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Annual National Veterans Golden Age Games | Defense Department photo/Army Sgt. 1st Class Michael J. Carden

by Daniel Fink, MD, Chair, The Quiet Coalition

According to Joseph Coughlin, director of the AgeLab at MIT and author of “The Longevity Economy,” a new book about marketing to aging baby boomers, it’s time to change our definition of “old.”

Coughlin claims that old age is a made-up social construct invented 150 years ago.

I’m not sure I agree with him completely, but he’s right about something. Much of what we think of as normal aging–obesity, hypertension, diabetes, weakness, disability, and early demise–isn’t normal aging but pathological aging.

I’d add hearing loss to that list.

Pathological aging stems from four factors:

  1. Abnormal exposures, e.g., sun, cigarette smoke, or noise;
  2. Poor quality nutrition, i.e. too much of the wrong nutrients (including calories) and not enough of the right nutrients;
  3. Disuse atrophy, especially for the musculoskeletal system; and
  4. Medical care based on inadequate knowledge about the best treatments for common conditions.

The treatment of hypertension is one example of the fourth factor. In the 1970s, it was thought that a normal systolic blood pressure was 100 plus the patient’s age, and that treating hypertension in the elderly was dangerous. Then a randomized trial–the Systolic Hypertension in the Elderly Program–showed that treatment of high blood pressure in older people prevented stroke. Two more recent examples are studies showing that treatment of cardiac risk factors prevents what was once thought to be inevitable heart disease as people age and then was found to reduce dementia risk, too.

Hearing loss in old age is very common. It’s called presbycusis, or age-related hearing loss. But the world’s literature–which I reviewed for a presentation I gave at the 12th Congress of the International Commission on the Biological Effects of Noise in Zürich, on June 20, 2017–shows that it isn’t normal. Without exposure to loud noise, good hearing is preserved well into old age.

In his book Coughlin discusses “transcendent design”–not just accessible design, or universal design, but:

[A]nother, even higher level of accessibility that I believe has been mistakenly lumped in with universal design: transcendent design. It’s essentially universal design that has been dialed up to 11 on a 10-point scale, with accessibility attributes so useful that they turn out to be highly desirable—even aspirational—for people with and without disabilities. If the defining, narrative-shaping forces in our older future will be those that make it easy for older adults to achieve their jobs as consumers, transcendent products and design features will be at the vanguard of this process.

Coughlin highlights, as an example of transcendent design, the OXO line of kitchen utensils, initially designed by entrepreneur Sam Farber because his wife couldn’t grip standard utensils due to arthritis. People buy OXO utensils not necessarily because they have arthritis or other grip issues, but because OXO utensils they are so good-looking and easy to use. The iPhone and Apple watch are other examples.

People with mobility, musculoskeletal, or auditory disorders don’t need special designs. They and everybody need well-designed utensils, tools, garments, furniture, and spaces that meet needs as people age and suffer inevitable temporary or sometimes permanent impairments.

Perhaps one day architects and interior designers can come up with transcendent designs for quiet restaurants, to make it possible to carry on normal conversations without straining to speak or to be heard, while enjoying the food and the company of our dining companions.