Thriving in the Ninth Decade and Beyond: Rethinking Care for Adults 85 and Older

Not Just “Old”: Engaged, Curious, and Still Evolving

Justice Ruth Bader Ginsburg was still writing landmark opinions at 86. Architect Frank Gehry is designing buildings at 95. Novelist Toni Morrison published her final book at 84. And in homes across the country, we see this spirit reflected every day—by artists, activists, bridge players, storytellers, and caregivers of their own.

Today’s “oldest old”—those 85 and up—are redefining what this stage of life looks like.

At TheKey, we care for many individuals in their late 80s, 90s, and beyond who may be navigating physical or cognitive changes, but who are still deeply engaged with life. They’re curious, connected, and committed to the relationships, routines, and rituals that give their lives meaning.

They don’t just want to age safely. They want to age well—with dignity, stimulation, autonomy, and joy.

That’s why our approach to care is different.

What Does “Oldest Old” Really Mean—And Why Does It Matter?

In gerontology, the term oldest old typically refers to individuals aged 85 and older. It’s the fastest-growing segment of the aging population, projected to triple in size over the next 30 years.

But this group isn’t monolithic. The needs of an active, socially engaged 86-year-old differ greatly from a 95-year-old managing frailty and advanced dementia. What they share is increased complexity—medically, emotionally, and socially.

Adults 85+ are more likely to:

• Live with multiple chronic conditions
• Experience sensory loss (hearing, vision, touch)
• Be taking 5 or more medications (polypharmacy)
• Have subtle or progressing cognitive changes
• Need support with balance, mobility, and daily activities
• Face social isolation, especially after widowhood or relocation

But they’re also more likely to:

• Have deep resilience and emotional insight
• Value conversation, humor, and intergenerational connection
• Find joy in rituals, music, spirituality, or storytelling
• Want autonomy in how and when support is delivered

The Risk of Over-Simplifying Care at This Stage

Too often, care for the oldest old focuses narrowly on safety and symptom management—missing the emotional, cognitive, and social needs that still matter deeply.

We hear this from our clients all the time:

“I’m not done yet.” “I like to stay informed.” “Just because I need help doesn’t mean I’ve stopped thinking.”

That’s why a one-size-fits-all, task-focused approach often falls short—and can even lead to withdrawal, resistance, or depression. For the oldest old, how support is given matters as much as what support is given.

What Thoughtful Care Looks Like at 85+

At TheKey, we believe care at this stage of life should be:

• Relational, not transactional
• Flexible, adapting to the person’s rhythms and values
• Stimulating, offering opportunities for conversation, memory, music, creativity, and reflection
• Respectful, recognizing that autonomy doesn’t end when care begins

This means:

• Pairing clients with caregivers who are emotionally attuned and well-trained in therapeutic communication
• Supporting cognitive health through our Balanced Care Method® and MindCare™ programming
• Reinforcing sleep, nutrition, hydration, and movement—not just as tasks, but as cornerstones of brain and body function
• Creating moments of connection such as playing a game, discussing the news, or revisiting family stories; it’s not just filling time, but enriching it

Common Needs We See Among Adults 85+

Why This Stage Deserves More Than Routine Support

Being 85+ doesn’t mean someone is fragile or disengaged—it means their needs are layered.

Care at this stage should:

• Prevent preventable decline
• Nurture identity and agency
• Offer structure and security without infantilizing
• Provide continuity across the physical, cognitive, and emotional dimensions of health

This is especially important when someone is:

• Recovering from hospitalization or surgery
• Transitioning from driving to non-driving
• Navigating early-stage dementia
• Grieving the loss of a spouse or long-time home
• Living far from family

How TheKey Supports the Oldest Old

We specialize in complex, nuanced care—especially for those 85 and older.

• Our Balanced Care Method® integrates six pillars of well-being: Move More, Nourish and Hydrate, Connect with Others, Flex Your Mind, Engage with Joy and Purpose, and Sleep Well.
• Our TheKeyMatch™ framework ensures that the caregiver match and approach to care match core needs, communication style, and care preferences.

We don’t just provide care. We build relationships. We protect identity. And we help older adults thrive even as their needs evolve.

That’s why TheKey is the preferred home care partner for many of the top hospitals, academic medical centers, and senior living communities across North America.

Final Thought

At 85 and beyond, life still holds potential, humor, connection, and purpose. The difference is in how care is delivered and whether it honors the full person behind the support.