ADVANCE CARE PLANS: Don’t Wait Until You’re Old to Plan for Old Age

ADVANCE CARE PLANS: Don’t Wait Until You’re Old to Plan for Old Age

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Photo: Toni Miles, M.D., Ph.D., director, Institute of Gerontology, University of Georgia, Athens. Also, hear the WBAI “HealthCetera” radio interview.

Also read, “ADVANCE CARE PLANS: African American Seniors and Life’s ‘What-Ifs.”


Are you a go-go or a go-slow? Or maybe even a no-go?

It’s not some new Dr. Seuss book, but another way to describe the various stages of growing older. Barring a catastrophic event, older adults typically fall into one of five major life stages that take them from active and healthy to completely dependent on others.

The catchy phrasing – originally developed Duke geriatrician Harvey Cohen, MD -- was quickly adopted by the aging community as an easy-to-explain concept to describe an elder’s functional ability.

When ‘Life is Limitless’

The top group is the go-gos. These are older adults who “are in excellent health and can do anything they want,” said Toni Miles, M.D., Ph.D., director of the Institute of Gerontology, University of Georgia, Athens.

They are the ones portrayed in the active senior advertisements, like those for Viagra. They live in the community and often move in retirement into fabulous homes or retirement communities. For them, said Miles, “Life is limitless.”

But everyone eventually begins slowing down. “George H.W. Bush was a go-go,” Miles noted. The former president even jumped out of an airplane to mark his 80th birthday.

Today at age 91, she added, “He’s being pushed around in a wheelchair by his son. He has clearly transitioned.”

While not every go-go gets their kicks from skydiving, they eventually do move on to the next phase, go-slow. These are people who still live in the community, are still in fairly good health and can generally manage their own affairs. “They’re slowing down but, importantly, recognize it themselves,” Miles explained.

Perhaps they no longer like to drive at night. “What they’re telling you is, maybe they have a vision problem, or they’re anxious.” The good news, she said, is that they’re aware and begin self-limiting their activities.

Eventually, people segue from being self-limiting to needing assistance with instrumental activities of daily living. These “slow-gos” might visit a clinician every few months to manage multiple chronic conditions. They may have a neighbor who checks in on them regularly, or hire someone to mow the lawn or have their groceries delivered -- activities that require a complex blend of both cognitive and physical performance.

A Little Help From Family, Friends

Although gerontologists note that people may experience the phases differently--with someone of 91 still walking all over town and another of 71 well in decline -- individuals need to plan for support they may been given the vicissitudes of old age.

Miles continued that the next step down from the slow-gos are the slow-slows. “These are people whose relatives are worried about them and might suggest they move into assisted living. Slow-slows generally rate their health as only fair and have problems managing several critical activities of daily living. That might include medication management, or help with dressing, eating or bathing.

The last group are the no-gos. “That’s the group unfortunately, that a lot of people have in mind when they say old,” said Miles. “But there’s all these other stages ahead of them.”

“This group no longer makes their own choices,” she explained, for instance, because of mental impairment or debilitating illness. “They have people making choices for them,” such as a spouse, adult children or another health care proxy the senior has designated to make decisions.

Miles, who has worked on federal eldercare policy issues, said that government, clinicians and nonprofit organizations need to think about how all of these pieces fit together and collaborate to create the best frameworks for every stage of aging.

She observed, “Selling a no-go lifestyle to a go-go is hard, so we need to have home and community services already in place when they suddenly find they need it.”

Some older adults have planned well but others have not. As baby boomers begin the transition from go-gos to go-slows and beyond, that could strain social safety nets.

“We haven’t had the conversation yet about how much responsibility we have as we enter old age for ourselves. I am responsible for how I arrive at old age and what resources I can bring and then, the social contract says in our society we owe each other something, “ she said.

Just what that “something” is has been the topic of much debate [http://tinyurl.com/z2h8m6s] within the gerontology and policy worlds. It is intensifying as more baby boomers begin reaching the go-slow and slow-go stages.

Engaging Brain and Body

Regardless of life stage, it’s never too early, or too late, to plan for old age. “You have to envision your future debilitated self,” Miles explained. “That is so hard. No one wants to do that.”

One step boomers can take is becoming more intentional on how they live their lives – finding a work-life balance and taking time to de-stress. Another is to make learning a lifelong process.

One of the biggest antidotes to debilitation at any age is education, according to Miles: “You should always be learning new things -- and it doesn’t have to be academic type learning, it’s whatever makes you happy.” She stressed, whatever the activity, do it at a very high level so both brain and body are engaged.

What else can we do to help ourselves to perhaps slow down the transition from go-go to no-go?

“Eat your vegetables. Exercise as often as you can. And get a good night’s sleep.” Those three things, said Miles, are keys to preserving cognitive function.

Having a brain that works will get a person as far as possible in their own aging process. “Then you can accommodate your own disability, you can make the decisions that you need to make.”

But, she cautioned, we need to anticipate that even that organ may eventually fail. So find a surrogate brain – your proxy -- when can take it up when needed.

This report was supported by a Journalists in Aging Fellowship, a collaboration of New America Media and the Gerontological Society of America, sponsored by the Silver Century Foundation. Also, hear her interview with Dr. Toni Miles on WBAI radio’s “HealthCetera” program.