New Old Age

Forty-five years ago, Betty Szudy and her wife, Maggie Roth, both 70, bought a Craftsman bungalow in Oakland, Calif. In 2017, at the same time their son and his wife were fruitlessly searching for an affordable apartment in the neighborhood, California was liberalizing its housing laws to encourage so-called accessory dwelling units, or A.D.U.s.

So, the family looked into building one. The parents now live in the main house and the adult children in the A.D.U. — in this case, a once-decrepit garage transformed into a 400-square-foot studio with a kitchen and bath. The arrangement makes it simple to share meals, planned or spontaneous, and to pick up items for the other household at Trader Joe’s. “I love having them around,” Ms. Szudy said.

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Denise Revel had a history of developing blood clots, so in 2011, when her leg grew painfully swollen and hot to the touch, she knew what to do. She headed for the emergency room.

She recovered from the clot but could not pay the medical bill. Working as a fitness instructor, she had no health insurance. “I’ve always been financially challenged,” said Ms. Revel, 62, who lives with her daughter in Stockbridge, Ga. “I was a single parent raising two children.”

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Each fall, Becca Levy asks the students in her health and aging class at the Yale School of Public Health to picture an old person and share the first five words that come to mind. Don’t think too much, she tells them.

She writes their responses on the board. These include admiring words like “wisdom” and “creative” and roles such as “grandmother.” But “‘senility’ comes up a lot,” Dr. Levy said recently, “and a lot of physical infirmity and decline: ‘stooped over,’ ‘sick,’ ‘decrepit.’”

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On a recent afternoon in Bastrop, Texas, Janet Splawn was walking her dog, Petunia, a Pomeranian-Chihuahua mix. She said something to her grandson, who lives with her and had accompanied her on the stroll. But he couldn’t follow; her speech had suddenly become incoherent.

“It was garbled, like mush,” Ms. Splawn recalled a few days later from a hospital in Austin. “But I got mad at him for not understanding. It was kind of an eerie feeling.”

People don’t take chances when 87-year-olds develop alarming symptoms. Her grandson drove her to the nearest hospital emergency room, which then transferred her to a larger hospital for a neurology consultation.

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Susan Hartt describes herself as an incorrigible optimist, drawn to change and challenge. After a long, successful career in marketing and public relations, she had reason to feel financially confident in her older years.

But three years ago, a bank foreclosed on her modest house in Hamden, Conn. “I don’t think I’ve ever been as anxious in my life,” she recalled.

Ms. Hartt, 79, had encountered a combination of adversities. After a late-life divorce she called “amicable and equitable,” she had no retirement plan; it had seemed unnecessary because her husband had a “substantial” 401(k). Successive jobs had grown less lucrative, and her freelance work dried up during the recession.

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Anne Cotton had enjoyed her years at an assisted living facility in Corvallis, Ore. But at 89, her health problems began to mount: heart failure, weakness from post-polio syndrome, a 30-pound weight loss in a year.

“I’m in a wheelchair,” she said. “I’m getting weaker. I’m having trouble breathing.” On Sept. 30, Dr. Helen Kao, her palliative care doctor and a medical director at Lumina Hospice & Palliative Care, determined that she qualified for hospice services — in which a team of nurses, aides, social workers, a doctor and a chaplain help patients through their final weeks and months, usually at home.

Ms. Cotton, a retired accountant and real estate broker, embraced the idea. “I’ve lived a very full life,” she said. “I’m hoping I’m near the end. I need the help hospice gives.” Her sister died in Lumina’s care; she wants the same support. For older patients, Medicare pays the cost.

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