The Measure of Our Age: Navigating Care, Safety, Money, and Meaning Later in Life

by M.T. Connolly

An expert on elder justice maps the challenges of aging, how things go wrong, and presents powerful tools we can use to forge better long lives for ourselves, our families, and our communities.
 
As tens of millions of Americans are living longer lives, longevity is creating challenges that cut across race, class, and gender. Caregivers help older relatives for “free,” but with high costs to themselves in time, money, jobs, and health. Scammers target countless seniors. The institutions built to protect older people—like nursing homes and guardianship—too often harm them instead. And epidemics of isolation and loneliness make older people vulnerable to all sorts of harm.
 
In The Measure of Our Age, elder justice expert and MacArthur “genius” grant recipient, M.T. Connolly investigates the systems we count on to protect us as we age. Weaving first-person accounts, her own experience, and shocking investigative reporting, she exposes a reality that has long been hidden and sometimes actively covered up. But her investigation also reveals reasons for hope within everyone’s grasp.
 
Connolly’s strategies and action plans for navigating the many challenges of aging will appeal to a wide range of readers—adult children caring for aging parents; policymakers trying to do the right thing; and, should we be so lucky as to live to old age, all of us. This book transforms how we think about aging.

Genres: Nonfiction, Health

444 pages, Kindle Edition

Published July 18, 2023

Reviews

[Phil · Rating 5 out of 5]

M.T. Connolly’s work as an attorney led to a focus on the question, “What makes aging so much harder than it should be?” After years of research, collaboration, and effort to create policy and legislation, she authored this book with the goal of helping readers “forge a more just, gentle, and joyful old age for themselves and for those they love.” I started reading it with my own aging in mind before I realized the larger questions of helping other people age well. Ms. Connolly examines systems— “how they work and how they don’t,” not only to help individuals, but to push our society to “spot potential pitfalls sooner, and steer around them.” (p. 4)

The Measure of our Age could benefit anyone concerned with aging, their own or others, known or unknown. It could serve as a textbook or training resource for nursing homes, assisted living facilities, continuing care centers, geriatricians, social workers, adult protective services, law enforcement personnel, meals on wheels volunteers, or families like yours or mine.

My introduction to old age came when I was quite young—four years old. Grandma Miller, age 82, came from Iowa to New Mexico to live with us because she could no longer manage on her own. As a little boy, I mostly resented her. Through the next ten years, as her arthritis worsened along with her hearing, and as she lost her eyesight, I easily avoided her. When she was in her 90s, Dad hired a woman to come on weekdays to care for her hygiene and to provide a bit of companionship. Then, because I wanted to become a medical missionary, Dad offered me five dollars a week to provide those nursing services. So, as a teenager, I changed Grandma's nightgown after giving her a complete sponge bath. I assisted her with her enemas and, as she became incontinent, changed the paper separating her from her bedsheets. I treated her pressure sores with ointment. I brushed her hair, trimmed her nails, and plucked her eyebrows and facial hair. I read her church magazine to her and listened to the radio with her. I put the last spoonful of food into her mouth before she died after 12 years as a member of our household.

She had hoped to spend her last years in a Church of the Brethren Home in Mount Morris, Illinois, with friends from the Midwest she had known for years. But her children overruled her and decided the home of her youngest son was a better idea. One of the issues Connolly discusses is the continuum between autonomy and safety. Did my dad and his siblings violate Grandma’s autonomy, or did they ensure her safety? Where on the continuum did their decision in 1952 fall? Was their motive better care for her, or better finances for themselves?

My feelings went from revulsion as a child to affection as an adolescent. Unconsciously, I carried that range of emotions with me into my role as a pastor. I would visit the elderly, mostly widows, and enjoy hearing their stories. However, I confess, I struggled as I encountered those with dementia. No matter how often I came to see them, they asked why I hadn’t come for so long. I reacted by avoiding them and feeling guilty about it. Only years later did I connect my reactions to my early years with Grandma.

My ambivalence helps me understand the range of behaviors among care givers—from heroic attention to scandalous neglect and abuse. Connolly compares abuse and neglect to the unnavigable rocks and rapids that can cause a canoe to wreck downstream. In fact, most of the research on aging has focused on the problems with care for the elderly—understaffing by profit-driven nursing homes, financial exploitation by caregivers (paid or family members), physical abuse, and neglect that can be fatal. How much better, she says, to have a map upstream, to avoid the hazards before it’s too late.

She cites three types of risk factors that can lead to abuse (pp. 252f.) First, factors relating to the older person; for example, cognitive impairment, physical frailty, or needing assistance which gives someone else access to their finances. Second, risk factors relating to someone like a caregiver or trusted person; for instance, what if it’s a grandson with a drug addiction, or a nurse’s aide who has a gambling habit? And third, risk factors relating to the context, such as poverty or lack of transportation. Each case is complex and unique, but these focal points help predict and prevent things that might go wrong.

My neighbor asked, “Are you planning to age at home?” I thought about it and said, “We don’t have any other plan at this time. We have a first-floor bedroom, levers for door handles, grab bars in the shower and by a couple of toilets, and a rollator walker. We may need to buy an electric stair lift before long.” AARP has a home checklist to help with such planning. Connolly’s book also provides insights into how to screen facilities, not by the pretty chandeliers, for instance, but by the staff ratio and turnover rate.

Connolly's work has been for Elder Justice, and in this, she realized the variety of connotations the word “justice” conveys to different people—everything from punishment to mercy. She writes:

For me, today, it evokes fairness, dignity, and hope—a way for society to steer itself by values, to define rights, and to provide ways for those who are wronged to be recognized and extract meaning from society’s response. (p. 280)

Connolly’s book deals with systems—care, safety, money, and meaning. The section on meaning comes at the end, where she writes:

My primary focus in this book has. . . been on the puzzles [treatment, logistics, and the price of care]. But it’s in the mysteries of aging where transformation can happen for us, and where positive cultural shifts must draw their strength. Drained of meaning, late life becomes largely a series of losses. If we can re-imbue aging with meaning, there’d be a lot less suffering. (p. 285)

Two of my favorite parts of her book come near the end. One describes a group in Kentucky that facilitated a play involving a nursing home’s staff and residents as well as some people from the surrounding community. The other part, the epilogue, tenderly narrates the passing of her father, including the last-minute lessons learned among her siblings.

As you read this book, you may find parts of it gloomy, particularly the review of how the elderly have been treated or mistreated in our society. On the other hand, however, I hope you’ll feel inspired by it to act with justice and to advocate justice for those who are older. The Fifth Commandment requires honoring our elders. Why? To create systems, policies, and norms that will benefit us when we ourselves need the care of younger people.

[Marilyn Rumph · Rating 5 out of 5]

The author, M.T. Connolly who is quite an authority on the subject, takes us through the sad and desperate state of eldercare. Anyone who has experienced an aging parent or other aging person will see much of their own experiences, but this book informs the reader of so much more. The book covers not only various types of elder abuse and neglect, but the legal aspects from regulation to laws that attempt protection and enable prosecution for criminal acts. The author tries to provide a framework for change, because none of us want to experience desperate measures as we, too, approach our final days. Thank you to the publisher and Net Galley for providing an arc in exchange for an honest review. I will purchase this book and use it as I, at 70 years old, plan my own aging plan.

[Kerry Burnight · Rating 5 out of 5]

This book is a must read!! My copy of "The Measure of Our Age" is filled with sticky notes, underlines, and exclamation points. I loved it so much that I recommended it to my book club and it's been a huge hit. Our book club ranges in age from 28-81 and we are having such deep and needed conversations about aging well and going through this life. This book raises so many important issues that we are all grappling with: caregiving, finances, healthcare, meaning, autonomy, and most of all, dignity. It's as good as my other favorite book, Atul Gawande's, "Being Mortal".

[David · Rating 5 out of 5]

This book is really important, and I'd have given it 5 stars for the list of resources on pages 311-313 alone. It's the product of a tremendous amount of experience, has a lot of good information that you probably have never seen or heard of, and powerful stories to illustrate the issues addressed. It's a book our society needs, and needs to think about. So I have a feeling I may buy a copy to keep around.

Having said all that, I do have to say that I found it overwhelming, and had to read it in bits, then put it down and come back to it later. No doubt that is because of my age: the "Later in Life" of the subtitle is not far off for me and my age cohort. We are already of the age to have seen these issues come up for those ahead of us, and it's a bit scary to contemplate the challenges that are looming ahead for me and mine. It's very scary to think about how poorly prepared our society is for dealing with an increasingly aging population, and it's a little scary to contemplate how one might navigate in what are bound to be some pretty choppy waters.

[Kathleen Flynn]

For some reason I expected a sort of different book. I was anticipating more service journalism -- HOW to navigate care, safety, money and meaning later in life-- than this turned out to be.

Although bookeneded by some lovely philosophical and lyrical sections about meaning, mostly this is about the author's experience as a government lawyer trying to help push public policies and legislation to protect older people from harm of various kinds: neglect in nursing homes, financial fraud and exploitation, physical abuse or neglect by their relatives.

Partly very wonky -- I confess I found myself skimming those sections. Partly horrifying -- the author reasonably enough chooses some of the most dire examples of elder abuse and neglect that she has encountered in her work, but it makes for unsettling bedtime reading to contemplate such fates befalling oneself or one's loved ones.

I am glad MT Connelly wrote this book, and not sorry I read it. But I finished it still looking for some granular and specific advice about navigating care, safety, money and meaning later in life.

[Carrie · Rating 5 out of 5]

Having recently become a caregiver to my mother, I found this book to be informative and insightful. Aging is difficult in our society, and there aren’t many great options out there for either the elderly or the caregiver. Connolly covers the aging process itself, as well as the difficulties of finding good care, nursing homes, scams targeting the elderly, the toll on caregivers, elder abuse, the legal protections in place (or lack thereof), and more. A bit academic at times, but the author’s experience in the area is clear and her research impressive.

[Mad Hapa · Rating 2 out of 5]

My 87-year-old friend recommended this book. It's mainly a history of Elder Justice and the unfortunate business of aging. It was, at times interesting, but often repetitive.

[Lynda Austin · Rating 4 out of 5]

Read this right after my hubby had finished it and we had many an illuminating discussion on its contents as it relates to my elder parents’ care plan as they age into their 90’s AND a rough framework for US to follow as we enter retirement in our mid 60’s.
Some interesting passages I noted:
* “Aging in place well as our needs increase requires planning, resources and determination.”
* “We’ve managed to extend our years, but to what end? We want to get old, but not BE old.”
* “For a better old age, it’s not aging we should fight, but fear.”

And finally:
* “Everything can be taken from a man but one thing - to choose one’s attitude in any given set of circumstances; to choose one’s own way.”

And hopefully, we baby boomers,who will age and create the largest segment of people who will require care management in our elder ages, will have better understanding of and broader choices of care available to us here in the United States. We have to make it so.

[Charity · Rating 3 out of 5]

Offers a big picture view on policies and laws related to elder justice, not specific strategies for families. An important but depressing view of the state of elder care in our country. We have a long way to go to support and protect our seniors.

[Christine · Rating 3 out of 5]

a bit too accademic for me - but raises good issues

[Shana · Rating 5 out of 5]

This is not a book well suited for audiobooks let me say that first, there are a number of Concepts and resources and links offered throughout the book that make this something worth buying on paper or at least on digital or you can reference it. The author is actually a beautiful writer to my surprise, since she's touted as an expert and really someone quite academic. I have been immersed in issues of mortality, aging, aging well and caregiving for disabled elders in my personal life the last bunch of years and in my work life over the last year when most recently questions around policy, public services for the aging have come up showing me how vulnerable we are and how little supported by government in the USA. Though fortunately California is as ever a beacon of innovation and good long term planning for our residents. This is a good companion piece to Atul Gawanda's incomparable book Being Mortal, which if you have read you will recognize as whole chapters are summarized particularly in the parts related to the history of nursing homes and retirement homes and the importance of purpose for people of ALL ages, including the elderly too often robbed of agency, privacy and purpose as their health and/or faculties decline.

It happens that I not only heard the author speak at a book reading where Steve Lopez interviewed her thoughtfully reflecting on some of the topics he covers in his Golden State column in the Los Angeles Times, but I also was graciously invited to join the after party and birthday celebration because my dear friend since I was 14 is a relative who was visiting from Europe. So my first exposure to this MacArthur genius was as the beloved family member, friend and gracious host of a memorable dinner celebration. I'm embarrassed to report I only had banal conversation to offer, focused as I was on my special reunion with Heike.

This book covers an enormous array of topics around aging from the practical, the legal, the Medical, and the emotional. The main point I think is a combination of we need to do better and hear some points of measurement from which we need to improve. And we need to do so with compassion and the understanding that the elderly are humans too, are adults too, are complicated too. Some of the most touching passages are the stories of her relationship with her father in his Twilight. Some of the most motivating are around her frustrations with trying to push legislation to improve the futures of all of us. I hope she will continue to write. David Whyte in one of his reflective books repeats what may seem obvious, but is a deep revelation, something I try to hold close, if lightly since I heard it a few weeks ago:
We will say goodbye to everyone we know and love. Either they will say goodbye to us or we will say goodbye to them. That is The Human Condition. We should count ourselves lucky to age and age well.

[David · Rating 4 out of 5]

Good blend of case illustrations with big-picture reviews of the scope of various problems associated with aging in the USA, as well as close consideration of the merits of initiatives aimed at coping with them. Any one topic (e.g., "deprescribing" to try to reduce overmedication and resulting iatrogenic drug interactions in geriatric medical care) could use more depth, but excellent intro to a wide range of concerns.

I know hell is crowded, and they may be running out of special places, but I'd nominate "people who run financial scams on cognitively impaired old people" for their own corner. Caregivers who are themselves struggling in some fashion and do a poor job -- not admirable, but at least you can have sympathy for the massive stress they face. But what is wrong with you if your choice of how to make a living is methodical search for someone whose brain can no longer see through your BS so you can separate them from their cash?

Detailed recap at the end of her 20 years or so of hard work on Elder Justice Act as a sort of omnibus effort to address many of the issues. Gives a good sense of how frustrating working through Congress must be. Based on, it seems, absolutely nothing to do with the substance it took forever to get passed, got in as a slice of the ACA ("Obamacare") but with no appropriated funding, got a massive infusion of funding during the pandemic (which saw some uptick in elder abuse, to be sure, but was mostly not directly relevant to the Act), and now a severe funding cut in 2023. Hard to plan and sustain programs that way to say the least.

Per the book jacket she received a MacArthur "genius" grant for this work and is "widely recognized" as a leading expert on elder justice. Not by this old person, as I'd never heard of her before, but I'll keep an eye out for other work -- good writer besides having impressive handle on policy and how it could help older adults.

[Monica Bessler · Rating 5 out of 5]

This is probably the best non-fiction book I have read for a long time. It took me by surprise.This book touches in a very personal way many facets of ageing and elder care, in particular financial, judicial, psychological, and philosophical aspects. Its depth and research reveal a commitment and passion summarising a life's work and experience. If you are unprepared,- as we usually are-, confronted with the care of an elder person, or, if you are thinking about the ways to plan your own later years, -as we all really should-, this is the book you want and should read! In fact, all our politicians who are being entrusted with the shaping and reforming of our future Health and Social Care ought to read this book. Having lived in the US, England, and Switzerland, I find the issues discussed based on the United States applicable for much of the Western World. It certainly has revolutionized my thinking and care for my ageing parents in Switzerland and my reflection about my own old age here in the UK. There is a message for the future and a path to peace for problems that seemed unsurmountable.

[Becky · Rating 4 out of 5]

This book is incredibly (and sadly) informative about the state of senior living in the United States. It is not a resource for caregivers; it is primarily a study on the situation. The sad truth is, as the author points out, people may be living longer (late 70s) but their health (physical and mental) often starts to fail in their late 60s. It is worse for the poor and is undoubtedly exasperated by poor habits. And, half of those who get to 85 will need some form of care. So we keep people alive longer with medications and surgeries, but their quality of life is poor anyway? The author describes the tremendous job of caregivers, the vast majority of whom are women, with a significant number of those being spouses, who often spend decades of their lives being run ragged by someone who is alive but unable to care for him or herself. And it isn't just being unable to drive; many can't fix meals, take care of finances, and are entirely dependent upon a child or spouse who is also a senior. Surely, we need to rethink how we are spending resources in this country so we can better deal with this situation.

[Theresa · Rating 3 out of 5]

Rating of 3.5

The author critiques the way we in the U.S. currently support (or don't support) people as they age and confront both physical and mental limitations. She identifies the types of situations that increase the risk of abuse or neglect. Some of this can get really hard to read! I appreciated though that she provides information about what we should look for when we look for care for aging loved ones (or one day, for ourselves).

Something I appreciated was the way that she thoughtfully explored the need to balance autonomy and safety. So often we fret because aging adults don't want to move or stop driving, and we step in on behalf of their safety. This isn't necessarily a wrong thing to do, but perhaps we can do it with more respect for people's need to make decisions about their own lives.

The book feels more uplifting when she describes a few examples that do a better job of keeping elderly people not only safe and as healthy as possible, but, importantly, connected to community and to people of different ages.

[Pam Coon · Rating 4 out of 5]

This is a thoughtful and well written book about growing older, centering on its challenges, particularly the injustices that can happen and how our legal system has been woefully inadequate in dealing with this topic. Old people are at the bottom of the social system and many are mistreated when they enter into facilities designed to care for them. The author also speaks about how vulnerable the aged are to scams. The author reveals in her first person accounts the shocking realities that have long been hidden and in some cases covered up. She weaves her own story of caring for an aging parent, who has assets, loving children, and an expressed wish to die at home.
This book will transform the way one thinks about aging, whether it be yourself (and yes, all of us will enter old age), or one you are caring for.

[Karen Levi · Rating 2 out of 5]

I was very disappointed in this book. I do not understand how this work could truly help anyone other than policy wonks and professionals in geriatrics. The author did not offer specific suggestions or insights into aging, except for what is already known--our society does not deal with aging well.
M.T. Connolly realized she should address "Mystery and Meaning," at the end of the book which reminds me of presenters, at the countless professional meetings I attended, never getting to treatment. They spend the entire lecture talking about the disorder, disease, or dysfunction.
Ms. Connolly's anecdotes are tragic ones--hoarders, starved old people, corpses left in homes by very sick caregivers. We hear these stories on the news. Terrible as these reports are, how do they help typical people to make decisions for aging parents or one's aging self?

[O · Rating 4 out of 5]

This book is a frightening read. I was ignorant to how fragile the systems helping people age are, although I don’t know why I was shocked in the first place upon reflection-there’s no money in helping people age well. Capitalism strikes again. It gave me a lot to think about and put some personal experiences in better perspective. The American society does not value its elders, so these are the consequences. I would recommend this book because we all (God willing) will age and it’s important to know what exists and what needs to change so we can advocate together.

[Robyn · Rating 5 out of 5]

THE MEASURE OF OUR AGE
MT Connolly

I probably should have read this before I got to this stage of my life. I can see myself in the situations Connolly so often described.

5 stars

Happy Reading!

[Stacy · Rating 4 out of 5]

A comprehensive look at growing older in the US. This has various chapters on financial issues, health care, caregiver info, elder abuse and other topics. I skimmed through some of it but it has a lot of info as well as a index with many more resources.

[Viraj Singh · Rating 5 out of 5]

Great overview of problems faced by elders by an industry leading figure who pioneered the elder justice act. The text itself was easy to read and get through, the problems discussed are applicable to everyone given we all will reach an old age or love someone who is/will be old or ideally both.

[Eden Ratcliffe · Rating 4 out of 5]

Very informative, I think anyone heading into the time of life where they are looking after their parents should read this.

[Buffy · Rating 5 out of 5]

Incredibly depressing, but that good kind. The kind that makes you want to do something about it.

[Hamlen · Rating 4 out of 5]

This is the scariest book I've read in decades.

[Krista · Rating 4 out of 5]

Thought provoking book that forces me to look at the gift of aging with a renewed focus on practical questions and planning today for my life in 25 plus years.

[Lynn · Rating 5 out of 5]

Excellent reseach and explanation of the many problems facing older Americans. MT clearly illustrates the many holes in the systems that are failing this population.