MONEY Health Care

The State of Senior Health Depends on Your State

Dollars and cents
Finnbarr Webster / Alamy

Reports on senior health reveal a north-south divide. Many worst-ranking states rejected Medicaid expansion.

What are the best and worst places to stay healthy as you age? For answers, take out a map and follow the Mississippi River from north to south. The healthiest people over 65 are in Minnesota, the sickest in Mississippi.

That’s among the findings of the America’s Health Rankings Senior Report released in May by the United Health Foundation. The report ranks the 50 states by assessing data covering individual behavior, the environment and communities where seniors live, local health policy and clinical care.

Minnesota took top honors for the second year in a row, ranking high for everything from the rate of annual dental visits, volunteerism, high percentage of quality nursing-home beds and low percentage of food insecurity. This year’s runners-up are Hawaii, New Hampshire, Vermont and Massachusetts. (See how your state fared here.).

The researchers base their rankings on 34 measures of health. But here’s one you won’t find in the report: state compliance with the Affordable Care Act (ACA). While the health reform law isn’t mainly about seniors, it has one important feature that can boost the health of lower-income older people: the expansion of Medicaid.

The ACA aims to expand health insurance coverage for low-income Americans through broadened Medicaid eligibility, with the federal government picking up 100% of the tab for the first three years (2014-2016) and no less than 90% after that. But when the U.S. Supreme Court affirmed the ACA’s legality in 2012, it made the Medicaid expansion optional, and 21 states have rejected the expansion for ideological or fiscal reasons.

And guess what: Most of the states with the worst senior health report cards also rejected the Medicaid expansion.

Nearly all Americans over age 65 are covered by Medicare. But the Medicaid expansion also is a key lever for improving senior health because it extends coverage to older people who haven’t yet become eligible for Medicare. That means otherwise uninsured low-income seniors are able to get medical care in the years leading up to age 65—and they are healthier when they arrive at Medicare’s doorstep.

Two studies from non-partisan reports verify this. The U.S. Government Accountability Office reported late last year that seniors who had continuous health insurance coverage in the six years before enrolling in Medicare used fewer and less costly medical services during their first six years in the program; in their first year of Medicare enrollment, they had 35% lower average total spending.

The GAO study confirmed the findings of a 2009 study report by two researchers at the Harvard Medical School. That study looked at individuals who were continuously or intermittently uninsured between age 51 and 64; these patients cost Medicare an additional $1,000 per person due mainly to complications from cardiovascular disease, diabetes and delayed surgeries for arthritis.

Fifty-two percent of Medicaid-rejecting states ranked in the study’s bottom third for senior health, including two very large states, Texas and Florida. Many of these states also can be found in a list of states with the highest rates of poverty among people over 65.

What emerges is a north-south divide on senior health. “Many states that haven’t expanded Medicaid are in the South, and there’s a clear link between socioeconomic status and health status,” says Tricia Neuman, senior vice-president at the Henry J Kaiser Family Foundation and director of the foundation’s Medicare policy program. “Insurance may not be the only answer, but it certainly is helpful.”

The United Health Foundation—a non-profit funded by the insurer UnitedHealth Groupdidn’t consider insurance coverage in its study, but it did consider poverty. Minnesota’s rate was 5.4%—well below the 9.3% national rate. Mississippi ranked dead last, with a 13.5% poverty rate.

In states that rejected the Medicaid expansion, we are witnessing a victory of politics over compassion and morality. Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology and a key architect of health reform in Massachusetts and under the ACA, summed it up in an interview with HealthInsurance.org earlier this year, saying that these states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.”

MONEY Social Security

As Social Security Cuts Take Effect, The Most Vulnerable Are Left to Cope

Cuts to Social Security have closed offices in some of the areas where they're needed most.

Until earlier this year, there was a Social Security field office in Gadsden County, Florida, in the state’s panhandle. It’s the kind of place where seniors need to get in-person help with their benefits rather than pick up a phone or go online.

“Our poverty rate is nearly double the state average, and we trail the state averages in education,” said Brenda Holt, a county commissioner. “Most of the people here don’t have computers, let alone reliable Internet access.”

Holt testified Wednesday before the U.S. Senate Special Committee on Aging, which is investigating the impact of budget cutting at the Social Security Administration over the past five years. Sixty-four field offices and more than 500 temporary mobile offices, known as contact stations, have been closed. And the SSA is reducing or eliminating a variety of in-person services that it once provided in its offices.

The SSA also has been developing a long-range strategy for delivering services. A draft document states that it will rely on the Internet and “self-service delivery”—and provide in-person services in “very limited circumstances, such as for complex transactions and to meet the needs of vulnerable populations.”

Gadsden County meets any criteria you could pick for vulnerability. But the field office in Quincy, the county seat, was closed with just a few weeks’ notice in March, Holt said. The nearest office is 30 miles away in Tallahassee—reachable only by car or a crowded shuttle bus that runs once a day in each direction.

The Senate committee’s investigation found SSA’s process for office consolidation wanting for clear criteria, transparency and community feedback. Only after persistent objections by local officials did the SSA offer to set up a videoconferencing station in a local library that connects seniors to representatives in its Tallahassee office.

“It’s deeply frustrated and angered our community,” said Holt. “Many of our residents live in a financial environment where they make choices between medications and food to feed their families. Problems with Social Security benefits can have a catastrophic effect on families.”

The SSA’s workload is rising as baby boomers retire; the number of claims in fiscal 2013 was 27 percent higher than in 2007. Yet the agency has 11,000 fewer workers than it did three years ago, and hiring freezes have led to uneven staffing in offices.

The SSA has received less than its budget request in 14 of the last 16 years. In fiscal 2012, it operated with 88% of the amount requested ($11.4 billion). The budget was restored somewhat in fiscal 2014 to $11.7 billion. And President Barack Obama’s 2015 budget request is $12 billion.

But service still suffers. The National Council of Social Security Management Associations reports that field office wait time is 30% longer than in 2012, and wait times and busy rates on the agency’s toll-free 800 number have doubled.

The SSA’s plan to save $70 million a year by replacing annual paper benefit statements with electronic access also has been a misstep, at least in the short run. Paper statements were suspended in 2011, but just 6 percent of all workers have signed up for online access, in some cases because of a lack of computer access or literacy but also because of sign-up difficulties related to the website’s complex anti-fraud systems.

In April the agency backtracked, announcing it will resume mailings of paper statements this September at five-year intervals to workers who have not signed up to view their statements online. (You can create an online account here.)

Wednesday’s hearing shed much-needed light on the customer service squeeze at SSA, though it would have been good to hear legislators acknowledge that Congress had no business cutting the SSA budget in the first place. The agency is funded by the same dedicated stream (payroll taxes) that funds benefits, and its administrative costs are low, 1.4% of all outlays. The SSA is funded by Americans’ tax dollars and exists to provide customer service to all Americans.

Nancy Berryhill, the SSA’s deputy commissioner for operations, did her best at the hearing to defend the agency’s efforts to cope. “It’s my job to balance service across nation—these are difficult times.”

Still, she conceded that there’s room for improvement. “We need to get more input from the community,” she said, speaking about the events in Gadsden County. “Adding the video service made a difference after the fact, but we need to be more thoughtful in the future.”

TIME Aging

7 Medical Tests Every Man Needs

Medical patient and doctor
Lee Edwards—Getty Images/Caiaimage

Admit it, guys: You don’t even like going to the doctor when there’s something wrong, let alone for preventative check-ups. But being proactive about your health—by getting recommended screenings for serious conditions and diseases—could mean you’ll spend less time at the doctor’s office down the road.

Depending on age, family history, and lifestyle factors, people need different tests at different times in their lives. Here’s a good overview for all men to keep in mind.

Diabetes

You may never need a screening for diabetes if you maintain a healthy weight and have no other risk factors for the disease (such as high cholesterol or high blood pressure). But for most men over 45—especially overweight men—a fasting plasma glucose test, or an A1C test, is a good idea, says Kevin Polsley, MD, assistant professor of internal medicine at Loyola University Health System in Chicago.

The U.S. Department of Health and Human Services also recommends diabetes screenings for overweight adults younger than 45 who have a family history of the disease, or who are of African American, Asian American, Latino, Native American, or Pacific Islander descent.

Fasting plasma glucose and A1C are both blood tests that should be done in your doctor’s office. The A1C test does not require fasting beforehand, but if your doctor wants to test you using fasting plasma glucose, you will be asked not to eat or drink anything but water for eight hours beforehand.

Health.com: Could You Have Type 2? 10 Diabetes Symptoms

Sexually Transmitted Infections

Even if you’ve been in a monogamous relationship for years, it’s not a bad idea to get tested if you haven’t already done so. Many common sexually transmitted infections can go undiagnosed for years. For example, people can go as long as 10 years without showing symptoms of HIV. The U.S. Preventive Services Task Force recommends that everyone ages 15 to 65 be screened for HIV at least once. This is especially important, Dr. Polsley says, if you have had unprotected sex, used injected drugs, or had a blood transfusion between 1978 and 1985.

In addition, the Centers for Disease Control and Prevention recommends a one-time hepatitis C screening for all adults born between 1945 and 1965, regardless of risk factors. “Believe it or not, there’s a lot of hepatitis C cases out there in which people either don’t have symptoms yet or don’t know what’s causing their symptoms,” says Dr. Polsley. “Screening for STIs is something I offer as routine at just about every physical, regardless of a patient’s age or health history.”

Health.com: Best and Worst Foods for Sex

Body Mass Index

You don’t need to make an appointment to figure out your body mass index, a measure of body fat based on your height and weight. Regardless of whether you calculate this stat yourself or your physician does the math for you, it’s important to be aware of this number, says Dr. Polsley.

A BMI between 18.5 and 24.9 is considered normal weight. Although this calculation isn’t perfect—and can sometimes label healthy people as overweight or vice versa—most doctors agree that it’s still an important component of assessing overall health. “It can be a very good opportunity to discuss diet and exercise, and to show our patients how important these things are,” Dr. Polsley says.

Health.com: 11 Reasons Why You’re Not Losing Belly Fat

Cholesterol

The American Heart Association recommends men have their cholesterol levels tested every four to six years once they turn 20. “Men have an overall higher risk for cardiovascular disease than women, and high cholesterol is often a big part of that,” Dr. Polsley says. But your doctor may want to screen you earlier (and more often) if you have heart disease risk factors such as diabetes, tobacco use, or high blood pressure.

Cholesterol is measured by a blood test, and your doctor may ask you not to eat for 9 to 12 hours beforehand. Generally, a cholesterol test will measure your levels of total cholesterol, HDL (good) cholesterol, LDL (bad) cholesterol, and triglycerides. Depending on your results, your doctor may make dietary recommendations or prescribe a cholesterol-lowering medication like a statin.

Blood pressure

Like high cholesterol, high blood pressure is often a symptomless condition—but luckily, the test for hypertension is quick and painless, involving a rubber cuff that squeezes the arm and measures the flow of blood through a large artery in the bicep. “You should have your blood pressure checked pretty much every time you see your doctor,” says Dr. Polsley, starting at age 18.

Don’t get to the doc often? Have it checked at least every two years, or yearly if your numbers were previously considered borderline (a top “systolic” number above 120 or bottom “diastolic” number higher than 80).

You can check your blood pressure at health fairs, in pharmacies, or at home with a monitoring device. If your systolic pressure cracks 130 or your diastolic goes over 85, your doctor may recommend lifestyle modifications—like exercising more and eating less salt—or they might prescribe medication.

Health.com: 31 Fat-Burning Recipes

Colonoscopy

Most men should be screened for colon cancer beginning at age 50, but those with a family history of the disease may benefit from earlier testing. Men and women alike tend to dread this test—in which a small camera is inserted into the anus and explores the large intestine for polyps or other signs of cancer—but Dr. Polsley says it’s not as bad as it sounds.

“The preparation for the test is actually the worst part,” he says: You’ll need to empty your bowls completely before the exam, which may involve not eating solid foods for one to three days, drinking lots of clear liquids, or taking laxatives. “The actual colonoscopy shouldn’t be too uncomfortable, because you’re sedated through the whole thing.”

But here’s the bright side: If your doctor doesn’t find anything suspicious, you won’t need another colonoscopy for up to 10 years.

Prostate exam

Screening for prostate cancer is more controversial than for other cancers, says Dr. Polsley, and some studies have shown that these tests can be expensive and unnecessary, and may do more harm than good. But he suggests that all men over 50 at least talk with their doctors about the pros and cons of these tests—usually either a digital rectal exam (in which the doctor inserts a gloved finger, or digit, into the rectum to feel for lumps and abnormalities) and a PSA test, which measures a protein called prostate-specific antigen in the blood.

Prostate cancer screenings can and do save lives, but they may also result in false-positive or false-negative results. And because many cases of prostate cancer progress very slowly, some men (especially older men) don’t benefit from aggressive treatment. Whether you decide to get screened for prostate cancer should be a decision you make with your doctor, says Dr. Polsley. In the meantime, it’s important to know the symptoms of an enlarged prostate—like having to urinate frequently or having trouble urinating—which could also signal cancer.

This article originally appeared on Health.com.

TIME Aging

10 Ways to Live to 100

Women exercising and laughing
Sam Edwards—Getty Images/Caiaimage

No one really wants to think about aging, but let’s face it: the habits you practice now can play a role in how long you’ll live, and how much life you’ll have in your years.

The world’s oldest man, Polish immigrant Alexander Imich, passed away on Sunday in New York City at the age of 111. That’s way longer than the average American male life expectancy of 76, according to the Centers for Disease Control and Prevention.

Health.com: 13 Everyday Habits That Age You

While Imich told The New York Times that he chalked up his longevity to good genes, there are healthy habits you can pick up to help you live a longer, happier life. Here are some ideas:

Find a hobby
Doing something you find truly fulfilling will give you a sense of accomplishment, and can help reduce stress.

Floss!
Flossing does more than clean your teeth: Getting all that inflammation-causing bacteria off your gums can reduce your risk of heart disease and stroke.

Health.com: 14 Reasons Why You’re Always Tired

Plan a vacay
Taking a break from work can lower your risk of heart disease and add 1 to 2 years to your life.

Rest up
Your body repairs cells during sleep, so skimping on it doesn’t do your body any favors. Plus, adequate sleep also affects your quality of life. Aim for 7 to 8 hours of shut-eye per night.

Get busy
Having sex releases the feel-good hormone oxytocin, another stress reliever. Plus, a study from the University of Quebec found that women burn 3 calories per minute of sex while men burn 4.

Health.com: 7 Foods for Better Sex

Be social
People with stronger friendships were 50% more likely to live longer than those with weaker connections, a 2010 analysis found. That makes the impact of friendlessness comparable to that of smoking (more on that below).

Eat right
You need to fuel your body with healthy foods to live a long life. Limit your intake of foods high in fat, salt, and added sugar (which can increase your risk of heart disease, obesity, and other chronic diseases) and look for superfoods rich in vitamins, minerals, fiber, and protein.

Health.com: Best Superfoods for Weight Loss

Hit the gym
Not only is exercise good for the heart, but working out can trigger the release of endorphins, pain-relieving chemicals known to boost your mood. Shoot for at least 150 minutes of moderate exercise a week, per the CDC.

Beat stress
A study published in the Journal of Clinical Endocrinology & Metabolism found that high levels of the stress hormone cortisol are associated with an increased risk of dying from cardiovascular disease. That’s even more reason to take up calming activities, like meditation and yoga.

Stop smoking and limit drinking
Imich, a former smoker, swore off both cigarettes and alcohol and you should follow his lead-at lease when it comes to the cigs. Smoking causes one out of 5 deaths in the U.S. each year, according to the CDC. Moderate alcohol consumption is good for you, but experts recommend that women have no more than one drink per day (or up to 7 per week); for men it’s 1 to 2 drinks per day, or a max of 14 per week.

This article originally appeared on Health.com.

TIME Aging

The World’s Oldest Man Has Died at 111

The New York City resident attributed his long life to a healthy diet and abstinence from alcohol

Alexander Imich of New York City died peacefully Sunday morning at the age of 111, according to friends.

Imich attained the title of world’s oldest man in April, and attributed his long life to a healthy diet and abstinence from alcohol, according to NBC 4 New York.

“I don’t know, I simply didn’t die earlier,” he told the television station last month. “I have no idea how this happened.”

Like many centenarians, Imich’s early life spanned various conflicts. Born in Poland on Feb. 4, 1903, he fled with his wife in 1939 after Nazi Germany invaded the country. They settled in the U.S. in the 1950s.

While Imich was the world’s oldest man, he was far from the oldest person. At least 65 women outranked him on that score, according to Gerontology Research, with 116-year-old Misao Okawa of Japan topping the list. The new world’s oldest man, 111-year-old Sakari Momoi, is also Japanese.

[NBC 4 New York]

MONEY real estate

Retiring? Stay or Go, You’ve Got Moves to Make

Housing accounts for the biggest part of your costs in retirement. So spend wisely.

Once you start looking at retirement over a horizon of five years or so, it’s time to start thinking about how you’ll manage your biggest single asset: your home.Whether you intend to stay put or move to that lake cottage, keeping real estate costs under control is key to your security.

Those costs may be larger than you think. On average, housing makes up one-third of spending for those ages 54 to 74—the largest single category. More than half of Americans ages 55 to 64 are carrying mortgages, higher than in previous generations. “Paying mortgage debt into retirement reduces your lifetime wealth and limits your spending,” says Pam Villarreal, a senior fellow at the National Center for Policy Analysis.

Staying in your house, with your mortgage paid, doesn’t free you from making decisions. Few pre-­retirees think about adapting their homes for retirement living. “It’s hard for active people in their fifties or sixties to think about what they might want 15 years from now,” says Bonnie Sewell, a financial adviser in Leesburg, Va.  Should you end up not being able to get around easily, though, you’ll have fewer choices and less ability to make them. So take action now:

Moving? Don’t take your mortgage with you. Nearly 30% of boomers plan to relocate when they retire, according to a new AARP survey. Many of them are seeking to cut costs by moving to a lower-tax state. Carry a mortgage, however, and this strategy may not have a big impact on your cash flow, as a recent analysis by Villarreal found. Mortgage debt can easily erode the benefits of lower taxes. Run your own numbers at whynotmove.org.

Cash flow

Sure, if you’ve got plenty of cash, mortgage payments may not seem like an issue. But there’s security, and flexibility, in not carrying debt. “Many of my clients see having no mortgage payments as a way of freeing up cash for future health care costs,” says Philadelphia financial planner Cathy Seeber.

If you plan to stay, renovate now. By your late fifties, your kids are probably out of the house, and the tuition bills are behind you—or nearly so. Time to renovate? Use this opportunity to make a few additional changes that will let you stay in your home for the next couple of decades. “The last thing you want to do in your seventies or eighties is manage a major rehab in an emergency,” says Sewell.

If you have a house with stairs, make sure you can live on one floor if necessary, says Mary Jo Peterson, a design consultant in Brookfield, Conn.  That may mean expanding a powder room to a full bath. You can also add design touches that appeal to people of all ages—a sloped ­entrance-walk instead of steps is more convenient for moms with strollers and college students dragging suitcases, not just the elderly. Find more ideas at aarp.org/­livable-communities, and your family home can last for generations.

 

MONEY working in retirement

Don’t Buy Into the Retirement Gloom

Senior in the workplace
Thomas Barwick—Getty Images

In the emerging Unretirement movement, you are your best investment.

This story was originally published at Next Avenue.

Gray wave. Age wave. Geezer tsunami. (Pick your favorite — or most hated — euphemism.) Catchphrases like these capture the realization that we’re living longer and that older Americans make up a growing share of the population. As economist Laurence Kotlikoff and columnist Scott Burns say in The Coming Generational Storm: “The aging of America isn’t a temporary event. We are well into a change that is permanent, irreversible, and very long term.”

Living longer should be a trend worth celebrating. But many people believe that America’s boomers can’t afford retirement, let alone a decent retirement. They fear that aging boomers are inevitably hurtling toward a lower standard of living.

And here’s their evidence: We’ve just been through the worst downturn since the 1930s, decimating jobs and pensions. Retirement savings are slim. Surveys show that boomers aren’t spending much time planning for retirement. The prediction that the swelling tab for Social Security and other old-age entitlements will push the U.S. government and economy into a Greece-like collapse seems almost routine.

The Unretirement Movement

Don’t buy into the retirement gloom. I’m not.

Here’s why: The signs of a grassroots push to reinvent the last third of life are unmistakable. Call it the “Unretirement” movement — and it is a movement.

Unretirement starts with the insight that earning a paycheck well into the traditional retirement years will make a huge difference in our future living standards. You — and your skills and talents — are your best retirement investment. What’s more, if society taps into the talents and abilities of sixty-somethings and seventy-somethings, employers will benefit, the economy will be wealthier and funding entitlements will be much easier.

The Unretirement movement is built off a series of broad, mutually reinforcing changes in the economy and society that are transforming an aging workforce into a powerful economic asset. Boomers are the most educated generation in U.S. history and they’re healthier, on average, than previous generations. A century-long trend toward a declining average age of retirement has already reversed itself and — it’s safe to say — you ain’t seen nothin’ yet.

“Many people aren’t slowing down in their 60s and 70s,” says Ross Levin, a certified financial planner and president of Accredited Investors in Edina, Minn. Adds Nicole Maestas, economist at the Rand Corp., the Santa Monica, Calif.-based think tank: “Yes, America has an aging population. The upside of that is a whole generation of people who are interested in anything but retirement.”

Your ‘Next Big Thing

Just ask Luanne Mullin, 60. She has done marketing for a dance company, opened a theater company and run a recording studio. These days, Mullin is a project manager at the University of California, San Francisco, overseeing the construction of scientific laboratories (she does mediation at the school on the side).

“I think there’s more and more of us at 60 who are saying, ‘OK, what’s my next career? What do I want to do that’s fulfilling?’” Mullin told me. “I’m all for what’s my next big thing.”Mullin loves her work, but she’s also wrestling with the same questions as many of her peers. “What is this aging thing?” she wonders. “Am I living fully? Is this the second half of life I dreamed of, or if not, how do I pull it together?”

When Unretirement is Tougher

For many in their 50s and 60s, the transition to Unretirement is much tougher — especially for those who are involuntarily unemployed, like Debbie Nowak.

She didn’t see the layoff coming. Nowak worked for more than 30 years in customer relations for the pensions and benefits department at Evangelical Lutheran Church in America, in Minneapolis-St. Paul, Minn., In November 2011, at 58, she lost her job there.

Nowak, who has a high school diploma, let herself grieve until the holidays were over. In the New Year, she got her severance, went on unemployment and began thinking about embracing something completely different from her old job. “I never thought of myself as a risk taker,” she says. “After 30 years, I thought I should take a risk.”

Nowak had a stained glass hobby, making window panes, mosaic trays, and other objects. That led her to the idea of working in the wood finishing and furniture-restoring business. Last year, she got a certificate from The National Institute for Wood Finishing at Dakota Community Technical College in Rosemount, Minn. To pay for it, Nowak took out a loan and the state chipped in from its displaced workers fund.

Today, she has a part-time job at small furniture-restoration company. “It’s a crap shoot, a risk I was willing to take,” says Nowak. “This is also a way to produce additional income in retirement.”

As Mullin and Nowak demonstrate, we’re living though a period of experimentation while redefining retirement. Many people are stumbling about, searching for an encore career, a part-time job or contract work that offers them meaning and an income.

Some find it extremely tough to get hired, cobbling together a job here and a contract there, assuming they’re healthy. Especially vulnerable are less-educated workers who never made much money or never had jobs with employer-sponsored retirement and health benefits.

How Society Will Change

The rise of Unretirement calls for a whole cluster of changes in how society rewards work, creates jobs, shares the wealth and deals with old age. Unretirement will affect where Americans live out their lives, too, as they seek communities and services equipped for them.

Taken altogether, boomers will construct a new vision of their retirement years, which will impact how younger generations will think about their careers.

“People tend to learn from examples or stories handed down from previous generations — but there are few stories to navigate the new context of old age and retirement for the baby boomers,” writes Joseph Coughlin, the infectiously enthusiastic head of MIT’s AgeLab, a multi-disciplinary center. “When there are no set rules you make them up. The future of old age will be improvised.”

Send Your Unretirement Questions

This blog aims to take a first draft at the Unretirement improv act. I’ll particularly focus on the personal finance and entrepreneurial start-up implications of the movement. I’ll talk about successes and failures, the impediments of age discrimination and the lessons people learn as they search for meaning and income in their next chapters.

Most of all, I hope to hear from you and find out about your experiences so I can address your questions in future columns. Send your queries to me at cfarrell@mpr.org. My twitter address is @cfarrellecon.

Peter Drucker, the late philosopher of management, noted that every once in a while, society crosses a major divide. “Within a few short decades, society rearranges itself — its worldview; its basic values; its social and political structure; its arts; its key institutions,” Drucker wrote in Post-Capitalist Society. “Fifty years later there is a new world.”

The transformation of retirement into Unretirement marks such a divide. Welcome to a revolution in the making.

Chris Farrell is economics editor for APM’s Marketplace Money, a syndicated personal finance program, and author of the forthcoming Unretirement: How Baby Boomers Are Changing the Way We Think About Work, Community, and The Good Life. He will be writing on Unretirement twice a month.

Related Links:

‘Partial Retirement’ Is On the Rise

A Manual for Encore Careers

 

TIME Aging

Centenarians Don’t Die for the Same Reasons We Do

133981931
Howard Kingsnorth—Getty Images

Those who survive to see their second century are indeed different from the rest of us, according to the latest research

Researchers in the UK say that people who live to be 100 or more are less likely to die of the chronic conditions that are the leading causes of death, such as heart disease can cancer, but more likely to die of sudden declines in their health caused by infections or frailty.

VIDEO: Watch: The Island That Holds the Secret to Long Life

After reviewing death certificates of 35,867 centenarians who died between 2001 and 2010 in England, the scientists found that around a third died in assisted care homes. The most common cause of death was frailty or old age (28%), followed by pneumonia (18%). Only 8.6% of those over 100 years died of heart disease, and only 4.4% died of cancer, which remain the leading killers in industrialized nations. By comparison, among those between ages 80 to 85, 19% died of heart disease and 24% died of cancer.

MORE: How to Live 100 Years

Understanding that most of the oldest old, among the fastest growing proportions of western populations, are more vulnerable to sudden events such as infections that can land them in the hospital and on a downward health spiral, should help countries to better prepare for the ever-growing proportion of longer-lived individuals, say the authors. Globally, centenarians are expected to grow from 317,000 to more than 3.2 million by 2050.

MONEY financial advisers

A 90-Year-Old Woman’s Tough Decision

Is it in someone's best interests to give up control over her own money? A financial adviser struggles with the question.

How do you ask a 90-year-old client to give up total control of her assets?

Recently I had a meeting with a long-term client (let’s call her Susan) and her out-of-state nephew in which the nephew and I asked her to resign as the trustee of her own revocable trust.

This is a tough conversation to have. In effect, we were asking her to transfer control of all of her money to her nephew. Susan agreed to do this, but only because she trusts my advice. Talk about responsibility.

Let me provide a little background. Susan hired me as her financial adviser just after the dot-com bust. She was recently widowed. Her husband had put their investments 100% in stocks. Her stocks were dropping in value a lot, she was scared, and she didn’t know what to do. She has no children and wanted most of her money to go to charity when she passed. (Susan was one of the inspirations for a book I wrote: RINKs — Retired, Independent, No Kids.)

We created charitable remainder trusts for Susan, which established annuities for her and helped diversify her portfolio tax-efficiently. We set up a revocable trust for the rest of her assets. With no children, she made one of her nephews a successor trustee for her trusts.

Susan’s investments have grown nicely over the years, and running out of money was never an issue. The issue was her declining health. She moved to a very nice assisted living residence, and we made sure most of her bills were automatically paid because she was becoming confused about money and forgetting to pay some bills. Her tax attorney had been suggesting to me and her nephew that it was time Susan stepped down and let someone else control her finances. I was resistant. I pushed back. My biggest concern: Would Susan be taken advantage of?

Yes, we financial planners go to seminars and meetings discussing estate planning and asset transfers. But nothing can actually prepare you for helping a client make such an important, irreversible decision. How can you advise a client to trust a distant relative when you don’t understand that relative’s own history or motivations about money? How can you explain this to someone, who may not really understand why this will be for her own benefit?

I think you have to rely on your best judgment of the individuals involved. You have to ask a lot of questions. And you have to respect the reasoning why the client, when originally creating the estate documents, would choose this individual over all other possible candidates to be the successor trustee. And that’s what I did in Susan’s case.

Yes, we make the big bucks managing money, and that’s what most people see. But the emotionally hard and more important work is helping clients make the really tough life decisions.

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Raymond Mignone has been a certified financial planner and fee-only investment adviser since 1989, with offices in Boynton Beach, Fla., and Little Neck, N.Y. He is the author of the book RINKs – Retired, Independent, No Kids. His website is www.RayMignone.com.

TIME

You’re Older Than You Think You Are

Thanks to your environment, you may actually be older than you think you are

As much as we try to fight it, we’re aging faster than we’d like, and we can blame our own bad habits for some of that. Researchers at the University of North Carolina (UNC) have developed a way to test for our molecular, or physiologic age, which, it turns out, may have little to do with the number that appears on our driver’s licenses.

This age reflects the various assaults on our bodies that come from things such as smoking, tanning, and stress, as well as exposure to ultraviolet light (every time we step outdoors). Led by senior author Dr. Norman Sharpless, director of the Lineberger Comprehensive Cancer Center at UNC, the scientists developed a litmus test for how quickly a group of immune cells known as T cells aged. As cells near the end of their natural life, they start dividing more slowly and accumulate more DNA damage, and that triggers a certain gene to become more active. Using that gene’s activity as a signal of such cellular senescence, Sharpless and his team started to test how different factors affected this gene.

So far, they report in the journal Trends in Molecular Medicine, cigarette smoke and ultraviolent light drove both mouse and human cells to age faster. No surprise there. Chemotherapy drugs use to treat breast cancer also stressed the cells to wear out sooner.

More surprising, however, was that a high fat diet, which Sharpless assumed would also contribute to aging, didn’t make the mice get much older. “Why we got that unexpected answer is unclear—it may be that the mice are different enough from humans, or it may be that the dose [of the high fat diet] wasn’t sufficient,” he says.

The things he and his team tested have involved agents or behaviors that damage DNA. But Sharpless knows that’s not the only thing that turns young cells old. He’s also aware that cellular senescence isn’t the only marker of a person’s physiologic age. But it does provide a good way to put all of our favorite anti-aging remedies to the test—like green tea, exercise and that glass of red wine with dinner. He also hopes that it can be used to predict which cancer patients may experience faster aging from chemotherapy and guide them toward less damaging drugs.

You won’t be able to do that on your own, since harvesting T cells isn’t something that’s available in a DIY kit, but Sharpless has founded a company that is creating a more user-friendly (and commercial) way to track how quickly we are barreling toward our golden years.

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