Aug 29 2011
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From Dependency to Interdependency: Coach Pat Summitt's Challenge to America

By Jason Karlawish, M.D., professor of medicine and medical ethics at the University of Pennsylvania, and recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research (2008).

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Pat Summitt’s announcement that, at the age of 59, she has been diagnosed with dementia caused by Alzheimer’s disease is sad news. Her plan to continue working as the head coach of the eight-time NCAA Division I national championship University of Tennessee Lady Vols basketball team is a shot heard round an aging world.

A person diagnosed with dementia still working? The idea seems bizarre, and yet a big-money college athletic program does not run its coaching staff like a small town volunteer basketball program. The University’s decision to retain her as a coach is an opportunity for society to engage in a vigorous debate about how we will live with cognitive impairment as well as with other impairments associated with chronic diseases common to older adults.

Summitt’s exact story is unusual. Alzheimer’s disease is rare before the 7th decade of life. But the theme of her story is common, and, in the coming decades, it will be even more common.

The United States is experiencing a longevity revolution. First, Americans are living longer. At the start of the 20th century, 4 percent of the U.S. population was over 65. Now, the proportion is 13 percent and by 2050, it will be 20 percent. Second, there are proportionately fewer people between the ages of 20 and 65, the traditional “working population.” Putting these two statistics together creates the “dependency ratio.” In the 1930s, this ratio was under 10 percent. By 2025, it will reach 30 percent and in Italy, Germany, Japan and France, it will be at least 40 percent.

With increasing age, come increasing disabilities as a result of diseases of aging. Declines in memory and other cognitive abilities, as well as declines in strength and endurance, translate into such problems as troubles managing money, driving or working a full eight hour day, five days a week. At the same time, the numbers of younger people who will pay for the care of older people is diminishing. These facts are often described as a kind of “silver tsunami” that will drown developed nations in the unaffordable costs of health and social services. But Coach Summitt’s plan suggests that this country can learn to thrive in this new longevity society.

The 20th century norms and expectations for aging, such as retirement at 65 or at the diagnosis of a chronic disease, simply don’t fit anymore. The reason is not simply a matter of treating older adults with dignity and respect, but of economics. We cannot create more young people, but we can harness the skills of older people and we can do that in ways that benefit all generations. The University of Tennessee’s basketball program is simply too high stakes to tolerate a coaching staff that is less than stellar. Coach Summitt and her colleagues have issued a challenge to America.

Disabilities caused by age-related diseases are not inevitable for all older adults, and when they do occur, as in the case of Coach Summitt, they can be mild and they can be monitored. This means that the workplace needs to reconfigure jobs in order to maximize a person’s existing abilities and deliver fair compensation. Systems need to be developed that permit people to continue working while at the same time undergoing confidential and objective monitoring for changes that might require retirement.

Volunteer work has to be taken to higher level of responsibility and commitment in order to create roles for older adults that address pressing social problems. The Experience Corps program that assigns older adults to work in challenging urban schools is a model example of harnessing older adults’ talents in a win-win manner. The children benefit from the tutoring, and the older adults benefit from the physical, social and cognitive engagement. Similar kinds of programs could be created for law enforcement and health care. In short, everybody wins and the dependency ratio morphs into the inter-dependency ratio.

The failure to reconfigure the workplace and society so that we tap into the resources of older adults will lead not just to a loss of their dignity and respect as we preemptively sideline still-talented people, but will also increase costs for their care without reaping the benefits of their remaining abilities. Older adults, even those with some degree of disability, are a tremendous resource of talent and skills. The tsunami of aging can become a gentle swell.

Jason Karlawish’s novel, Open Wound: The Tragic Obsession of Dr. William Beaumont, will be published this fall.

Tags: Behavioral/mental health, Clinical care, Early intervention, Human Capital, Investigator Awards in Health Policy Research, Research & Analysis, Voices from the Field