Who is Dr. Bill Thomas?

by, Kavan Peterson, Editor, ChangingAging.org

Dr. Bill Thomas is an international authority on geriatric medicine and eldercare. He is a professor at the Erickson School at the University of Maryland, Baltimore County and has been heavily involved in the culture change movement to promote elderhood as an honorable and valuable position in our society. Click here to read more.
Eldertopia and the New Old Age

Dr. Bill Thomas: Eldercare, aging and us

Dr. Bill Thomas speaking at the 2007 Pioneer Conference, Part 1:

Dr. Bill Thomas at the 2007 Pioneer Conference Part 2:

What Is Old Age For?
by William Thomas

Old age is humanity’s greatest invention, and on an even deeper level, it invented us. Old age transformed the way our most distant ancestors gave birth, reared their young, lived together, and fed themselves. Later it propelled the development of culture, language, and society.

Humans are primates, and among all primates we are most closely related to chimpanzees. We hold 98 percent of our genetic code in common with them. Yet a comparison of human and chimp life cycles reveals some unexpected differences.

Human beings can live twice as long as our nearest relatives—surprising in itself. Astonishing, however, is that all of this additional longevity follows the loss of fertility. Chimp and human females become fertile at nearly the same age and remain fertile for about four decades. For the aging chimpanzee, death follows hard on the heels of the loss of fertility. The human female possesses a nearly 50-year longevity bonus that follows the end of fertility. Our post-reproductive longevity exists because it affords our species a unique and powerful competitive advantage. Hidden within this extraordinary elongation of life is the story of who we are and how we came to be.

The first grandmother
One million years ago on the plains of Africa, a hominid child cries out from hunger. Her mother has recently given birth and is distracted by the needs of her helpless infant. The delivery was long and difficult and much blood was lost. The mother barely has the strength to nurse her infant. She can neither feed nor care for her older child. The mother of the new mother, the grandmother of the crying child, is moved to act. Thus was the first tentative step taken down the long road that led to the development of the modern human being. The deliberate enlistment of grandparents into the work of rearing the young stands as a defining characteristic of Homo sapiens.

Substantial advantages accrue to offspring who can be cared for by two generations of adults. The extra food and attention significantly improve survival rates. University College researchers in London found that in Gambia, infant mortality rates dropped by 50 percent if the maternal grandmother was present in the household (interestingly, no benefit was found when the paternal grandmother was in residence). Ruth Mace, one of the researchers, noted that the presence or absence of the father had no bearing on infant survival: “If the grandmother dies, you notice it; if the father does, you don’t.”

Research in India has found similar results. Surely the grandmothers’ contributions of time, energy, and material resources across generational lines are important, but that is not all there is to it. Humans, in particular humans living in active multigenerational families and communities, benefit from intergenerational affection.

The genius of human longevity
The development of menopause and the refinement of grandparenting played a critical role in the physical evolution of the modern human, but the story does not stop there. About 40,000 years ago, another remarkable round of adaptations changed how people lived. Homo sapiens generalized the benefits of grandparenthood by linking old age to the work of social evolution. The development of human culture—its refinement, storage, and transmission—was woven into the fabric of old age.

An African proverb says, “The death of an old person is like the loss of a library.” In these words are embedded the important role given to older adults in many African cultures. After a person has productively lived his or her life as an adult in the community, he or she is honored by initiation into the elder circle. This usually happens around the age of 65.

These elders, now masters of the school of life, have the responsibility for facilitating the transition from childhood to adulthood of new generations. They are responsible for and oversee the process of initiation. The idea of elders as “library” also reveals the fact that only the elders have full access to the tribe’s knowledge base. The elders safeguard the highest secrets of the tribe and protect its medicine and inner technologies. They incarnate the wisdom of the society, which they happily share, often in the form of storytelling.

Anyone in the last half of life can attest to the difficulties, the aching joints, the fading eyesight. What is open to interpretation is the meaning of these changes. What if they are understood as a form of preparation (not unlike adolescence) for a new life as an elder of the community?

The physical decline that comes with aging actually cements the relationship between old and young. Indeed, an old man still capable of stalking, killing, and butchering a mastodon would have little inclination to spend hours doting on grandchildren, telling them stories, and instructing them in the ways of their people. An old woman still capable of producing young of her own would hardly be inclined to pour time, love, and attention into the lives of her grandchildren. The physiological changes that accompany old age, and upon which contemporary society heaps unlimited scorn, are actually essential preconditions for a socially productive old age.

Human elders have long been known as peacemakers, and for good reason. The physical changes that accompany advancing age make conflict, armed and otherwise, worthless to the old. Like statesmen serving their final terms in office, elders are freed from the tactical maneuvering that defines the struggle for adult rank and prestige. It is this freedom that allows them to put forth unique interpretations of the problems faced by their families and communities. The awareness of one’s mortality that normally arises in late life—and so terrifies adults—opens new perspectives for elders on the world in which they live.

Being an elder
The promises of the current anti-aging fad perpetuate an illusion of unlimited longevity. This strengthens the characteristic adult devotion to doing, having, and getting. The result is an underdeveloped, increasingly dysfunctional population of developmentally delayed adults who are prone to catastrophic errors of judgment. The mania for
having and getting diminishes the value of stewardship in our culture. The preservation of resources for the benefit of those yet to be born, or even for the common good of those living now, is airily dismissed as simple-minded idealism. At the root of it all is the adult fantasy of unlimited time, unlimited wealth, unlimited resources, and unlimited information.

Adulthood itself is a right and fine thing. I am an adult. I love adulthood. I find daily pleasure in living as an adult and have no interest in returning to the childhood I have outgrown. Nor am I ready to enter into an elderhood that requires perspective, experience, and judgment that I do not yet possess. Adulthood, rightly understood, provides us with a productive, potentially glorious interlude between youth and old age. The problems begin when we conceive of it as a permanent necessity, an apex of human experience that must be defended and enlarged no matter what the cost.

Adulthood is chained to the rock of doing. When two adults meet, it is rare for more than a minute to pass before one of them pops the question, “What do you do?” Adults inhabit a world of tasks and schedules, payments, obligations, and jobs that need to be done. Yet in all this busy doing, they may ignore deeper questions of whether those tasks are worth doing and whether they foster meaningful relationships. These are questions not of doing but of being.

Doing and being are best thought of as two sides of one coin. As humans age, the action-oriented strategies of DOING-being give way to the indirect and subtle influence of BEING-doing.

Consider how adults and elders bake cookies. The adult tends to approach cookie baking as one more item on a long list of things to do. The children are either banished from the proceedings or—if the adult is feeling particularly guilty about a perceived deficit in the “quality time with the children” account—the children will be included, with some apprehension. The cookies are baked with dispatch, and dire warnings about eating raw cookie dough (possibly salmonella) are issued along with lessons about the virtue of cleaning up as you go.

The elder is much more likely to want to bake cookies than to have to bake cookies. As a result, children are more than welcome. Eating raw cookie dough? “Never mind what your mother says; go right ahead.” Flour, sugar, and eggs are used with abandon. Bizarre and experimental cookie shapes are welcomed. The crucial difference between the adult and the elder is that the former is fixated on the doing while the latter seeks the being. The adult cares about the cookies and is happy to log some quality time if possible. The elder cares about the relationship and is content with the cookies no matter how they turn out.

The central social and cultural challenges of our time revolve around the malignant enlargement of adulthood and the adult obsession with DOING-being. Adulthood, intoxicated by its own might, is intent on remaking youth and old age in its image. It has already defined the best child as the most precocious child. The wunderkind mimics adult behaviors and styles of work and learning. Likewise, adulthood demands that those who would remain worthy defy their age and continue to think, walk, talk, look, and work like adults.

Liberating elders
In 21st century America, only two categories of people still face routine and even permanent institutionalization—criminals and the elderly. In the last half of the 20th century, prisons and nursing homes both experienced a steady rise in the number of inmates. The true nature of the nursing home is especially obvious to those schooled in the ways of institutions. One prisoner wrote to tell me how much the nursing homes where he visited his grandmother reminded him of prison, and I have received many communications like this one from a former nursing home resident:

I have recently returned from “rehabilitation care” in a nursing home. I have pretty severe cerebral palsy and had breast cancer surgery. The nursing home environment did more to slow the healing process than help. I got a terrifying glimpse into a future in such facilities. I would rather die than have to exist in such a place where residents are neglected, ignored, patronized, infantilized, demeaned, where the environment is chaotic, noisy, cold, clinical, even psychotic.

Early advocates for the aged understandably concentrated their efforts on eradicating the mistreatment of the old. They were among the first to speak openly against the agism and overt bigotry practiced toward the aged. The much broader effort to liberate elders and elderhood, however, has yet to be truly begun. Such a crusade is necessary not because it can right wrongs that are visited on older people (although it can) but because it is the essential precondition for a new culture committed to a better quality of life for people of all ages.

The elder-guided society (I call it Eldertopia) is and should be run by the vigorous adults of the time. Elders should intervene at critical points to ensure that the adults take into account perspectives that are too easily ignored by those gripped by the fever of rank and wealth.

Since 1900, the percentage of Americans over age 65 has more than tripled, and those who reached age 65 in 1998 could expect to live on average another 17.8 years. Far from being ravenous locusts determined to consume an ever-increasing share of scarce resources, our growing number of elders represents an unprecedented windfall. I believe that the elders of our time form the only force capable of returning adulthood to healthier bounds. Consider the gifts a liberated elderhood could offer our society.

Elders have always made important contributions to the young of their families and communities. For thousands of years, relationships between young and old have made life better for both groups. In Elder­topia, all school construction and remodeling projects would include housing and community services for elders.

Elder councils could provide a balancing perspective that considers the long-term consequences of any proposed action. The topics addressed might well include matters that the conventional political system would rather sweep under the rug.
Elders have long spoken for Earth, its living creatures, and the children who are yet to be born. Elder­topia would have an Elder Conservation Corps that would tackle projects that strengthen the health and vitality of the natural world.

Any honest accounting of the potential influence of elders and elderhood must address the contributions not only of fit and energetic elders. It must recognize the contributions that people who are weak, ill, infirm, dependent, demented, disabled, and dying can make to this struggle. The old and frail are able to surmount the dizzy bustle that clings to the young—to enter a time and place in which the spiritual and emotional dimensions of human life take precedence over the humdrum workings (and failings) of organs, tissues, and systems. This is among the most admirable of all human endeavors. What the old and frail do is show us the way. They provide us with greater insight into and a clearer perspective on the human condition.

The most elder-rich period of human history is upon us. How we regard and make use of this windfall of elders will define the world in which we live.

Adapted from What Are Old People For? How Elders Will Save the World, by William H. Thomas, M.D., copyright 2004. Used by permission of VanderWyk & Burnham (www.VandB.com), Acton, Massachusetts. All rights reserved. William Thomas is a geriatrician who created the Eden Alternative and the Green House Project .