Aging Well

What Makes a Good Life in Late Life?

The United States is an aging society, where one in five people will be 65 or older by 2035. While bioethics scholarship on aging has historically concerned itself with issues at the end of life and the medical care of patients with chronic or progressive conditions, it is time for bioethics to look at the experience of aging itself and to articulate “a concept of good citizenship in an aging society that goes beyond health care relationships,” write Nancy Berlinger and Mildred Z. Solomon in the introduction to What Makes a Good Life in Late Life? Citizenship and Justice in Aging Societies, a new special report from the Hastings Center Report in 2018.

Berlinger, a research scholar at The Hastings Center, and Solomon, president of The Hastings Center, are co-editors of the report, with Kate de Medeiros, the O’Toole family professor in the department of sociology and gerontology at Miami University. The report is a product of a two-year grant-funded initiative at The Hastings Center to begin to determine how bioethics can better reflect and meet the needs of our aging society. It features 16 essays by leading scholars and practitioners in architecture and design, bioethics, disability studies, economics, gerontology, health policy, housing studies, medicine, philosophy, political science, and urban planning.

Takeaways from the report include:

Many older people face economic and other forms of insecurity that stem from changing social policies, not a personal failure to plan.

Increasing numbers of older adults grapple with precarious financial, environmental, and social conditions in late life. In “Precarious Aging: Insecurity and Risk in Late Life,” Amanda Grenier and Christopher Phillipson describe how economic insecurity accrues over the course of a person’s life due to factors such as declining access to pensions and inadequate coverage of the full cost of health care. These social factors expose older people to risks they cannot mitigate on their own. Reductions in social welfare programs worsen these problems. Amanda Grenier holds the Gilbrea chair in aging and mental health at McMaster University; Christopher Phillipson is a professor of sociology and social gerontology at the University of Manchester.

Aging societies must respond to the challenges that older adults face in their communities.

Despite policies and programs that aim to help older adults age in a familiar environment, an older person’s housing may not align with his or her changing needs, write Jennifer Molinsky and Ann Forsyth in “Housing, the Built Environment, and the Good Life.” Community planners, developers, policymakers, and others responsible for how communities plan and build should acknowledge what our aging society needs and work toward consensus around design and facilities that serve older as well as younger residents. Molinsky is a senior research associate at the Harvard Joint Center for Housing Studies; Forsyth is a professor in the department of urban planning and design at the Harvard Graduate School of Design.

In “Age-Friendly Initiatives, Social Inequalities, and Spatial Justice,” Emily A. Greenfield recommends that local efforts to make communities more supportive of people as they age also embrace opportunities to reduce socioeconomic disparities that affect older adults and others in that community. Greenfield is an associate professor in the School of Social Work and a faculty affiliate of the Institute for Health, Health Care Policy and Aging Research at Rutgers University.

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Also in this special report:

Kate de Medeiros: “What can Thinking Like a Gerontologist Bring to Bioethics?”

Lauren Taylor: “How Do We Fund Flourishing? Maybe Not through Health Care”

Bonnie Steinbock and Paul T. Menzel: “Advance Directives for Refusing Life Sustaining Treatment in Dementia”

Daniel Callahan: (“Aging: Drawing a Map for the Future” https://onlinelibrary.wiley.com/doi/10.1002/hast.920)

Joel Michael Reynolds: “The Extended Body: On Aging, Disability, and Well-Being”

The full text of the report, What Makes a Good Life in Late Life? Citizenship and Justice in Aging Societies, can be found here.