Welcome to gerontolescence
Just as the baby boomers had a long transition from childhood to adulthood, they are now conquering life after the age of 55
Alexandre Kalache, President of the International Longevity Centre-Brazil, co-president of the Global Alliance of International Longevity Centers, and former director of the World Health Organization Global Aging Programme
I don’t know how the idea first sparked in my mind. It might have been because of one of those luminous spring mornings when, driving westward to my parents’ house, the massif stood at the end of the highway like a pot of gold. Framed by the trees on both sides of the road, Mount Rosa, covered with snow, appeared like a vision and I felt it calling. As a collection of peaks, it sits peacefully and majestically between Italy and Switzerland with the calm of a queen that, everybody knows, can unexpectedly show her rage. Maybe it’s the name “Rosa” that gives it a kind, friendly flair that contrasts starkly with the male counterpart “Bianco”, the daunting highest peak in the Alps. The moment I gave words to my idea, I was already looking for a team that would take me there, 15 thousand feet above the ground. I felt a strange mix of concern and excitement. These feelings came in waves and, as Ulysses, I tied myself to the mast of my doubts, while I listened to the song of the adventure.
The date for the hike was set for the first weekend of July. A very early wake up and we were breezing along that same highway that presented the mountain image to me. The sparkling mountain air welcomed us as we opened the car doors in the little town’s square, our last stop to get the food and the gear we needed. The wooden floor of the village food store gave hollow sounds under our steps. Mouthwatering cured meats sat on wooden shelves, forms upon forms of cheese revealed their straw yellow hearts - a key to gauge the mild or decisive flavor by an unwritten equation between color and firmness - woven baskets overflowed with fresh breads. I traded my blue mountain boots for a pair of white high-mountain boots with crampons. After a short hike, the seven of us, and our two guides, sat on rocks in a forest of pine trees, telling stories as chirpy as birds and enjoying a cold lunch. Soon after, we traded the palette of greens full of life for the silent vastness of the snow and a five-hour march that took us to the mountain hut where we would spend the night. On the ground floor of the building, white and red checkered tableclothes gave the pine tree wood tables a cheerful look. On the opposite site, some climbers were chatting at a long bar counter. The room was filled with a dry and serene light and the whole place buzzed with beehive ferment. I could pick up different languages spoken and, although each group kept to itself, we were all swimming in the same electrifying stream. I sat on a bench outside the hut, looking carelessly at a couple of dogs playing, the placid mountain valley at my feet. I felt at peace.
Sleep turned into a large-mesh fabric, which I could slip in and out of it, courtesy of a headache, a side effect of the rarefied atmosphere. We were already at 11 thousand feet. Wandering around the hut in the dark, I spotted through a window a row of lights in the night. The first groups moving to conquer a thin crest were already on the their way before the sun melted the snow. I marveled at their slow determination and waited for the first light to appear. Tied to my climbing buddies, I began to walk. The crampons made a crunchy noise in the iced snow and when the sun illuminated the valley, it gave the snow a brilliant luminosity. I had the feeling of climbing a mountain made of sugar. We crossed a handful of thin and deep crevasses and I marveled at their aqua, ethereal core. Hour after hour we inched slowly forward. It’s not that every step was more painful than the previous one, it was just as painful, but it needed more willpower to take it. One deep breath, one step, one crunchy sound, repeat. My mind was like a yellow canary hitting the bars of the cage every time it tried to fly. When we finally reached the last slope under the Queen Margherita Hut, a perched refuge that looks like a railroad car poised precariously on a overhang rock, we were like surfers riding up, instead of down, a wave.
Contemplating the challenges of an aging population must have appeared like a mountain to climb to Alexandre Kalache, President of the International Longevity Centre-Brazil, co-president of the Global Alliance of International Longevity Centers, and former director of the World Health Organization Global Aging Programme. The same way the massif revealed to me that morning on the highway, he must have seen the entire construction of aging and its mind-boggling development through the statistics. Study after study, research after research, conference after conference, as every climber knows, the ascent gives moments of revelation and he certainly had many, as he recalled in our delightful conversation.
You specialized in Tropical Medicine. How did you become interested in aging?
I went to medical school because I was interested in public health. I thought that proving myself as a doctor would make it much easier to have a career in public health. I worked in clinical medicine for four years and then moved to London for my Master’s degree. It was there that I heard about geriatric medicine for the first time. You see, in Brazil, the focus was on infant mortality, infectious diseases, and low life expectancy and I trained in tropical medicine because that was one of the key issues we had to deal with as, at the time, the percentage of Brazilians over 60 was no more than 5%. When I moved to London, the stark difference in the population distribution called my attention immediately.
What happened then?
One day, I read an article in The Lancet stating that 83% of the geriatricians working in the UK were not British-qualified doctors, but came from developing countries. Somehow, British-qualified doctors were not interested in geriatrics. It was a space considered for “second-class” doctors, which of course they were not. The second year of my Masters was dedicated to writing my dissertation and I wrote exactly about that: why MDs are not interested in geriatrics. In order to come up with an explanation, I designed a survey and submitted it to all the 850 geriatricians who practised at that time. There was no Internet and the survey had to be done by post. Imagine the headache in soliciting a response. Nonetheless, I ended up with a 92% response rate and I identified two groups: those who were satisfied with their job as geriatrician and those who were not. It came out as a revelation that the first group was composed of doctors who had had a chance to be in close contact with older people during their childhood. Preferably, they lived under the same roof. The other group, instead, thought of geriatrics as a quick way to have a career.
Subsequently, I conducted another study, this time on young medicine students in their first clinical year. The students, on a rotation scheme, spent time in different hospital wards. After a month spent in geriatrics, we measured their attitude and discovered that they mirrored the attitude of the doctors they worked with. The longer the doctor worked, the more disengaged they were and the young medical students adopted that attitude, complaining we took them away from tech medicine to put them in contact with patients with multiple pathologies. They declared they were not familiarized with older people and they felt depressed in talking with them.
When was it?
It was 1975 and the projections were already clear. The natality was shrinking and the population was aging. At that time, in Brazil, there were 6.5 children per woman. In the year 2000, it was less than two. I could see what was going to happen. I presented the results throughout the country and I got an offer as clinical lecturer at Oxford University. Although it was not my plan to stay in UK, I did so and got my PhD. That is when it first became clear to me that there was a hiatus between reality and the future and we were not prepared for that.
Did you belong to the group of MDs who had a close relationship with older adults during their childhood?
Yes, I was surrounded by older people in my childhood. I had a lot of interactions with them. I got bored of my peers very quickly - we were allowed to play amongst boys only - and I ended up sticking around my grandparents. They were immigrants from Portugal, Italy, Greece and Lebanon with dozens of siblings. They had so many stories to share and they always had some treats for me. I learned how to cook just by looking at them doing so. When I was 15, my widowed grandmother came and lived with us in Rio. One day, my mother told me my grandmother had cancer and asked me if, as an aspiring medical student, I would help her look after my grandmother. For three years I had the privilege of spending time feeding her, talking with her, and playing the piano to cheer her up.
With the growth of nuclear families, contemporary children do not have the same chance.
This is a disaster. In the nuclear family children and teenagers do not have contact with older people. In poor classes they do out of necessity, but we are seeing the consequences of this situation with the pandemic, whereby older people either pay the price of their isolation or are exposed to contagion through younger people who need to work.
The study-work-retire paradigm contributes to the marginalization of the older population. What is your take?
We need to reinvent the life course because of aging. The German chancellor Otto von Bismarck introduced the idea of retirement in 1881. The majority of jobs required physical labor and so it appeared that sending these workers home with some money to provide for their needs was the most sensible thing to do. Because few people reached the age of seventy and beyond, it was an easy equation. Now, 140 years later, we’re still doing the same thing, even if we have thirty or forty years of life after we retire and this is a big mistake. When we age is the time we need money the most. Take Brazil, for example, the average retirement age, for those who have a pension, is 57. We need to rethink the whole way we organize the life course segmentation.
What types of changes should we implement?
First of all, we need to learn to learn. We need to learn all our life. Especially today, knowledge becomes obsolete very fast. We need to re-invent the study-work-retire model. We need to be in contact with other generations in our universities. We must get ready to jump from one job to the next and in order to do so we need to learn entrepreneurial skills. As we age, we need to have quality of life and a broad range of opportunities. But little money means little quality of life and little satisfaction. This impacts on the self-esteem of the person we become as we age.
Stronger intergenerational solidarity and a reframing of care are critical in approaching the challenges of an aging population. Are we doing enough?
The way we look at caring is especially bad for women. Our society expects them to do it all: working, learning, raising a family, and caring for the aging parents. We expect women to care and they run the risk that nobody will be around to care for them when it will be their turn to be taken care of. Men have to learn how to care too, how to provide care for children, grandchildren, and grandparents. Longevity forces us to think differently. For instance, I pushed to have a wider adoption of geriatric medicine in the curriculum of Brazilian universities. Only 10% of the universities teach geriatric medicine. I told medical students they were going to intoxicate and kill their patients, because they haven’t learned how to care for older patients. All they learn is how to treat a young male body, but they will increasingly deal with older women. In 2070, 35% of the population of Brazil will be over 60.
You minted the concept of “gerontolescence.” What is it?
I was born in 1945, I’m a baby boomer. I entered medical school in 1965 when the last baby boomer was born. As infants and children, we had lots of attention, we enjoyed better health care than any other generation in history; we were the first to benefit from vaccinations and screening medical technology. We learned for much longer, we are more knowledgeable and affluent than others. We are a very numerous generation and because we are so numerous, we had an impact on culture when we were younger and we keep having an impact now. We revolutionized the transition between childhood and adulthood. We actually invented this transition.
Now that we are older, we have more time to crystallize who we are. Sometimes, I joke saying that we are the generation that came home with a girlfriend and closed the bedroom door behind us and our parents didn’t know what to say. Now we do the same and our grandchildren do not know what to say. We think differently about freedom, about rights. I am 75 and am completely different from my father at the same age. Just like we had a long transition from childhood to adulthood, we are having a long transition from adulthood into old age. Gerontolescence marks this transition. In the span between 55 to 75 years, we experimenting and rethinking old age.
The majority of the elderly population will be living in the poorest countries. What are the implications of this situation?
There are huge implications, especially for developing countries. For instance, France doubled the number of over-65 in 6 to 7 generations. They were 10% in 1845 and 20% today. In the developing countries, instead, this change is happening in one generation only. Because of a longer life expectancy and a falling birth rate, we are compressing the speed of aging. In 2030, in less than ten years, 64 countries will have a fertility rate lower than the replace rate. This means that we are having a rapid aging without the resources to deal with this stage in life.
The developed countries had the time and the resources to replace family care with state care, but in a developing country there are so many pressing issues - the Amazon forest is burning, we are dealing with growing rates of pollution - that we risk transforming longevity, the most important achievement of our life, into a problem.
Migration is complicating the picture, correct?
As a son of immigrants myself, I am perfectly aware of this challenge. Migration makes everything more complicated. Migrants leave their aging parents and grandparents behind. We also need to factor in the internal migration. I’m a professor in Granada, in Andalusia, where the proportion of older people is 45%.
In 2007, the UN declared that more people live in the city than in rural areas. We need to prepare the cities for the aging population, because that’s where people are going to age. That’s why, when I was director of
the World Health Organization Global Aging Programme, I launched the Age-friendly Cities initiative and I rang the alarm: cities are not ready for their aging population.
Western societies have a cultural bias against aging. Does this impact on the way we look at aging as a problem to be solved instead of an opportunity to be seized?
Ageism is a big cultural problem. When I launched Active Aging the goal was to define and optimize opportunities for health, longer life, participation, and security. Health should be guaranteed at any age. Longer life means having more opportunities and participating is key to being a respected member of society. We also need security, because the worst thing that can happen is to age without feeling protected. We need policies that embrace these changes. If we only count on the individual effort, we risk penalizing the victim.
That’s why I feel uneasy when people automatically equate aging with wisdom. Many people grow older without becoming wiser, because they are excluded, mocked. There’s a lot of ageism around and women, in particular, bear the brunt of this situation. The lack of opportunity robs people of the possibility to develop wisdom.
Aging stands out as a chance to look at the world from a more just, equitable and sustainable perspective. Do you agree?
I agree. This is why we need to embrace aging, bring the population together. At WHO I commissioned 16 studies on the resilience of older generations, from the earthquake in Turkey to snowstorms in Canada. Old people have seen it all: war, riots, economic crisis and they know that there is a light at the end of the tunnel. We need to work together across all generations. Old people don’t compete; they want to leave a mark, a legacy. We need to seize the fact that they are a transformational force for the greater good.
