“It Takes a Village, Part II,” by Dr. Michael Birt, published in Slate Magazine

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Originally published in Slate Magazine, September 26, 2013.

It Takes a Village, Part II

How to support the coming boom in the elderly population.


Endurance swimmer Diana Nyad emphasized that many people made her successful swim possible.
Photo by Yamil Lage/AFP/Getty Images

This article arises from Future Tense, a partnership of Slate, the New America Foundation, and Arizona State University. On Oct. 4, Future Tense will host an event in Washington, D.C., on how increases in human lifespan could transform public policy, society, and the economy. For more information and to RSVP, visit New America’s website.

Judging by the extensive recent news coverage, Diana Nyad’s successful attempt to swim from Cuba to Florida struck a chord for many people around the world.

There are lots of good reasons for the attention. At 64 years old, she offered an appealing validation to active baby boomers everywhere. She survived water brimming with sharks and jellyfish, not to mention squalls and an unpredictable Gulf Stream. And she persevered—this was her fifth attempt. The first was in 1978, when she was 28, and the most recent at age 62. All of that spells admirable to me.

But what struck me most powerfully were the words she spoke upon leaving the water, her face scorched and puffy from exposure to the ocean water. She said, “I have three messages. One is we should never, ever give up. Two is you never are too old to chase your dreams. Three is it looks like a solitary sport, but it takes a team.”

Yes, it takes a team. For Diana Nyad it took a team of 35 members, including shark scouts and a pulmonologist who joined this year after she suffered a severe asthma attack on a previous attempt.

But for the rest of us, it also takes a team to stay alive and healthy, especially as we get older. Why? Whether we live in the United States, Europe, Asia, or virtually anywhere else, the need to form our own personal, informal support teams will grow dramatically if we want to age successfully.

A recent Standard & Poor’s study warns that “no other force is likely to shape the future of national economic health, public finances, and policymaking as the irreversible rate at which the world’s population is aging. … The cost of caring for [the elderly] …will profoundly affect growth prospects and dominate public finance policy debates worldwide.”

GBD vs Solving for X

For the first time in human history, the number of people over the age of 65, as a percentage of the global population, will surpass the number of children under the age of 5. At the same time, this demographic “X” is being matched by an unprecedented shift in the global burden of disease, with a sharp decrease in infectious diseases and a startling rise in the level and duration of chronic afflictions such as diabetes, cancer, heart disease, and Alzheimer’s.

While individual longevity is cause for great celebration, governments around the world are now looking to contain or curtail potentially astronomical expenditures on aging-related social and health care. In place of longevity, “healthy life expectancy” will be the new metric of success for health systems desperate to delay the human and financial cost of disability in their populations.

It’s relatively painless to talk about “rapid population aging” and “plummeting fertility rates” as disembodied global trends. But the individual experience of those trends is what will force many of us to build our own teams, or face a dire lack of public support in the future. Nowhere will we feel the pinch more than in the shortage of future caregivers.

The United States is better off than many countries, but we have our own demographic challenges. Not only will we face a shrinking financial capacity for national and local government to provide services for aging populations, but we’ll also experience a dramatic shortfall in the number of family members who can supply caregiving services. AARP’s recent Care Gap Report points to a sharp decline in the “caregiver support ratio” for boomers once they hit their 80s.

Few of us can afford our very own team of shark scouts, but there is a lot we can do on our own.

Most of us look to our families first to form our personal health teams. My wife’s family has banded together to help with the complex and demanding tasks of caring for a loved one suffering from advanced dementia. My older brother has formed a highly functioning team of medical professionals and community support to help him deal with the challenges of a wife requiring end-of-life care. Unfortunately, his health has also suffered, a very common experience for caregivers.

But many of us face these issues without a spouse, partner, or children to take care of us. I’ve seen this recently with a close friend and colleague who chose a radical mastectomy after a breast cancer diagnosis. A truly global networker, she mobilized that network to help her get through the surgery and navigate what we know will be a challenging regimen of chemo, radiation, and post-op recovery.

Another great example of Solving for X that has grown to a national level is the “Village” movement, a concept which originated as a grassroots effort in Boston’s Beacon Hill in 2001, when a group of neighbors came together to develop services that would enable older adults to remain in their homes and community. The resulting “village” notion has since been replicated around the country, with more than 100 active or developing communities.

With the geographic dispersal of families and with older adults wishing to keep from burdening their loved ones, growing older at home has become more of a challenge. “People end up moving because they can’t change the light bulbs or [they] get isolated when they get home from the hospital and can’t coordinate everything,” according to Judy Willett, director of Beacon Hill Village. “Villages” present a solution by connecting members with the services and resources they need to live a comfortable, safe, and healthy life at home.

A team can help us even in the most unlikely place. In May 1975, a team of Chinese climbers carried an 18-foot aluminum ladder up to the Second Step, a promontory very close to Mount Everest’s summit of 29,029 feet. Once impassable, the Tibetan approach to the summit was opened using a simple, effective, and affordable ladder. Thanks to that team, more than 1,500 climbers have experienced the ultimate joy of any mountaineer—to climb the tallest mountain and stand at the top of the world.

Like climbing the world’s tallest mountain, we think of longevity as an intensely individual journey of one. But drawing on Diana Nyad’s wonderful words and the examples above, perhaps we should rethink longevity as a team sport. The good news is that it is never too late to start building your own personal health team, whether you want to swim with the sharks, climb the world’s tallest mountain, or walk around the block tonight. Longevity and health can go together, but it’s time to pick your team now.

Michael Birt is director of the Center for Sustainable Health at ASU’s Biodesign Institute. He began working on aging issues in Japan in 1990.

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