A Society with Many More Seniors with Walkers than Youngsters in Strollers, Part II

GUESTS: Dr. John Rowe and Dr. Linda P. Fried

I’m Richard Heffner, your host on The Open Mind.

And this is another in a series of programs that relate to our quickly and dramatically aging society.

Key to our conversation once again is the MacArthur Foundation’s “Research Network on an Aging Society”, which asks us to imagine a society with many more seniors with walkers than youngsters in strollers, when those over age sixty will clearly outnumber those under fifteen … and which asks us to consider realistically what Americans will have to do to accommodate these new demographic facts of life.

Here again today is the Chair of MacArthur’s Aging Society “Network”, Doctor John Rowe of Columbia University’s Mailman School of Public Health. Earlier, Dr. Rowe led Harvard’s program in academic geriatrics, was President and CEO of Mount Sinai Hospital and Medical School in New York, then served as President and CEO of Aetna, the health care organization.

With him is another member of MacArthur’s Aging Society “Network”, Doctor Linda P. Fried, Dean of the Mailman School of Public Health and Professor of Epidemiology.

Dr. Fried is the co-founder of Experience Corps, which “helps improve academic outcomes for elementary school children while simultaneously promoting the health of older adults”.

And Dr. Fried I would begin today by asking whether you think one of the ways of approaching this question of “what are we going to do” about us old people … and I’m referring to myself …

FRIED: MmmHmm.

HEFFNER: … is finding more and more ways of making the olders … people … the elders I should say, and the younger people in our society … benefit from each others presence.

FRIED: You know, I think that’s the right question. I think it’s the question that we have to figure out together. But we already have huge numbers of models of that. We benefit tremendously from each other’s presence in terms of obvious things like grandparenting … children with grandparents to invest in them have a layer of psychological benefit that, that really helps with their growth and development. And we all recognize that on a daily basis.

We also do better together by having multi-generations outside of the home, too. One, one example that … which you already alluded to is the Experience Corps program which we designed as a way to see those benefits very visibly for who we are as a society.

And the reason for the benefits are that older adults volunteer tremendously. There’s a great desire to give back as people get older and to make sure that future generations do well.

And a program like Experience Corps which is designed to really harness that great desire to make a difference, the time that people have, their life experience and smarts, into a way to really help all of our children is one clear demonstration of mutual benefit. Investing in one generation to ensure the success of another.

HEFFNER: Well, Dr. Rowe and I spoke earlier at another program about the, the myths …

FRIED: MmmHmm.

HEFFNER: … that characterize the problems of old and young. And one of them, of course, had to do with this myth number five, “policymakers must choose between investments in youth or the elderly”. Does this program fit into your undermining that myth?

ROWE: Very much so. It’s very interesting that advocates for one group often attempt to get more resources for their chosen group by trying to degrade the value of other groups. It’s a bit like negative advertising in a political campaign rather than just saying the good things about your candidate, you say bad things about other candidates.

And some advocates for youth programs and we’re all for youth programs, obviously, have taken a position that, that children are the only age group that’s worth …. quote “investing” in.

And that policymakers must choose between the young and the elderly.

And we see it very differently. We see the solution to be inter-generational programs. Activities that benefit individuals who are young as well as elderly in the same kind of program.

Linda’s Experience Corps in which older individuals volunteered 15 hours a week for young children in inner city schools found benefits for the children and also benefits for the elders.

Another prime example we touched on was in South Africa … my favorite example in the world … where when pensions were given to grandmothers, the granddaughters in those households were taller, and heavier and I think did better in school.
HEFFNER: But how do you, how do you institutionalize this insight?

I’m fascinated by what you say, Dr. Rowe, and I’m, I’m so grateful to you and the Corps …

FRIED: MmmHmm.

HEFFNER: … that you described in which everyone benefits. But how widespread is this? How widespread can it be? Do you think we’re likely, as a people, to institutionalize this level of cooperation? Not picking the young or picking the elderly …

FRIED: MmmHmm. MmmHmm.

HEFFNER: But making them work together.

FRIED: Well, there are several different answers to that. One is we have to see the possibilities and not make the assumptions that we have to select one group compared to another. Or that we have to pit groups against each other.

I started thinking about this many years ago, actually asking myself the same question you just asked me … if there was a way to bring out the potential here because it’s not good for a society in, in the long run to have to choose between its people.

And if you can bring out the mutual benefits that are already there and make them even stronger, then we become stronger as a society.

And so I asked myself that question a long time ago and I designed Experience Corps with Mark Friedman to really try and provide one model.

Since that time … Experience Corps is now in 22 cities in the United States providing an example of at least a starting point for a frame change.

But I think we have to, as a, as a country, really, recognize that this is not all a deficit equation. There are tremendous benefits of having more older adults around for everybody.

HEFFNER: Well, what does the Experience Corps do? How does it work …

FRIED: MmmHmm.

HEFFNER: … that enables you now, I gather, to give a much more optimistic answer to the question that I asked you …

FRIED: Right.

HEFFNER: … and that you asked yourself.

FRIED: Right. So Experience … we designed Experience Corps on several key principles. One was using evidence as to what children needed to support their success. Young children …

HEFFNER: In school?

FRIED: … in public elementary schools. Public elementary schools in this country are really inadequately supported in terms of human capital.

Children are … particularly at risk children, but most children need more adults in their lives supporting their success and, and there’s a lot of evidence that children act out in school in negative ways if they are frustrated or not able to keep up.

And so if you could design a program that would give children the people around them … the support of adults and in this case, older adults, to ensure that they don’t fall behind, that they’re in there succeeding, that they’re getting the skills that they need that … and teachers need lots of help in that.

That’s one approach and we very carefully, working with early childhood educators, designed roles appropriate to older adults who have not historically been educators, so that they could bring value added to the children’s success and support the success of the teachers.

And at the same time we very intentionally … I very intentionally built on public health evidence as to what helps people stay healthy, active, engaged, independent as they get older.

HEFFNER: Thinking now about the other end of the population scale.

FRIED: Right. Right. And what would be meaningful to people. What … where … how do you construct something and let them know that they’re making a huge difference.

Because people, older people, like most people, come if, if they can contribute significantly. And they stay if they are.

And if you can hide inside that ways to help them be healthier then perhaps they’ll stay for one thing and benefit for another reason.

ROWE: I think it’s worth stepping back and thinking about what the problem is we’re trying to solve here.

And we live in an age segregated society. Many of your friends are your age, my friends are my age, your know. Thirty year olds hang out with thirty year olds, they live with thirty year olds, etc., etc.

We build housing that is designed for people of certain ages. Many people feel that as the cost of old age entitlements, Social Security, Medicare and the like continue to escalate … it will pit one generation against another.

We haven’t seen that yet. But it may happen. The likelihood that it will happen is in my mind related to whether or not we continue with this age segregated society.

The second point is that when we look at an aging society most people think that this is all doom and gloom. It’s the demographic time bomb.

What we’re trying to say and as Linda is very articulate in saying with her program is there’s also a positive side. There’s an upside … there are opportunities as well as challenges.

How … the question you’re asking is how do we unlock those opportunities in an age integrated society. And, and I think we have to keep that goal in mind every time we design a city or a transportation system (laugh) or an educational system, or the work place, or the work site, or retirement rules, etc. We need to think about the goal of an age-integrated society that will unlock the advantages.

HEFFNER: Well, in thinking this way … and I wondered as Linda Fried discussed this … you know, I’m the practical one and the … not the nay-sayers …

ROWE: And we’re, we’re the academics.

FRIED: (Laughter) Right.

HEFFNER: Well, I didn’t’ quite mean it that way …

ROWE: (Laughter) I interrupted you.

HEFFNER: And, and I was, I was changing it from the practical one to … you just took a drink from that cup … I know from our first encounter that you generally think in terms of the cup being half full and I generally think in terms of it being half empty.

And I look at this and ask whether, in reality … does the school system in general accept and make room for the elderly in this way? What have you found?

FRIED: So, I would say that we are not proposed … excuse me … we are not prepared mentally to see older adults in the schools as a net plus.

Our frame of mind is to think about aging in a very negative and deficit focused way. And so just as we intentionally have to decide who we want to be as a society, in an aging society we have to look at the evidence as to whether those presumptions are true.

And they’re not true. But I can tell you from the moment that I designed Experience Corps that the up-front process of working with schools initially, and principals, to see if they would accept a cadre of older adults as trained volunteers suggests is not easy.

But, and, and I’ll tell you one story. So in Baltimore where I first fielded Experience Corps, one of the principals who I subsequently became great friends with agreed that we could try out the program with her and bring in 10 older adults.

And we trained them, we recruited them, we trained them … they were actually members of her community … they were there because they profoundly wanted to make a difference for the success of the kids.

But when I brought them in and she saw that one of them was in a wheelchair … ahmm … she looked at me and she said, “I’m questioning my sanity”.

Fast forward three months … I, I talked to her and she said, “You know, this morning I saw four little children carefully pushing this gentleman’s wheelchair down the hallway. And asking who could push him on the elevator, who could stand next to him, whether any of them could sit on his lap”.

She said, “This has been fabulous”. And after that she said, “Can I have 60 more volunteers.”

So our presupposition that having older adults in the schools is going to be essentially a baby-sitting service by the schools … once people experience what older adults in their school can do, it’s transformational and their attitudes change.

But if, if they were asked up front to make a decision based on their image of what an older person is, they wouldn’t say yes.

ROWE: So while that man couldn’t walk he obviously could interact with the kids very effectively.

FRIED: It, it was fabulous.

ROWE: We have to understand that, that aging is changing. Old people are different than they used to be. Much of what we have to say about the potential opportunities of an age-integrated society is based on the supposition that old people will live longer and healthier and continue to be functional later in life.

And all the trends we see, all the surveys we see are going in that direction.

HEFFNER: Also, in terms of our own educational experience over the past decades, we’re obviously talking about a more mature more mature group.

We’re talking about a better educated group …

ROWE: Quite so … yeah.

HEFFNER: Any of the big cities that you have aimed at going along with you?

FRIED: 22 out of 22 are. In Baltimore City Experience Corps has been adopted by the Baltimore City School System.

Also true in Philadelphia as a key component of, of how to educate their students. And they … both cities are rolling the program out across the whole city in their elementary schools. You know …

ROWE: And, and a county … our group … our MacArthur funded group has been approached by a county in California where the government of their county has said, you know, the California State budget is in trouble …

HEFFNER: MmmHmm.

ROWE: … many of the aides that used to work (laugh) in the schools are gone, their jobs have been eliminated … can you help us design strategies that will enhance volunteering in the school system in our country?

FRIED: And, and what Jack is, is suggesting, which I think is very important, is that for us to be intentional about how to really experience more fully the benefits of being an aging society, we have to think beyond any one model in terms of the needs and implications.

So, how do we keep people healthy as they live longer lives. That’s a key issue both in terms of their ability to contribute, but it’s a key issue in terms of our experience of what aging means as a society, if people are healthy and contributing and participating.

Programs like this could be very intentionally designed as Experience Corps is …

HEFFNER: And again …

FRIED: … to help people stay healthy.

HEFFNER: … and again your experience is, with the Experience Corps, that …

FRIED: So …

HEFFNER: … through participants, the elderly have shown …

FRIED: So people who participate in Experience Corps feel better. But they also are stronger. They are much more physically active. We designed the roles to exercise their minds as well, and we’re seeing very exciting data which we’re not totally surprised about that their brains are actually functioning better.

Their memory’s better, particularly if they started out a little bit at risk of memory impairment, their memory’s better and their … what’s called “Executive Function” … their problem solving abilities are much improved.

And we just completed a study led by Michelle Carlson looking at functional MRIs of the brain which shows brain activity and shows that Experience Corps volunteers with about a high school education, over just one year of participating, actually have much more active brains in the very key problem solving areas of the brain than they did. And the people who didn’t participate, ahmm, showed no change.

So there is, if we’re intentional about how we design roles, we can also bring tremendous benefit to the older participants as well.

ROWE: You know there’s a value added that goes beyond the assumption “Well, they’ve got to do something, keep themselves busy, isn’t it nice that they’re going and volunteering in the church or the school or whatever”.

And one of the central points of resistance that we found is that in our society unless something is monetized, unless it has a financial value, it doesn’t count.

People assume that these kinds of volunteering activities are just sort of ways to keep busy … get off the couch. It, it … one example, one way to look at it … if there are two women in apartments next to each other here in New York taking care of their frail older husbands, that’s not in the economy, nobody sees that, nobody sees the value of that … financial impact of that.

If they switch jobs and took care of each other’s husbands … now they’re in the economy, they pay each other the same amount, they’re in the GDP and if one of them quits she’s probably eligible for unemployment insurance. Now we’re counting it.

HEFFNER: Okay, let me ask you, have you counted, have you monetarized the Experience Corps experience?

FRIED: So, we are starting to. We’re actually, with support from the MacArthur Foundation conducting a study to do that.

But the very initial analyses are very positive that the improvements in health of the older adults combined with the … if we project out … the likelihood that children who are succeeding through third grade are going to stay in school, graduate from high school, continue into higher education … that is a net plus financially, economically in terms of societal investment …

ROWE: It has an ROI …
HEFFNER: ROI?

ROWE: Return on Investment.

HEFFNER: The American theme.

ROWE: The American theme.

HEFFNER: Okay, but let’s, let’s move away slightly from the American theme. Tell me again about the children themselves.

FRIED: MmmHmm.

HEFFNER: Their academic … what’s been added … what’s the value that’s been added to them in the schools?

FRIED: So I can tell you the early data … in a year or two we’ll have a lot more. But there’s very clear benefit in terms of their reading success, performance and their love of reading.

There’s very clear benefit in terms of behaviors, behaviors that are key to long term success in school. So readiness to learn which seems to be greatly improved by the kind of relationship building with, with the older adults in the school. With training the older adults to help children enjoy things like reading.

But in addition, ahmm, a study that we did in the Baltimore City schools where we put a critical mass of older adults in every school from kindergarten through third grade, enough to ensure that every child was touched by support from an older adult.

We see dramatic improvement in behavior. Dramatic improvements by these children. So that they seem, according to the principals and teachers, they stop acting out for attention in a negative way because they’re getting so much positive support and attention in a positive way.

And because of that children in kindergarten through third grade who get referred to the principal’s office at high rates … the rates drop by 30% to 50% in an Experience Corps school.

HEFFNER: I was going to ask you about the matter of behavior because you had said something before we began the program about older societies.

FRIED: MmmHmm.

HEFFNER: Violence is down, behavior is better generally.

FRIED: MmmHmm.

HEFFNER: So that there is something that we old …

FRIED: MmmHmm.

HEFFNER: … older people accomplish.

FRIED: So there … I think you’re setting me up very nicely. But there are many things that older people accomplish. We … when we have the image of a population with strollers compared to a population with walkers and we focus on the walkers it causes us, I think, to forget all the benefits.

Certainly communities with a higher proportion of older people in them actually seem to have lower violence rates. They have more stability because older people are more likely to be home owners.

Older adults in communities are the volunteer corps of communities in general. Bringing food to neighbors and looking in on whether people are doing okay and watching that the community is okay. So there’s this silent fabric which is layered upon what Jack was saying about the net benefit financially of just the care giving and volunteering roles.

So US data would say … says … that older adults just in care giving for family members and neighbors and in volunteering contribute $162 billion dollars a year in this country in net worth of roles. Which I might add is much higher than the cost of long term care itself.

ROWE: So these benefits, of course, are dependent upon getting older people to interact with younger people and that would be greatly facilitated by having age-integrated communities.

So people say, “Well, what do you mean by that? How would you do that? How is that different than what we do now?”

I’m no architect or urban designer, but I, I think I’d put the retirement communities near the schools. (Laugh)

You know, I wouldn’t put them off in some gated community somewhere.

I think I’d design the transportation systems and the city centers in such a way that they’re accessible for older people as well as younger people.

HEFFNER: Well, that’s the problem you’re going to have to solve … that the network is going to have to present to the powers that be …

ROWE: That’s right.

HEFFNER: … to resolve. And I’m afraid I have to say that our time is up …

FRIED: Oh …

HEFFNER: … now, but I want to thank you, Dr. Fried …

FRIED: My pleasure.

HEFFNER: … and Dr. Rowe for joining me again on this discussion that needs to go on and on and on.

ROWE: Thanks.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. Meanwhile, as an old friend used to say, “Good night and good luck.”

And do visit the Open Mind website at www.theopenmind.tv

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.