For more than 25 years, I served as a psychology professor and researched grief and bereavement. I consulted and taught individuals, couples and families to meet the demands that chronic illness exacts, to build safety nets and resilience in the presence of stress, and to create space for the problems that the loss of a loved one brings. I was widely published, including a well-received book (Life After Loss:  Contemporary Grief Counseling and Therapy), and produced professional audio and video recordings on end-of-life and palliative care.

Throughout, I struggled with the truth that my wife lived with a genetic cancer syndrome causing chronic health concerns, including multiple presentations of vicious cancers over the course of 33 years. She was as well-educated as I; we met the challenges of her illness with state-of-the-art treatment and care, including two decades of participation with the National Institute of Health’s research projects related to Lynch Syndrome.

Then She Died

In the summer of 2016, she began to fail for no apparent reason. Her research teams and physicians had no explanation, nor could they offer any further course of treatment. As she lost energy and strength, I became more alarmed.

The principal investigator of her study told me, “Jack, she has outlived this disease longer than any of us ever expected. She is a medical marvel and there is nothing further that we have to give. It may be time to call in hospice.”

One of her gifted practitioners, a neurologist, suggested that her body “just had enough,” which he termed idiopathic metabolic myopathy, diagnosed when the body unexpectedly stops translating nutrients into chemical energy.

They were right. Her body was exhausted and said “No more!” She died over the course of five weeks as an in-patient in a local hospice, attended to by personal and loving friends with whom we had worked over the years.

The Process of Grief

I arrogantly thought I was ready for my wife’s death. But it took me no time to realize that the experiential nature of grief is very, very different from academic study or clinical facilitation of others through the process. My spouse, lover and favorite playmate was gone. For years, I had taught that the process of grief does not change a person as much as it reveals another part of the self. What I quickly learned is the understanding of myself as student, professor and scholar had little relevance to living as a 61-year-old man whose wife of 38 years had died.

There Are Benchmarks

Much has been written about the natural process of grief. Those in the presence of loss are taught to stay in motion, however that looks personally, and to talk about their feelings of the impact caused by the absence of the deceased. Much is made of the first year following the death of a loved one. There is such focus to understand and explain the loss and come to terms with voids created by the absence of the deceased.

Meeting the markers of the “firsts” such as holidays and birthdays are places for attention, coupled with the erroneous belief that getting over such hurdles will lead to an easier acceptance of the loss.

Little is discussed of the second year, when those who grieve begin to assume a new identity reflecting new circumstances of life. The second-year experiences surprise us in that our loved one will always be absent, yet somehow present. Personally, I became uncomfortably aware of the discrepancy between the world that is now and the world that was.

The Sadness of the Second Year

Sadness is more than an abstract feeling. It penetrates the source of a person’s being and emerges when there is nothing, nothing, nothing to do except live with the loss. It is about resignation and invites one to turn attention inward, to take stock and to adjust.

For me, sadness continues to fine tune my memory in order to tolerate the good, bad, and ugly of my marriage. Over time, sadness has become a bass note to the day-to-day music of my life.

Time has a different meaning. Like all of us, I rely on chronological and sequential time to stay in the rhythm of the day (I have a young friend who calls this “the default world”), but in this second year, I live in what I’ve learned is kairos time, when an hour can be forever, a year a moment. I don’t understand this very well, but trust that time as we typically know it is not real. It is neither an event nor a thing, but a human-mind interpretation of a sense.

For some strange reason, I believe that I can simultaneously grasp the past in memory, the present by attention and the future by expectation. This is the oddest experience and more than a little squirrely.  Life goes on in a linear way, so for many of us grieving the loss of a loved one, the second year forces us to face the harshness of loneliness because the social support of others fades.

What to Do?

In grief, it is never a good idea to curl up into a ball and wait for the will to live to pass away, as appealing as this thought may be. Better, acknowledge the loss and the truth that things do change.

Companionship counters loneliness. While I miss the companionship of my wife, I want the company of others. Such proximity allows an honoring of her spirit, rather than focusing on my intellect. The presence of others bears witness to the struggles of life.

Realize, with “real eyes,” as Rockland, Maine spiritual director Deirdre Felton says, “Doors are opening. Doors have closed. Take a breather and spend time with the new chrysalis that will hatch in its own time, with a new version of yourself, still who you are, but now somehow different.”

(Across caregiving and community, business and intergenerational attitudes, the pandemic and how we respond to it could change us forever. Next Avenue turned to some of our Influencers in Aging, a diverse group of thought leaders, for their insights, counsel and opinions of what could lie ahead — if we choose.)

This is a dark age for many of us. The coronavirus pandemic has put global populations at risk, stripped millions of people from jobs and savings and isolated us in ways many have never experienced. For those of us of who are older, the danger is elevated. But the lessons of history offer perspective.

Humanity survived and thrived in the wake of earlier pandemics. The pain inflicted by invisible enemies like the Black Death, smallpox, and the Spanish Flu was devastating, but the world recovered.

In this moment, as we face physical isolation, financial loss and threatened health, finding purpose may actually save lives.

We have survived even worse — our own inhumanity. That’s why this is a time to turn again to the work of Viktor Frankl and his powerful book, Man’s Search for Meaning.

Frankl was the prominent Austrian neurologist and psychiatrist who wrote of his personal experiences in the Auschwitz concentration camp. He observed that prisoners who found purpose in the face of unimaginable conditions were far more resilient and likely to survive than those who did not.

What Purpose Can Do for Us

Frankl’s words, “life is never made unbearable by circumstances, but only by lack of meaning and purpose” are a call to action today. Finding purpose, a fundamental requirement for human health and well-being, will not cure the coronavirus, but may well mitigate its effects and enable a more rapid recovery.

In this moment, as we face physical isolation, financial loss and threatened health, finding purpose may actually save lives.

Researchers agree that purpose in life increases overall well-being, improves mental and physical health, enhances resiliency and self-esteem and decreases the chances of depression. A strong sense of purpose is associated with slower development of age-related disabilities, reduced incidence of cardiovascular disease, improved cognitive health and longer lives. Finding purpose can promote energy, satisfaction and protective preventive health behaviors.

As Dr. Philip Pizzo of Stanford University, another Next Avenue Influencer in Aging, wrote in a recent piece for the Journal of the American Medical Association, “having a purpose, seeking social engagement, and fostering wellness through positive lifestyle choices are important in reducing morbidity and mortality and improving the life journey.”

While each of us sees purpose through our own lens, there is common ground. Some suggest that purpose is found at the intersection of our talents and skills and a need in the world. Others say it is the thing that drives us and keeps us going when things get tough.

Certainly, contributing to and caring for others is a shared instinct and aspiration. Social connection, engagement and sense of community are also key parts of the formula. Importantly, a loss of purpose can be a symptom of isolation.

That is a risk we all face today. So, if isolation is the enemy, how can we preserve and elevate our sense of purpose during a period of social distancing?

7 Ways to Find Purpose in the Pandemic

Here are seven ideas:

1. Call and email. Connect with family, friends and colleagues, particularly with those who are alone. This is an opportunity to renew and mend relationships and offer comfort to those in need.

2. Volunteer. Help others by reaching out to community organizations to offer assistance. The benefits of volunteer service are powerful, both for beneficiaries and for volunteers themselves who often realize enhanced physical, mental and emotional well-being related to their service.

We’re living history today, and this is our opportunity to record it.

3. Prioritize learning. Determination to learn can foster a sense of purpose. Reading connects us to new people, places and ideas. Online courses and periodicals expose us to fresh perspectives. Virtual museum tours, music lessons and performances, poetry readings and cooking classes are all available.

4. Write. Writing challenges us to organize and express our thoughts. Begin a journal. We’re living history today, and this is our opportunity to record it.

5. Exercise. Set daily goals and do what’s possible. The health benefits are obvious, but fitness goals can also be a manifestation of purposeful living.

6. Count our blessings. A sense of awe and gratitude are associated with purpose and an increased inclination to engage in altruistic behaviors that make a contribution to others.

7. Plan for what’s next. This pandemic will ultimately be controlled, so now is a time to prepare for recovery —at home, in business and in community. Things may be different, but human beings have proven to be remarkably adaptable and we’ll adapt to this as well.

Of course, all of us will have good days and bad as the coronavirus pandemic plays out. But each of us can choose to adopt positive attitudes and control our own response to the circumstances.

Let’s take the lessons learned from reading Viktor Frankl and live this difficult time with purpose.

The last few days, I’ve been receiving calls and texts from friends and neighbors. One person was running to the drug store and asked if I needed anything. Another friend wanted to be sure I had food. And another called just so we could talk about how surreal life during the coronavirus pandemic feels.

I have a progressive neuromuscular disease, use a power wheelchair, and can no longer drive.  My husband works 12-hour shifts at a local hospital. Our nearest relative lives six hours away.

I am well acquainted with social isolation.

Your neighborly acts of kindness can make a difference in someone’s life.

Being alone can be difficult. Over the years, I’ve deliberately created a network of friends and neighbors who know my circumstances and don’t mind lending me a hand.

In the days to come, more of you will be confined to your home. Many of your neighbors might be alone, ill, afraid or in need of assistance — especially if they are physically distancing themselves from other human beings.

10 Ways to Show Kindness

Now is the time to reach out to one another.

Do you know the people who live on your block or in your apartment building? If you don’t, put a note on their door with your name and phone number. Explain that you live next door or down the street. Tell them you want them to feel free to ask for help.

Many people are uncomfortable asking for help. Instead of just saying, “Do you need help?” offer to do something specific for them.

Here are examples of what you can do:

1. Before you run to the grocery store, drug store or a restaurant to pick up take-out, call and ask your neighbors if they need you to pick up something for them.

2. Volunteer to walk their dog(s).

3. Would if be helpful for them if you put their mail and newspaper beside their front door?

4. Does their yard need maintenance? Ask if they would like you to mow their yard, shovel the snow from their driveway or water their wilting flowers.

5. Do they need assistance putting their trash out or bringing the empty cans back into the garage?

6. If you have extra soap, toilet paper or other staples, leave a care package at your neighbor’s door.

7. Cook a meal or a batch of cookies and share them with your neighbor.

8. If you’re looking for ways to engage your children, have them make cards and crafts for the neighbors. Just to be safe, place items in a zipped bag with instructions to wait seven days to open, for germ prevention.

9. Go online and join your neighborhood group to communicate with those who live nearby. Websites like Nextdoor already exist or you can create a private group on Facebook. Just remember, many of your neighbors might not use social media. Some people don’t text. Find out how your neighbor prefers to be contacted.

10. Even if your neighbors say they don’t need help, continue to offer. Accepting assistance from a stranger can feel awkward.

Your neighborly acts of kindness can make a difference in someone else’s life.

Last week, the House of Representatives joined the Senate in giving final approval to a five-year renewal of the programs and services of the Older Americans Act (OAA). This represented a strong bipartisan reaffirmation of the value of the law to maintaining the independence of people 60 and older. President Donald Trump is expected to sign the legislation soon.

Why should you care? For one thing, the Older Americans Act’s efforts assist 11 million people each year all around the country, with services ranging from congregate and home-delivered meals to transportation services to elder abuse prevention to part-time employment. For another, the new legislation will provide new initiatives — and continue current ones —  helpful to family caregivers, people with early-onset Alzheimer’s and low-income older Americans, among others.

Highlights of the Reauthorized Older Americans Act

The bill’s two main highlights: reauthorizing the Older Americans Act for five years and providing a 35% increase in funding over that time period. It also reaffirms that this law addresses two growing societal challenges: 1) social determinants of health (economic and social conditions influencing difference is health status) and 2) social isolation and loneliness.

61% of home-delivered meal participants said they’d skip meals or eat less in the absence of these programs.

One program that addresses social isolation is the Older American Act’s congregate nutrition program. By law, it must provide participants with a meal, nutrition education and a socialization opportunity (although the coronavirus pandemic will alter this, as explained below).

I’ve worked on a grant program with the National Association of Nutrition and Aging Services Programs, funded by the RRF Foundation for Aging, which studied the value of socialization. It found than 90% of older adults surveyed said the main reason they participate in the program was for socialization.

The Older American Act’s reauthorization would bolster efforts in this area by directing the U.S. Assistant Secretary for Aging to develop a long-term plan for supporting state and local efforts to combat social isolation, involving screening for social isolation as well as education on preventing and responding to negative health effects associated with social isolation.

How It Will Help With Caregiving and Nutrition

For caregivers, The Older Americans Act legislation will: provide new grants to home care workers; continue funding the 2018 RAISE Family Caregivers Act for another year (as Next Avenue explained, that law helps relatives and partners who provide medical assistance to loved ones); and, for the first time, provide caregiver and long-term care services to those with early-onset Alzheimer’s disease.

On the nutritional front, the bill addresses two other trending issues for older adults. It takes into account cultural considerations and medically tailored meals for the federal nutrition program and the legislation provides screening for malnutrition for the first time.

Before the bill passed, evaluations of some existing Older Americans Act programs demonstrated their significant value to beneficiaries.

For example, 61% of home-delivered meal participants said they’d skip meals or eat less in the absence of these programs.  And a review of the law’s National Family Caregiver Support Program found that its caregiver services reduce caregiver burden as well as help family caregivers continue in their role for longer.

What the Older Americans Act Needs

The only real shortcoming of the Older Americans Act is inadequate funding.

It received just 1.1% a year, on average, in federal money from FY 2001 to 2019. The nutrition programs have fared slightly better, but when adjusted for inflation, total funding appropriated for Older American Act nutrition services during those years actually fell by 8%.

The Older Americans Act reauthorization wouldn’t have happened without the bipartisan leadership of Reps. Suzanne Bonamici (D-Ore.),  chair of the subcommittee with jurisdiction over the law; Bobby Scott (D-Va.) and Virginia Foxx (R-N.C.), chairs of the committee with jurisdiction, and Sens. Susan Collins (R-Maine), Bob Casey (D-Pa.), Patty Murray (D-Wash.), and Lamar Alexander (R-Tenn.), all of whom played a pivotal role in the Senate.

Help Due to the Coronavirus

A very recent demonstration of the day-to-day importance of the Older Americans Act just occurred last week.

In the early hours of March 14, the House passed the Families First Coronavirus Response Act, which included $250 million in emergency funds for the senior nutrition programs of the Older Americans Act. It responded to expected major changes in the operations of senior nutrition programs due to the pandemic. Many thousands of  congregate recipients will likely become home-delivered recipients for an undetermined length of time.

Further, this funding will help meet the growing demand for providing shelf-stable meals and congregate meals in alternate ways, such as “grab and go” options.

The Senate is expected to pass the bill with these funds later this week and the President has signaled his support.

Paul Downey, co-chair of the American Society on Aging’s public policy committee, said: “It is gratifying that in these uncertain political times one thing that both Republicans and Democrats agree on is the importance of passing the Older Americans Act. It is critical to the health and well-being of millions of older adults in the United States.”

(Editor’s note: This story is part of a series for The John A. Hartford Foundation.)

Around the time Sana Goldberg began nursing school, her grandfather had a serious, undetermined health problem.

“I remember from the moment of entering the ER to the week later when he was dismissed from the hospital — having such a sense of confusion about what was going on,” Goldberg, a nurse who practices in New Haven, Conn., recalls.

Although Goldberg’s mom was a doctor and Goldberg herself had worked extensively in hospitals and been around this, she’d never before been so intimately connected to the process of dealing with a significant medical issue.

To have a really solid primary care provider is too important to compromise on.

“Because I’m a reader, I went and looked for books, and I couldn’t find much that I felt like was a really good resource,” Goldberg says. “There are a lot of books out there about hospital safety or how to communicate better with your doctor. But they all were sort of paternalistic and didn’t really get at the core of what I was trying to figure out.”

It hit Goldberg that this kind of “how to” information — all compiled into one place — would be profoundly useful for people to have on hand.

“I thought it would be really great if this could be distilled and given to patients because the health care climate is really difficult right now for a lot of people. And so to have better tools to interface with that — I think people are wanting to have that.”

Her book, How to Be a Patient: The Essential Guide to Navigating the World of Modern Medicine, breaks down a wealth of information and expertise into easy-to-understand (and easy-to-find in times of stress) chapters and sections like “How to Choose a Primary Care Provider” and “When You Can’t Get a Diagnosis.”

Chapter 23 goes in-depth on “When You’re Getting Older (Or When It’s Your Parent),” with plentiful guidance on switching to a geriatrician, mental health and loneliness, transportation, end-of-life choices and more.

This is the type of book you keep in a handy place and reference as life happens and issues come up. It’s friendly, approachable, realistic and takes into account the ways modern medicine is not always fair to patients of various genders, sexual orientations, races and ethnicities. Next Avenue asked Goldberg to expand on some of the most intriguing and relevant parts  in her book:

Next Avenue: In the book you discuss ‘unlearning’ things. What are some of the main things you’d like people to unlearn about health care and how it works?

Sana Goldberg: Unlearning the idea that your role as a patient is to be passive and be a recipient of directions and orders. You show up at the doctor, they tell you what to do, you never question somebody in a white coat. This system then becomes really intimidating and you don’t question it, and it becomes OK that a lot goes on that you might not understand.

Knowing that you have agency during medical encounters is really important, and to unlearn this deference to medical providers.

Self-advocacy at the doctor is intimidating for a lot of people. What do you recommend to people who are scared to speak up or ask questions that might seem accusatory or like they’re questioning the doctor’s authority?

What I always tell people first is to acknowledge that the system is imperfect. Even a doctor that you have a lot of trust in is still working within a system that’s imperfect.

So it’s OK to think of yourself as working with them to figure something out rather than directly challenging their authority.

I tell people it really helps to write down your concerns or questions before you go in rather than being on the spot and knowing the clock is ticking. Think about what you want to say and have that in your mind before you go in.

And having an advocate with you can help to bolster your courage in a situation — to feel supported by somebody.

Your book has an entire section about bringing an advocate to the doctor. You suggest always bringing an advocate to appointments and you detail who that person can be and how you can choose them. Some people might be nervous to bring an advocate to appointments, especially if they feel like they should be able to do everything themselves. Why is it so important for people to bring an advocate along?

I get questions about this a lot. [Needing an advocate] is a really strange statement to make and I think it’s pretty foreign, especially for a high-functioning adult or someone thinking about privacy.

My goal is to get people to reframe how they think of their health care and how they interact with their health care. And so to have a consistent person who is up to speed on what’s going on with your health care — the long-term goal is that you have a person who can build a relationship with your providers and be your advocate if something more pressing comes along.

In a hospital setting, it’s really important to have another pair of eyes. In an appointment, the same thing holds because it’s usually such a short time period.

A lot of times, people are nervous because it’s intimidating to be around medical professionals. Or people feel like they’ve been waiting so long to get an answer and [the doctor] is the person who can help, and they’ve got to make the most of this. It can be daunting.

Have another person who can remember a question you might’ve forgotten to ask or who can be there just to receive information that you might not be able to pay attention to because your mind is on other things.

Something we hear from readers is that it’s difficult to communicate with doctors and feel like you have enough face time with them. You touch on this in the book. What’s your advice?

Before you go in, think about the timeline of your symptoms. So rather than saying, ‘This started hurting, I don’t know, sometime last August,’ you’re able to talk about the frequency of the pain, how long it lasts and what you’ve tried to do to remedy it that hasn’t worked. Really thinking dynamically about the problem you’re going in for and having prepared a little elevator pitch of how to talk about it.

The second thing I would say is being comfortable asking questions — and not only just asking questions and getting answers, but being sure that when you’re given an answer, it’s given to you in a way that you can understand.

As medical professionals, we work a lot on health literacy and making sure on our end that we’re not just speaking gibberish over somebody’s head. But patients are really reluctant. There’s this eagerness to please and just say, ‘Yeah, I understand,’ even if you don’t know because it wasn’t communicated very well. So just keeping in mind that it’s OK to say, ‘Can you explain that in another way? I didn’t understand.’

The last thing is feeling comfortable reining the conversation back in if you feel like it is going somewhere that wasn’t the place that you intended or something that you brought up wasn’t prioritized in the way you hoped.

What should you do if a doctor isn’t responding well when you speak up or ask questions?

Firs,t try some of those skills like challenging something or trying to redirect the conversation. But ultimately my stance is that if you don’t feel like you’re heard or you can’t have a productive conversation when you’re trying to communicate with your provider, then it’s probably good — especially if it’s a primary care provider — to find somebody that you can communicate with.

And that’s especially important if you’re older and you have different parties involved in your care and you have to be this conduit of information between them.

To have a really solid primary care provider is too important to compromise on. You can try to advocate and have agency in those interactions and use the tools that are in the book, and then if it doesn’t work, I always think it’s OK to find somebody new.

There’s bad news and so-so news about the retirement insecurity of American female workers in the new Aegon Retirement Readiness Survey 2019. But the good news is that if employers, the U.S. government, financial advisers and those workers take a few key steps, today’s cloudy retirement prospects for women could become sunnier.

After receiving the survey of 14,400 employees and 1,600 retirees in 15 countries  — from Aegon Center for Longevity and Retirement and nonprofits Transamerica Center for Retirement Studies (TCRS) and Instituto de Longevidaded Mongeral Aegon — I parsed its massive data. Then, I learned more about the findings and advice for working women from the survey’s author, Catherine Collinson, CEO and president of TCRS. (The report’s also called The New Social Contract: Achieving retirement equality for women.) And I asked Cindy Hounsell, president of the nonprofit Women’s Institute for a Secure Retirement for her thoughts. Finally, I had a candid conversation with Holly Lawrence, a 59-year-old freelance writer in Washington, D.C. who has written eloquently for Next Avenue about her financial struggles. She had some piercing opinions about the survey’s results.

Only 23% of the U.S. women surveyed correctly answered three basic financial literacy questions dealing with interest rates, inflation and risk diversification.

“Our overarching goal for the report is to inspire and empower women to take action,” said Collinson. “My sense is that women need a vote of confidence. And small steps can lead to a big impact over time. For many women, taking the first step is the hardest.”

The News About Women and Retirement Insecurity

So, to the news:

First, the bad news. Only 25% of the U.S. women surveyed believe they’re on course to achieve their retirement income needs and just 26% are confident they’ll be able to retire with a comfortable lifestyle. By contrast, 40% of men say they’re on course to achieve their retirement income needs and 48% are confident about their retirement prospects.

“It is alarming,” Collinson said, speaking about the responses of women and the disparities with men.

Two reasons for American women’s retirement insecurity, she noted, are the gender pay gap, making it harder to find spare cash to save for retirement (median income of women surveyed: $40,375; for men, $54,599) and caregiving expenses that cut into retirement savings.

“Almost every woman my age is having to think about how to take care of a parent or a millennial child if he or she can’t get a job,” said Lawrence.

She noted that the retirement insecurities the women expressed in the survey resonate with her.

“I’m definitely on the worried side,” she told me. “I’m underemployed without savings and living below the poverty level. I’ve felt lucky just to make my rent and utilities, with a smidgen in a low-earning savings account.”

And now for the survey’s so-so news: The researchers produce what they call the Aegon Retirement Readiness Index score and it has risen for U.S. women from 5.8 in 2014 to 6.1 in 2019. Collinson calls the 0.3 rise here “a small increase.” Her explanation for it: “When the economy is doing better, people are more likely to be engaging in retirement planning and more optimistic about the long-term.” (The index score rose for women globally, too, from 5.5 in 2014 to 5.8.)

But even a 6.1, Collinson noted, is just a “medium” retirement readiness score. Above 8 is “high.” The score for American men is now 7.1, up from 6.7 in 2014.

What Could Help Women Feel Better About Their Retirement Prospects

What could boost women’s Retirement Readiness Score? A few things, according to Collinson.

More employers could offer retirement savings plans to their part-time workers. The survey found that women in America are nearly twice as likely to work part-time. And part-timers typically aren’t allowed to contribute to 401(k) or similar retirement plans where they work. “Access to workplace savings plans has proven to be an effective way encouraging people to save,” said Collinson.

Hounsell noted that the new federal SECURE Act will encourage employers to let part-timers put money into workplace retirement plans. “That will make a difference,” she said.

Financial advisers and the financial services industry could do more to assist women.  “For many financial advisers, training is deeply rooted in working with men,” said Collinson. “They’re not necessarily understanding or addressing the needs of women and the life course of women in a way that is empowering and can lead to better decision-making.”

Women can try to become what Collinson calls “habitual savers.” Just 50% of women in the survey said they’re habitual savers — always saving for retirement. The percentage was lower for female boomers (45%) and even lower for Gen Xers (39%). About a third of boomer and Gen X women aren’t currently saving for retirement at all.

“Habitual saving is one of the most important things we can do to self-fund a greater portion of our retirement,” Collinson said. She acknowledged, however, that there are times when we can’t save as much as we’d like — or at all — due to pressing financial needs.

Lawrence told me she accumulated some savings years ago, when working in New York City. But that money dwindled due to high rents, her inability to find full-time work and medical emergency expenses.

Lawrence hopes to start saving again, though she detests when financial firms chide people for not putting away enough money for retirement. “I glaze over when they say: ‘You should have been here [with a large amount of savings] by now.’” She added that “the study says it’s imperative women take greater control over their savings and retirement planning, and I certainly agree. But I think that type of sentence packs in some assumptions. If companies make people feel guilt and like they’ve already lost before they get started saving for retirement, they’ll never start.”

What About Social Security?

Hounsell worries that possible cuts in Social Security and Medicare benefits to shore up those programs will only make retirement prospects more frightening for women — and men. “It is clearly a worry,” she said, adding that the foundation for women’s retirement is still Social Security.

She’d like to see Washington make several changes to Social Security: higher benefits for widows; an “anti-poverty” minimum benefit that would not impact the income limits to qualify for Medicaid; bigger benefits starting at age 85 or 90, reflecting Americans’ longer lives and a caregiver earnings credit to offer retirement protection to women (and men) who have spent significant time as family caregivers.

The Power of Financial Literacy

One last finding in the Aegon survey that I think is worth noting. Only 23% of the U.S. women surveyed correctly answered three basic financial literacy questions dealing with interest rates, inflation and risk diversification; 36% of men did (that’s better, but frankly not very impressive).

“We have a tremendous opportunity to increase financial literacy in the United States and around the world,” said Collinson. “How can someone make informed decisions about retirement saving and investing over the long run without an understanding of the most basic concepts?”

Her advice: Take advantage of retirement-saving educational tools and resources offered by your employer, if they exist. Read personal finance websites and publications. Enroll in a personal finance course at a local college.

Lawrence agreed and told me she has made a point of teaching herself about personal finances, watching videos and reading online media. She wants to see other women follow suit. “Even if we don’t have a 401(k) or savings, we need to start educating ourselves about these financial instruments,” Lawrence said. “Education is power.”

Once you’ve seen the Eiffel Tower, well, you’ve seen the Eiffel Tower. But when you learn about the history of how it was built (this architectural marvel was designed as the entrance to the World’s Fair of 1889 commemorating the 100^th anniversary of the French Revolution), you get a new world view.

On his website, European guidebook author and public television travel host Rick Steves says,  “Travel changes people. It broadens perspectives and teaches new ways to measure quality of life. Many travelers toss aside their hometown blinders. Their prized souvenirs are the strands of different cultures they decide to knit into their own character. The world is a cultural yarn shop.”

As I get older and hopefully wiser, I notice that I’m not as interested in just ticking sights off my bucket list when I travel. Like a student, I also want to dive into the history, art and culture of a place. After a lifetime of traveling, I’m now able to connect the puzzle pieces of my journeys into a cohesive understanding of the world.

And I’m not alone. Travel companies geared to mature adults have noticed this trend and are offering educational trips in the U.S. and around the world — often with a high level of repeat business.

Choose What’s Right for You

“Our travelers are eternally curious people who want to learn more about the destinations we travel to than most tours offer,” says Karen Ledwin, vice president of program management for Smithsonian Journeys, a nonprofit travel group affiliated with the Smithsonian Museum.

After a lifetime of traveling, I’m now able to connect the puzzle pieces of my journeys into a cohesive understanding of the world.

Smithsonian Journey trips are dynamic and diverse travel experiences led by experts from a variety of fields — academia, the diplomatic corps, scientists and curators, among others, says Ledwin, “and our travelers love not only to hear their insights in lectures, but also to engage with them over meals and during our casual Travelers’ Corners discussions. In addition, we satisfy our lifelong learners through experiential activities from painting classes in the garden of a Tuscan villa to a meeting with Smithsonian scientists at the Smithsonian Tropical Research Institute in Panama.” (Prices are $2,310 and up.)

Another well-known nonprofit travel company, Road Scholar, bills its trips as “university of the world” experiences. Like Smithsonian Journeys, Road Scholar (formerly Elderhostel) offers a slew of educational tours both nationally and internationally.

Its tours are divided into categories such as “Art History and Museums,” “Jewish Studies,” “Literature,” “Philosophy & Religion,” “Science & Technology” and “Theater,” among many others. There are also walking and hiking, multi-sport, national park and water sports adventures; these typically also have educational elements.

Traditional trips are designated from “Easy Going” to “On Your Feet” (some walking is okay) to “Keep the Pace” (walking much of the day) to “Let’s Go!” (a day on the move). Hiking and sports-oriented trips are rated “No Sweat” to “Spirited” and “Challenging.” You can also select a “Choose Your Pace” tour that allows you to customize activities to your level of physical ability ($999 and up).

Judy Lang, 72, and her husband Paul, 74, of Shelton, Conn. have ventured out with Road Scholar several times, visiting Alaska, Iceland, Montana and the Delaware Water Gap.

While they were at Denali National Park in Alaska, Judy says,  “We did a number of day hikes and saw amazing scenery, flora and fauna. The educational talks in the evening shared what life is like in Alaska in the middle of winter when the tourists have gone home, as well as what the local residents did.”

In Iceland, the couple traveled along the southern coast of the country and learned about Iceland’s power sources, geothermal springs and lagoons, Icelandic horses, mosses and trolls. “We re-live these trips every time we tell someone about them!” she says.

Travel With an Insider

The Traveling Professor is a small-group touring company led by Steve Solosky, formerly a professor at the State University of New York. The tours take between 10 and 14 people depending on the destination and have ambitious itineraries. At each stop, groups meet with expert, licensed guides who are native to the area and can go beyond the usual guidebook text.

Based on what he likes when he travels, Solosky looks for guides who can tell visitors about the fascinating history and details of a site or city and who are capable of answering detailed questions. He also likes “traveling with someone having ‘inside information’ on local dining spots, special exhibits and who gets me into the places others can’t,” he says. (The tours cost $1,899 and up.)

Cruising Options

American Cruise Lines offers over 35 river and coastal itineraries in the Northeast, Southeast, Pacific Northwest and along the Mississippi River. It also has themed cruises (Lewis and Clark, Mark Twain, Civil War, etc.) for people with specific historical, literary or other interests. (These trips cost $1,770 and up.)

Viking River Cruises are geared to mature English-speaking adults and focus on European art, history and culture. Each cruise makes one to two port stops a day as the ship winds its way up or down Europe’s most famous rivers like the Rhine, Seine, Danube and Douro. A free sightseeing tour is included at all stops, and special-interest excursions are available for additional fees. Viking also offers tours in the United States. (The cruises cost $2,599 and up.)

Free Walking Tours and Apps

For those looking for more flexibility and budget-style ways of immersing themselves in the culture and history of popular cities and sites, a number of free walking tours such as Freetour.com, Free Tours by Foot and Sandemans New Europe Tours have popped up in recent years. These tour companies don’t charge for the tours but ask that you tip guides commensurate with the value you place on the service you received. Tour guides are typically high-quality, local, freelance guides who work hard to make sure customers are satisfied, which means they’ll be compensated.

If you choose to go it alone, Rick Steves offers downloadable walking tours through his Rick Steves Audio Europe App; the app and tours are all free. Other apps for Apple devices include AnyTour, TravelStorys and VoiceMap Audiotours, which are also free to download but typically charge for individual tours.

You can also go old school and carry a printed guidebook or download e-guidebooks to your smartphone or tablet from major travel leaders like Fodors, Lonely Planet, and DK Eyewitness Travel Guides.

At a retirement community in Bend, Ore., individuals with cognitive impairment brew craft beers. An educational service agency in Baton Rouge, La., holds parties where family caregivers and their loved ones with Alzheimer’s disease can mingle.

These practices exemplify the application of the Montessori method to people living with dementia. Montessori is an educational philosophy developed for children well over a century ago. Today, research supports use of the method for people with dementia, and experts say it is gaining traction at adult day centers, assisted living residences and skilled nursing residences. The techniques also can be used by family caregivers at home.

Developed by Dr. Maria Montessori, an Italian physician and teacher, the Montessori method emphasizes self-directed, meaningful activities that reflect an individual’s interests and abilities. The overarching philosophy is one of respect, dignity and equality, and the goal is to provide a sense of accomplishment and purpose.

An Example of Patient-Centered Care

The Montessori method for people with dementia is an example of “patient-centered” care, a model that involves patients in decisions about their care and considers their full range of needs.

“For a long time, we’ve been talking about patient-centered care, but what’s new is that we now have evidence that supports the impact of these approaches,” says Sam Fazio, senior director of quality care and psychosocial research at the Alzheimer’s Association. “Research on using the Montessori method in dementia care shows a decrease in use of medication, reduced wandering and agitation and an approach that is very much in line with who individuals are, and have been.”

“People with dementia are not a group — they are individuals, just like us, and our program focuses on that.”

But Fazio notes that an industry-wide transition from standard practices in dementia care to the Montessori method or other person-centered programs isn’t likely anytime soon.

“The conventional model has always existed in a medical framework,” he says. “How do you change an organization’s culture from focusing on completing tasks to engaging with people in a way that’s built around their strengths? Just helping families change their thinking about how to connect with a relative with dementia takes time. Of course, it’s worth the effort.”

Fazio, the lead author of the Alzheimer’s Association’s Dementia Care Practice Recommendations (last updated in 2018), adds that although the association supports practices that support patient-centered care, the agency does not endorse any one program over another.

Brian Pangle, CEO of the Clark Retirement Community in Grand Rapids, Mich., does endorse the Montessori method, which he first learned about during a 2015 event in Washington, D.C., by LeadingAge, a national association for nonprofit aging services providers.

“It really resonated with me and fit with what we’d wanted to do at Clark,” Pangle says. Clark’s two campuses, serving about 60 residents, offer memory care in assisted living and skilled nursing.

Encouraging People to Be Active

Pangle asked Chris Simons, Clark’s director of dementia and life enrichment services, to come up with a year-long implementation plan and program evaluation. Five members of Clark’s life-enrichment staff worked with the Association Montessori Internationale, a global non-governmental organization dedicated to Montessori education, to complete a six-month certification program. In 2017, Clark initiated the Montessori method.

“People with dementia are not a group — they are individuals, just like us, and our program focuses on that,” says Simons. “We have Montessori activity stations with appropriate signage and we also assign roles to people based on their interests.”

Some residents maintain the community garden, some set the table for meals and others choose to sweep up afterward. “We asked a pastor’s wife to teach another resident to play piano and we gave a desk and a briefcase to a retired businessman. Families enjoy seeing loved ones once again doing something they used to do all the time,” says Simons.

Programming is as important as medication, says Cameron J. Camp, director of research and development at the Center for Applied Research in Dementia in Solon, Ohio. “When people apply the Montessori principles, it’s not only the right thing to do but provides a better quality of life for everyone — residents, staff and managers. It’s a great business model, too. Aspen Ridge Memory Care in Bend, where residents make beer, has a waiting list.”

Camp has been appointed as principal investigator on numerous projects funded by the National Institutes of Health and served as president of the adult development and aging division of the American Psychological Association.

A Call for Change

Armed with a doctoral degree with training in cognitive psychology and gerontology, early in his career Camp worked with older adults in Kansas, looking at ways to improve their memory. In 1983, he moved to New Orleans, where he worked with individuals with dementia.

“The techniques I was using were worthless, and I realized we needed a different way to help them circumvent their deficits,” he says. That same year, Camp enrolled his son in a Montessori school. “I remember walking in, and the heavens opened and I could feel the angels sing,” he says. “As I learned more about the method, I asked a colleague if this might be the way forward,” for a more effective treatment approach for people with dementia.

“For twenty-five years, I’ve been researching how to use the Montessori method with older adults,” Camp says, “and now people are waking up to the fact that this generation coming into long-term care is different. Baby boomers won’t passively accept what they are told. Plus, younger workers today also don’t want to be told what to do; they want to be empowered.”

Camp’s goal is to change the industry standards by the time he is ready for long-term care. “I’m sixty-seven, so I have about a twenty-year window to get it ready for me,” he says, with a chuckle. Despite the industry’s predominant aversion to change, Camp is optimistic.

“There is hope,” he says. “Providing a good way of life is the best treatment for any human being, and this should be our focus. This isn’t just about dementia. Treating people with respect and dignity is a way of living.”