A recent article in the Washington Post features geriatrician Bill Thomas, named by the Wall Street Journal as one of America’s top 10 innovators. Thomas is a physician and current professor at the University of Maryland Baltimore County’s Erickson School of Aging who is attempting to transform elder care.

Thomas’s work focusses on two main theories about elder care: first, the institutions we set up to deal with the elderly shape their experience of aging, and usually not in a positive way; and second, how we think of aging affects how we age – again, generally not to our benefit.

With respect to the first concept, Thomas found that the usual design of retirement or care homes tended to dehumanize and isolate residents. To combat this, he founded what is known as “The Eden Alternative” — a system of transforming nursing homes by introducing pets (cats, dogs, hens, parakeets) and gardens, as well as day-care for children of staff members. Finding that caring for plants and animals, and having a sense of interdependence and inclusion among generations, vastly improved residents’ outlook and autonomy, Thomas continued his work by creating intimate residences for older people, dubbed “Green Houses,” which feature private rooms and bathrooms. He discovered that the small size of these places encouraged and enabled mobility in ways large institutions did not, because the sheer size of most nursing homes effectively disabled residents. In both of these types of residences, the Eden Alternative homes and the Green Houses, medication use plummets, death rates decline, autonomy and mobility increase.

With respect to how we conceptualize aging, Thomas views this as the most pernicious stumbling block to improving the lives of older adults. As the Washington Post explains, “Thomas believes that Americans have bought so willingly into the idea of aging as something to be feared that it has become a self-fulfilling prophecy leading to isolation, loneliness and lack of autonomy.” This does not just mean that we become more depressed by age if we assume it will be debilitating, or we feel our ailments to a greater extent. People with negative conceptions of aging are in fact more likely to experience dementia later in life. We can literally call our own dementia and ill health into being.

To address this broader societal problem, Thomas took the drastic step of quitting his work in elder care to become something of a performer. He tours the country in a show that combines sociological analysis with more traditional narrative forms. The show exhorts people to embrace old age as a “third phase”, following childhood and adulthood, which comes with its own distinct benefits and drawbacks. Thomas believes that by normalizing rather than stigmatizing old age, we can transform our experience of it. We should focus less on the abilities older adults lose, and more on what they gain. Our culture may be overly focussed on autonomy, but we should learn to embrace older age as a time of freedom and apparently even enhanced creativity. Part of Thomas’s show explains that our brains process information differently at different times of life: older people tend to be less literal, and better at making associations and improvising.

While this way of thinking may be foreign to moat people, it is at the heart of many innovative ideas in elder care, such as the Netherlands’ “Dementia Village” and the associated “Alzheimer’s Village,” soon to be opening in Italy. These homes attempt to allow residents who may not be oriented to time and place to nevertheless lead active and fulfilling lives.

Similarly, many people who care for dementia patients emphasize the benefits of joining the person in their world, rather than attempting to impose a linear or orderly line of conversation. For example, actress Karen Stobbe has developed a series of workshops on using improvisation techniques with people who have dementia. After struggling to communicate with and manage her mother, who was suffering from dementia and living with Karen and her family, Karen found that by embracing her mother’s framing of events and her worldview, she could work in a much more cooperative fashion with her, and remove much of the conflict and frustration that resulted from trying to remind her mother of the confines of her current reality. (For more on Karen and her experience with her mother, listen to the radio interview with her here.)

None of the above approaches should be seen as minimizing the real vulnerabilities that can result from dementia and cognitive decline, but those vulnerabilities are only one part of what it means to get older. Further, the best way to address the risks to older adults may be to focus less on exclusively protective measures, and more on fostering the benefits of aging. While estates practitioners see older adults who are vulnerable to and indeed victims of financial, emotional, and even physical abuse, we also observe that prevention lies in fostering social connections and community supports for older people, as much as in addressing the root of any particular instance of abuse.