Over the next 25 years, the proportion of the American population that is age 65 or older will grow from 13 percent to 20 percent, according to U.S. Census Bureau projections. In raw numbers, the number of Americans over 65 will grow from 35 million to 70 million. As Americans live longer lives, more people will come to face difficult choices similar to those Bob Stern confronts in : how to measure the quality of life against the quantity of life; how to deal with increased health problems and the end of a career; and, perhaps, a diminished sense of autonomy and self-reliance — qualities that characterize the American ideal of individualism.
These shifts affect almost everyone as they age, according to Dr. Timothy Quill, a professor of medicine, psychiatry and medical humanities at the University of Rochester School of Medicine and the author of books on end-of-life choices and the ethics of physician-assisted suicide. "Being in charge and being independent are strong American themes," he said. When an illness requires hospitalization or long-term care, individuals can find themselves dependent on others for care, eroding a sense of autonomy and making them feel less self-reliant.
While both men and women are affected by this shift, men are often less prepared for the changes, according to some researchers who study the patterns of aging. Dr. Marion Somers, director of the geriatric care management program at the Brookdale Center on Aging at Hunter College, argues that women may have an adaptive advantage in dealing with such transitions. "A woman watches her body change many times in her life, and men don't have that experience," Dr. Somers said. The experiences of childbirth and menopause, in particular, can help women prepare for changes that come later in life.
Men are also more likely to feel their identities are intimately connected to their working lives, according to Dr. Somers. "The world radically changes when men retire," she said. "When a woman retires, she's often happy to go into more of the family domain. Even career women who are not domestic usually have projects and hobbies."
In addition, men may be less inclined to seek help, whether through family support or more formal therapy. Older men can be less closely connected to family support networks than older women — even among those without living spouses or adult children. Many are reluctant to seek professional help as well, according to Dr. Quill. Such men "often don't talk about their feelings, because they're uncomfortable being dependent," he said.
These difficulties can be exacerbated, Dr. Quill said, when an illness comes on suddenly, prompting sudden changes in an individual's life. "A lot of people adapt to an illness slowly," Dr. Quill said, "because they get ill slowly." An illness that progresses gradually, while potentially as damaging to the quality of life, can be less traumatic psychologically, allowing an individual to grow accustomed to a new set of capabilities.
The physical and emotional changes that affect men as they age can also be caused by hormonal changes, according to Jed Diamond, a therapist and author of Male Menopause. "Men go through a change of life that is hormonally and biochemically based that affects our sexuality, our sense of masculinity, and our sense of ourselves," he said. "I've found that men who recognize this and get the proper treatment are really much healthier and much more satisfied than men who simply go through his change and don't deal with it."
As men come to the end of a working career, Diamond said, they may find themselves disconnected from their primary source of social interactions. As an alternative, he urges them to identify a calling, an occupation more focused on satisfying emotional needs than on earning income. Often, he said, such a calling involves working as a mentor or teacher. "When we're growing up, we're taught that to be a man involves solving your own problems," he said. Sharing the wisdom acquired over a lifetime is often a means to improve men's sense of connection and self-worth as they age, according to Diamond.
Diamond, Dr. Quill, and Dr. Somers all agreed that the American ideal of self-reliance and independence is a major factor in preventing men from seeking help. "In some ways men are the most misunderstood group," Dr. Somers said. "They're used to the world being at their command, and they're in charge. As they age, they lose that sense, and it comes as a shock."
Daniel McDermon is a writer living in New York City.