In a cruel twist of timing, Sally Magnuson’s husband of 55 years died of COVID-19 on February 10, 2021—the very day the couple was scheduled to get their first vaccines. Around the same time, Magnuson, 80, of Plano, TX, also contracted COVID; she spent weeks in the hospital and relied on supplemental oxygen for months afterward. 

Despite all that, she still starts each day with gratitude.

“I literally thank God daily for my life and for what I have,” said Magnuson. She recounted her blessings: she was hospitalized but never needed to be intubated; she had excellent medical care; she had the support of friends, who brought meals and flowers. 

She recalled the time her nurse asked her to call if she needed anything; the nurse was occupied with a patient who was dying that day. 

“I knew I was so much better off than that poor man,” Magnuson said. “Even with everything that’s happened, there’s a lot to be grateful for. I’m a lucky person.”

Today, Magnuson is on the mend and regaining strength. As a growing body of research suggests, her grateful spirit may have helped her get there. Gratitude can make people healthier, happier and more satisfied with life.  

Gratitude can help lower your blood pressure and improve immunity, and you’re less likely to become anxious or depressed. 

“Gratitude is literally one of the few things that can measurably change peoples’ lives,” wrote Robert Emmons, PhD, professor of psychology at the University of California at Davis and a leading expert on the science of gratitude. “Gratitude has one of the strongest links to mental health and satisfaction with life of any personality trait—more so than even optimism, hope or compassion.”

The long list of health benefits associated with gratitude includes lowered blood pressure, improved immune function and better sleep, as well as reduced risk for depression, anxiety and substance abuse. Heart patients who practice gratitude may recover more quickly. Grateful people also tend to have better habits: they exercise more, eat healthier and are less likely to smoke or abuse alcohol. 

Regulating one’s emotions is fundamental to increasing an older person’s number of healthy years, and gratitude aids in that, according to Daniel Levitin, PhD, author of Successful Aging: A Neuroscientist Explores the Power and Potential of Our Lives (2020).

“Gratitude causes us to focus on what’s good about our lives rather than what’s bad, shifting our outlook toward the positive,” he said.  

This research supports the wisdom that traditions have taught for thousands of years: gratitude works. All the world’s major religions teach the need for gratitude. It’s one of eight core teachings of yoga. Cicero called gratitude “not only the greatest of virtues, but the parent of all others.” 

Not-So-Secret Weapon

What exactly is gratitude? 

Psychological studies tend to compare groups of people who’ve completed some type of gratitude exercise—such as keeping a list of things they’re grateful for—to control groups that completed a similar but neutral exercise, such as writing down what they ate for breakfast. But gratitude has many facets. It can mean reflecting on good things in one’s life, expressing thanks to God or a higher power, expressing thanks to others or even receiving words of gratitude.  

“From the psychotherapeutic point of view, we tend to focus on the kind of gratitude that’s centered on appreciating one’s blessings and communicating to others the meaning and value they have for you in your life,” said Brian Carpenter, PhD, professor of psychological and brain sciences at Washington University in St. Louis, MO.

Experiencing gratitude does not mean glossing over real challenges that need acknowledgement and attention, Carpenter said, stressing that gratitude is a coping strategy that should be offered to—but not imposed upon—older adults. He cautioned that staying rigidly determined to focus gratefully on the positive, and willfully ignoring negatives, could veer into a form of denial.

But a sense of gratitude may be a particularly powerful tool for helping older adults face the challenges of aging. When confronted with illness or the need to depend on others for help, the choice to respond with gratitude can create a sense of control. 

Expressing gratitude can make you feel less helpless, more in control. 

M.K. Werner, 62, of Plano, TX, recognized that when she underwent treatment for cancer 11 years ago. While at the hospital, Werner resolved to thank every person who helped her along the way. 

“If someone came into my room to clean, I thanked them,” she said. “If someone put towels in the dispenser in my room, I thanked them. It became something I could do. I was completely powerless over what was happening with my body, but I could choose my attitude and how I treated people.”

Although it wasn’t her intent, Werner thinks her expressions of gratitude resulted in better, more attentive medical care. 

“Nurses would tell me they had asked for me, or they were happy to have me on their list of patients that day,” she said. “I think they knew I appreciated them.”

Barbara Morris of Surprise, AZ, also boosts her sense of agency by expressing gratitude. At age 93, she must rely on others to drive her and assist with other chores. Gratitude makes her feel less helpless. She says “Thank you” whenever she can. She assists helpful family members financially from time to time. And she loves to send flowers to people who’ve done something kind for her. 

“It not only makes them feel good, it makes me feel good,” she said.  

Older and More Grateful

The capacity for feeling and expressing gratitude seems to grow with age. One 2017 study reported that the experience of gratitude was greatest in older adults, compared to other age groups. Researchers speculate that older people may be more aware that time is limited, and that can lead to feelings of gratitude. 

Loss, an inevitable part of aging, can also heighten a sense of gratitude. 

“Ironically, tragedy often catapults people toward gratitude whereas constant good fortune can actually make it hard to feel grateful,” wrote Mary Pipher, PhD, in Women Rowing North: Navigating Life’s Currents and Flourishing as We Age (2019). “Privileged people may habituate to a comfortable, easy life.”

Jane Yancey, 81, of Plano, TX, connects her grateful spirit, in part, to losses she’s experienced in life. She grew up hearing her parents’ stories of sacrifice and hardship during the Great Depression. Her first husband was killed in a car accident; her parents took care of her one-year-old child while she worked. Then she met her second husband, who raised her daughter as his own. 

“I’m grateful I had a family to help me,” she said. “I’m grateful for my supportive husband. I’m thankful and grateful for every breath I take. I thank God for every day I’m still above the grass!” 

Yancey wonders if her children, now grown, will have the same capacity for gratitude, or will understand how fortunate they have been.

“I don’t know if it’s as easy to be grateful if you’ve never been without,” she said. 

Some say it becomes easier to practice gratitude as you grow older. 

Receiving expressions of gratitude can be life changing, said Benny Barrett, 72, a retired police officer in Dallas, TX. Years ago, Barrett arrested a young man and testified in the trial that resulted in a prison term. After he was released from prison, the young man asked to speak to Barrett. 

The young man’s message: thank you.

“He poured out his heart to me,” Barrett said. “He was grateful I’d taken him away from a bad situation and people who were a negative influence.” 

The encounter affected Barrett deeply. Going forward, he said he treated offenders with more empathy, as human beings with the potential for redemption.  

Older people may experience gratitude more consistently simply because they have more time. Christel Autuori, director of the Institute for Holistic Health Studies at Western Connecticut State University, teaches a gratitude practice to students as a stress management tool. The students are asked to write five things each morning for which they are grateful, and to keep them in mind throughout the day; students report this simple habit helps them stay more positive. 

College students tend to be wrapped up in themselves and their studies, Autuori said, but she thinks it’s easier to practice what she preaches as she gets older. For example, Autuori has lived in the same home in Connecticut for 40 years. It has a long driveway through the woods. When her children were young, she said, she’d power up that driveway with “blinders” on, never paying attention. 

“Now that my kids are out and on their own, I’m able to see the forest for the trees,” she said. “I take time every day to appreciate the beauty that has always been there.” 

Cultivating Gratitude 

A few months ago, while struggling with low-grade depression, Teri Ervin, 64, of Dallas, TX, decided to renew a daily practice of gratitude. Each day, before she gets out of bed, Ervin reads aloud a list of all that she’s thankful for—her health, her husband, her home. She tries to add a new item each day, perhaps related to her plans for the day. If she’s meeting a friend for lunch, for example, she expresses gratitude for that friendship. Over coffee, she writes about what makes her grateful, using a box of cards with written prompts. In just a few months, she already sees a change.

“I noticed a huge shift in many aspects of my internal life and my close relationships,” she said. “It makes life much easier.”

Simply choosing to be grateful isn’t enough to gain its benefits; most people need strategies to keep grateful thoughts alive. Author Emmons encourages people to adopt a gratitude practice, as Ervin did. That might take the form of journaling, writing letters to express gratitude to people who’ve been positive influences in one’s life, or even gratitude visits—meeting with a friend or acquaintance who was particularly helpful at some point. 

Gratitude can serve as an emotional signpost for older adults as they look back on their lives or embark on a new phase. In her practice as a retirement coach, Dorian Mintzer, PhD, 76, of Boston, MA, encourages her clients to start with gratitude as they begin to envision how they’d like to use their “bonus years” after leaving the workforce.

“When people take time to reflect back on their lives—the good, the bad and the ugly— they appreciate what they’ve come through, and they often feel gratitude,” she said. That, in turn, helps clarify what they want for the next phase of life. 

Carpenter, of Washington University, saw the power of gratitude in the case of a client who was struggling with depression. The man had chosen to make a major life transition in his mid-80s. A series of setbacks followed; the client began to question his choices and blame himself. 

“He wondered if his life would’ve been just fine had he just stayed put,” Carpenter said. “But he managed to work himself through that by adopting a stance of gratitude, by acknowledging that, despite the real adversity he was facing, he still had a lot to be thankful for.”

Sure enough, with time, the client’s depression began to lift. His optimistic spirit returned, and he was able to embrace life again. 

“For him, gratitude was really a lifeline,” said Carpenter. 

When Kathy Thomas’ “big Catholic family” gathers for the holidays, everybody plays bingo. Her 90-year-old mother, Rosemary Doyle (“RoRo” to the grandkids), calls the game, and the winners get fun prizes, like gift cards for Starbucks or Whataburger. 

“When we start the bingo, the kids look up from their phones and play; they even post the game on their Instagrams, and their friends all want to join,” said Thomas. “It’s something we can all do together.”

Playing together is a way that Thomas’ family stays connected. When the pandemic hit, the family kept up the tradition via Zoom. It’s just one example of how play can enrich the lives of older adults. 

“You’re never too young or too old to play,” said Anna Yudina, marketing director for the Toy Association. “Research links play with a number of wellness benefits in adults, such as reducing stress, boosting life satisfaction and empowering people to be creative, flexible thinkers.”

Play spans a wide gamut, from organized sports and serious hobbies to video games (about 15 percent of gamers in the United States are 55 or older). But all types of play seem to have positive benefits for older adults. Even spontaneous play with grandkids offers benefits—adults who play with children burn 20 percent more calories per week, experience fewer falls, become less reliant on walking aids and are less likely to develop Alzheimer’s in their 70s, according to the Genius of Play initiative, which promotes the value of play for children and adults. 

What Is Play? It’s Personal

Stuart Brown, MD, is the founder of the National Institute of Play, a nonprofit that studies the value of play. He resists offering an absolute definition of play because it’s so personal. One person might find hang gliding to be a joyful form of play; another might view it as sheer terror. But Brown does identify the properties of play: it’s done for its own sake; it’s voluntary and fun; it makes us lose track of time and feel less self-conscious. Play also offers opportunities for improvisation and leaves us wanting more.

“Play energizes us,” wrote Brown, author of Play: How It Shapes the Brain and Opens the Imagination and Invigorates the Soul (2009). “The ability to play is critical not only to being happy but also to sustaining social relationships and being a creative, innovative person.”

Brown identifies seven categories of play: body play/movement; object; social; imaginative; storytelling; transformative and creative; and attunement (such as the babbling and eye contact shared between mother and baby). 

Body and object primarily involve physical movement, helping to maintain muscle tone and coordination. Social play alleviates isolation and loneliness. The remaining categories engage the brain, helping to preserve cognitive function. 

But those distinctions aren’t hard and fast—depending on the specific play, there can be a great deal of overlap between body and mind. Group games can engage the mind while lessening loneliness. Crafts or music (examples of transformative play) involve both mind and body. And all forms of play promote relaxation and reduce stress, especially when laughter and humor are involved.

A Changed Life

Jeannette Jancetich says her favorite form of play—ballroom dancing—changed her life. She choked up a little when recalling the first time she walked into the Fred Astaire Dance Studio in Phoenix, AZ, two years ago.

“Today, I’m in better health, I have better posture, I feel great, I’ve lost weight and I’ve made friends who feel like family,” she said. 

A retired banking software executive, Jancetich, 72, said that, due to constant travel, she never had time for dance when she was working. Now, she takes lessons three times a week and competes often. She loves it all: the rehearsals, the costumes and makeup, and the choreographing of dance numbers to fit each competition event’s theme. 

Jancetich’s instructor, Sarah Petrov, estimates about 30 percent of her students are older adults. Teaching them reminds her of a job she had in college, working with older adults in a neuropsychology clinic to help improve their brain health.  

“Dancers must use both their cognitive and motor skills to follow complicated choreography,” she said. “That’s much like the exercises we used to improve brain health in the clinic.”  

Connecting through Play

Play connects people, often in ways that span generations, according to Mary “Molly” Camp, MD, an assistant professor of psychiatry at UT Southwestern Medical Center in Dallas, who specializes in geriatric mental health. She remembers bringing her young son, then 18 months old, to a nursing home to sing and visit with residents. He playfully tossed a ball to an elderly woman in a wheelchair who was nonverbal, due to dementia. Her face lit up and she threw the ball back to the boy.

“They had this immediate connection,” she said. “That tells me that play is hardwired and innate.” 

Similarly, Tomislav “Tom” Perić connected with younger people when he rediscovered his favorite form of play—jiujitsu—at age 62. Most of the people he trains with are young enough to be his child or grandchild.  

“They consider me the village elder,” he said. “It’s rewarding when younger people at least seem to listen when one offers advice or suggestions.”  

Now, at 70, he’s ranked 10th worldwide in his age and skill level categories. 

“There’s nothing that I’ve done in the past decade that has been as rewarding, physically and psychically, as martial arts,” he said. “It’s the only activity that makes me feel like I’m 35 again.”

At the end of each class, Perić said, “all cylinders are firing. I feel satisfied that I have learned something new. Physically, I feel more limber. I feel a sense of camaraderie with my teammates. And for a moment, I feel like anything is possible.”

Mastering skills like ballroom dance or martial arts involves practice and repetitive drills that require concentration and persistence. Do these pursuits still qualify as play? 

Yes, according to Camp.  

“People can approach play with a very serious mindset,” she said. “That sense of being fully immersed in the activity and ‘in the moment’ is what adds to their enjoyment.” 

Less serious, lighthearted play—card and board games, crafts, singalongs, puzzles and more—is also beneficial. Activities directors in senior living communities constantly try to devise new ways to get residents to play, to help them stay active and engaged and to meet other people. Play can serve as a distraction that helps ward off bouts of agitation and depression, common issues for those with Alzheimer’s or dementia. And while games like balloon badminton may seem simplistic, they lure residents to common areas for laughter and team play, which helps people feel like contributing members of their community.

Play can even heal relationships. Camp has heard from older adult patients who reported that some forms of play—like golfing or playing cards—helped mend or maintain longtime friendships that fractured in recent years over bitter political differences. Play provided a shared interest, Camp said, “that allowed them to keep connecting with each other without stepping on those land mines.” 

A Childlike Spirit 

As the creator of popular board games like Taboo, Outburst, Super Scattergories and Boom Again, Brian Hersch has carefully analyzed what makes an activity fun. 

At its best, he said, play reconnects us with childhood memories as well as with a childlike spirit. 

“Play allows us to disengage from the obligatory and takes us back to our childhoods,” he said. “It reminds us of those innocent times of just having fun, before life became crowded with obligations.” 

Hersch has two rules of thumb for every game he’s created: it must generate laughter and “head slaps.” When people laugh, they’ll play the game again and tell their friends about it. And head slaps happen when players truly connect to the game. 

“If it’s a trivia game, for example, and the questions lead players to say, ‘Oh, no one knows that,’ then it’s no longer fun,” he said. “But if they slap their heads and say, ‘Of course!’ when they hear an answer, then you know it’s working. Even if they couldn’t come up with the answers, they were connected to the game.” 

All Work, No Play

Many researchers believe American adults of all ages don’t spend enough time playing. Some may feel compelled to fill each day with productive activity; others may assume play is too silly for grownups. One study found that 84 percent of adult respondents said that taking time to play helps them be more productive at work. 

“Play is just as important for our overall health and wellness as sleep, nutrition and exercise,” said Tom Norquist, past president of the International Play Equipment Manufacturers Association. “It keeps us feeling young and energetic.” 

Norquist says that his career taught him to maintain a playful attitude in life. “I take pride in enjoying all those little moments—swinging on a tire swing with my granddaughters, hiking with my wife, doing cannonballs into our pool every summer—because I don’t take life too seriously. Play is a way of life.”  

When the COVID-19 pandemic struck in March 2020, Carmen Emery, 75, began emailing uplifting spiritual meditations to about 300 friends from church. She quickly realized the daily emails needed something more, so she added three or four funny memes at the end of each meditation, with one-liners like “My housekeeping style can best be described as ‘There appears to have been a struggle’” and “Don’t blame others for the road you’re on. That’s your own asphalt.”   

Emery’s friends appreciated the meditations, but they really loved the goofy memes. Messages of gratitude poured in.

“I get lots of people quoting their favorites,” she said. 

Buoyed by the response, Emery kept up with the messages, sending emails for more than 500 consecutive days, including two weeks in December when she battled COVID-19.  

“Looking for memes each day has been a blast,” she said. “And sharing humor lifted my spirits and gave me a way to spread joy with others.”

Health Benefits

Humor helps people weather difficult times, and a growing body of research suggests it goes even further. Humor is a tool that can help older adults stay healthier, happier and more able to cope with the challenges of aging. 

“Every single body system that is negatively affected by stress can be positively affected by humor,” said Karyn Buxman, a registered nurse and professional speaker, who calls herself a “neurohumorist.”

Laughter increases adrenaline and oxygen flow and releases endorphins. Laughing and enjoying humor help lower cortisol. (High levels of cortisol are linked to cancer, heart disease and diabetes.) Studies suggest that humor can help people solve problems and make better decisions. Humor can decrease loneliness, depression and anger.

Laughter, along with an active sense of humor, may help protect against a heart attack. Cardiologists at the University of Maryland Medical Center found that people with heart disease were less likely to laugh, in a variety of situations, compared to those without heart disease.

“The old saying that ‘laughter is the best medicine’ definitely appears to be true when it comes to protecting your heart,” said Michael Miller, MD, director of the Center for Preventive Cardiology at the University of Maryland. 

A small study at the University of Texas, Austin, asked healthy adults to watch a humorous, 30-minute video or a documentary. Researchers then measured artery function and flexibility. Both measures improved immediately in the volunteers who watched a comedy and stayed that way for almost 24 hours. Artery function decreased slightly among those who watched a documentary.

Laughing, Not Crying

Research points to humor as a powerful coping tool for helping older adults deal with the negative aspects of aging. As a caregiving expert who works with older adults, Pamela Wilson sees that often—like the time when she had to assist an older woman with Alzheimer’s in using the toilet. Humor lightened the mood. 

“Whoever thought I would need this kind of help at this age?” the woman joked. 

“Making a joke helped her to not be so embarrassed,” said Wilson. “Because we were laughing together, she didn’t feel as badly about the situation.” Wilson added that older adults who are able to adapt often seem to be the ones who are more able to laugh at themselves. 

“Especially as we age, life either gets funnier or more sobering,” said Dena Kouremetis, 70, who writes a column, (R)aging with Grace, for Psychology Today. “That adage about laughing instead of crying begins to make real sense.” 

If you’re feeling lonely or isolated, sharing laughter can help.

Humor is also a source of social connection that brings friends, families and couples together. Kouremetis says shared jokes and laughs keep her relationship with her husband humming along.  

“Humor gets you through the losses that come with aging,” she said. “If you don’t have a shared sense of humor, you’re not going to get through it.”

Humor also tends to be contagious and best enjoyed with others.  

“Sharing laughter—watching a favorite sitcom with a spouse or reminiscing about funny memories with friends—reduces isolation and loneliness, which contributes to good physical, psychological and cognitive health,” said Jennifer FitzPatrick, a social worker and author of Cruising through Caregiving: Reducing the Stress of Caring for Your Loved One (2016). 

Laughing With or Laughing At?

Humor about the process of aging is important and helpful as people age. Humor is very personal, and there is a line between what’s funny and what’s offensive, but the ups and downs of aging do offer a rich mine of humorous situations. Several aging and caregiving experts interviewed for this article praised The Kominsky Method, a Netflix dramedy series that tackles topics like erectile dysfunction, health problems and end-of-life with humor and empathy.  

“You have two characters [played by Alan Arkin and Michael Douglas] who are very good friends, talking about this stuff that happens every day when you’re older,” said Wilson. “They’re not afraid to talk about it. They’re laughing about it.”      

Aging provides plenty of what comedians might call “material.” Older adults are more likely to face chronic health issues, with the daily challenges that come with them: medications, doctor visits and more. Even active, healthy older adults sooner or later face the realities of aging—the need for reading glasses, occasional forgetfulness, diminished physical strength, minor aches and pains. Having the ability to laugh at the absurdities of life becomes an effective coping strategy. 

Humor is closely intertwined with positivity or being “in good humor”—maintaining a cheerful attitude and having a willingness to be playful and creative, according to Kathy Laurenhue, CEO of Wiser Now, Inc., a publishing company focused on well-being in aging. Positive, optimistic people often see the humor in a situation. They tend to be more resilient, have better coping and problem-solving skills, seek social support more often and live longer and healthier lives than those who are generally negative. 

Humor vs Laughter 

Laughter and humor aren’t quite the same thing, cautions Chandramallika Basak, associate professor at the Center for Vital Longevity at the University of Texas at Dallas.       

“Laughter is more expressive, but humor is more cerebral,” Basak said. This is reflected in research that suggests that aging-related cognitive decline can reduce an older person’s ability to comprehend humor. In one study, older adults were less likely to choose the correct punch line for a joke in a multiple-choice test. On the other hand, older subjects were more likely to show appreciation and enjoyment of humor.

“That’s not surprising to me as a cognitive scientist,” said Basak. “Short-term, working memory plays a big role in humor. That’s a function of the frontal lobe, one of the first areas of the brain to decline with age. But the amygdala, the part of the brain that responds to fear and laughter, doesn’t decline as rapidly.”  

As we age, our taste in humor may change too. Researchers have divided humor into three categories: affiliative humor, which promotes social bonding through self-deprecatory, ‘I can relate to that’ humor; aggressive humor, which mocks or ridicules others; and self-enhancing humor, which highlights the positive aspect of a situation. Older adults tend to enjoy affiliative humor and are more likely to object to aggressive humor. 

Coping with Fear

As a “physician-comedienne,” Cynthia Shelby-Lane, MD, takes humor very seriously. She completed training at the Second City Training Center in Chicago and performs standup in comedy clubs in her spare time. 

She’s convinced humor keeps her vital; she’s still practicing emergency medicine at 70. Humor also helps her connect with patients and brings relief in agonizing moments, such as the time in the emergency room when she handed a baby aspirin to a 350-pound, 6-foot-3 man who had just had a heart attack. 

“A baby aspirin?!” he said. “Are you kidding? Doc, have you seen my size?” The two shared a good laugh. The patient was moved to the ICU and died later that evening.

“I’m glad we could laugh together before he died,” she said. “He was so scared, but that moment eased his fear.” 

Humor’s ability to disarm fear also makes it a good teaching tool. Gail Rubin, a death educator, uses humor to nudge older adults to have conversations they’d rather not have about death and end-of-life planning. When she speaks to audiences, she tosses off one-liners like “Let’s get death out of the closet” and “Talking about sex won’t make you pregnant; talking about funerals won’t make you dead.” 

It’s an effective icebreaker. “When people laugh, they relax and they learn,” Rubin said. “Laughter opens people up to what they need to know.” 

Humor Interventions

If laughter is truly the best medicine, can humor be used as an intervention to promote health? Can people bring humor into their lives intentionally?

An older adult needn’t be good at telling jokes or being funny to enjoy the benefits of humor. But humor isn’t a one-size-fits-all prescription. 

“One person might really enjoy potty humor, another slapstick, and another satire,” said Marie Gress, a licensed social worker in Michigan. 

But anyone can intentionally add humor to the daily routine by nurturing friendships with people who make them laugh or by bookmarking funny videos on their computers. Buxman keeps a file of “moments of mirth”—funny experiences she can revisit, mentally, down the road, recreating the burst of good feeling. She even enlists strangers for hits of humor: “If I’m in an Uber, I’ll ask the driver, ‘Tell me about the craziest person you’ve ever driven.’” 

“It’s about mindset,” Buxman said. “Funny things are always happening. You can learn to start seeing and experiencing the humor that was always there.”  

In 2014, Sharon Kassakian, 75, was diagnosed with macular degeneration in one eye. But the condition was manageable, and she felt confident enough to move to Portland in late 2016 to be closer to family. Then, in 2018, her vision began to deteriorate. She started having difficulty seeing with her other eye. 

“It was a nightmare,” she said. “I was adjusting to life in a new city and adjusting to vision loss.” 

Three years later, Kassakian’s eyesight remains very unstable—OK one day, not so good the next. Doctors can’t promise she won’t eventually lose her sight entirely. The diagnosis was emotionally devastating, Kassakian said, similar to her earlier experiences in life when family members died.

“You’re losing something that you’ve had your whole life,” she said. “I wake up every morning with fear. Will it be the same, worse or better?”

More and more older adults will face similar challenges in the coming years. According to the National Eye Institute, about one-third of Americans over 65 are living with some form of “vision-reducing eye disease.” As the population ages, that number will increase, making vision loss a serious, public health issue.

“This year, the oldest baby boomers are turning 75, when age-related vision loss really kicks in,” said Ed Haines, chief program officer for the Hadley Institute, a Chicago-area nonprofit supporting people with blindness or vision loss. “We have a looming epidemic that no one has planned for, and we don’t have an infrastructure to deal with it.”

What Can Be Done?

The leading causes of blindness and low vision in the United States are age-related eye conditions—macular degeneration, cataracts, diabetic retinopathy and glaucoma—and the numbers are on the rise. Cases of macular degeneration, for example, are expected to climb to 17.8 million by 2050 among those 50 and older, according to the Centers for Disease Control and Prevention. Cases of diabetic retinopathy are expected to quadruple by 2050. 

For older adults affected, vision loss can severely affect quality of life.

“It’s a big loss of independence,” said Neva Fairchild, national aging and vision loss specialist for the American Foundation for the Blind. “Things you were able to do before —read your mail, pay your bills, watch TV, cook meals—they’re all taken away, at least until [you] have some accommodations in place.”

Many aging-related eye diseases can be controlled with treatment—if caught early. In addition, vision loss can often be managed with assistive devices, such as corrective lenses or magnifying devices, and occupational therapy that helps people learn techniques to adapt and maintain independence. But Medicare doesn’t always cover the cost of eye exams or assistive devices, and doctors often don’t have the time or knowledge to refer patients to therapists.

Tech and training can help, but many doctors don’t even know they exist.

“Historically, in this country, visual rehabilitation did not evolve under the medical model, therefore it’s typically not covered by Medicare or private insurance companies,” said Haines. “If you break a hip, a discharge planner makes appointments with a physical therapist and a plan for getting back on your feet. When you get a diagnosis of irreparable vision loss, it’s devastating, yet you’re sent home with nothing.” 

The key is to connect patients with the right technology and the right training, but often, patients and even doctors don’t know that exists. 

“I’ve heard it a thousand times: ‘The doctor told me nothing more can be done,’” Fairchild said. “What the doctor means is that there’s nothing more that can be done medically. There’s no surgery or eye drops that will give back the patient’s vision. But there’s almost always something more that can be done to help the older adult adjust and function more independently.”

Catch It Early 

If caught early, many causes of aging-related vision loss, including glaucoma and cataracts, can be treated before they cause significant damage.  

“In general, if they’re treated early enough—with medicines, surgeries, laser treatments and regular follow-ups—the vast majority of patients don’t lose vision from a functional standpoint to the point where it severely limits their daily activities,” said Donald Abrams, MD, ophthalmologist-in-chief and director of the Krieger Eye Institute at LifeBridge Health in Maryland. “The sooner we treat it, the better off you’ll be.” 

The best way to protect your vision is to have regular eye exams.

While “dry” macular degeneration (the more common type, which generally leads to gradual loss of vision) is not treatable, “wet” macular degeneration (the type that causes leaky blood vessels in the eye) can usually be treated with injections. 

A patient’s best defense: regular eye exams beginning at age 50. Black and Hispanic people, who are more prone to many age-related eye conditions, and those with a family history of eye disease, should start annual exams at age 40. A comprehensive eye exam should include a test of eye pressure as well as dilation of the pupils. (Not all optometrists perform all of these diagnostics. Ask first.) A thorough eye exam can detect genetic conditions or abnormalities in the eye that may indicate a need for more surveillance. Medicare pays for comprehensive eye exams for some patients with diabetes or those with increased risk for glaucoma due to ethnicity or family history.

Prevention is also key. Good health habits will reduce the likelihood of losing one’s vision—exercising, eating a balanced diet including dark leafy greens and fish high in omega-3 fatty acids, avoiding smoking, wearing sunglasses and a brimmed hat outdoors, and management of other health conditions like diabetes. Doctors may also recommend vitamin supplements (usually a combination of antioxidants, carotenoids and omega-3 fatty acids) for people with signs of macular degeneration. 

Problems beyond Lost Vision

Elise Franz, 67, (not her real name) was a successful graphic designer and freelance writer for art magazines until six years ago, when she had cataract surgery. Instead of improving her eyesight, the surgery seemed to trigger a cascade of other problems, including macular edema, diabetic retinopathy, glaucoma and optic nerve damage. 

Once a frequent traveler who’d jet off to Paris on a whim, now Franz rarely leaves her home except to go to the doctor.  She once churned out articles easily, getting lost in the flow; now the writing process is tortuously slow. She positions her face right next to the computer and uses extra-large type. 

“Everything is problematic,” she said. “And people don’t understand. I’ll go to the doctor’s office, and they’ll hand me a pile of paperwork. I tell them, ‘I can’t read that.’ They hand it to me anyway.”

Franz was recently diagnosed with heart issues too, which she thinks resulted from her inactivity due to her vision loss.

“I used to love to exercise, to go swimming,” she said. “Now, it’s hard to do everything. The fact that I can’t see has had deleterious effects on my physical health. It’s not like I can go out my front door and go for a walk.” 

As Franz’s story shows, older adults with vision loss often suffer more than a loss of the ability to enjoy favorite activities. Vision loss can exacerbate other health problems and lead to emotional and psychological challenges. With a diagnosis of macular degeneration, for example, “Your perception of yourself, and vision of your future, is thrown into total disarray; you despairingly imagine a life of darkness, social isolation, dependency, risky treatments, loss of friends, hobbies, participation in activities of interest such as sports, theater, art and reading—in short, a kind of early death,” wrote psychiatrist Arnold Wyse, MD. 

Older adults who are visually impaired often become isolated. Everyday activities, like attending worship services or eating a meal at a restaurant with friends, become problematic.  

“People with vision loss often become paranoid about eating out,” Haines said. “They don’t want to drop food or spill it on themselves. Navigating a buffet is a nightmare. You’re unable to see when people are waving at you. That’s a big deal when I’ve worked with folks in small towns because everybody waves. And if you don’t wave back, if the person who waved doesn’t know you have a vision impairment, they feel they’ve been insulted.”

Haines added that the Hadley Institute typically gets a surge of inquiries after the holidays from families who notice a decrease in a loved one’s vision during a visit. Often, fearing for the elder’s safety, families will rush to move the person into assisted living, without taking the time to learn about other options to allow the elder to remain independent. 

Help from Tech and Training

Older adults can tap into resources that help them adjust and function—if they know where to look. The federal government maintains the Older Individuals Who Are Blind Technical Assistance Center, a clearinghouse of agencies serving older adults with vision loss. 

Many digital devices are helpful for people with vision loss. Virtual assistants, like Amazon’s Alexa, can provide information (time, weather forecast, sports scores, even make phone calls) in response to voice requests. Some devices can be operated via speech commands, although there’s a learning curve to adapt to that. 

“Apple did the visually impaired community a huge favor,” Haines said. “Every Apple device can be accessed with speech commands. If you lose your vision, you don’t have to throw out your iPad. We’ve had individuals in their 90s learn how to do this.”

Because of Apple’s success with speech access, Haines added, other platforms like Android are adding similar features. 

However, technology isn’t the only fix, Haines cautions. Adapting the home environment and learning how to perform daily tasks with reduced or no vision are often even more helpful. The Hadley Institute offers an extensive catalogue of online, distance-learning workshops, all free, that teach people how to adapt tasks of daily living for reduced vision. 

For example, a short video demonstrates how to pour liquids into a cup, using simple techniques like squaring oneself up next to the counter, adding task lighting and placing the cup on a tray of a contrasting color, making it easier to see and easier to clean up spills. (View a short sample here.) The workshops can be ordered by mail in other formats too: large print, digital talking book audio, or braille. 

Occupational therapists can also help patients with vision loss. They visit patients’ homes to coach them on ways to safely manage their activities of daily living, including bathing, toileting, cooking and cleaning. They also may recommend adjustments in the home environment, customized to the person’s needs and type of vision problem, like adding task lighting in key spots or installing drapes to block glare. 

Making Adjustments

After connecting with a variety of resources, Kassakian feels more hopeful now.

She worked with a therapist who helped her with the grieving process that came with the loss of vision. She found a nonprofit ride service that takes her to doctors’ appointments. She discovered Hadley’s free online workshops. She joined two support groups, both offered via Zoom—one by Hadley for emotional support, another for sharing tech tips. At the latter, she learned how to use the accessibility features on her iPhone.   

“I have blind friends now, and I’m just amazed at how they sometimes function even better than I do,” she said. “There is a grieving process, but you can learn to live with vision loss because there are so many services and resources.  Now I know where to turn for support.” 

Hanne Caraher loves rowing. She’s very good at it. So good, she’s won a national gold medal and has competed in championships in Canada, Poland, Germany and Hungary (she won there too). After years of early morning practices—which meant arising at 4:20 a.m. five days a week—she’s now rowing with the Gray Knights at Thompson Boat Center in Washington, DC. 

She’s only been rowing for 11 years now. And she started when she was 72. 

“I found all the things that were connected with rowing were fun. It totally changed my life,” said Caraher, now 83, who also won a medal in 2019 on a boat rowed by competitors whose average age was 80.

Caraher is not alone in her love of the sport. More and more older adults are discovering rowing as a way to stay physically active, as well as mentally and socially engaged. USRowing, the sport’s governing body, says its membership grew from about 67,000 in 2013 to 75,000 in 2018 (the most recent tally available). About 14 percent of members are 50 and older. (While there’s no gender breakdown for older rowers, women make up about 53 percent of USRowing’s total membership.) 

At the 54th Head of the Charles Regatta—one of the sport’s biggest events, held on the Charles River in Massachusetts—about a quarter of entries in 2018 were men and women 50 and up. 

Even as COVID-19 curtailed many races and team activities, older rowers still stay in shape through indoor rowing, virtual races, singles boats (allowing rowers to remain safely distanced) or other safety measures. And while some competitions are on hold, that doesn’t dampen the enthusiasm that older rowers express for the sport.

“Rowing has got under my skin like no other form of exercise ever has,” said Patricia Carswell, a British rower in her 50s, who blogs and podcasts about rowing at GirlontheRiver.com. “The river has me in its thrall, and I love the endless challenges that go with such a technically difficult sport.”

Vigorous but Safe

Rowing offers all the benefits of vigorous exercise, but with minimal risk of injury or impact on the joints—a plus for older adults. Contrary to popular belief, rowing is not just an upper-body exercise. It uses all the body’s major muscle groups: legs, arms and core (torso). 

“Rowing puts only minimal stress on the joints, far less than walking, running or biking,” said Mark Slabaugh, MD, an orthopedic sports-medicine surgeon with Orthopedics and Joint Replacement at Mercy Medical Center in Baltimore. “Only swimming is less strenuous on the joints. Those with limited range of motion in any of their joints can still participate in rowing, due to the low stress on the hips, knees, ankles and shoulders.”  

Slabaugh said he might caution patients with symptomatic, rotator-cuff tears (a type of shoulder injury) against rowing. Otherwise, the sport is safe for most people, he said, adding that newbies of any age should start slowly, building up intensity gradually.  

Research confirms the fitness benefits. Slabaugh cited a 2012 study in Japan that measured the results of an indoor rowing regimen for a group of older men: improved aerobic capacity, decreased fat and improved muscle tone, all key metrics for functional health for older people. Researchers have also found that the lungs of rowers who train seriously use oxygen more efficiently than those of most other athletes. 

The focus on the present moment and mindfulness in rowing is a kind of Zen.

— Charles Gilbert

In addition, studies have found that rowing improved physical fitness among breast-cancer survivors. They were once urged to avoid lifting or exerting their shoulders, to reduce the risk of lymphedema; now, many doctors encourage them to row. Rowing groups have sprung up specifically for breast-cancer survivors. 

Like other forms of vigorous exercise, rowing may ward off depression. Some rowers say that the rhythmic, repetitive nature of rowing is like meditation.

“The focus on the present moment and mindfulness in rowing is a kind of Zen,” said Charles Gilbert, 66, who rows with Princeton National Rowing Club in Princeton, NJ. “A Zen practitioner told me that my rowing 1.5 hours a day on the water constituted my Zen practice.”  

Rowing also benefits the brain. It involves learning new skills that require concentration, which may offer added brain health benefits. Most boat clubs offer “learn to row” programs, generally about six weeks long, to teach newbies the basics, but rowers never stop improving their technique. 

“Rowing is a lifetime sport,” said Tom Murphy, 67, president of Rocky Mountain Rowing Club in Denver. “It appears easy to learn the basic motion, but it takes a lifetime to master.” 

Competition as Motivation

While older adults can row recreationally, many compete as part of a team in races and regattas, and that can push them to train harder and more consistently. 

“When you’re in a boat with other people, you can’t stop,” said Lisa Miller, 56, who rows with Dallas United Crew in Dallas, TX. “It pushes you to get past your limits. On my own, in the gym, I would’ve stopped.”

Miller likes the sense of accountability. For example, she said, if one person doesn’t come to practice, the coach must rearrange seating on the boats. “You don’t want to mess up your teammates,” she said. “You don’t want to get that call from the coach, asking, ‘Where are you?’” 

Rowing is one sport where team members look forward to getting a year older. 

For some, rowing is their first experience of athletic competition. 

“I’m a pre-Title IX babe,” said Joanne Caye, 72, a rower in North Carolina. “I didn’t get this stuff when I was in school. Just to be able to compete is something that is really heady for me. I get pushed in absolutely wonderful ways. I never knew that about me.”

Caye was introduced to the sport in her late 40s through another mom on her son’s high school rowing team. Now, 25 years later, her son is grown (and no longer rowing) and Joanne is retired, but she’s still rowing as part of Carolina Masters Crew Club.

Rowing allows people to remain competitive even as they age. Classification is based on age, and handicaps are assigned based on these classifications, allowing young and old to compete fairly, side by side. Gilbert jokes that rowing is one sport where participants look forward to getting a year older, because that helps boost the boat’s average age, raising the handicap. 

“In rowing, the goal is to get older and stronger, so that you can keep contributing,” he said. 

‘Built-in Sisterhood’

Rowing teams often form close-knit communities that stay connected outside of practice and during the off-season. Many clubs host social gatherings, philanthropic service projects and classes for disadvantaged children or disabled veterans. For retired older adults, regular rowing practice creates routines and teamwork that many miss after leaving the professional world. 

As a retired professor of social work, Caye sees a lot of value in the intergenerational social connections she’s made as a rower. “It’s wonderful to have a built-in sisterhood,” Caye said. “Rowing connects me with women who are younger than me and keeps me attuned to changes in trends.” 

Liz Jenista, 37, is one of those younger women on Caye’s team. She’s been rowing with the same club for 15 years. Having moved from California to North Carolina soon after graduating from college, Jenista calls her rowing club her “multigenerational family away from my actual family.” Friends made through rowing have become an important support network, helping her and her husband navigate the job market, purchase a house and even parent their two children, ages six and 10. Some rowers handed down gently used clothing and supplies when her children were babies; others have babysat. When they rode together for hours on the way to regattas, Jenista often asked teammates for advice on child rearing.

“Talking through behavioral challenges and hearing about [older members’ children] who faced similar challenges but grew up and became successful adults—that’s so reassuring,” Jenista said.  “It’s been very valuable having the perspective of older women.”

Time in Nature

Most competitive rowers spend time on indoor rowing machines, whether in the off-season, during inclement weather or due to COVID-19 restrictions. But the time spent outdoors is a key attraction—and a major benefit—of rowing. 

“The benefits are even more profound when you’re in nature, breathing clean, fresh air and getting away from the normal daily routine, especially during COVID when we need to avoid staying indoors for too long,” said sports-medicine surgeon Slabaugh. 

There’s a growing body of research that suggests time spent outdoors itself has benefits. In a 2019 study published in Scientific Reports, a journal published by Nature, 20,000 study participants reported better health and well-being when they spent 120 minutes or more in nature each week. 

Many rowers commented on the magical feeling of rowing on a body of water early in the morning before the world is awake. 

“You’re getting back to nature,” said Miller, the Dallas rower. “You’re out on the water and it’s quiet, except for the clicks of the oars. You see these beautiful sunrises. It’s a great way to start the day.”