This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

According to the U.S. Census Bureau, Michigan's population of people aged 60 and older is growing more rapidly than any other age group. By 2030, roughly 24% of Michigan's population will be 60 and older — an increase of 32% since 2012. With this coming growth in Michigan's older adult population, the existing movement towards age-friendly health systems has broadened to embrace the concept of "age-friendly everything."

"Michigan is one of the fastest-aging states in the nation," says Paula Cunningham, AARP Michigan's state director. "... There are tremendous savings for the state to invest in age-friendly services that allow people to age in place, stay in place, and live at home."

In 2019, Gov. Gretchen Whitmer declared Michigan an age-friendly state in partnership with AARP's Age-Friendly States and Communities initiative, which is a driving force behind the age-friendly everything movement in Michigan and across the nation. Michigan was the first state in the Midwest and fifth in the nation to join this age-friendly movement. What does age-friendly everything include?
Megan Wolfe.
"When we think about age-friendly everything, we think about what can be changed to make a community, city, county, or state age-friendly," says Megan Wolfe, senior policy development manager at Trust for America's Health, a non-partisan Washington, D.C.-based public health policy, research, and advocacy organization. "We look at social determinants of health — those conditions wherever we are born, live, work, pray, or play: the access to nutritious food, transportation, housing, safe and accessible education and employment, the built environment. All these things have significant impacts."
 
AARP organizes "age-friendly everything" into eight domains of livability: outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, work and civic engagement, communication and information, and health services and community supports. The Michigan State Plan on Aging allows the increasing number of older Michiganders to access available services, remain socially connected, and make their own decisions, especially as regards staying in their own homes. To support the latter, the plan also seeks to increase the number of direct care workers, as they are key to home care when dementia or chronic health issues limit older adults' abilities.

"Once policymakers and practitioners become aware of this movement, the need to embrace older adults in all the practices and policies really opens their eyes to what's possible, what's doable," Wolfe says. "It's an 'Aha!' moment and they ask, 'Why haven't we been doing this all along?'"
Ewa Panetta.
While bringing communities into alignment with age-friendly objectives seems like a huge undertaking, some issues can be resolved with relatively simple fixes. Ewa Panetta, Michigan Health and Hospital Association (MHA) Keystone Center manager of patient safety and quality, shares a story about an older man living in a downtown area close to shops and city parks. He was fully able to walk, but was afraid to cross the street because the streetlight was not long enough for him to make it all the way across.

"The city changed how long the crossing light was. There are simple solutions that we don't think about unless we are in a specific situation," Panetta says. "We are all going to get older and age. Our goal is that we can age in a way that still provides quality of life." 

Ageism and the cultural mindset

In a time when communities are working to dismantle implicit biases about race, gender, sexual orientation, and disabilities, they must also examine biases resulting in ageism.

"We are all aging, no matter what our age is," Wolfe says. "Nothing angers me more than the term 'silver tsunami.' It involves a picture of a storm developing to describe the aging of our population. These are human beings and we need to embrace them."

Before the Industrial Revolution, older adults held positions of authority in society and within families. As people moved from farms to cities, the older generations began losing their authority and esteem. While other cultures rely on elders for their wisdom and experience, mainstream U.S. culture often treats older adults as being cute, silly, and incompetent. These perceptions hold older adults back.

"We have to dispel those perceptions every single time, whether it's in the news media or someone [saying about theirself], 'It's my age. Chalk it up to my age.' We all need to take an active role in dispelling those," Cunningham says. "There are older adults doing phenomenal things throughout all of our communities. The language, the words matter in terms of how we refer to older adults. We should not limit our perceptions or limit their ability to do whatever they want to do."
Paula Cunningham.
Because older adults, like minority populations, are often thought of as "other," they are at risk for elder abuse, health and emergency care discrimination, and workplace discrimination as well as a loss of dignity, self-worth, and quality of life.

"When we say 'senior' or 'elderly,' we think of them as being other than us. This is a detriment not just to this group of people who are aging. Older adults have so much to give," Wolfe says. "We're losing those generations of experience and wisdom and skill and humor and understanding in how to relate in a different way. … It does real harm to all of us when false perceptions define us, put people in groups, and set them aside."

Age-friendly health systems

The problem of ageism also extends to our health care system. Panetta notes that older adults not only often live with multiple undiagnosed and untreated conditions, but also face communication barriers when they seek medical help. She believes state-mandated implicit bias training will help address some of those concerns.

In Michigan, health care systems and public health agencies are working to make our state more age-friendly. Funded by the Michigan Health Endowment Fund, the MHA Keystone Center is one of these. Much of this work across the state reflects the evidence-based "Four Ms'' framework. The Four Ms challenge providers caring for older adults to ask what matters the most to them; confirm that medications are helping and not harming; address mentation, e.g., dementia and depression; and ensure safe mobility.
Clare Tanner.
"Public health has a very important role to play, to understand the health of a community and what makes a community healthier. Public health can't do it all, but we can help communities understand some of the larger systems changes that need to occur," says Dr. Clare Tanner, program director of the Michigan Public Health Institue Center for Data Management and Translational Research. "For example, a big barrier to age-friendly health is [older adults] not having affordable housing. The lack of affordable housing leads to more nursing home placement.  Having services and support to help people stay in their homes is not enough."

Home is where the health is

The aging population is growing because people are living longer, but not necessarily healthier, lives. When an age-friendly society better supports older adults, they will experience better health and be able to take more active roles in their families and communities. And, as Michigan's communities become more age-friendly, more Michiganders will be able to age in place at home.

"There are economic benefits, emotional benefits, and health benefits to be in your own home where you want to be, to live with dignity, respect, and not depend on other people," Cunningham says. "We have learned that for every dollar that the state pays to subsidize someone in a nursing home, they can save two dollars if that person stays at home longer. It's a tremendous savings for the state to invest in age-friendly services."
AARP Michigan volunteer Howard Pizzo and Paula Cunningham on the Lansing River Trail.
When older adults feel included and respected in their communities, they will be both happier and healthier. Research has proven that happiness lowers risk for cardiovascular disease, lowers blood pressure, enables better sleep, improves eating habits, supports regular exercise, and reduces stress. 

"We don't want people leaving our state to go to Florida or somewhere else," Cunningham says. "There's not only an economic benefit, but also an emotional and mental health benefit, to being in your own home, which is where 90% of older adults want to be."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

AARP photos by Roxanne Frith. All other photos courtesy of the subjects.