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The history of long-term care for older persons is filled with mistakes and shortsighted solutions. But the hopeful message of this book is that change is possible. Tomorrow’s seniors will be the beneficiaries of new digital technologies that will significantly improve their ability to live independent and dignified lives.
Stephen Golant, Ph.D., Professor Emeritus, University of Florida, and author of Aging in the Right Place


In 10 years, all 72 million Baby Boomers will be over 65. The current healthcare delivery system will be unable to meet their needs. Older people, and government, cannot afford it. People know it, and the stress of this affects their daily lives. We will continue to live longer, accumulating chronic conditions. But there is a new way forward.

Technology revolutionizes healthcare

Technology will enable us to bring healthcare to people within the community where they prefer to live, rather than in institutions. Digital technology can continually maintain and accumulate a clear picture of a person’s changing conditions, suggest coordinated interventions, and help orchestrate actual delivery of care. A home will no longer be an isolated environment, but will be integrated into a network that is constantly sharing and receiving information and support.

The big players will move in

We are already reformulating retail, banking, manufacturing, communications, education, transportation, nutrition, and exercise. We are on the cusp of a new approach to health. We will combine technology, insurance, and chronic healthcare. Digital players will adapt their technology to address this enormous need and new opportunity (they are already beginning to do so). As they did 100 years ago in creating hospitals to address infectious disease, community leaders will come to the fore to create community-based systems that address the chronic disease in their midst. 

Government will shift priorities

Government will evolve from acting as an absolute controller of a system that is outdated and no longer affordable to serving as a monitor of innovations and protector of consumers.

Minds will change

Freed from institutionalization and segregation, inclusion of older people in the lives of others will deflate ageism, as it has happened with racism, sexism, homophobia, and religious intolerance over the past 60 years. The historic terms of aging will give way as carriers of old meanings and expectations, to words that suggest acceptance and accommodation into the normal life course. Aging will quickly evolve from a frightful, isolating, misunderstood era of life, to one integrated naturally and fully into the life course. And aging as we know it will disappear.

How this can happen is the story of Aging Forward.

Look Inside Aging Forward

Where Are the Old People?

We usually do not perceive the changes in our environment that are lengthening life and the dramatic effects of increased longevity. If we look around for what, in loose talk, we call “old people” who fit the outdated stereotype, we will see a few. If we look around instead for “adults over 70,” we will find a lot more. In 1950, 70 was old. Now, that’s no longer true. So, what does “old” mean today?

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Living in the Age of Extended Chronic Conditions

Our cultural understanding of the nature of disease is still based on the belief that acute disease is the fundamental culprit that affects most lives. Until around 100 years ago, widespread infectious diseases such as smallpox or tuberculosis that could kill people at any age were the primary threat to human health. Today, however, that element, which held true through all the previous millennia of human existence, is no longer dominant.

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Digital Interventions for Older Adults Will Create an Alternative to Nursing Homes

Given a choice between care in a family setting and care in a nursing home, most older people prefer to maintain control and independence and choose to remain in their own home. Increasingly, interventions in the environment can provide the assistance needed for older people to live safely at home for much longer than has ever been possible, and new interventions are being developed all the time.

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This groundbreaking book highlights the impact of the deluge of older people on our broken healthcare system. The current financing system is a significant barrier to change and improvement. David’s 30 years of experience provide some important insights about how America can meet the challenge. It offers a realistic and practical path out of the current stagnation and denial.
Richard Berman, Former Director of the office of Health Systems Management, New York State, former member of The US Prospective Payment Commission; and a member of The National Academy of Medicine/National Academy of Sciences (formerly known as the Institute of Medicine)

About the Authors

David Dunkelman, M.S., J.D.

Raised in Ohio, David Dunkelman, M.S., J.D., expanded his experience by traveling around the world for a year after graduating from college. He visited 26 countries and three war zones, and observed many ways people live and die. He left the United States an angry young man and returned a patriot after seeing how so many other societies functioned. After graduating from Temple University School of Law, he helped his family’s apparel company grow to an organization distributing to 5,000 retailers nationally. The company closed when computers suddenly disrupted the nation’s centuries-old clothing supply chain, an ominous preview to what would also happen to aging in America.

Changing focus, Dunkelman earned a master’s degree from the Center for Studies in Aging at the University of North Texas, after which he eventually landed in Buffalo, New York, where for 30 years he was the founding President and CEO of The Harry and Jeanette Weinberg Campus, one of the nation’s largest and most multifaceted campuses for older people. The campus was the first such organization to be named a winner of the national Peter F. Drucker Award for Innovation in Nonprofit Management.

Among his many individual awards are the Community Leadership Award from the Foundation for Jewish Philanthropies, Buffalo (2013), and the Dr. Evan Calkins Meritorious Service Award for “lifetime contributions to the field of aging,” presented by the Western New York Network in Aging, Inc. (2007).

Using creative problem-solving techniques developed at the State University of New York at Buffalo, Dunkelman has consulted nationally with more than 25 communities, helping them to develop strategic approaches to facility and programmatic design for older people. He writes and speaks about aging in America.


Martha Dunkelman, Ph.D.

Martha Dunkelman, Ph.D., is a writer and editor who has written numerous articles, reviews, and brochures, as well as serving as book editor for an online periodical. She has also written and edited materials for the Educational Testing Service and the College Board. She credits her father, Dr. Maurice Levine, with teaching her to write in her teenage years, when she was not always the most willing student.

A graduate of Wellesley College, she later received a doctorate from New York University under the wise and kind guidance of H. W. Janson and spent many years in teaching and administration as a professor at Wright State University, the University at Buffalo, and Canisius College.

She learned about the care of older people from decades of bearing witness to the struggles and achievements of her husband David.

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Quotes from Aging Forward

“We don’t usually think of frail older adults as active consumers. But as they become aware of more consumer choices, competition for their business is creating a huge new market. We’re already spending more than a trillion dollars a year on interventions of all sorts. The provider who produces a less expensive, less medicalized intervention to meet a particular need will get more business.”

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aging forward: interview with the author

Whether it’s a fear of nursing homes, worry about money running out, or the political crises impacting the future of Medicaid and Medicare, the uncertainty of aging is on the minds of many Americans. Aging Forward author, David Dunkelman talks us through why we all need to be thinking about this, and how the solutions to our concerns are all around us just waiting to be applied.

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This groundbreaking book envisions a new direction for aging and aging care networks and, in doing so, invites us to imagine better care for all people with ongoing health or mental health conditions. Not only a “must read” for health professionals, interprofessional educators, and health policy makers, it would be a great book for anyone interested in these topics or in a future involving networked care.
Nancy J. Smyth, Ph.D., LCSW, Professor and Former Dean, University at Buffalo School of Social Work


Facts and Figures About Aging

The number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65-and-older age group’s share of the total population will rise from 16 percent to 23 percent.

Nearly 95% of older adults have at least one chronic condition, and nearly 80% have two or more.

Multiple chronic diseases account for two-thirds of all healthcare costs and 93% of Medicare spending.

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In the Media

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