IntroductionAmericans are living longer, and transforming age 85 and over from an uncommon and remarkable event to the expected last stage of the life cycle. Every decade the number of Americans age 85 and over increases about 40%: from 2.Aging Americans are living healthier as well as longer. The number of impairments reported among older adults is decreasing, and the percentage of older adults without impairment is increasing. 2 Older Americans also feel healthier. One-third of people in their 70's view themselves as middle-aged. 3 Two-thirds age 75 and over, report that they are in good, very good or excellent health. 4,5It is not clear why we are living longer and healthier. Credit for this phenomenon has been given to advanced technology and medical breakthroughs, like surgical advances, pharmaceuticals, and immunizations. Yet countries that are not technologically advanced and do not spend a fraction of what we do on medical care, have made even more impressive improvements in living longer and healthier. 6 Societal changes like increased medical access, higher income or educational levels, improved public health measures, and less oner-2