As someone who writes a lot about the medical and social issues of aging, I am constantly faced with a problem: What am I supposed to call old people these days?
I know. Some of you are mad at me already, but it gets really tiresome to have to alternate among the hazy euphemisms that are supposed to stand in for the hated word "old." Older, as in older adults or older people, seems to be the most acceptable term, but it offends the part of me that prefers words with some precision. Older than what? Everybody's older than somebody. Senior citizen has fallen out of fashion, but "seniors" is OK in some quarters. (Definitely not all.) Some writers use "mature." Do we really have to wait till we're 65 to be mature? I rather like "elders," but when does that start?
I am old enough to remember when it was OK to call people not much older than I am now (62) old. I get that ageism is a serious problem, especially if you feel good and want to — or have to — keep working after 65 in a setting that prizes youth. In some quarters, 30 is over the hill. So, I see why advocates dislike the word old and all its pejorative implications. We live in an era when both our recent presidential candidates were past traditional retirement age, when rock stars tour in their 70s, when Tony Bennett is beloved and charismatic at 90, when doctors, lawyers and professors routinely work well into what used to be old age. We need to rethink what old means.
But I personally think that some of my baby boomer peers — the oldest are now 71 — are ridiculously sensitive about words that imply they've lived a while. I also think it's crazy to use the same word to describe me that you'd use for my frail, almost 88-year-old mother. I asked her how she thinks people should describe her and she said "ancient." She wasn't joking. I am clearly beyond middle-aged, from a math perspective, unless I got every possible good gene in my family. It would make my life as a writer who sometimes has to write about age groups easier if we had more than one word for the huge swath of the population over that arbitrary line: age 65.
My guess is that our inability to embrace a word isn't so much about the word itself but about how Americans feel about the last stage — or two — of their lives. Most of us still don't even want to talk about, let alone face, what inevitably comes after old age: death. We desperately want to look and act younger than our chronological age and pretend we'll never need a walker or forget our children's names. Young is a compliment. Any version of old is not. As long as that remains true, no word for people with graying hair and wrinkles can remain untainted for long.
I asked some experts for help with my terminology problem and found that they've been struggling with it, too. For years.
"We need a word or words to describe this period, and we just don't have them yet," said Tracey Gendron, a gerontologist at Virginia Commonwealth University. She prefers not to categorize people, but says referring to older adults and the aging population is acceptable.
As she and others pointed out, one source of the problem is that we're dealing with something new. "I think we're in an unprecedented time, this longevity revolution," she said.
Aging experts, she said, have tried calling people young old (65 to 74), old old (75-84) and oldest old (85+). Age-based categories at this stage of life often aren't helpful, she said, because there is so much variability in how people age.
"The variation in aging is vast," said Christine Arenson, a geriatrician at Thomas Jefferson University Hospital. Most geriatricians think of their target patient group as starting around 70, she said, but a 40-year-old who has had diabetes for 20 years might have much in common with older patients. "Most 65-year-olds in America are quite healthy still," she said.
Work by John Shoven, a Stanford University economics professor, shows how aging has changed since 1930. He looked at three groups: those who had a 1 percent, 2 percent and 4 percent chance of dying in the next year. Shoven thinks achieving 1 percent risk roughly corresponds with the end of what most of us think of as middle age. Shoven himself — he's 70 — likes to think of middle age as the middle of our adult years, not the middle of our whole life. He thinks if your chances of dying are less than 1 in 100, you're still young. He doesn't think we're old until our risk climbs to 4 percent. The striking thing is that the age at which people reached those milestones has climbed impressively. In 1930, an average man reached the 1 percent threshold at 44. Men now hit that mark around 60, women at 65. The age at which men have a 4 percent risk of dying in a year rose from 65 in 1930 to 76. Women now get there around 80.
That jibes with Jerry Johnson's experience. He is chief of geriatric medicine at Penn Medicine and is himself 69. He says that many 70-year-olds have more in common medically with 50-year-olds than with 80-year-olds. "Between 70 and 80, a lot happens in terms of endurance and energy conservation and exposure to new diseases and co-morbidities," he said. Between 80 and 85, many people begin to think and act differently.
He hasn't found a word that pleases everybody. Some patients don't want any word for the older age group. He thinks a label helps with "succinct communication" but added that "labeling is always flawed. There's no way to get around it."
There seems to be general agreement among experts that "elderly" and "senior citizen" and "aged" are on the outs. "Elders" has fans because it connotes respect, but, apparently, some critics think it's too much like "elderly."
Kirsten Jacobs, associate director, dementia and wellness, for LeadingAge, a senior housing group, said people should also steer clear of "silver tsunami," a term often used to describe the coming increase in need for senior services as boomers age. Equating aging to a natural disaster, she said, sends the wrong message.
The Journal of the American Geriatrics Society announced last month that it will now require writers to use "older adults" for people 65 and older. If they want to talk about a smaller group, they can list the ages. That puts it in line with the American Medical Association's position.
The geriatrics society and seven other aging organizations worked with the FrameWorks Institute, which helps advocates and scientists communicate more effectively about their social issues, to study attitudes and messages around aging. The institute, which conducted interviews and surveys, concluded this year that aging has a major image problem. People almost always see it as negative. The way we talk about aging is littered with "othering" language that sees older people as "them" and not "us." As Allen Glicksman, 63, director of research and evaluation for Philadelphia Corporation for Aging, joked, "Old is 10 years older than you are."
The project did not look at which words older people would like to be called. Nor did it ask whether the oldest old category should have a name of its own. It did ask survey takers about five terms: older adult, older person, senior, senior citizen and elder, said Drew Volmert, director of research for the FrameWorks Institute. The survey asked how old a person labeled with each word was likely to be and how competent they were. Seniors, senior citizens and elders were all thought to be in their late 60s and less competent than younger people. An older person was seen as more competent than the seniors and senior citizens, but only a little younger, around 64. Older adults were seen as around 54. Volmert thinks that's too young for the aging population, so he uses older people.
The report is largely about the bigger issue, changing the way we think of aging so that the concept includes both the value of experience and the eventual need for more help. Experts seem to agree with me here. The real problem is with how we think about aging, not with specific words.
"We need to take it back, the word old," Gendron said.
Still, I accept that the words we choose affect our thoughts. So, it looks like I'm stuck with using "older" for now. For the record, I don't care if you call me old. When I'm a little older.
Finding a good word for a stage of life is one thing. Ageist language, which permeates our culture, is another. To say someone is youthful or has a young spirit is a compliment. Some also talk down to older people as if they were children. It's called elderspeak. Professionals may ignore an older person completely and talk to a younger companion.
Tracey Gendron, a gerontologist at Virginia Commonwealth University, said she knows that many people mean well, but she thinks it's time for older people to call out ageist language when they hear it. Here are some of her examples of how to respond.
They say: "You don't look 70."
Response: "What is 70 supposed to look like?"
They say: "How are you doing, young lady?"
Response: "I understand you're trying to compliment me, but I'm not young and I'm OK with that."
They say: "I'm frustrated because I had to teach Mom how to use the GPS again."
Response: "Your mom had to teach you to use a spoon multiple times."
They say: "What can I get for you, sweetie?" (Or, dear or honey).
Response: "Please don't call me sweetie or dear. My name is —-."