Editor’s letter: old age is over—if you want it.

It’s 2035, and at your 60th-birthday checkup your doctor lays out an appealing menu of options. You seem to be getting the sniffles more often these days—how about some rapamycin to shore up your immune system? The second generation of senolytics has just come out, and your Aunt Sandra said they’re already doing wonders for her joints. Or how about some epigenetic smoothing? It’s supposed to completely do away with Alzheimer’s, and even though your polygenic score says your risk of developing it is only 7% higher than average, you can’t be too careful … And then, says your doctor, leaning in confidentially, apparently there’s a whole new class of mTOR inhibitors, and they’re looking for volunteers for the first human trial. Of course, it’ll be years before you know if it works, but just imagine—you could live to 115, or 120, or even more!

You’re torn. On the one hand, yes, it would be lovely to see the great-great-­grandchildren grow up. And keeping yourself serviceable for a bit longer is certainly wise—after all, they just raised the retirement age again, and you lost a good chunk of your savings on that oceanfront property that’s now an ocean property. On the other hand, your kids (and their kids) will have it hard enough managing their own retirements without also taking care of you. Politics is getting ugly; some people think the solution to the national debt crisis is to stop Social Security and Medicare for anyone over 85, and everyone’s seen the footage from the age riots in Japan. And besides, do you really want to see what the world looks like after another few decades of climate change?

This issue of MIT Technology Review is about big advances in longevity medicine that may be coming soon—some of which I’ve alluded to above, and which you can read about in our stories on the biology of aging (start with What if aging weren’t inevitable, but a curable disease?)—as well as the challenges and opportunities of a world in which people live longer and healthier lives.

As David Rotman argues, for such a world to be prosperous and harmonious, society needs to shed stereotypes of older people as unproductive, inflexible, and technologically challenged. Indeed, as Joseph Coughlin explains, our very notion of “old age” was invented around the same time as the theory of eugenics and is about equally valid. Groups like the Longevity Explorers and Senior Planet  give the lie to the idea that older people can’t start new ventures or learn to use technology. They can also show how to design technology for seniors that—unlike most of what’s on offer now—both suits their needs and doesn’t have “OLD” written all over it.

(Coughlin, by the way, is speaking at EmTech MIT, our annual conference on the biggest topics in technology on September 17–19. So is Joan Mannick, who is leading development of one of the most promising potential anti-aging drugs.)

But there’s also a version of the future in which we’ve failed to adapt to an aging world, just as we are currently failing to adapt to global warming. It’s a future in which many older people, facing the prospect of a longer life and slower final decline, are forced to delay retirement so their savings don’t run out; they continue to face ageism and pressure to quit their jobs; those still working have to support a ballooning health and welfare system; and urban infrastructure proves woefully inadequate to the needs of a growing generation of seniors.

And, just as with global warming, which future we get depends on choices we make today. I hope you’ll find this issue a useful guide to some of those choices.