The geriatrician Louise Aronson discusses why Americans over sixty-five are entering the workforce. Source Photograph from Getty

In her book “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life,” Louise Aronson, a geriatrician and a professor of medicine at the University of California, San Francisco, examines Americans’ fraught relationship to the aging process, from our enthusiasm for supposed anti-aging cures to our troubled health-care system and the persistence of ageism among employers. Too often, Aronson argues, people over the age of sixty-five are viewed as a single group—one whose needs and desires and humanity are given short shrift, particularly within a medical system that is ostensibly centered around the needs of the elderly.

Questions about the place of the elderly in American society have become especially pertinent in our current political moment. On Inauguration Day, 2021, a septuagenarian—Donald Trump, Joe Biden, or Bernie Sanders—will almost certainly be sworn into the office of the Presidency.

To discuss the perceived and real effects of aging, I recently spoke by phone with Aronson. During our conversation, which has been edited for length and clarity, we discussed why so many Americans over sixty-five are entering the workforce, whether the Presidency is the wrong job for someone over seventy, and why we tend to view older Americans as a single, distinct group.

Your book is very sympathetic to the realities of aging, as it should be. But what have you made of the fact that our next President is likely going to be seventy-four, seventy-eight, or seventy-nine when he is sworn into office? And how should we think about that as citizens?

What a lovely question. I guess I would see it as the most visible part of a national trend, which is that, for the last several years, by far the fastest-growing segments of the American workforce, and this comes from the Bureau of Labor Statistics, have been people age sixty-five and up. That includes two groups, and, actually, they parse it a bit, even though I complain in my book that we often don’t parse it. One is ages sixty-five to seventy-four, and one is ages seventy-five and up. The relative increases are four to five times higher than the increases in workforce gains in people in their thirties, forties, and fifties. So it’s really this new phenomenon, which has come after a slight lag.

When we set Social Security and retirement in our sixties, the average age of death was about sixty-two. And now the average age at death is seventy-nine, with huge variation according to gender and race. The leading [Presidential] candidates are all white, which gives them a mortality advantage, as does the fact that they’re all educated. So people their age very routinely live into their eighties. And, actually, a man at age seventy-five has on average eleven to eleven and a half years of additional life, most likely, the vast majority of which are healthy.

To take a step back from the Presidency, how do you view this workplace trend?

I think it’s a good trend for a variety of reasons. One is that society simultaneously is quite ageist about, say, “Isn’t it time to retire?,” or “That person’s over the hill,” or not hiring, or all those hiring pull-down menus where they might not include a variety of birthdays of people who could be perfectly competent for the job. I speak to a lot of people in companies where they’re, like, “But maybe they won’t last very long.” And they don’t consider the youth equivalent, which is that most younger people now switch jobs really often.

I’m digressing, but we can’t have a society that simultaneously discriminates on the basis of age and doesn’t hire or phases people out on the basis of age, and then complains about older people as a burden. You can’t have it both ways. You can’t say, “Oh, you’re not fiscally contributing,” and then, “We’re not going to let you fiscally contribute.” That is short of productive—economic and societal hypocrisy, basically.

One of the reasons I called the book “Elderhood” was because I really wanted to emphasize the fact that modern old age—the old age that evolved over the twentieth century, when we moved from an average lifespan of forty-nine to seventy-nine—is colossal, that elderhood has become like childhood and adulthood. It is a phase of life that lasts decades and includes a huge diversity of people and functional abilities. So we easily accept that a neonate, infant, and toddler are children, just as teen-agers are children. And those are pretty different-looking animals. Similarly, we have a twenty-year-old in our household, and we’re in our mid-to-later fifties, and those are pretty different, too. You could argue a little less so, but, the further along I get, the more I’m aware of the differences.

So how old are you? I know it’s a rude question, but, in this case—

No, no. Fifty-six.

I’m thirty-seven, just so we’re all honest and on the record.

I did search you, to get the sense of who I was talking to. I find I actually sometimes do get different questions depending on how old the person is.

So, while we all talk about our twenties or thirties as being so different from each other, you’re saying the difference between sixties and seventies, or seventies and eighties, and eighties and nineties, are actually huge?

Exactly. A fascinating thing has happened in geriatrics just in the last decade, which is that we now sometimes take care of two generations. I’ve had patients in their hundreds where their kids are in their seventies or eighties. And I routinely have people in their eighties and nineties who have kids in their sixties or seventies. So it’s really becoming multi-generational, because of the vast numbers of people living so many more years, and we need to acknowledge that those people are different. Different decades, no matter how old or young you are, are all very different, and that’s part of life’s excitement. We keep moving forward.

Do you have some broad way of thinking about different ages or stages of elderhood?

I think one of the problems with old age is that we all begin young. So it all seems very old and foreign to us. There have been some subcategories. A psychologist, Bernice Neugarten, named the stages Young Old, Old, and Old Old, and that was roughly sixty-five to seventy-four, seventy-five to eighty-four, and then eighty-five up. We do have increasing numbers of centenarians, so that is a broad range. But one could argue that the sixty-five-to-seventy-four range, except for the most disadvantaged—and there are all these structural things that contribute to that, like stress and poverty—is a blurred line in medicine. Are you more like an adult? Are you more like an elder? And either can be true. And, as you get into seventies-to-eighties, there still is a range, but there are more people who are going to resemble the older people.

We got sidetracked, but can you say more about why you think it is good for older people to stay in the workforce?

One is that the economic burden goes down. The longer you work, the less likely you are to be the so-called burden. But perhaps more important is that health and quality of life go up when people keep working. I should also qualify that to use the word “work” broadly. We tend not to count traditionally female things, like caregiving, although we’re seeing increasing grandparents participating. But there are many ways in which you can contribute to your family or your community. People who have lots of wealth may be doing volunteer jobs—that’s still work. But we know unequivocally that people who keep working maintain higher levels of physical function and cognitive function. They just tend to be healthier. It probably relates to this growing database on purpose and health, and optimism and health. If you’re doing something that feels like it has purpose or meaning—although these are things we actually often intentionally strip old people of—then you have a reason to get up.