This is part 2 of a series about caregiving from a distance. Read part 1 here.

Fern, 92, called her daughter in a panic. She couldn’t turn off her television because she couldn’t find the remote. Due to Fern’s hearing loss, the volume was very high. Fern was afraid the blaring TV would keep her and her neighbors up all night.

Her daughter, Monica, couldn’t help. She was in Michigan; Fern lives alone in Sarasota, FL. 

Fern’s situation wasn’t life threatening. But it’s an example of how even a minor issue can become a crisis when an older loved one lives far away. For the millions of Americans in that situation, it’s a major source of stress. In fact, research suggests that long-distance caregiving is even more stressful than face-to-face caregiving. 

Unlike those caring for an older adult nearby, long-distance caregivers often face situations that can’t just be handled as they arise, whether it’s a missing TV remote or a serious medical crisis like a stroke or an injury due to a fall. There are no easy fixes. But experts advise that thinking ahead, and assembling a support team, can help families navigate long-distance caregiving more effectively. Here are some tips. 

Divide and Conquer 

Start by gathering family members for a conference, virtually or in-person, advises Maria Hood, a social worker and director of admissions at United Hebrew, a senior care community in the New York metropolitan area.  

“Develop a strategy to divide and conquer,” Hood says. Make a plan to rotate visits and regular phone calls. Clarify roles so no one person feels overburdened. Those who can’t visit in person might tackle other tasks: a family member who is an accountant can help manage financial issues; another who’s a medical professional can establish lines of communication with the older adult’s physician. 

As much as possible, involve the older adult in the conversation, and initiate it before a medical crisis or other “point of vulnerability” occurs, adds Barry Wu, MD, professor of medicine (geriatrics) at Yale School of Medicine.  

“Understand what your [older adult] family member’s wishes are,” Wu says. “If they don’t want aggressive treatment in the event of a medical emergency, the family should know that. If their heart stops, or they stop breathing, do they want to be hospitalized? Do they want a feeding tube? You need to know what their wishes are.” 

Other questions to ask might include:  

• What kind of support would be helpful now? That might include transportation to doctor visits or outings, help with meals, errands or housekeeping. 
• Could alterations in the home make life easier and safer? For example, switching from an upstairs bedroom to a downstairs bedroom or installing a ramp leading down from the front porch could prevent future accidents or make daily life easier.
• What about anticipated future needs? If an illness or loss in mobility makes it difficult or impossible to live alone, what would the older adult want to do? Move into assisted living? Move in with a family member? Stay at home, with in-home support, as long as possible? 

Remember to keep the older adult’s wishes paramount, says Teri Dreher, an RN and patient advocate who assists older adults and their families. 

“A sense of dignity, autonomy and agency over one’s own life is even more important as we age,” she says. “Nobody likes their children to talk to them like they’re children.” 

Dreher says older adults can become stubborn or unwilling to share honestly about their struggles. Some may resist discussing the issue or insist, “Don’t ever put me in a home.” In that case, a visit to an assisted living community might help reassure them. 

“I worked with a couple in their late 70s that stayed in their house, even though they couldn’t take care of it, until the house was finally condemned,” Dreher says. “Once they moved into a senior living community, they saw how great the food was and changed their minds immediately.”

Start the money conversation as part of these family talks. How is a loved one paying for daily expenses now? How might they pay for additional care if it’s needed? These questions are important for any caregiver, but especially when family members aren’t close enough to quickly access financial records. Needs can change suddenly; an older adult could become incapacitated temporarily or permanently. 

Explore Resources 

Many agencies and local governments offer services to assist older adults—these can be lifesavers when family members can’t be present. However, it’s not always easy to find out about these services. For example, some local charities, city governments or agencies offer wellness checks—regularly scheduled phone calls to check in with an older adult, with follow-up calls and/or visits if they don’t respond. To determine if such a service is available in the older adult’s community, try searching online using the zip code or town (such as, “older adult welfare check 75024”). Or check the search tool of Shepherd’s Centers of America, which provides welfare checks through more than 50 affiliates around the United States. 

Hood suggests contacting a hospital in the older adult’s area and speaking with staff in the social work department. Similarly, the marketing staff at a senior living community near the older adult’s home will likely know what’s available locally.

Create a directory with contact information, including the older adult’s physicians, local fire, police and EMTs, and non-emergency numbers, like those of the apartment security staff or community director where the older adult lives, and names and numbers of neighbors, friends and family members. Add a list of medications and a list of locations of key documents, such as insurance policies and the person’s will. Share copies with family members and post a copy on the older adult’s refrigerator or another prominent spot. 

Enlist Technology

A big source of stress for many long-distance caregivers: worry over the older adult’s safety. Unfortunately, it’s not uncommon for older adults, especially those 90 and older, to fall and end up on the floor for hours before someone comes to help. If the older adult is amenable, consider a medical alert pendant and/or installing an in-home monitoring system. Most require some type of subscription or monthly connection fee that is not covered by insurance or Medicare.  

These systems are typically either “active,” where the user presses a button on a home unit, wearable device or wall to call for help, or “passive,” transmitting data from the user to a trusted care partner without requiring any action on the older adult’s part should they fall or become unresponsive. For example, the Apple Watch offers a passive fall detection function that can be set up to call 911 automatically if the wearer falls. (However, this technology isn’t yet 100 percent reliable and automatic updates to the watch’s software may disable the function without alerting the user.) 

Make the Most of Visits 

Many older adult living communities see an uptick in inquiries right after the holidays, when family members visit and notice signs that their loved one isn’t coping well. Visits are a good time to observe. Look for piles of dirty dishes or unwashed laundry; unopened mail, overdue notices or other signs that paperwork isn’t getting handled; rotten food in the fridge—or no fresh food at all; scorch marks on pans or countertops, possibly signs of inattention to cooking tasks. 

Visits also present opportunities to set up local lines of communication. Accompany the older adult on a doctor visit and ask to be added to the list of emergency contacts. Inquire about joining future telehealth visits, with the older-adult patient’s permission, as a way of tracking health conditions.

Keep in mind, after the visit, that an older person’s health, mobility or cognitive status can change quickly. Be ready to pivot. 

Finally, use a visit to enlist “boots on the ground.” Go to home care agencies, visiting nurse associations, transportation services and other local support services to learn what they offer. Exchange contact information with the older adult’s friends and neighbors and encourage them to call if anything raises concerns, like unusual behavior or if something seems out of place (a door left open or lights on overnight).

The key to long-distance caregiving: find local people who can provide help when your loved one needs it.

If finances allow, consider a consultation with a geriatric care manager in the older adult’s area. Also called “aging life care managers,” these professionals are usually licensed nurses or social workers experienced in the care of older people. They can provide a neutral assessment of the older adult’s situation and advise on options available locally. Generally, they serve clients and families whose incomes are too high to qualify for publicly financed services like Medicaid. Care managers can also offer references to reputable home-care agencies or professional caregivers in the area. Find a care manager in the older adult’s community by using the Aging Life Care Association’s expert search tool or the Eldercare Locator, a public service of the US Administration on Aging.

If the older adult has complex medical issues, consider hiring a local patient advocate who can step in should an emergency arise. Once a relationship is established, the patient advocate can accompany the older adult to the ER and serve as a point of contact until an out-of-town family member arrives. 

Unfortunately, these services are not inexpensive. Labor costs have increased considerably in recent years. In-home care now averages about $26 an hour for homemaker services (cleaning, cooking, etc.) and $27 an hour for a home health aide, according to Genworth’s Cost of Care Survey. Some companies’ employee assistance programs (EAP) assist employees in caring for older family members, with help finding caregiving services and even help covering the costs. 

Some Medicare Advantage plans also provide coverage for personal care assistance, non-medical transportation and in-home meal delivery through a private provider or services like Papa.com. Papa is a platform that connects older adults with Papa Pals, vetted local people available to provide companionship or to assist with cooking, cleaning, transportation and laundry. 

A Papa Pal came to the rescue when Fern couldn’t find her remote. Connor Carroll has been visiting 92-year-old Fern regularly, helping her with light housekeeping, running errands and assisting with other daily needs. After each visit, he calls Fern’s daughter, Monica, to fill her in on how Fern is doing. 

“We’ve built a rapport,” Carroll says. “It’s a comfortable relationship. Fern calls me ‘the son she never had.’ Monica tells me it’s nice to have me as her eyes and ears in the area.”

Hood says that’s a key to long-distance caregiving: connecting with professionals and others in the local area who can step in to help when needed. 

“When it comes to caring for an older adult,” she says, “it really does take a village.” 

This is part 1 of a series about caregiving from a distance. Read part 2 here.

A few years before he passed away, Maria Hood noticed that her father wasn’t shaving or showering regularly, which was unusual, because the retired military man had always been impeccably groomed. 

“He wasn’t getting into the shower because he was afraid of falling,” she said. “And his home, normally spotless, was getting messier. The dust bunnies were starting to have babies.” 

It was clear he needed help. But her father lived in Florida, and Hood was in New York.

Hood’s dilemma is a reality for millions of Americans: providing eldercare from afar. According to a 2012 Journal of Gerontological Social Work report, nearly one-third of informal caregiving occurs from a distance. 

Studies estimate that four to seven million people in the United States are long-distance caregivers, and those numbers are expected to rise as longevity increases and birth rates decline. Mobility factors in too. Adult children move away from their parents to pursue careers; parents migrate to warmer climates when they retire. When the older adult begins to experience medical issues, or mobility or cognitive decline, relocating isn’t always possible for either party. 

While the physical and emotional toll of caregiving is well documented, less has been documented about how distance plays a role. What is clear: “Geographic separation can exacerbate care-related stressors,” according to the 2012 report. 

“When you live far away, you don’t know what’s going on,” said Hood, a social worker and director of admissions at United Hebrew, a senior care community in the New York metropolitan area. “You are not the person with eyes on the ground.” 

Long-distance caregivers don’t handle round-the-clock physical care, but many experience significant emotional and psychological distress. They may feel even more distressed than local caregivers, as researchers Joan Monin, PhD, and Richard Schulz, PhD, were surprised to find in a 2009 study.

Distance can make problems seem worse than they actually are. 

“Caregivers who lived farther away, who were the siblings of the primary caregivers, often were more distressed than the caregivers providing the daily support,” said Monin, associate professor at Yale School of Public Health. 

Similarly, a 2004 study found that long-distance caregivers were more likely to report emotional distress than caregivers either residing with their care recipients or less than one hour away.

Stress often stems from the perception that a loved one is suffering, whether it’s physical pain, loneliness and isolation, or confusion due to dementia. Distance tends to amplify that perception. 

“When you’re not nearby, you may be thinking the situation is bad all the time,” Monin said. “There’s no way to know if things are actually fine if you’re not there. The psychological distress is the ruminating, the feeling that you need to stay vigilant.” 

In working with older adults with dementia and their children, Teri Dreher often hears concerns about safety—and feelings of helplessness.  

“I call it the fear of unknowing,” said Dreher, a registered nurse and patient advocate who assists older adults and their families. “It’s not understanding what’s going on and being so far away, you can’t do anything except worry.” 

Diana Cannon, a companion caregiver for older adults in the Dallas area, serves as “another set of eyes” for families who live out of town. Clients hire her to visit their loved ones in senior living communities, sometimes even in high-end facilities that purport to provide round-the-clock care. 

If you hire a caregiver locally, she can report in regularly and even send smartphone videos to reassure you. 

“That’s a big source of stress—making sure family members are getting adequate care,” she said. Communities may boast posh facilities and lavish amenities, she said, but don’t always offer consistent care, which usually boils down to the staff person on duty, who’s typically working for low pay. 

“You don’t know what’s going on, especially if the person has dementia,” Cannon said. “I’m there to make sure they’re not lonely, that they get turned over regularly [if bedridden], that someone answers when they hit the call button, that they’re being listened to and their medications are being dispensed correctly.”

One of her clients called Cannon an “extra daughter.” The client lives in Houston; her mother lived in a senior living community in Dallas until her death at age 96 in 2018. Because her mother had severe hearing loss, talking over the phone was almost impossible. 

“I’d have to scream the whole time,” the daughter said. She hired Cannon to visit and call afterward with updates. Sometimes Cannon even sent short iPhone videos showing how her mom was doing. 

Even with the means to pay for extra help, the client said, caregiving from a distance was stressful for her and her sister, who also lives hours away. 

“When you’re there with your loved one, you wish you were doing what needed to be done at home,” she said. “When you’re at home, you wish you could be there. Diane was our ‘boots on the ground.’ She helped reassure us that Mom was getting good care.” 

Strained Relationships 

Family dynamics often complicate the long-distance caregiving situation.

“Distance can invoke a lot of feelings of sadness, guilt and shame,” said Vanessa Sommer, lead family therapist for signature programming at Caron Treatment Centers in Pennsylvania. “The adult child feels guilt for not being able to be an immediate support source. The caregiver who lives far away may feel a sense of rejection if they offer something as support or help, and it’s refused. The parent may feel abandoned. Or they don’t want to be a burden to their kids or to be seen as less than capable.”

The family’s relationship history plays a role too. “Caregiving crises can bring up a lot of old resentments,” Sommer said. 

When one adult child lives close to the older adult—and the other lives far away—that can lead to conflicting perceptions of how the older adult is faring. 

“The adult child who is closer may have more daily engagement and involvement with the older adult, and they see the changes over a period of time,” Sommer said. “Whereas the distanced child who has only intermittent contact may not necessarily see the physical changes, and that can lead to disagreements.” 

It’s not uncommon for siblings to argue over caregiving decisions, especially when medical crises arise, according to Marilyn Gugliucci, professor and director of geriatrics research at the University of New England. 

“Just as there are helicopter parents, there are helicopter kids—adult children who are too controlling because they fear losing the parent,” she said. “The older adult may have said, ‘I don’t want to go through heroic measures, I’ve had my life, let me go when the time comes.’ But one of the adult children might feel the need to control their lives to ensure they live longer.” As much as possible, the older adult’s wishes should dictate how to proceed. 

It can be difficult to find out from a distance about local resources available for caregivers. 

The stress of caregiving often has ripple effects on the relationships with the caregiver’s spouse and children. Sommer, who works with families of older adults with substance abuse disorder, says a stressful caregiving situation usually affects the entire family. 

Cognitive loss or personality changes due to dementia can make communication even more problematic. Plus, older adults are often reluctant to admit that they’re having difficulty. 

That’s been a challenge for Hood, who is also caring for her in-laws, who live in Tucson. 

“So much depends on the prior relationship between the adult child and elderly parent,” said Hood. “My mother-in-law is the most amazing, sweet woman. But is she at her best dealing with a husband in poor health? Not always.” 

Family members may get frustrated when an older adult is less than forthcoming, or even dishonest, about their situation. Monin encourages empathy. 

“Imagine someone doubting your ability to care for yourself,” she said. “That can be super threatening, even when the parents and children have a good relationship.” 

“All you can do is give each other a lot of grace,” said Hood. “Try to put yourself in the person’s shoes. Most older people are fiercely independent. They don’t want to burden their children. They may dread moving into a senior living community or having someone coming into their household. It’s easier to think, ‘I’m OK.’” 

Searching for Solutions

Tracking down assistance in another city can also pose challenges. Some communities offer services like daily telephone calls or other welfare checks for older adults. Finding out about those services, however, isn’t easy for those who live far away. Monin thinks policy makers need to assist long-distance caregivers in finding and connecting with resources from afar. She’d like to see a searchable, technology platform that would allow caregivers to find reputable resources in the care recipient’s local area, such as senior community centers, long-term-care centers, hospitals, physicians and other networks of supportive communities.  

In the meantime, to keep stress as manageable as possible, experts advise thinking ahead. Anticipate problems, know the older adult’s wishes in the event of an emergency and have a plan. 

“It’s all about prevention,” said Barry Wu, MD, professor of medicine (geriatrics) at Yale School of Medicine. “If your loved one falls, for example, you don’t want to be scrambling at the last minute.” 

Wu is in Connecticut; his 90-year-old mother lives in Pittsburgh. He relies on technology to help bridge the distance. 

“Her mobility has steadily declined over the last few years, so I set up cameras in her room, with her permission,” he said. He can look in on his mother any time from his smartphone. In addition, he calls her once a day, at a specific time, to make sure she’s OK. He assembled a list of local contacts—his mother’s physicians, the security person in her apartment building, neighbors and friends—which he posted on her refrigerator and saved in his phone. When problems crop up, he can call on his brother, who lives in the Pittsburgh area, to step in. 

Maria Hood began to travel to Florida more often once her father’s housekeeping and hygiene started to lapse. She hired a housekeeper to tackle some of the household chores, which allowed her father to stay in his home a little longer. Eventually, he moved into an independent living senior community, and then, after an injury, into skilled nursing, where he spent the rest of his days. 

In response to her experiences with her father and her in-laws, Hood and her husband sat down with their son and daughter and expressed their wishes for how they’d like to be cared for when the time comes. She draws on her own experience for her job at United Hebrew as she advises families navigating caregiving from a distance.

“The first thing I tell them is, ‘You are not alone,’” she said. “There are a lot of people in the same boat.” 

When Bob Evans lost his job in 2009, he began to consider what was next. He’d spent more than 30 years in the horticulture industry, mostly in sales and customer service positions in landscaping and lawn care. 

His wife reminded him that, in his 20s, Evans had wanted to become a nurse but set the dream aside to support the family. 

“It’s too late now,” he replied.

“I don’t think so,” she said. 

So Evans went back to school—in his mid-50s, the oldest person in his class. He earned a nursing degree and got a job as a registered nurse in a hospital. Just as he’d imagined in his 20s, he loved the work. 

People can expect later-in-life pivots, like Evans’ new career, to become more and more common as we live longer, according to the Stanford Center on Longevity. Human life expectancies doubled between 1900 and 2000. Living to age 100 will become commonplace by the middle of the 21st century. 

As more people live to 100, they may alternate time spent on work and career with periods devoted to family or caregiving.

“The 100-year life is here,” according to the Center’s report, The New Map of Life. “We’re not ready.”

Most people still expect life and career to follow the timeline shaped by a 60- or 70-year lifespan, according to the report, viewing the “extra” 20 or 30 years afforded by increased longevity as an extension of retirement and older age. In this model, college and graduate school, childrearing and prime earning years are crammed into the 20s, 30s and 40s. 

That needs to change, according to the report. This unparalleled demographic shift “calls for equally momentous and creative changes in the ways we lead these longer lives.” 

As more people live to 100, the report predicts, life trajectories will become more fluid and more flexible, and multiple transitions over the course of life will be viewed as “a feature, not a bug.” People will shift gears routinely, to new phases of work and career, possibly alternating with periods devoted to lifelong learning or family and caregiving responsibilities. 

Adapting to Change

“As people live longer, they’re realizing that retirement is not a destination, it’s a transition and a time of new beginnings,” said Dorian Mintzer, a retirement coach and coauthor of The Couple’s Retirement Puzzle: 10 Must-Have Conversations for Creating an Amazing New Life Together (2014). “It can be a time to rewire, rejuvenate and revolutionize.” 

Longer lives may lead more people to follow unconventional paths, like that of Jim and Lynda McDevitt of Plano, TX. Now in their early 70s, they’ve pivoted twice in the last two decades. After retiring in the early 2000s from long careers with the Internal Revenue Service, the couple opened a neighborhood wine shop called Corner Wines—and loved it. 

“We liked to say, ‘We’re like Cheers,’ because the shop was a place where everybody knew your name,” Lynda McDevitt said. “Most of the friends we have now, we made at our store.” 

Eventually, the shop’s six-days-a-week schedule began to take a physical toll, and the couple wanted to spend more time with their granddaughter. They sold Corner Wines in 2020. Now they call themselves “officially retired” but continue to stay engaged, providing occasional consulting services and leading “wine-themed” group tours to places like Tuscany and Napa Valley. 

Self-confidence is the key to success when you start a new career or any other new endeavor.

“We had such a passion for wine, we couldn’t let it go,” Lynda McDevitt said. 

Several factors made the McDevitts’ later-in-life transition possible. Both enjoy good health. Pensions from their IRS careers provided a financial base. Wine was their passion, but they’d honed practical skills while at the IRS: the basics of accounting, managing and marketing a business. Both had work experiences that gave them the confidence to start something new: Jim had presented proposals to top officials at the IRS; Lynda had fielded media interviews as an IRS spokesperson. 

That type of confidence is key in embarking on any new career or endeavor, Evans said. Even though he had worked in a very different field before he became a nurse, basic skills—like computer proficiency—buoyed his confidence to tackle the next phase. 

“Computer literacy was a big part of being able to jump back into college in my late 50s, to be able to function and graduate,” he said. “You can’t really stay in the game if you can’t work at a computer at least at a minimum level.” Former co-workers in his previous career who didn’t embrace the computer and internet have had more difficulty adapting, he added.

Along with confidence, a new start takes humility. 

“Assuming the role of novice required … swallowing my pride,” Evans said. That was humbling but necessary to learn the skills to serve patients.

Finding Purpose

In filming her 2022 documentary Lives Well Lived: Celebrating the Secrets, Wit & Wisdom of Age, which aired on PBS, filmmaker Sky Bergman chose interviewees, ages 75 and up, who were resilient, active and engaged—and discovered that all shared a common trait. 

“Everyone had a sense of purpose,” said Bergman, who is professor emeritus of photography and video at Cal Poly State University in San Luis Obispo, CA. “That purpose could change over time, and often did change over time, but that was the common thread.”

A health scare in 2003 helped Mellanie True Hills, 71, of Greenwood, TX, identify her next purpose. She developed a heart blockage, followed by atrial fibrillation (“afib”), which caused her heart to race. Surgery corrected the problem, but at the time, patients had little access to reliable information about afib. After Hills retired from her corporate job, she created a website, StopAfib.org, and began organizing annual patient conferences featuring experts. 

Skills developed over her long career in IT, web development and accounting all came to her aid. But Hills also credits her thirst for knowledge and her lifelong learning habit. 

When you start something new, don’t be afraid to change or to take a risk.

“When I was young, I had a boss who said, ‘Mellanie finds a vacuum and fills it,’” she said. “That is the mindset you need to have to start something new. You see a need and you fill it. It’s also a matter of not being afraid to change. That is hard for some older adults. Not being afraid to take a risk. Risk is the price you pay for opportunity.” 

Jan Gero pushes himself to keep taking risks artistically at the age of 90. After five previous careers—architect, modern dancer, fashion designer, documentary filmmaker and artist—he has reinvented himself as a monologist. Recently, he performed a one-man show, Naked at 90: An Evening with Jan Gero. 

His daily life is solitary, which he prefers, but he shares a video journal online and hosts The Compulsive New Yorker, a public access cable show from his apartment in New York. 

“I’m basically just saying what’s on my mind,” he said. “A lot of what I’m doing is trying to come to terms with death, because it’s a finality, a biological reality. Every day, I’m kind of asking myself the question, ‘Am I on the path to going down with a smile, rather than a sneer?’” 

Envisioning the Extra Years

Jerry Cahn, an executive coach in New York, recently launched a workshop titled, “Age Brilliantly: Maximize Your Ability to Lead a Fulfilling 100+ Year Life.” It’s not just for executives approaching retirement, however. 

The 30 “extra” years that many will enjoy shouldn’t be viewed as tacked on at the end of life, he said. Those years might be devoted to sabbaticals at any age, to provide breathing space for creative growth. Cahn cited a young professional who left one high-pressure job but postponed the start of his next job to devote four months to travel, including visits to Mount Everest, Nepal and the Camino de Santiago in Spain. 

Cahn added that many executives meticulously plan their finances for retirement and later life but head into their post-career years with vague plans, such as, “I’d like to travel.” 

“That might mean traveling six or seven weeks out of the year,” he said. “But what about the other 45 weeks? They don’t tend to think about that.” 

Mary “Molly” Camp, MD, assistant professor in the department of psychiatry at UT Southwestern Medical Center in Dallas, said more and more of her patients want to talk about how they’ll handle retirement and the second half of life. 

Young people might seek help for transitions—a guidance counselor when choosing a college or a therapist for premarital counseling. But there’s little to guide middle-aged or older people to prepare for the later transitions in life. Camp hopes that’s beginning to change.

“We’re evolving in our knowledge of human development, where we don’t think of adulthood as something you reach and then it plateaus and stays the same,” she said. “Instead, we’re understanding that life changes through lots of different phases, lots of different transitions, including career changes and retirement. It’s not that we turn 55 and everything becomes static.” 

Yet Another Chapter 

The COVID-19 pandemic forced Bob Evans to pivot again in 2020. His age and health issues made it too risky for him to work around COVID patients. He left nursing with plans to eventually return—then discovered that he enjoyed retirement. His wife, an IT recruiter, still works from their home in the Cleveland area, so Evans, 68, handles the household duties, including maintaining their large, landscaped yard, and volunteers with the Cleveland Hiking Club, helping to build a new pavilion at a local park. He looks in often on his father, who’s 93 and lives nearby. He’s developed an interest in family history. 

Just in case, he also keeps his nursing license up-to-date. 

“I’m not sure what the next chapter is going to be,” he said, “But that’s the fun part.” 

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.”