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5 Fixes for Aging in America

Shifts in attitudes and policies can pave the way to thriving in later life.

Interviews by Melissa Hartman


When I say that I do geriatrics, often people’s first response is, “Oh, that’s so sad. That must be so difficult.” 

There’s nothing sad about my practice. I have a pretty elderly patient population in my clinic—they are all over 75—and they are out living happy, healthy lives. Yes, they accumulate chronic diseases, and we manage those. But my patients don’t experience aging in the negative ways promoted by our culture. 

In the grocery store’s beauty aisle, there’s anti-aging lip cream and anti-aging moisturizer and anti-aging everything. But I am pro-aging. Because some things are better as you get older. Creativity continues to grow. Older people have more measured reactions to some stressors. They’re better problem solvers. They tend to have a more clarified sense of values and stick to them. So, actually, happiness goes up as they get older. 

These are messages we don’t hear often. We need to confront the negative stereotypes about aging with the reality.


A lot of our public policies and spending around health insurance and health care go toward cures and treatments. 

What we don’t have is an infrastructure of care for people as they age. 

Our society does not value care the way we value curing, preventing, and managing chronic diseases. We have no comprehensive public financing of long-term care. Medicare will pay for home health care, but only in the context of getting better. Unless she's on Medicaid, there’s no way to pay for a caregiver to come to the home and help get your mother out of bed in the morning. It’s a terrible gap. 

We need to raise awareness about the costs to families who must provide caregiving. These costs along with unmet caregiving needs must not be forgotten when considering our priorities for supporting an aging population. What will tip the balance from policies that prioritize technological solutions to those that prioritize dignity through sufficient public financing of long-term care services?


No matter what you do, everybody’s hearing slowly and progressively declines a little bit year by year over your entire life.

Hearing loss is the single largest risk factor for dementia. Treating it can promote cognitive and brain health. The challenge is to drive awareness so people can act on their hearing loss. 

This fall, we will launch a national campaign called Know Your Hearing Number to encourage people to use an app that measures how well they hear. 

If people begin tracking their “hearing number” like they track their weight or blood pressure, it can change how people engage. The problem with hearing loss now is that getting hearing aids is a life event. But if you treat hearing just as a metric that changes over your lifetime, you can start trying different technologies like over-the-counter hearing aids to help you hear and communicate better. 

That changes how you think about hearing, and optimizing it becomes a normal, ordinary thing.


Resilience has to do with accommodating stress. We know that exercise, sleep, and good nutrition do a lot to help us to handle stress. Prioritizing these things goes a long way to make people more resilient at any stage of life. 

We can do a better job of motivating people to value these behaviors. Perhaps we can change structures, like making it easy in the workplace to get 30 minutes of daily physical activity. 

For older people who can’t just start jogging around the neighborhood, we need fundamental knowledge of how to safely manage health in the face of loss of resilience. We need to design care in a way that respects the person’s wishes and optimizes what we can according to where they are now. Teams at Hopkins are working hard on these vital research priorities.

There may be compensations that still allow for a very fulfilling life, even if one loses some function. Even if one isn’t going to be running marathons, there’s a lot more we can do to enhance the fulfillment of their aging.


As people age, many will develop health conditions or face financial barriers that make driving difficult or impossible. In fact, there are over 7 million nondriving older adults in the U.S. Making public transportation accessible is critical to helping older adults maintain independence and quality of life. 

Research shows that using public transportation is associated with greater levels of physical activity and social participation for older adults. It also connects you to almost every other social determinant of health: You need transportation to get to your health care facility, to shop for groceries, to be able to volunteer, to see your friends and family. 

We need improved accessibility standards that go beyond the Americans with Disabilities Act. And they need to be informed by the lived experiences of older adults and people with disabilities. To do that, we need better data to identify and address accessibility gaps, as well as increased funding for accessible transit infrastructure. This is how we can create a system that works for everyone.