Aging in America: Staying Active and Involved is Key to Productive Aging

By Alison Laurio

illustration of people with letters that spell AGING

Like many countries, the United States is undergoing a vast demographic shift — with large increases in the number of older adults, one in five of whom will be at least 65 years old by 2030.

This means more social workers are needed to help with many of the issues older people face — like Alzheimer’s disease and other dementias, elder abuse, hunger, poverty, lack of housing, and social isolation. These are just a few of the challenges among the older population where social workers are involved, and where their skills will continue to be in demand.

Despite the need, there is a shortage of social workers trained in aging and a lack of interest in this area among social work students. On the positive side, the profession recognizes — and is working to correct — the workforce deficit.

Also positive are social work’s efforts to ensure older individuals remain active and engaged. That in itself not only supports those who are aging and helps them feel more vital and part of communities, it also can help change societal attitudes toward aging — which happens to us all.

Productive Aging

One of the American Academy of Social Work and Social Welfare’s Grand Challenges for Social Work is to advance long, healthy and productive lives. Its goal is to “create opportunities, to acquire new knowledge and skills, and to utilize talents and resources in a variety of paid and unpaid roles that maximize health, foster economic security, provide purpose in life and enrich families and communities.”

Ernest Gonzales, MSSW, PhD, is an assistant professor at New York University’s Silver School of Social Work and a co-leader on that Grand Challenge, which is one of 12 challenges identified as inspirational objectives for society in the U.S. He said remaining active and involved is part of productive aging.

“The way we define productive aging is any activity by older adults that produces a good for society whether it’s paid or not,” Gonzales said. “For research purposes, we have to narrow that broad definition: employment formal and informal, volunteering and caregiving.”

Why it is beneficial is complicated, he said. “There is a growing body of evidence that certain aspects of health, including psychological health, can have some really good benefits for an individual.”

The U.S., along with every country around the world, is aging, and some are aging rapidly, Gonzales said. “Baby boomers formally volunteering saves the nation $60 billion per year, and it gives them purpose and drive.”

But work by family caregivers often is not acknowledged, supported or paid, he said. “Informal caregivers, according to two sources, provide anywhere from $100 (billion) to $600 billion a year in services. It’s very much valued, and it’s essential to the health and well-being of people who need help. But we could do a better job in supporting informal caregivers.”

Social workers educate people and help them embrace productive aging in varied ways, he said. They advocate for certain programs like the Older Americans Act, which supports a range of services like Meals on Wheels, and legal and in-home services. Social workers also help older adults gain employment and volunteer positions, Gonzales said. They assist veterans, those who are homeless, and those with low English proficiency in finding work.

“Social workers are on the front line assessing the capacity, needs and services this high-risk group needs,” Gonzales said. “They are right there in the trenches for them. A lot of students graduating from our (school) are out there developing programs. Social workers have a person-in-environment perspective and they see a number of ways to help create programs that help older adults.”

Their work is not without challenges, he said. “I think age discrimination is alive and well. Older workers take longer to find employment and likely have a salary that is lower. I think tackling ageism is really important.”

He pointed to an intergenerational AARP program, Experience Corps, that involves older adults tutoring and mentoring young people. “The program has documented more reading improvement, greater comprehension, and it’s better for the adults. It’s a demonstrated win-win solution.”

Many older adults want to continue to help, and many of them with higher incomes already do, Gonzales said.

“The challenge is how to get the others,” he said. “Experience Corps provides a small stipend that helps offset things like transportation. They were able to demonstrate that small stipend meant volunteers were more likely to complete the academic year, and their mental health improved. That’s a nice strategy and a triple win.”

Early Engagement

woman walks dog

The productive engagement of older adults is a concept that came about 30 years ago, said Nancy Morrow-Howell, when people saw taking care of older adults as a drain — a dependency rather than a contribution.

Morrow-Howell, MSW, PhD, is the Betty Bofinger Brown Distinguished Professor of Social Policy at the Brown School of Social Work at Washington University in St. Louis. She teaches gerontology courses and a freshman course on aging, and is director of the Harvey A. Friedman Center for Aging. She also is a co-leader on the Grand Challenge to Advance Long, Healthy and Productive Lives.

“We focus on older adults working, providing service in communities, and formal and informal caregiving,” she said. “We focus on programs and policies that can support older persons in those roles.”

When thinking of older individuals, the attention often is on “medical conditions and all kinds of limitations,” Morrow-Howell said. “If we focus on volunteering and productive engagement, we get a different vision of the capacity of older adults. We’re looking at ways to involve people when they’re younger so they can continue that through their retirement. Getting somebody started in volunteering is easier when they’re younger, so when they separate from work, they continue volunteering.”

One of the most common ways for people to start volunteering is simple: someone asks them, Morrow-Howell said. “The benefits are clear — it’s more person power. They try to bring in people who tend to have attributes like high relationship skills and more experience generally.”

Volunteering also is “very beneficial for those volunteering,” she said. “We have evidence it contributes to their physical, psychological and cognitive health as it supplies more person power to organizations that need it. I think when younger people are exposed to service — like utilizing them on a college campus — they are likely to continue it throughout their life course. As gerontologists, our role is supporting that through retirement.”

As corporations eye more involvement, Intel has what Morrow-Howell calls an innovative program where workers considering retirement can receive a stipend and continue heath benefits if they volunteer at a nonprofit in a part-time job or volunteer role.

“Donating your experience to a nonprofit is a way to ensure meaningful engagement,” she said, adding that social workers run many nonprofit organizations that are a critical part of using volunteers — and they are reaching out to older adults. They also can deliberately develop programs that recruit and benefit from older adults.

“We’ve been pushing this concept for 20 years, so it’s not new,” Morrow-Howell said. “There is more awareness now that people need to be purposely and meaningfully engaged to have a healthy life. Now we can help by making sure those people are engaged.”

There are some new ideas about how to support older people in these roles, she said. “We need to focus on what older Americans can and want to do. It’s a contribution I think we need to keep growing. I think productive engagement works. We need to — and want to — work longer.”

Social workers interested in this can first figure out what is going on in their communities. United Way, for example, has a lot of volunteers. Area Agencies on Aging also know what's happening, and they have experience surveying communities to determine where there are volunteers and where they are needed, she said.

Workforce Support

The Eldercare Workforce Alliance has 35 members, including NASW and other national organizations representing consumers, family caregivers and health care professions. It addresses workforce issues like recruitment, training, and compensation and retention; and provides information and support to consumers and family caregivers, its website states.

Amy York, executive director of the alliance, said her organization was established more than 10 years ago after a National Academies of Sciences, Engineering and Medicine report stated the country was underprepared to care for older adults and the baby boomer population.

The federal government’s Health Resources & Services Administration’s Geriatrics Workforce Enhancement Program also was established then, she said. “A lot of the workforce is not trained in geriatric care. Because the health care system is so siloed with specialists on specific diseases, it makes it much more difficult to care for the whole person. All the money flows toward the acute side and little flows to the social and long-term needs.”

“That’s key here,” York said. “What needs to change is we need to fund the social needs of adults. That’s where social workers have a critical role.”

Social workers play an important part in older adult care, including care coordination and mental and behavioral health, she said. “There are not enough psychologists, psychiatrists and social workers trained in this, especially as the baby boomers continue to age.”

Mental and behavioral health is an important area, as is dementia, she said. Research around what the best models for care are — and getting those implemented community-wide — is also vital.

“When we get to 85 and older, that’s when we get to the need, and social workers will be key to making that work,” York said. “The models that do best are the ones that are connected with communities. I think social workers are an important piece for that.”

York believes the issue of caring for older adults is a crisis all over the country and deserves national attention.

“I think we need to urge caregivers to talk about their experiences, because they’re the voices who are going to make the biggest difference for most of us at some point in time,” she said. “Ultimately, to address this issue, elected officials have to hear that this is a problem. …The general public needs to be more aware of it. Most people, unfortunately, become aware of it when it becomes a crisis in their own life.”

Student Perceptions

Former NASW President Gary Bailey, DHL, MSW, ACSW, is the assistant dean for Community Engagement and Social Justice and a professor of practice at the College of Social Science, Public Policy and Practice at Simmons University in Boston. He said there are not as many social workers going into working with older adults “as the population data would indicate we need.”

Bailey himself initially wanted to work with children, so that he might have his summers off. But when Massachusetts passed a law capping property taxes, that meant less money in municipal budgets, including schools. A grad school classmate suggested a program that worked with older people at risk, and Bailey jumped at the opportunity.

He says moving into the aging field was the best thing he ever did, and he now normalizes aging as part of life with his students. This has meant not to be afraid of his own aging and to focus on starting where people are — whether they’re 100 or 63 years old.

A lot of young people may tend to shy away from older people, saying they sit around reminiscing, Bailey said. But he added that everyone reminisces, including young people who may share stories from high school or college — of times when life made sense, and they felt safe and happy.

Morrow-Howell and Gonzales also say not many students consider working with older adults.

Gonzales said students do not receive a wide-ranging background in aging, because of the tendency to focus on disease, disability and decline.

“The Grand Challenge has a balanced perspective: Aging is not a sign of disease,” he said. “I think as social workers we need to emphasize the strengths of aging adults. I think if we emphasize that, students would be more interested in aging and how they can help not only their lives but the entire family’s life. It’s a great opportunity to get into the aging field.”

Leigh Glenn contributed to this article.

Addressing Alzheimer's Disease

illustration of brain

“Alzheimer’s is the most under-recognized threat to public health in the 21st Century,” said Dr. David Satcher, a former U.S. surgeon general and director of the Centers for Disease Control and Prevention.

While initially seen as an aging issue, Alzheimer’s disease “meets the three-point criteria for identifying a public health issue,” because the burden is large, the impact is major, and there are ways to intervene, according to the Alzheimer’s Impact Movement.

Large Burden

  • More than 5 million Americans have Alzheimer’s.
  • As the most expensive disease in America, costs exceed a quarter of a trillion dollars per year.
  • It is growing. The number of people living with Alzheimer’s is projected to triple to as many as 16 million in 2050, and the costs are expected to rise to more than $1.1 trillion.

Major Impact

  • Alzheimer’s caregivers have more than $11 billion in additional health care costs every year.
  • Among people with dementia, one in every four hospitalizations is preventable.
  • Two-thirds of the health and long-term care costs associated with Alzheimer’s care are borne by Medicare and Medicaid.


Public health officials can use traditional tools and techniques to improve quality of life for those living with Alzheimer’s and to reduce its associated costs. These include primary prevention, early detection and diagnosis, data collection, and access to quality care and services.

The BOLD Act

Signed into law on Dec. 31, 2018, the bipartisan BOLD Act establishes Alzheimer’s Centers of Excellence nationwide to expand and promote interventions. It provides funding to carry out the Public Health Road Map that promotes early detection and diagnosis, reducing risk and preventing avoidable hospitalizations. It also increases the analysis and reporting of data on cognitive decline and caregiving to inform future public health actions. The act authorized $100 million over five years to carry out public health activities addressing Alzheimer’s and other dementias. Congress must fully fund the law by providing $20 million in fiscal 2020 for the CDC.

— From the Alzheimer’s Impact Movement

Aging Facts

illustration of people in the park

Baby boomers are reshaping the older population in America by driving the current growth of the 65 and older age group, according to a June fact sheet from the Population Reference Bureau.

In a key-findings update from 2015, the bureau found the number of Americans age 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and its population share is projected to increase from 16 percent to 23 percent.

The older population is more diverse racially and ethnically, and the non-Hispanic white portion of the population is projected to decrease from 77 percent to 55 percent, it states.

Other developments include increased education levels and average U.S. life expectancy, and the gender gap in life expectancy has narrowed from seven years in 1990 to five years in 2017.

Also positive is that the poverty rate for those 65 and older has dropped to nine percent today from nearly 30 percent in 1966.

Challenges for the age group include increasing obesity rates, wide economic disparities across population subgroups, and higher divorce rates than in 1980.

Aging baby boomers could require an increase in nursing home care of more than 50 percent, and Alzheimer’s disease numbers could more than double by 2050 — to 13.8 million.

With growing numbers, Social Security and Medicare expenditures will increase from a combined 8.7 percent of gross domestic product to 11.8 percent by 2050.

What will help? Policymakers can reduce current gaps in education, employment and earnings among younger workers, the fact sheet states.

— From the Population Reference Bureau, December 2015, updated June 2019

Elder Abuse

Hundreds of thousands of adults over age 60 are abused, neglected or financially exploited every year. It can happen at their home, a family member’s house, a nursing home or an assisted-living facility. Types of abuse include physical, emotional, neglect, abandonment, sexual and financial

Some men are abused, but most victims are women. Older people who have no family or friends nearby and people with disabilities, memory problems or dementia are likely targets. It can happen to any older person, but those most often affected are people who depend on others for help with everyday activities, including bathing, dressing and taking medicine. Those who are frail also may appear to be easy victims. Signs of abuse or neglect include:

  • Trouble sleeping
  • Seems depressed or confused
  • Loses weight for no reason
  • Acts agitated or violent
  • Becomes withdrawn
  • Stops taking part in activities he or she enjoys
  • Has unexplained bruises, burns or scars
  • Looks messy, possible has unwashed hair or dirty clothes
  • Develops bed sores or other preventable conditions

Abuse can have long-term effects. Any kind of abuse can leave the mistreated person fearful or depressed. The victim sometimes thinks the abuse is his or her fault. Counseling and support groups can help heal emotional wounds.

From the National Institute on Aging at NIH

65 Years and Older

The American Community Survey report published by the U.S. Census Bureau in October 2018 covers “The Population 65 Years and Older in the United States: 2016.” It includes population numbers, demographic characteristics, marital status, living arrangements, disabilities, economics and more.


  • Lower fertility and increased longevity have led to the rapid growth of the older population across the world and in the United States.
  • In 2015, among the 7.3 billion people estimated worldwide, 617.1 million (9 percent) were aged 65 and older.
  • By 2030, the older population will be about 1 billion (12 percent of the projected total world population), and by 2050, 1.6 billion (17 percent) of the total population of 9.4 billion will be 65 and older.
  • The rapid growth of the older population contrasts with an almost flat youth population (under age 20) and moderate increase in the working-age (aged 20 to 64) population projected over the same period.
  • The U.S. older population grew rapidly for most of the 20th century, from 3.1 million in 1900 to 35 million in 2000. Except during the 1990s, when the relatively smaller Depression Era cohort of the 1930s reached the age of 65, the growth of the population 65 and older surpassed that of the total population and the population under the age of 65.
  • The U.S. will experience further expansion of the older population for many decades to come, fueled by the baby boom cohort that began turning 65 years old in 2011.


  • The American Community Survey estimated there were 49.2 million people age 65 or older in the United States in 2016.
  • More than half (58 percent) were ages 65 to 74.
  • There were 14.3 million, or 29 percent, who were 75 to 84 years old.
  • There were more older females (27.5 million) than males (21.8 million).
  • The disparity in numbers between the sexes increased with age.
  • Nearly twice as many females (4.1 million) as males (2.2 million) were 85 and older.

Marital Status

  • In 2016, most males and females age 65 and older had been married at some point in their lives.
  • More than twice as many women age 85 and older were widowed compared with men of the same age.

Living Arrangements

  • In 2016, the likelihood of living in a family household diminished with age.
  • Older people were far more likely to live alone and in group quarters with age.
  • About 55 percent of the older population living alone had access to the Internet, compared with 84 percent of those living in a family household, and 77 percent living in a non-family household.


  • Serious difficulty walking or climbing stairs was the most prevalent disability for all older population groups.
  • Ambulatory difficulty was present in more than 15 percent of those ages 65 to 74, more than 25 percent in ages 75 to 84 and almost half of those ages 85 and older.
  • About 69 percent of those 85 and older had at least one type of disability. The disabilities include vision, hearing, ambulatory, cognitive, self-care and independent living.


  • Labor force participation decreased with age, but more males than females remained in the labor force.
  • Older men (43 percent) had greater employment in management, business, science and arts occupations, consistent with their educational attainment, than older women (38 percent).
  • Older men and women ages 65 to 74 had higher median earnings in the past 12 months compared with workers 16 and older.
  • Among those 65 and older, Social Security was the most common type of household income.
  • Women 85 and older had the highest poverty rate among the older population — 13 percent to the males’ 8 percent.

Read the full report

Social Work Advocates

Social Work Advocates
December 2019 / January 2020 Issue

There is more awareness now that people need to be purposely and meaningfully engaged to have a healthy life. Now we can help by making sure those people are engaged. Nancy Morrow-Howell, MSW, PhD, Professor, Brown School of Social Work

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