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“OLD IS A DIFFERENT ANIMAL ALTOGETHER”

The Shared Predicaments of the End Game

All would live long, but none would grow old.
—Benjamin Franklin
Americans from different backgrounds face a set of shared predicaments, and often come to shared realizations, as they reach their later years. Consider the experiences of James and Lila.1

James and Lila Describe Aging in Similar Terms

Though they live but a short car ride away, James and Lila have never met and appear to have little in common. James is an African American man who lives in a public housing development in Rockport. Lila is a white woman who lives in a single-family home that she owns in Baygardens. Despite their geographical proximity, they have been separated by an immense social distance for much of their lives—a chasm created by the racial, socioeconomic, and gender inequalities that have historically shaped, and continue to shape, American society. Consequently, James and Lila have lived very different lives. James was born in the 1930s and raised in the South during the era of legal racial segregation. Although Lila was born around the same time, she was raised in Northern California. James moved to the West Coast as soon as he was able, where he carved out a living doing manual labor and taking odd jobs. He never married. Lila stayed in California her whole life. She went to college, where she met her husband. She got married, raised children, and spent her middle years working as a homemaker.2
Although the earlier parts of their lives were quite different, James and Lila (like most of the elders in this study) described shared experiences and challenges when discussing growing older in contemporary America. James eloquently summed up sentiments common among seniors in this study when he stated,
What you don’t really understand about seniors is the way they feel. You can never understand the way they feel because you from another generation, and with that you have different ideas on the way that older people are supposed to fit into a category. The whole world is in that position. No one understands being old but old people. That’s just an event that happens and it’s catastrophic. You can’t change it. It’s like a tree out there. When it’s young it’s growing, when it gets to a certain age, it spreads out, but it don’t grow any more. It’s just, branches come back and they fall off, but you still the same. And when you get old, everything is a chore. Everything you do is a chore. Just getting up in the morning is a chore. Because you can’t sleep the same, you can’t eat the same, you can’t walk the same. And you don’t have the same dreams. Everything changes. Old is a different animal all together. And the only way you can understand it is you have to get there. [emphasis added]3
Lila, who was a bit less talkative, made a similar point to a friend over lunch at a senior center when she commented, “When you get old things change. How you think and feel.” Her comment was met with knowing nods.
James and Lila’s convergent descriptions of the end game are not coincidental. As the reader will see in the pages that follow, like their peers in each of the four neighborhoods in this study, James and Lila faced a set of common practical and symbolic challenges associated with growing old in America. This chapter charts how these challenges shaped everyday life for seniors in this study and how they led to shared realizations about predicaments that often crossed racial, socioeconomic, and gender divides. In doing so, it will show how the practical and symbolic challenges associated with the aging body organized experiences and stratified opportunities for those in this study.

“My Body Won’t Let Me”: Physical Changes and the Organization of Everyday Life in Old Age

As noted in the introduction of this book, a large component of the connection between inequality and aging plays out through selective mortality; that is, who survives long enough to “grow old.” Nonetheless, the practical and symbolic challenges associated with aging presented even the most differently positioned seniors in this study with shared challenges and experiences. While uneven in timing, the eventual degeneration of the aging body creates shared challenges that shape how seniors engage with the world around them. For those in this study, the physical aspects of aging were inseparable from their lived experience and in many cases became a structuring force in their lives.4
As our bodies reach advanced age, we undergo numerous physiological changes. Tissues break down. The cardiovascular system and heart become less efficient, and blood vessels become less elastic. Bones shrink and muscles atrophy. The immune system weakens, and the ability to fight off disease decreases. While ample resources, good fortune, strong social networks, and robust genes can delay and soften the onslaught of these processes (an essential issue charted through this book), all who live long enough have to face these issues.5
In accordance with these physical aspects of aging, public health researchers and medical practitioners have sometimes referred to the elderly as a “medically engaged population”: a category of people subject to increased health needs and consequently a “biological imperative” to seek care. Anthropologists and medical sociologists have criticized such characterizations as resulting from processes of medicalization or biomedicalization that extend technologically reified systems of expertise, knowledge, and control. On the ground the reality is a bit less ambiguous—physical challenges, and their implications for social action, were a vivid aspect of lived experience, a structuring force in seniors’ lives, and a very real axis of stratification that shaped the end game across neighborhoods. As subsequent chapters will show, the shared predicaments that set the basis of the game are essential to tracing how other mechanisms of inequality differentially shape later life for those from different backgrounds.6
I now turn to those physical issues that I observed to be central to shaping the everyday lives of seniors across neighborhoods: declining stamina, health problems, mobility, and cognitive and sensory changes.

“I’m a Ferrari, but I Can’t Get out of Third Gear”: The Social Significance of Declining Stamina

When we reach our later years, most of us will have to deal with the consequences of having less available energy. Confronting declining stamina and what it meant for social life was an ubiquitous concern within all four neighborhoods in this study. The extent of this, and the magnitude of the corresponding social ramifications, caught many of the seniors in this study off guard. For others, fatigue deeply limited what they could do and became a structuring aspect of everyday life. Even when it was more of an annoyance, however, declining stamina necessitated a response. The comments of Eleanor, a seventy-three-year-old retired white woman, provide a common description of how physical slowdown and declining energy can shape life even for relatively healthy individuals. She noted,
Well, the main part [of getting old] is that you’re actually surprised that you’re physically not able to do what you could do before. Before it’s, well, eight hours on end that I could do things, you know, if I had a big task in the yard that I wanted to do . . . I love gardening. I could spend three, four, hours without stopping and do it. When you’re older it’s part of the immobility that’s bothering you. And, you know, you compensate for it, but in the main, it’s either aches or pains, or not having the stamina.
Even the most active seniors in my study admitted that they do not have the stamina they did when they were younger. Although the timing, severity, and response of losing stamina varied, it was something with which all of them eventually had to come to terms.7
In more extreme cases, a lack of stamina profoundly limited how seniors could live their lives. Put another way, fatigue created problems of social action that became a major structuring force in the lives of older Americans. The experiences of Dave, a poor white man in his early sixties living in Elm Flats, provide a representative example. Dave prided himself on his mental acuity, but physical problems from numerous diseases and a general lack of energy limited his ability to go out and do things. On my visits I would always ask Dave how he was doing, to which he would often quip, “I’ve so many problems, my problems have problems.” Despite his quick wit and sense of humor, Dave was extremely anxious. He was particularly afraid of falling due to overexertion or lack of energy. Dave told me falling was just about the worst thing that could happen to a senior like him, because in many cases (including his own), it would result in a loss of independence. Without children or close family members, Dave felt he was particularly vulnerable and was afraid of spending his final days in a nursing facility. He often talked about the importance of keeping enough “energy in reserve” to avoid such an incident.
Dave confessed that the disjuncture between what his mind wanted to do and what his energy levels allowed him to do was deeply upsetting. He explained the predicament by analogy: “I think I’m a Ferrari but I can’t get out of third gear . . . I get about two hours of good energy a day, where it is safe for me to move around and do things.” I once naïvely commented that the free time of retirement must have provided Dave, who always enjoyed reading, with the opportunity to read new books. He responded, “Well, keep in mind this is in the context of having lots of health problems and very little energy. I can’t do a lot of things.” On the occasions when we would go out together, simply walking down the stairs to the car placed a noticeable strain on Dave. His range for physical and social action was limited by his physical issues and lack of stamina.
For many seniors like Dave, the predicament created by the convergence of fatigue and various health problems was a major factor that shaped how they could organize their lives. Meals, visits with friends, and doctors’ appointments had to be scheduled to accommodate physical limitations. In Dave’s case, what he could eat, with whom he could visit, and where he could go were determined in large part by his physical limitations. The problem of fatigue became more salient even for healthy seniors as they age or younger seniors as they became sick. For instance, Sandy, an eighty-nine-year-old former nurse who occupied an apartment for independently living seniors in Baygardens, stated the problem clearly in one of our many informal conversations. She told me the hardest part of growing older was that as one ages, “Your body just doesn’t do what you want it to do. You are tired all the time and you get confused.” For Sandy, the decline became most noticeable in her eighties. For others who were less fortunate, the challenge came earlier, but the shape of the predicaments were similar. In each case the social possibilities and experiences of growing old were inseparable from their physical dimension.8

“A Full-Time Job”: Health Problems, Death, and the Organization of Activity

In addition to having less energy, most individuals in this study encountered physical health problems (i.e., observable physiological changes that affected everyday life in a way that seniors found undesirable) with greater frequency in their later years. Once again, this had a major effect on how they approached everyday life.9
Many seniors in this study spent a good portion of their week, and much of their limited energy, in medical settings. Dave, for instance, often quipped that if he went to see medical providers every time he was supposed to, he would spend his entire life in the hospital. For those with conditions requiring ongoing treatment (e.g., cancer, diabetes, wounds), this effect was magnified. A comment made by Jane, a sixty-five-year-old white woman with breast cancer, articulates a typical frustration: “I feel like having cancer is a full-time job. It has just been a really fucked-up week. The house is a wreck, dishes are piled up, I have all these appointments, and my car is broken . . . I haven’t even checked my e-mail in three days. It has been a fucked-up week.”
For many of the people in this study, following a treatment regimen limited time, energy, and the ability to do the things they enjoyed. In Jane’s case, between the tiredness, constant medical tests, doctor appointments, chemotherapy infusions, trips to the pharmacy, and side effects, the logistical demands of dealing with physical conditions could easily take up most of her time. She also lamented the effect of her recent physical issues and the corresponding decline in energy on her social life, noting, “I can’t do the things I want to do. I am tired and depressed.” As with other people in these circumstances, her health problems shaped both how she acted and how others acted toward her. This often led to the exclusion of other more desirable aspects of life and created new challenges in maintaining previous identity (i.e., when she followed medical advice, a topic I return to in Chapter 3).10
Further, dealing with the pain associated with common health problems such as arthritis was an omnipresent issue among the seniors in my study. The presence of (often constant and sometimes excruciating) pain became a salient aspect of everyday life as people grew older or sicker (often together), and the need to address it in some way crossed neighborhoods. Even for younger participants (i.e., those seventy-four and under), many of whom were active and had experienced comparatively minor physical problems, the issue of managing “aches and pains” was a key part of their everyday experience. The subjective meaning of pain and the way people responded varied widely between (and even within) different groups, a topic that I address in depth in Chapter 3. Some seniors saw pain as a challenge, others an injustice. Many took narcotic pain pills; others tried holistic approaches to minimize discomfort. However, for seniors across neighborhoods, pain shaped how they experienced and approached everyday life. An eighty-year-old white woman with arthritis provided a typical example when she noted to friends, “Everything hurts. I want to go out and have all these new experiences, but my body just won’t let me.” The medications seniors were prescribed for pain could also compound issues with stamina. Those who did not enjoy narcotic pain medications but needed them to cope would often have less energy and be less alert than they were previously.11
Health problems also forced seniors to grapple with issues of mortality—both their own and that of others. For seniors in all four neighborhoods, growing old was associated with confronting the deaths of others such as friends, loved ones, and acquaintances. The loss of people through death (or permanent institutionalization) produced concrete challenges in both the instrumental and psychosocial arenas. One issue for seniors was acknowledging and developing strategies for facing the inevitable prospect of their own death. As seniors watched friends and family die, and they recognized that their own bodies were not as strong as they once were, they were presented with the inevitability of death. Further, the death of those in seniors’ networks meant watching existing networks shrink (even if new ones were built). As Chapter 4 will show, while network change affected seniors from all four neighborhoods, it did not do so equally. However, just as widespread changes in physical capacities created s...