Trained negotiators can help families struggling with vexing elder-care issues.The four adult children were in agreement.Their father, William Curry, a retired electrical engineer and business executive, was sinking deeper into dementia. They had found a memory care facility about a mile from their parents’ house in Chelmsford, Mass., where they thought Mr. Curry would do better.But their mother, Melissa, who was 83 when her family began urging her to make this change in 2016, remained determined to continue caring for her 81-year-old husband at home, despite the increasing toll on her own health. When her children raised the issue of a move, “she wouldn’t discuss it,” said her daughter, Shannon Curry, 56. “She’d clam up. Sometimes she’d cry.”Yet Melissa Curry’s memory was faltering, too. She would forget to give her husband his medications, or get the doses wrong. The family worried about falls and fires. Even after they persuaded her to accept a hired aide several days a week, the couple was still alone most of the day as well as overnight.As the weeks passed, “we were really at an impasse,” Ms. Curry said. “Do you override your mother?”Enter the mediator. Through a friend, Ms. Curry learned about Elder Decisions, a company offering “elder adult family mediation.” Her parents and siblings all agreed to give it a try. Crystal Thorpe, the company’s principal and founder, and a co-mediator, Rikk Larsen, interviewed family members by phone, then scheduled a session around the parents’ dining room table.Often associated with business disputes or divorce and custody cases, trained mediators can also help families struggling with an array of vexing elder-care issues: appropriate living arrangements, care responsibilities, communication and information sharing, and health and financial decisions.When families seek mediation, they “want to do what is best, but have different perspectives on what ‘best’ might mean,” Ms. Thorpe explained.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Homeownership is not the boon to older Americans that it once was.When it came to housing, Susan Apel and Keith Irwin thought they had planned adroitly for later life. They bought a four-bedroom house on two acres in Lebanon, N.H., 24 years ago, and “we made sure to pay off the mortgage before we retired,” said Ms. Apel, 71.That way, the home equity they had built up — they estimate their house is now worth about $700,000 — would allow them to sell and downsize into smaller, more manageable quarters when they needed them.That time has arrived. Ms. Apel, a retired law professor, is having trouble climbing stairs. Mr. Irwin, 71, previously an account manager for a local business, is wearying of yard work and snow shoveling, and finding workers to do those chores instead has become difficult.“We’re seeing the writing on the wall,” Ms. Apel said. They have started shopping for “a nice two-bedroom condo with a little den, all on one floor.”But they can’t find one. Local developers are putting up four-level townhouses with even more stairs. The few suitable one-floor homes available get instantly snapped up. City dwellers fleeing Covid helped pump up housing prices: One unit the couple saw recently cost $950,000 and needed work, Ms. Apel reported. Even “tiny shoeboxes” are selling for $600,000.“We were very grateful to live in this lovely place and to have paid off our house,” Ms. Apel said. “It never occurred to us that it didn’t give us the ability to move out of it.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The pandemic played a role in increased consumption, but alcohol use among people 65 and older was climbing even before 2020.The phone awakened Doug Nordman at 3 a.m. A surgeon was calling from a hospital in Grand Junction, Colo., where Mr. Nordman’s father had arrived at the emergency room, incoherent and in pain, and then lost consciousness.At first, the staff had thought he was suffering a heart attack, but a CT scan found that part of his small intestine had been perforated. A surgical team repaired the hole, saving his life, but the surgeon had some questions.“Was your father an alcoholic?” he asked. The doctors had found Dean Nordman malnourished, his peritoneal cavity “awash with alcohol.”The younger Mr. Nordman, a military personal finance author living in Oahu, Hawaii, explained that his 77-year-old dad had long been a classic social drinker: a Scotch and water with his wife before dinner, which got topped off during dinner, then another after dinner, and perhaps a nightcap.Having three to four drinks daily exceeds current dietary guidelines, which define moderate consumption as two drinks a day for men and one for women, or less. But “that was the normal drinking culture of the time,” said Doug Nordman, now 63.At the time of his hospitalization, though, Dean Nordman, a retired electrical engineer, was widowed, living alone and developing symptoms of dementia. He got lost while driving, struggled with household chores and complained of a “slipping memory.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Federal law requires states to go after the assets, usually homes, of people who died after receiving benefits for long-term care.The letter came from the state department of human services in July 2021. It expressed condolences for the loss of the recipient’s mother, who had died a few weeks earlier at 88.Then it explained that the deceased had incurred a Medicaid debt of more than $77,000 and provided instructions on how to repay the money. “I was stunned,” said the woman’s 62-year-old daughter.At first, she thought the letter might be some sort of scam. It wasn’t.She asked not to be identified, because the case is unresolved and she doesn’t want to jeopardize her chances of getting the bill reduced. The New York Times has reviewed documentation substantiating her account.The daughter moved into the family’s Midwestern home years earlier, when her widowed mother, who had vascular dementia, began to need assistance.Her mother was well insured, with Medicare, a private supplemental “Medigap” policy and long-term care insurance. The only reason she enrolled in Medicaid was that she had signed up for a state program that allowed her daughter to receive modest payments for caregiving.But that triggered additional monthly charges through a Medicaid managed care organization, and now the state wants that money back.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

New criteria could lead to a dementia diagnosis on the basis of a simple blood test, even in the absence of obvious symptoms. Determining whether someone has Alzheimer’s disease usually requires an extended diagnostic process. A doctor takes a patient’s medical history, discusses symptoms, administers verbal and visual cognitive tests.The patient may undergo a PET scan, an M.R.I. or a spinal tap — tests that detect the presence of two proteins in the brain, amyloid plaques and tau tangles, both associated with Alzheimer’s.All of that could change dramatically if new criteria proposed by an Alzheimer’s Association working group are widely adopted.Its final recommendations, expected later this year, will accelerate a shift that is already underway: from defining the disease by symptoms and behavior to defining it purely biologically — with biomarkers, substances in the body that indicate disease.The draft guidelines, Revised Criteria for Diagnosis and Staging of Alzheimer’s Disease, call for a simpler approach. That could mean a blood test to indicate the presence of amyloid. Such tests are already available in some clinics and doctors’ offices.“Someone who has biomarker evidence of amyloid in the brain has the disease, whether they’re symptomatic or not,” said Dr. Clifford R. Jack Jr., the chair of the working group and an Alzheimer’s researcher at the Mayo Clinic.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A society in which members of different generations do not interact “is a dangerous experiment,” said one researcher.On Fridays at 10 a.m., Richard Bement and Zach Ahmed sign on to their weekly video chat. The program that brought them together provides online discussion prompts and suggests arts-related activities, but the two largely ignore all that.“We just started talking about things that were important to us,” said Mr. Ahmed, 19, a pre-med student at Miami University in Oxford, Ohio.Since the pair met more than a year ago, conversation topics have included: Pink Floyd, in a long exploration led by Mr. Bement, 76, a retired sales manager in Milford Township, Ohio; their religious faiths (the senior conversation partner is Episcopalian; the younger is Muslim); their families; changing gender norms; and poetry, including Mr. Ahmed’s own efforts.“There’s this fallacy that these two generations can’t communicate,” said Mr. Bement. “I don’t find that to be true.”“Zach tells me about his organic chemistry class, about being a student in 2024. I afford Zach an opportunity to share with me what it’s like to be him, and vice versa.”Miami University began Opening Minds Through Art, a program designed to foster intergenerational understanding, in 2007 and introduced an online version in 2022. This semester, about 70 pairs have enrolled in the video program. Another 73 students engage in O.M.A.-sponsored arts activities with people who have dementia at a nursing home, a senior center and an adult day program.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The move to a long-term care facility is often difficult but necessary for frail patients. For their partners, it can mean a new set of challenges.Even as the signals of approaching dementia became impossible to ignore, Joseph Drolet dreaded the prospect of moving his partner into a long-term care facility.Mr. Drolet, 79, and his beloved Rebecca, 71, both retired lawyers and prosecutors in Atlanta, had been a couple for 33 years, though they retained separate homes. In 2019, she began getting lost while driving, mishandling her finances and struggling with the television remote. The diagnosis — Alzheimer’s disease — came in 2021.Over time, Mr. Drolet moved Rebecca (whose surname he asked to withhold to protect her privacy) into his home. But serving as her round-the-clock caregiver, as she needed help with every daily task, became exhausting and untenable. Rebecca began wandering their neighborhood and “getting dressed in the middle of the night, preparing for trips that weren’t happening,” Mr. Drolet recalled.Last year, when he determined that Rebecca no longer really knew where she was, he felt it was time to move her to a nearby memory-care residence.Putting a spouse or partner in a nursing home, for any reason, represents a fraught transition for any couple, one that can mean release from the sometimes crushing burden of caregiving, but can also be accompanied by lingering depression, anxiety and guilt, studies have shown.“That everything was on my shoulders for the care of a very vulnerable person — that stress left,” Mr. Drolet said. After Rebecca left, “the 24-hour duties could be taken by somebody else.” His constant fear of what would happen to Rebecca if he died or became disabled also abated.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Last Thanksgiving, Cynthia Mosson had been on her feet all day in her kitchen in Frankfort, Ind., preparing dinner for nine. She was nearly finished — the ham in the oven, the dressing made — when she suddenly felt the need to sit down.“I started hurting in my left shoulder,” said Ms. Mosson, 61. “It got really intense, and it started to go down my left arm.” She grew sweaty and pale and told her family, “I think I’m having a heart attack.”An ambulance sped her to a hospital where doctors confirmed that she had suffered a mild heart attack. They said testing revealed serious blockages in all her coronary arteries and told her, “You’re going to need open-heart surgery,” Ms. Mosson recalled.When such patients head into an operating room, what happens next has a lot to do with their sex, a recent study in JAMA Surgery reported. The study reinforced years of research showing that male and female patients can have very different outcomes following an operation called coronary artery bypass grafting.C.A.B.G. (pronounced like the vegetable) restores blood flow by taking arteries from patients’ arms or chests, and veins from their legs, and using them to bypass the blocked blood vessels.“It’s the most common cardiac operation in the United States,” taking place 200,000 to 300,000 times a year, said Dr. Mario Gaudino, a cardiothoracic surgeon at Weill Cornell Medicine and lead author of the study.Twenty-five to 30 percent of C.A.B.G. patients are women. How do they fare? The mortality rate for C.A.B.G., though low, is much higher for women (2.8 percent) than men (1.7 percent), Dr. Gaudino and his colleagues found.Analyzing results from about 1.3 million patients (average age: 66) from 2011 to 2020, the researchers also determined that after C.A.B.G., about 20 percent of men had complications that included strokes, kidney failure, repeat surgeries, infections of the sternum and prolonged respirator use and hospital stays. Among women, more than 28 percent did.Cardiac and pulmonary rehabilitation respiratory therapist Abbey Smit, right, took Ms. Mosson’s blood pressure at a rehabilitation appointment at IU Health Frankfort Hospital.Kaiti Sullivan for The New York TimesOf those complications, “many are relatively minor and self-resolving,” Dr. Gaudino said. But recovering from sternal wound infections can take months, he noted, and “if you have a stroke, that can affect you for a long time.” Though outcomes improved for both sexes over the decade, the gender gap remained.The study “should be regarded as an exploding flare in the sky for all clinicians who care for women,” an accompanying editorial said. Yet to cardiac researchers, the results sounded familiar.“This has been something we’ve known since the 1980s,” said Dr. C. Noel Bairey Merz, a cardiologist and researcher at Cedars-Sinai Medical Center. Heart disease, she pointed out, remains the leading cause of death for American women.With C.A.B.G., “the general assumption was that it was getting better because the technology, the knowledge, the skills and training were all improving,” she said. To see the gender disparity persist “is very disappointing.”Several factors help explain those differences. Women are three to five years older than men when they undergo bypass surgery, in part because “we recognize coronary artery disease more easily and earlier in men,” Dr. Gaudino said. “Men have the classic presentation we study in medical school. Women have different symptoms.” These may include fatigue, shortness of breath and pain in the back or stomach.Fewer than 20 percent of patients enrolled in clinical trials have been female, so “what we’ve been taught is essentially based on research in men,” he added.Partly because they’re older — about 40 percent are over 70 — women are more apt than men to have developed health problems like diabetes, high blood pressure and vascular conditions, “all factors that increase risk in cardiac surgery,” Dr. Gaudino said. They also have smaller, more fragile blood vessels, which can make surgery more complex.The disparities affect other forms of cardiac treatment and surgery, too. Women have worse outcomes than men five years after receiving a stent, a 2020 review of randomized trials reported.Ms. Mosson’s daily medications.Kaiti Sullivan for The New York TimesThey’re “less likely to be prescribed and to take statins, and particularly less likely to take the high-intensity statins, which are the most lifesaving,” Dr. Bairey Merz said. “The list goes on and on.”When C.A.B.G. works well, the results can feel miraculous. Rhonda Skaggs, 68, had a quadruple bypass in July 2022 and spent 12 days in intensive care before going home to Brooksville, Fla. Six months passed before she returned to work at a Home Shopping Network outlet store.“Now, you’d never know I had open-heart surgery,” she said. “I walk 10,000 steps a day. I teach line dance classes twice a week. I have my life back.”But Susan Leary, 71, a retired New York City teacher now living in Fuquay-Varina, N.C., is facing a second procedure after bypass surgery at Duke University last month.“Women are less likely to get all the vessels that need to be bypassed bypassed,” said her cardiothoracic surgeon, Dr. Brittany Zwischenberger, co-author of the call-to-arms editorial in JAMA Surgery.A few years before, Ms. Leary had sought a procedure to shrink away the “ugly-looking” varicose veins in her legs; now, she lacked viable blood vessels for grafting. “How did I know I was going to need some of those veins for my heart?” she said.She had a double bypass, instead of the triple bypass she needed, which represents “incomplete revascularization.”“It can contribute to worse outcomes and future interventions,” Dr. Zwischenberger said. “Fortunately, she’s a candidate for a stent” for the third blocked artery, which involves inserting a mesh tube into the vessel to widen it. The procedure is scheduled for next month.Advocates of improved care for women argue that their surgical risks can be reduced.Dr. Lamia Harik, a cardiothoracic surgery researcher at Weill Cornell Medicine, and her colleagues have found that nearly 40 percent of women’s mortality during C.A.B.G. stems from interoperative anemia. (Their study is in press.)On the treadmill during her rehabilitation appointment. Ms. Mosson has begun a three-times-weekly cardiac rehab program, recommended for patients who’ve undergone bypass surgery. She finds that her stamina is improving.Kaiti Sullivan for The New York TimesThat occurs when operating teams administer fluids to dilute patients’ blood during the procedure, allowing them to use the large cardiopulmonary bypass machine (“the pump”) that keeps blood oxygenated and flowing while surgeons do the grafting.“This is something modifiable,” Dr. Harik said. For women, surgeons might use smaller pumps or reduce the volume of added fluid, or both.To learn more, Dr. Gaudino and other researchers have begun enrolling women, and only women, in two new clinical trials. The international ROMA study, the first all-female surgical trial, will investigate two C.A.B.G. techniques to see which produces better outcomes; the federally funded Recharge trial will compare stenting with C.A.B.G.“In the past, a lot of surgeons thought this was inevitable,” Dr. Gaudino said of the differences between the sexes. “Maybe they will not disappear, but they can be minimized.”Ms. Mosson said her surgeons were pleased with the results of her quadruple bypass, though she was readmitted to the hospital briefly for fluid in her lungs. She has begun a three-times-weekly cardiac rehab program, recommended for patients who’ve undergone bypass surgery, and finds that her stamina is improving.She still contends with the psychological aftermath of her heart attack and surgery, as Ms. Skaggs did and Ms. Leary still does. They describe shock — none had a history of heart disease — depression and anxiety. “I’m still struggling with the fear it will happen again,” Ms. Mosson said.One antidote, for Ms. Leary, was being recruited for ROMA; Duke is among the clinical trial sites. She jumped at the chance to enroll.“Let me be a part of it,” she said. “Maybe my daughter will need this information someday.”

Americans in the lower middle class are losing ground financially, researchers have found.Monique Louvigny, an event coordinator in the San Francisco Bay Area, economizes where she can. She drives a 10-year-old Prius, brings a thermos of coffee to work instead of patronizing a place with baristas, and takes advantage of a drive-through food pantry once a month.Laid off at 57, “I kind of reinvented myself,” she said. She rebuilt her career as a freelancer, overseeing receptions and conventions for many companies and institutions, including the local de Young and Legion of Honor art museums.But her income fell to less than $30,000 last year. “It’s erratic,” she said. “In January, I have 12 days of work.” In the summer, she might have only three or four.Ms. Louvigny, 64, feels fortunate on two fronts. For health insurance, she has qualified for Medi-Cal, California’s Medicaid program. And two years ago, she paid off the mortgage on her condo in relatively affordable Vallejo. A housemate pays rent, which helps cover maintenance costs and rising condo fees.“I think I can hang on for two years, workwise,” she said, and then she plans to begin receiving Social Security benefits at her full retirement age of 66.Ms. Louvigny’s earnings place her in a category defined in a recent study in the journal Health Affairs as lower middle class for Americans nearing retirement. It’s a group that has steadily lost ground financially over the past two decades, with stagnating earnings and fewer economic resources than it had in the early 1990s.Not only do such losses portend insecure retirement, but they also have disturbing implications for both health and life expectancy, the study and others have found.The upper middle class, on the other hand, has fared distinctly better.“There’s a lot of attention paid to the inequities between the very bottom and the top of income distribution,” said Jack Chapel, the lead author of the study, an economist and doctoral candidate at the University of Southern California. “We wanted to look at the middle class, where people are struggling.”Drawing on data from the national Health and Retirement Study between 1994 and 2018, the researchers found “a bifurcation” among Americans in their mid-50s, he said.In effect, they now divide into two middle classes: the more secure upper tier (which, in 2018, had on average more than $90,000 per person in annual resources, including income and the annualized value of home equity, retirement savings and pensions); and the increasingly precarious lower middle class. In 2018, people in that group had average annual resources of less than $32,000.In the early 1990s, by contrast, “our lower-middle-class group had pretty comparable outcomes to the upper middle class” in measures of health and economic well-being, Mr. Chapel said.No more. In two dozen years, the gap between them widened. Homeownership, for instance, declined by 5 percent in the upper middle class but declined by 31 percent in the lower middle class, only 54 percent of whom owned homes in 2018.For those still working, earnings rose 27 percent in the upper middle class and fell 5 percent for lower-middle-class workers, adjusted for inflation. “They’re making less because they’re working fewer hours or at lower wages, or both,” Mr. Chapel said. They were also far less likely to have employer-sponsored health insurance.Total financial resources projected over their lifetimes after age 60 — including earnings, savings, pensions, housing wealth and public benefits like Social Security — stagnated for lower-middle-class people, rising just 2 percent over 24 years to about $406,000.But total resources reached about $975,000 for the upper middle class, a 26 percent increase. (For the wealthiest group, the comparable figure was nearly $3 million.)Teresa Ghilarducci, an economist at the New School for Social Research whose studies have found similar results among middle-income Americans, pointed to one reason for the growing disparity. “The house has become a reservoir of debt,” she said. “Financial institutions have figured out how to extract wealth from homes with refinancing and second mortgages, and they’ve gotten more sophisticated.”For most middle-income people approaching retirement, she said, the primary source of wealth isn’t home equity or retirement savings. It’s Social Security benefits.One particularly stressed subset: older workers in physically demanding jobs. A report from the Older Workers Retirement Security Task Force, convened by the National Academy of Social Insurance, recently estimated that at least 10 million workers over age 50 belong in that category.Those jobs include “a lot of service-related work requiring you to be on your feet all day,” said Joel Eskovitz, a member of the task force and an AARP policy director. “People in retailing, home health aides, janitors. And a lot of jobs connected with Amazon and other tech companies — warehouse work, deliveries.” Workers in these jobs are disproportionately Black, Hispanic and Asian.Because “they’re not jobs that you can hold onto until deep into your 60s,” Mr. Eskovitz said, such workers often claim their Social Security retirement benefits early, at age 62. Doing so leads to “a significant reduction in monthly benefits and lifetime income” compared with waiting until full retirement age, now 67 for most beneficiaries.The gap between the two middle classes also shows up in measures of health. Among the lower middle class, “there’s almost no decline in smoking,” Mr. Chapel said. “But the upper middle has cut smoking roughly in half.”Those with lower income have more chronic health conditions and are far more likely to describe their health as fair or poor. (One exception: Obesity has risen dramatically for both income groups.)That translates to differences in life expectancy, too. “Everyone is living longer, but the upper middle class is getting much more of a gain, and a higher proportion of their remaining years are quality years,” without serious health problems, Mr. Chapel said.Between 1994 and 2018, life expectancy at age 60 increased twice as much for upper-middle-class men and women as for those in the lower middle class.Even those whose slightly higher incomes technically place them in the upper middle class can feel insecure. “I just pray I get to keep my job at least until I hit 65,” Patricia Thompson, who is 62, wrote in a Facebook message.She and her husband live in Hickory, N.C., where she earns $53,000 a year as an acquisitions editor for a small press and where her husband, 71 and retired, receives a $1,500 Social Security payment and draws $500 from retirement savings each month. That’s above the 45th percentile in total household income for a married couple.But they are still paying off a mortgage and a car loan, and “I have no pension,” Ms. Thompson wrote. “I barely have savings because of student loans late in life. Where’s the safety net for people like me?”“It really is a huge policy challenge, figuring out how to ensure different groups can live in dignity in retirement,” Mr. Eskovitz said.At a time of discussion about raising the Social Security retirement age, policymakers and advocates have suggested a number of measures to bolster financial stability for lower earners and those who are prematurely pushed out of the labor force.The Older Workers Retirement Security Task Force generated a long list of suggestions, including a “bridge benefit” for workers with physically arduous jobs, allowing them to receive partial Social Security payments early without locking them into reduced benefits for the rest of their lives.Raising the cap on the income subjected to payroll taxes could improve Social Security’s solvency for everyone.Mr. Chapel pointed to a new Labor Department program called RETAIN, which helps ill or injured workers return to their jobs and includes workplace accommodations, rehabilitation and retraining.Ms. Louvigny thinks she will be OK, as long as she can keep working for a few more years and remains careful about her spending. “I try not to worry,” she said. “I do not allow those thoughts.”

Winston, an older silverback, is getting enviable medical treatment. Now his keepers must confront an issue that vexes doctors and older humans, too: How much intervention is too much?This month, as the patient lay anesthetized on a table, a cardiologist made a half-inch incision through the skin of his chest. She removed a small implanted heart monitor with failing batteries and inserted a new one.The patient, like many older males, had been diagnosed with cardiac disease; the monitor would provide continuing data on heart rate and rhythm, alerting his doctors to irregularities.Closing the incision required four neat stitches. In a few hours, the patient, a gorilla named Winston, would rejoin his family in their habitat at the San Diego Zoo Safari Park.“Winston, at 51, is a very old male gorilla,” said Dr. Matt Kinney, a senior veterinarian at the San Diego Zoo Wildlife Alliance who led the medical team through the procedure. With improved health care, new technology and better nutrition, “we see animals living longer, and they’re healthier for longer, too,” he said.In “human-managed care” (the term “in captivity” doesn’t fly at zoos anymore), gorillas may live two decades beyond the 30- to 40-year life spans that are common in the wild, and longer than zoo gorillas did in decades past.As with their human relatives, however, aging also brings chronic illnesses that require testing, diagnosis and treatment. Gorillas are prone to heart disease, the leading cause of death for them as for us.So now the questions for Winston’s caregivers resemble those that doctors and older human patients confront: How much treatment is too much? What is the trade-off between prolonged life and quality of life?Geriatric wildlife care “has gotten more and more sophisticated,” said Dr. Paul Calle, the chief veterinarian of the Wildlife Conservation Society, based at the Bronx Zoo. “The medical and surgical knowledge of people can be directly applied.”It looks more like human geriatric care. To keep gorillas healthy, zoo veterinarians not only turn to technologies and drugs developed for humans, but also consult with medical specialists like cardiologists, radiologists, obstetricians and dentists.Winston, for instance, takes four common heart drugs that people also take, though at different dosages. (He weighs 451 pounds.) The heart monitor he received, smaller than a flash drive, is implanted in humans as well. Winston received his annual flu shot this fall, and he is undergoing physical therapy for arthritis. “We’re looking to provide comfort to these animals later in life,” Dr. Kinney said.That doesn’t come cheaply: There were nearly 20 doctors, technicians and other staff in the operating room when Winston received his new monitor. But the San Diego Zoo Wildlife Alliance, parent organization for the zoo and the safari park, covers Winston’s care through its annual operating budget. Donors and partners offset some additional expenses.“None of our animals have insurance, and they never pay their bills,” Dr. Kinney noted. Several of Winston’s longtime caregivers, called wildlife care specialists, have retired. But Winston, who has achieved silverback status with age, remains on the job, managing his “troop” of five gorillas, keeping the peace and intervening in squabbles when needed.“He’s such a gentle silverback, an incredibly tolerant father,” said Jim Haigwood, the curator of mammals at the San Diego Zoo Safari Park. “His youngest daughter, he’ll still allow her to take food out of his mouth.”The zoo has twice introduced females with sons to the troop, which in the wild might lead to infanticide. But Winston’s caregivers believed he would be accepting, and he was.“He raised those males as though they were his own sons,” Mr. Haigwood said. (Once they became rambunctious teenagers, however, they were resettled in their own habitat, an option that human parents might occasionally envy.)Winston, a western lowland gorilla native to Central Africa, arrived at the San Diego Zoo in 1984. He enjoyed robust health until 2017, when his caregivers noticed “a general slowing down,” said Dr. Kinney, who arranged Winston’s first echocardiogram.Winston during a procedure at the Paul Harter Veterinary Medical Center, next to the San Diego Zoo Safari Park, in 2021.San Diego Zoo Wildlife AllianceThe test showed only “a couple of subtle changes, nothing alarming,” Dr. Kinney said. Everyone was relieved. Normal aging.Then in 2021, the whole troop contracted the coronavirus, probably transmitted by a human. As in human patients, age mattered.“Winston was the most severely affected,” Dr. Kinney said. “He had a cough, pretty significant lethargy, lack of appetite.” He began holding on to objects as he walked.After an infusion of monoclonal antibodies, Winston recovered. Now the whole troop has been vaccinated and boosted against the virus.But while Winston was being treated, the veterinarians and human doctors ran other tests that found concerning health issues. Winston’s heart had begun pumping less efficiently; that led to a daily regimen of blood pressure and heart drugs hidden in his food, and to the implanted monitor. He also takes ibuprofen and acetaminophen for arthritis in his spine, hips and shoulders.More worrying was a CT scan and biopsy showing a cancerous tumor damaging Winston’s right kidney. That prompted the kind of risks-versus-benefits conversation that should inform decisions about invasive treatment for older patients, but that is often skipped for humans.“Do we do a surgical procedure?” Dr. Kinney recalled wondering. “The big concern was, what would the recovery look like?” After considering Winston’s age and life expectancy, and determining that the tumor wasn’t growing, “we were comfortable with continuing to monitor him,” he said.For now, “we’re at a good balance,” he said. That is not entirely a medical issue, but reflects Winston’s ability to lead his troop — including a female, Kami, with whom he has had “a very devout partnership” for 25 years, Mr. Haigwood said.Some aspects of healthy aging might come more easily for zoo primates than for people; their keepers provide only healthy choices. “They’re not smoking,” said Marietta Danforth, the director of the Great Ape Heart Project, a research effort at the Detroit Zoo. “They’re not eating cheeseburgers.”Winston’s vegetarian diet consists primarily of tree branches and root vegetables. The half-acre Gorilla Forest where he lives, with its hills and pond and climbing structures, promotes exercise.Still, geriatric care necessarily involves end-of-life decisions. Winston could die a natural death one day like Ozzie, a gorilla who died at Zoo Atlanta two years ago at 61, or Colo, who was 60 when he died at the Columbus Zoo in Ohio in 2017.But if his quality of life declines, if he stops interacting with the troop and his caregivers or begins suffering, parallels with human care end. Even in California, with its medical aid in dying law, euthanasia remains illegal for humans. It is an option for Winston.“It’s a privilege in veterinary medicine,” Dr. Kinney said. “It also comes with great responsibility.”If Winston’s doctors, specialists and caregivers conclude, after extensive discussion, that a painless death would be preferable to a diminished life, “it’s a very calm process,” Dr. Kinney said. After an overdose of anesthesia, he said, “within minutes, there is cardiopulmonary arrest.”About 350 gorillas — and 930 great apes in total, including bonobos, orangutans and chimpanzees — live in U.S. zoos, Dr. Danforth said. However well cared for they are, some animal rights activists and primatologists argue that they don’t belong in zoos. But even People for the Ethical Treatment of Animals, whose position is that wild animals belong in the wild, acknowledged in an email that zoos like San Diego’s, accredited by the Association of Zoos & Aquariums, meet high standards of animal care. Winston “has had high-quality years,” Dr. Kinney said. The gorilla has also become a beloved media personality. San Diego will mourn his loss, whenever and however it happens.For now, “we want to be sure Winston is living a good life, that he’s fulfilled,” Dr. Kinney said. “We have a good understanding of what makes Winston Winston.”