By Jeremy Schwab

In many ways, older adults in the United States today have it better than their predecessors of earlier generations. They are living longer (on average) and benefit from better heart medications, innovations in chemotherapy, and improved assistive devices like hearing aids and walkers. They have also ridden a wave of national economic growth through most of their lifetimes, and consequently many are in a good financial position.

But old age looks very different depending on where you stand on the socio-economic ladder, cautions gerontology researcher Deborah Carr. Take for instance video chat technology like Facetime (or Zoom or Skype). Today, elders can see and converse with family and friends who are spread out geographically, and the importance of this connection has become critical in the time of COVID-19. But those who can’t afford an updated computer and broadband service are left out of the loop.

And this scenario plays out in a wide range of situations, where those seniors nearer the bottom rung are less able to access the resources that they need to live a good life.

“Old age amplifies the problems of poverty,” says Carr, a professor and chair of the Department of Sociology at BU Arts & Sciences. “Poverty and economic inequality hurt us at every age, but they are most harmful to older adults because they amplify biological declines that accompany aging.”

In her recent book Golden Years?: Social Inequality in Later Life (2019, Russell Sage), Carr lays out these disparities and their effects. She notes, for instance, that low-income older adults have a harder time finding caregivers in their network of friends and family.

“Most older adults rely on a family caregiver,” says Carr. “Lower-income people often have fewer people they can rely on, not because those people don’t want to help but because they also face health obstacles of their own or need to work for pay.” In short, these communities have higher rates of conditions like dementia and diabetes, making them both in need of more caregiving and less able to care for each other. On top of that, people in these communities are less able to afford high-quality professional caregivers.

Conditions in poorer neighborhoods and towns often increase the chance of health problems in old age: hazardous jobs, exposure to more pollution and polluting industries, the stress of neighborhood violence.

The view from the top (and the middle)

Contrast this with the experience of a typical middle- or upper-income senior. Those in the middle have more to live on: often a pension in addition to social security income, and an all-important home they can sell to fund long-term and end-of-life care. But these seniors also face considerable stresses in old age. They often can’t afford high-end assisted-living facilities, and can find themselves financially stretched when facing multiple health problems or other life circumstances. And they fall into the gap where they receive Medicare but not Medicaid, meaning they have more out-of-pocket health costs than do lower-income seniors.

Carr describes the lives of upper-income seniors as, on a whole, quite good.

“At the very top, they are doing pretty well,” she says. “They own homes, have private pensions, stocks, interest income. They can afford to live in the best nursing homes and hire the best caregivers. For many of these older adults, old age really is the golden years. They’re exactly like those people you see in the pharmaceutical commercials, relaxing on their boat with their preppy clothing and their lovely homes, and that is a reality for some.”

Technology, loneliness, and the administrative burden

Carr, who culled the information for her latest book from over 100 books and articles by peers in the field and her own research, describes some challenges that confront older people across the income spectrum, though those with low incomes often struggle more.

One of these challenges Carr calls the “administrative burden.” While most older adults are retired, they still have a job to do: managing their own physical, emotional, and financial health. And it can take up a considerable amount of their time. They must navigate all of the daily and weekly appointments, phone calls and paperwork, in some cases without assistance. This burden is felt most by those with multiple health problems as well as those without cars.

Technology poses another challenge for many older persons, especially those who did not need to use computers much in their working lives. Some are also distrustful of new technology.

“Technology has great promise for connectedness, assistive devices, even robot caregivers,” says Carr. “But trust issues are a big problem. A lot of older adults, for instance, don’t want to share their credit card numbers or personal information online.” Another challenge is remembering those dozens of online passwords necessary to navigate everything from insurance claims to bank accounts.

Loneliness is a common problem that many seniors grapple with. And it can be a hidden one.

“Loneliness is not just living along but feeling alone,” says Carr. “There are a lot of older people who live alone, especially women, but don’t feel lonely. They might have close friends, or a romantic partner. Meanwhile, one third of older adults who are married report loneliness. This

can be either because their marriage has become stale or their spouse has severe dementia and they can’t communicate anymore. And they are tethered to the person they’re caring for.”

Lonely elders are more susceptible to elder abuse, which can take the form of scams perpetrated by telemarketers or, sadly, by their own caregivers.

A new threat

As if the normal challenges of old age weren’t enough, COVID-19 has brought a new and frightening risk to older adults, and its devastation has been felt the most in poorer communities. This is due to a number of factors. Low-income older adults are more likely to live in smaller homes or apartments and to live with children or grandchildren. This puts them at greater risk for contracting the virus, especially since their family members are more likely to work in high-risk settings like grocery stores or nursing homes.

Unfortunately, this also means that lower-income elders will know more people who die from the coronavirus.

“Perhaps most tragically, lower-income older adults are more likely to lose a beloved spouse, child, sibling, or friend during this crisis,” says Carr. “More members of their communities are likely to die, and the emotional pain of multiple deaths can be devastating. These losses are all the more tragic because we cannot be with our loved ones at the moment they die due to “no visitor” rules at hospitals and nursing homes.”

A call for change

“Something has to be done to help older adults age well,” says Carr. “By the year 2030, one in five Americans is going to be a ‘senior citizen’.” And thanks to improved medical technology, more will live into their 90s and beyond. “What I call extreme old age is something we as a society are not yet prepared for,” she says. “We are not prepared for caring for so many older persons, especially those with dementia who may require extensive care”

Carr praises Medicare, which was established in 1965, for reducing late-life poverty. But she says this basic safety net is not enough. “There are things that have to be done. The most obvious is increasing social security benefits for those in the lowest tier of income, and lowering the age for qualifying for Medicare” because lower-income people often have serious health problems before they reach age 65.

Carr also suggests that increased funding for public schools or programs like the Supplemental Nutrition Assistance Program (SNAP) could help improve health and financial outcomes for lower-income people earlier in life, so they don’t face as many health and financial challenges in old age.

Finally, she advocates changing the dialogue around the elderly.

“So many conversations about old age are very negative,” says Carr. “We’re forgetting about the fact that older adults are our lifeline to our family history. Older adults make up the largest block of volunteers. They vote in higher proportions. They have so many skills, so much knowledge and so much savvy. Older people shouldn’t be viewed as a problem, but as a wonderful resource that all of us can benefit from.”

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