November 18, 2011

CANADA: What it’s really like to grow old

TORONTO, Ontario /Macleans.Ca / Life / November 17, 2011

Millions of boomers will suffer from cognitive loss and dementia. Maybe they already do

By Brian Bethune

Photo by Brent Foster
Old age is not for sissies, Bette Davis memorably proclaimed. But we’re working on it, and just in the nick of time. The baby boomers, the Western world’s social arbiters ever since their birth spawned a frenzy of school building, are passing another milestone in their march toward a gerontocracy the likes of which the world has never seen. The first of them turned 65 this year, and in Canada they will keep doing so at the rate of 1,000 a day for another 18 years, until the number of seniors is twice that of today. And what boomers need, boomers tend to get, from financial entitlements to social science and psychological theories, and these days the concept of positive aging is flourishing.

For those who will admit to aging at all, that is. More than half of the respondents aged 65 to 74 described themselves as middle-aged or young, in an American survey. Media reports are full of people whose children have had children—grandparents they were called, back before the flood—who insist on being called anything but. (The New Grandparents Name Book has suggestions: Bubbles, GoGo, Napa, Pebbles.) The burgeoning Zoomer media empire, which admittedly includes the middle-aged as well as the elderly in its target audience, remade CARP magazine into Zoomer, adding fashion, beauty, food and wine and relationship articles to the health and finance pieces that dominated the magazine when it was published by the Canadian Association of Retired Persons.

Despite the strong streak of denial in all this—Bubbles?—there is clearly an aura of positivity around contemporary aging, even in an era of mangled private savings and wobbly public finances. Both those who will have to live on retirement income (or have postponed retirement for financial reasons) and those who are going to pay for a significant portion of it through their taxes—a fusion recipe for intergenerational conflict—have good reason for a negative outlook. But positive aging is a concept divorced from economics. Rather, it is associated with great strides in physical health that are allowing us to live longer, as well as the resources being poured into the battle against what Toronto’s Baycrest geriatric-care centre calls the coming “sharp increase in the rate of dementia,” and the efforts of some to tease out the hidden upside in age-related cognitive decline.

Researchers like Stanford University psychologist Laura Carstensen cite the “positivity effect” in old age—the way elderly adults invest more of their diminishing cognitive resources in emotionally meaningful activities. They do this, according to Carstensen’s theory of “socio-emotional selectivity,” from rational, even wise, motives, to derive the most emotional satisfaction possible from their remaining time. The “paradox of aging,” she writes, means that millions of people “suffer significant [cognitive and physical] loss with age but experience life more positively.”

It’s all enough to make William Ian Miller—born in 1946 and thus one of those pioneering golden-years boomers—take to his bed and turn his face to the wall. The University of Michigan law professor can’t quite believe all these tales of contented seniors. Did Cartensen interview “any Tea Party members”? he writes in his blackly funny and wonderfully thought-provoking Losing It, a raging screed directed less against the dying of the light than against any denial that the lamps—his, mine, yours—are indeed dimming all the time. “Now there are some happy, positive oldsters for you.” Emotion and cognition are thoroughly intertwined, Miller notes, so the old people who report themselves happy in the surveys cited by positivity effect adherents—and those who deny their age—may well “have lost the means to make the critical judgments to evaluate accurately their situation.”

Miller is the author of several discursive and elegantly written legal-philosophical-historical works, including Faking It and Humiliation, that draw heavily on ancient literature and philosophy, especially Icelandic sagas. Much of what he’s written, in fact, could have been distilled into a vast Everything I Ever Needed to Know I Learned From the Sagas (With Some Help From the Hebrew Bible). To note that Miller has little time for what he calls, in an interview with Maclean’s, “the aggressive stupidity” of positive aging theorists, is to understate matters badly. Their conclusions may be suitable for our culture, the first in history to find it “unnatural to die even in old age,” Miller argues, but he prefers to mine more tough-minded cultures for clues as to how we should deal with this grim business of inching into the grave. Among them, as Scripture and saga alike record: constant complaining, crafting wisdom proverbs with an undercurrent of paranoid cynicism, taking to one’s bed—as an acknowledgment you’re no longer a player in the social game—dreaming about taking it all with you, scheming about cutting heirs out of your will or how to settle old scores. And then doing your best to ensure you attain whatever it is your society deems a good death.

Miller can be biting, and bitingly funny, about physical decline. Take one common indignity of aging, primarily, though not exclusively, for men: the way hair stops growing where you want it and starts sprouting where you very much don’t want it. Shaving one morning, Miller is enraged to see in the mirror something he had failed previously to notice—a half-inch hair growing from his ear. Impulsively swinging his razor at it, he cuts his ear, becoming more angry when it won’t stop bleeding, and fully maddened when he realizes why: “Because of the anticoagulant effect of the aspirin I take so I can—the joke of it—live longer.”

In ridiculing physical decline Miller is merely in line with an ancient attitude toward the elderly—ageism, we call it now—that is as robust a tradition as any measure of respect granted the aged for their wisdom. Western culture has always had little tolerance for old people behaving in ways their offspring find unseemly. Younger medieval Europeans mocked them mercilessly for any sign of interest in sex: Renaissance artist Lucas Cranach’s painting of a bald man embracing a young woman—who has her hand in his purse—is entitled The Old Fool. “Think of the women screwing Berlusconi,” echoes Miller in disgust. Or, for that matter, of an aging quarterback texting an image of his, uh, goalpost to a young woman. Born and raised in Wisconsin, Miller is a devout member of the Church of the Green Bay Packers, and the story of the team’s former star Brett Favre functions for him as an Awful Example, the tale of “a man who committed suicide in front of us and didn’t even notice it.”

But in truth, Miller can mock the physical side because, unlike many fading athletes, his entire sense of self is not wrapped up in it. In his case, what cuts to the bone, or rather right to the shrinking brain, is the mental side—declines in memory, processing speed, sensory acuity, and the capacity to focus. Our brains begin shrinking in our early 30s, starting with the prefrontal cortex where, as Miller sourly remarks, “a good chunk of you resides.” (Miller encapsulates this unpleasant fact in his faux-senile subtitle: In Which An Aging Professor Laments His Shrinking Brain, Which He Flatters Himself Once Did Him Noble Service .. .”) Even if Carstensen is correct, Miller laments, and old people do turn away from learning new things for rational motives, what about those—law professors, for instance—for whom learning is a joy and an end in itself? Where’s their positivity effect?

The true horror of cognitive decline, of course, is the insidious way it creeps up. An athlete, if he’s not Brett Favre, can tell when his powers are failing, but how is a mind worker to know? The “it” in Losing It is as much confidence as cognitive power itself, making the issue, as elegantly phrased by Miller, one of “wrongly maintaining it or rightly losing it.” When to shut it down, call it a day, a career, a life? The uncertainty is why Miller wrote his book now, “for fear that if I delay, I will not be able to write it.” And that’s why, too, the last word (literally) in Losing It goes to Miller’s younger colleague at Michigan, a woman who can be described—choose your perspective—as emotionally tone-deaf, a cruel sadist or the sort of uncomfortable-truth-telling pal we all need. In part, she secures pride of place because she provided Miller with a wittily perfect ending, but mostly because she left him with little choice but to come to a full stop: “Do you want me,” she asked, in words he’s not liable ever to forget, “to let you know when you are repeating yourself? Or would you prefer I let it slide?”

On this point, if no other, advocates for the aging will concede Miller a palpable hit. Dr. William Reichman, president and CEO of Baycrest—which combines front line care for the aging with one of the world’s top research institutes in cognitive neuroscience—can speak with enthusiasm and expertise about programs and research studies aimed at preventing cognitive decline before it begins. “At Baycrest we focus on brain-dementia issues the way other health care centres focus on the heart. We’re trying to find who might be at risk as early as possible.” Reichman points to Baycrest’s huge new study on brain size and cognitive power, and to new imaging techniques that allow doctors to check for low levels of amyloids in spinal fluid. That in turn would indicate the amyloids—insoluble fibrous protein aggregates—are clustering in the brain, a development associated with such neurodegenerative diseases as Alzheimer’s.

Early detection would give full scope to an array of preventive measures. “We’ve learned that physical activity is as important to brains as to hearts,” Reichman says. “As well, it matters how rich the environment is. Where rodents have to solve problems, their brains show less damage than those of couch potato rodents.” The goal, as the new brain care mantra would have it, is “morbidity compression,” a concept akin to oncologists’ newly modest aim of making cancer something a person dies with, rather thanfrom. “Staying healthy and active to 100,” Reichman, 54, lightly sums up, “and then falling off a cliff. I’m willing to give up five years of longevity if the rest of my life is healthier. Of course, you’ll have to ask me again at 85.”

Prevention is not just the best therapy; right now it’s practically the only therapy. Currently, almost a quarter of people over 65 have mild cognitive impairment; every year, roughly one-fifth of those are diagnosed with Alzheimer’s disease. “And by the time you show memory loss due to Alzheimer’s you’re already in a state of advanced brain failure,” Reichman allows. “There have been no new good therapeutics in Alzheimer’s in decades—our lack of success there speaks for itself.”

Brain health is “huge, huge,” agrees Susan Eng, vice-president of advocacy for CARP. “It underlies every other aspect of home care for the aged. If we can’t help families keep safe those elderly members who need heavy-duty care, the only other option is institutionalization.” Either option will require money, as does the therapy that is available for the mildly impaired. And while money is never the entire cause of intergenerational conflict, it’s always there near the root. Eng can speak to that. In CARP’s ongoing struggle to end mandatory retirement for airline pilots, Eng found the pilots’ union fighting against her “tooth and nail, because they want younger pilots to have room to move up in the salary scale.” It was very much an intergenerational battle, she says, and “it was ugly.”

Not only are there not as many younger workers to support the boomers’ demographic bulge as there are working boomers supporting their parents’ generation, some of the young aren’t interested. Some Gen-Xers, in particular, see demography as a zero-sum game—what one generation has, another cannot. One American blogger greeted the occasion of the boomers turning 60 in 2006 with, “Ugh. Their hypocritical marriages, their ugly, spoiled children, their secret conservatism, their blatant selfishness, their erectile dysfunction and dry vaginas. Please God, let them die so that others might live.” Earlier this year, filmmaker and comedian Albert Brooks published his first novel, Twenty Thirty, about America 19 years in the future. With cancer cured in 2015, corralling the boomers’ last remaining predator, the country is older and broker than ever. Young people bitterly resent the perpetual-motion treadmill they pace while maintaining their hyper-aged parents’ entitlement programs. Miller, for his part, is sympathetic to the young, referencing both their deepest suspicions and the forgetful old in a chapter exquisitely entitled “Can you recall what you had for dinner, Cronus?” (The concept of the cannibalistic old is ancient itself—in Greek myth Cronus devoured his children until his sixth child, Zeus, managed to kill him.)

But while he realizes that his salary would fund four entry-level academics, Miller has no intention of leaving his job—nor will age-discrimination laws allow him to be forced out of it—despite what he calls his “clearly decaying” scholarly ability: “I still have kids of my own to feed, though I might be feeding them with someone else’s.” (Miller’s memory blanking—an age-related phenomenon—particularly troubles him: when explaining to a colleague that Claude Rains was correct to round up the usual suspects in Tangiers, Marrakesh, whatever city that was, and the colleague replied, presumably in as neutral a tone as possible, “Casablanca,” Miller’s response was, “I am going to go shoot myself.”)

He knows, of course, and realizes his readers know too, that all the erudition and hard thinking distilled into Losing It—from a marvellous deconstruction of King David’s deathbed revenge chat with Solomon to his accounts of the cunning last acts of several Icelandic killers—are a kind of boast: Miller’s still functioning, still got it, in every meaning of “it.” That doesn’t mean there isn’t a more serious end—literally—in mind in a book dedicated to facing mortality. How to go out in style? What is a good death these days? The best, Miller decides, would be to die, surrounded by family, with sufficient wits left to realize it was happening, and sufficient time to “make a few ironical remarks, to prove I have not lost it all.” Then he could breathe his last.
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