For people older than 85, the risk of developing Alzheimer’s is 14 times higher than for those ages 65 to 69. Contrary to the narrative that America is a selfish society in which most people neglect their older relatives or neighbors, the Alzheimer’s Association reports that 83 percent of help received by old adults in the United States is provided by family members, friends or other unpaid caregivers. Approximately two-thirds of the caregivers are women and one-third of those aiding people with dementia are daughters.

The financial impact on both the old and those in late middle age is staggering. The median savings of people in their middle age is just $15,000, according to the National Institute on Retirement Security. Social Security plus $15,000 presents a scary prospect for those who hope for a decent standard of living throughout the average 20-year American retirement.

When dementia strikes, all bets are off because even if there is a child who desperately wants to keep his or her sick parents at home, it becomes increasingly difficult, if not impossible, to do so without home health care aides — which, again, Medicare usually generally does not pay for. The problem is not just the shortcomings of Medicare, or the inadequate savings of many Americans, or the absence of effective treatment for Alzheimer’s. It is all of those things.

First, it is vital to address the disturbing human realities behind the statistics. An aging society affects everyone, but it affects women most because of their greater longevity. How can we continue to count on women to provide two-thirds of unpaid caregiving? I gnash my teeth every time I encounter one of those ubiquitous television ads for a business called “A Place for Mom,” which provides much-needed service by helping people find long-term care for parents. It’s not called “A Place for Dad” for a very good reason. We assume that Mom (or Daughter) is caring for Dad at home.

Second, public programs and private companies need to cooperate to provide opportunities for old people who want to and are perfectly able to go on working. That’s an important objective of AARP, which held town halls on aging in Iowa last summer. Most candidates attended at least one of the meetings, but the discussions received little national publicity.

Third, a healthier attitude toward aging also means examining moral issues. Physician-assisted suicide, for example, is the source of a fierce ethical debate that matters greatly to anyone who can imagine growing old. Questions about the end of life, like those about abortion, should be posed in every national forum. According to a Gallup poll conducted last year, 72 percent of Americans agree that doctors should be allowed to help end a patient’s life painlessly if there is no hope of a cure and the medical assistance is requested by patients and their families. The support drops to 65 percent if the phrase “doctor-assisted suicide” is used instead of “end a patient’s life” — yet another case of the American preference for euphemism.

No single “program” can deal with the intimate, painful problems associated with the growing proportion of old people who experience long but not necessarily healthy lives. Facing our own fears about what it means to grow old, without resort to soothing euphemisms, is the essential psychological shift that all Americans must make before we can meet the deadline to create a better reality for the old and their families.

Susan Jacoby is the author of “Never Say Die: The Myth and Marketing of the New Old Age.”

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