“When did I get old?”
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Sitting in her favorite reclining chair and looking out the window of her apartment, Marian reflected on over 40 years of living, working, and raising a family in “The City that Never Sleeps.” She migrated to New York City from North Carolina in her mid-twenties, and would spend the next 4 decades enjoying the parks, playgrounds, museums, and performing arts that have long characterized “The City.” She acclimated to the “hustle and bustle,” the diversity of peoples, language, and customs, and she came to appreciate the access provided by the public transportation system —despite the deafening noise of the train that passed by her apartment about every 20 minutes well into the night. The drive and pace of the city demanded that she keep up in order to survive, and until age 65, she was able to hold her own in the community she had come to love.
Three days before her retirement, Marian woke up to her alarm as she had done every morning for the last 25 years to get ready for work. This week marked the countdown to the next phase of her life —the phase of “retiree,” time to be more than a part-time grandmother, and the flexibility to travel and spend quality time with friends. 
Marian sat up, swung her legs toward the floor, and when she went to stand up, she fell to the floor. Not able to pull herself up, she called her daughter who lived “down the hill” and asked her to come up and help her. When her daughter arrived, she called an ambulance. Marian had suffered a stroke. She survived, but never returned to work. She received her retirement certificate and gifts in the mail. After several months of physical and occupational therapy, Marian was able to pack up her apartment and move back to the south.
I first met Marian in 1980, and she was always up for having a good time, planning family reunions, and hosting card games and Sunday dinners at her apartment. During one of my last conversations with her before she passed away in 2005, she asked, as if thinking out loud, “Leandris, when did I get old?”
According to a report issued by the Centers for Disease Control and Prevention (CDC), The State of Aging & Health in America 2013, “The growth in the number and proportion of older adults is unprecedented in the history of the United States. 
Two factors – longer life spans and aging baby boomers – will combine to double the population of Americans aged 65 years or older during the next 25 years to about 72 million. By 2030, older adults will account for roughly 20% of the U.S. population.” (Executive Summary, p.ii) Are we as intentional about preserving our health as we are about planning financially for retirement and older adulthood? Or, will the consequences of chronic conditions such as uncontrolled high blood pressure catch older adults off guard and diminish the quality of their remaining years? What does it mean to age in a healthy way?
Healthy aging is a public health issue. It is also a health disparities issue. The health status of older adults is related to race and ethnicity (for example, minority status is associated with life experiences of multiple forms of discrimination), socioeconomic position, and sexual orientation and gender identity. Gaps in education, income, and wealth, along with the cumulative impact of chronic stress and social exclusion associated with race and language barriers negatively impact the health of older adults. (Wallace SP., Social Determinants of Health Inequities and Health Care in Old Age in Public Health for an Aging Society, (eds) Prochaska, Anderson, and Binstock. Johns Hopkins University Press: 2012; pp 99-118).
Not unlike most public health issues, ensuring older adults remain healthy and independent for as long as possible requires the active engagement of individuals, families, community institutions and organizations, policymakers, employers, and the public health and healthcare sectors, to name a few. We also need prevention research and strong public-private partnerships to chart a long term and equitable vision that comprehensively meets the needs of older adults.
Branch and Meng in their article “Global Perspectives on Public Health and Aging” in Public Health for an Aging Society remind us that “Lack of preparation, inadequate public health and public policy development, and understaffed and undertrained medical care providers can have detrimental consequences in population health, as limited health care resources can be easily overwhelmed by the sustained increase in demand because more people are living longer with more chronic conditions.” (p.372-373)
How each of us lives during our youth will likely impact how we age. In many instances, we have the ability to prevent and/or delay debilitating chronic diseases. It is in everyone’s best interest to take action to protect the health of older adults.
CDC is at the forefront of promoting healthy aging across the U.S. Every state, jurisdiction, rural community, city, county, and neighborhood in our nation is impacted by an aging populace in one way or another. In the Call to Action in The State of Aging & Health in America 2013 report, CDC details population health strategies that public health and policymakers can implement to improve health outcomes for older adults.
How are you preparing to age with the best health possible? How might families and faith-based institutions, for example, advocate for a built environment that is older adult friendly? What are some initiatives of your state and local government to support the physical, mental, and social wellbeing of older adults?
4 comments on ““When did I get old?””
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Access to healthcare is the key here. The for-profit healthcare system we have makes it hard for people to afford even with the improvements we have had. So we need to change our cultural structure. Insurance companies, doctors, and drug companies all expect big money for people. They are poorly regulated so their costs are running rampant. Why should a ten minute visit with a doctor cost $450? Why is the cost of medical insurance bigger than my house payment? Why should the cost of insulin be $460 per month? These costs are way out of proportion. The dread of unexpected bills keeps people from getting needed preventive medical care. ACA has taken a good first step but it needs to be improved.
I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading although it’s a sad story. Nice blog. I will keep visiting this blog very often.
It is an all too common story that does not usually even have this happy of an ending. I am not sure what lesson is meant to be learned by the story of Marian. Is it suggesting that people in New York City have shorter life spans than other parts of the country? Public transportation would be a positive aspect I would think as walking is good. Is the author suggesting that disparity existed in the care that she received at some point in her life due to her race, religion, age? If she completed rehab, why did she then decide to leave the city? If she was able to pack out her own apartment I can’t imagine that her resources would be about the same as they would have been had she worked a few more days. It is important for us all to understand that our health is a lifelong that we must not only cherish but also play an “active” role in. It is equally as important to understand that we cannot live forever. Many do not have the opportunity to ever dream of retiring so Marian must have been doing pretty well to have been in the situation she was in before the stroke. The other sad part of this story is that she was evidently willing to watch her children’s children but evidently wasn’t welcome to stay “down the hill.” A great article makes you think and this article accomplished that for me although I would have liked to know more about her story and more about why it was felt that it should be in this part of the website.
Health equity is key through out all aspects of life and leading into the years of the older adult. Scheduling timely health screenings and monitoring health can help prevent predisposed morbidities or borderline morbidities. seeking help from social services and community health centers can guide the older adult to resources that can screen and help with chronic diseases. Inquire at your nearest community health center on information for programs available for the older adult and to maintain high health equity.