  When told by biased, Ageist health care providers that their problems are due to old age, they are destined to just get worse, and they need to sign into a nursing home or hospice care, they are likely to believe the authority and sadly comply.

This internalization of a self-image of themselves as having nothing of value to contribute and a body destined to fall apart, leads to depression, disengagement, and a higher level of illness, frailty, and disability than would occur if they stayed fully involved with life.  The Baby Boomers, as a group, have very different generational characteristics. (Yankelvich)  They are more highly educated than any group in history reaching advanced age.  They are more likely to dig for new information, thriving on "coloring outside the lines" and pushing non-conformity.    Early disillusionment as a result of the Vietnam War, the assassinations of John and Robert Kennedy and Dr. Martin Luther King, Jr., and the inequality of women and minorities lead to a pervasive questioning and suspicion of those in authority.  The Baby Boomers came of age during the Civil Rights Movement and The Women's Movement.  They were leaders in finding ways to change themselves and the world for the better.

When their company suggests they need to retire and make way for those younger, Boomers are more likely to file an age discrimination suit or reinvent themselves and start a new business.  Rather than be persuaded to leave church leadership to those younger, Boomers are more likely to decide to go to Seminary and start their own church.  And, if told by a health care provider that their problems are due to old age and will simply get worse, many will change physicians, consult the Internet, go to the health food store, study mind-body medicine, and learn meditation.

Baby Boomers, joining with the "Silents," the younger trailing end of the Greatest Generation, are assuming the role of change agents.  They are working to overcome Ageism and adopt a 21st century understanding of the truth, purpose, and potential of advanced age.  They are providing the leadership to change the understanding and practices of those "in authority."  As the children of the GIs, the oldest of the Greatest Generation, they serve as their advocates, helping protect them from the effects of bias and prejudice, changing the system in the process.  They are presiding over Culture Change, replacing "Ageism" with "Sageism."

CULTURE CHANGE MEANS:
The old image of retirement, spending one's final years in a life of leisure - playing golf, traveling, and taking it easy is rapidly becoming an idea that is "over-the-hill."  Equally outdated is the misconception that when people become old, they are destined to become frail, incompetent, crotchety, and in need of a nursing home.  These "Ageist" images are rooted in erroneous perceptions that those of advanced age have little of value to contribute, therefore, they should simply get out of the way of those who do, finding a way to entertain themselves, and them removing themselves to institutional care. "Ageism" is being replaced by "Sageism" where elders fully develop, greatly contribute, and actively live out the Third Phase of Life.  Knowledgeable resources are readily available to help them prevent or bounce back from infirmities, enabling them to fully live out their years without prolonged disability.  Instead of outdated beliefs that elders have little to contribute, there is recognition that the skills, wisdom, and life experience of those in the Third Phase of Life are a vital natural resource.  When opportunities for "Saging" are developed, these resources can dramatically enhance the potential of individuals, organizations, and communities, leaving a lasting legacy.

Additionally, the high costs of elder care are significantly reduced when elders recognize the importance of continuing to grow and develop and have the resources, support, and expectation to continue to remain independent and contributing.  When health care services have the expectation that elders can regain functioning and maintain independence, different decisions are made.  This results in elders living out their lives with less infirmity, a higher quality of life, and with a lower cost of care.  Communities have the potential to tap into the valuable resource of its elder citizens, or to be highly progressive and recruit to their community those in their Third Phase of Living.  To be successful, however, they need to assure that their community is rooted in 21st Century Sage approaches.  Serving "Senior Citizens" has become a big business focus.  Everything from retirement communities to hospitals, to in-home assistance, to pharmaceutical services, to senior centers target the "needs of seniors."  Most of the time, these approaches are based on old, outdated, "Ageist" models of who elders are and what elders really need.

*      Twenty-first Century Sage Communities provide an emphasis on elders:

*      Growing and learning every day of their life;

*      Using one's life experiences, skills, and knowledge to make a positive difference in the lives of others through both paid and volunteer services;

*      Avoiding and compressing any disability or diminished capacity, having compensatory tools to fully live life, even in the presence of limitations.