POSITIVE AGING
BOOKS AND IDEAS WE WILL DISCUSS AT THE
FIRST MEETING ON 16THFEB 2019
1. THE END OF OLD AGE: Living A Longer, More Purposeful Life
Marc E. Agronin, M.D.
“The End of Old Age: Living a Longer, More Purposeful Life” by Marc E. Agronin is a guide to growing old with as much grace and vigor as possible. He starts out describing why society needs its elders. In some anthropology books, the authors write that in tribal days, aging was beneficial because an individual who could no longer reproduce was of no use to the tribe. When the elderly died, they cleared the way for young, fertile individuals who could hunt and bear young.
Agronin sees the role of elders as being far more than dying a swift death to make way for the young. He believes that elders had and have many important roles. One is a savant, an individual who knows a great deal about a topic and is able to share that information. Another is a sage — someone with tremendous life experience. Still another is a curator, someone who cares for a valuable object or memory. To illustrate this concept, Agronin uses the example of an elderly woman who spent time in Auschwitz when she was a child. Now an older woman, she brings children to the concentration camp and shares her stories with them. The next role an elder can play is that of creator and a final role is seer.
The next question the author addresses is why we age. He discusses a concept he calls “age points,” which include an event — a moment when a person realizes that he or she is aging; suspension — a period of uncertainty; reckoning — a way to conceal gaps between what we have and what we need — and resolution, coming to terms with aging.
The next section of “The End of Old Age” is about thriving. The author discusses how it can be easier — but so much more boring — to remain stagnant. He makes the point that people today even want our looks to be stagnant, always remaining youthful. Agronin describes this stage of aging, when the individual doesn’t want to take on new hobbies or tasks as “geropause.” The best way to combat geropause, he says, is to start working on a project you once enjoyed or to start on an entirely new project.
The final section of “The End of Old Age” is “The Action Plan,” in which Argonin outlines five steps. The first is to define your limits. You don’t want to try and fail because you took on too much. The next is to assess your resilience. How many times can you try and fail?
Next comes defining your reinvention. Do you want to take up a hobby or task you’ve done before, or do you want to try something completely new? What do you want your legacy to be? Who do you want to inherit your legacy? Find a way to celebrate your new activity.
The back of the book has worksheets to allow you to work your way into a graceful, enjoyable old age. “The End of Old Age” is an informative book. Dr. Agronin is a psychiatrist who works with older patients. The best part of his book is when he shares stories from his practice. Some parts of “The End of Old Age” are a little dry, especially when he over-explains his lists. Overall, though, this is an interesting book that will help older people and those who love them.
2. THE MATURE MIND: The Positive Power of The Aging Brain
Gene D. Cohen, M.D. Ph.D.
Staying alert
So what about the truth of experience? Why are there so many dotty old folks about? Cohen shows two reasons for this: disease and fitness. First, brain decay is largely related to diseases such as dementia and Parkinson's. Secondly, the rule of the mind is the same as with the body: use it or lose it. If you keep your mind active then it will reward you by staying active and increasing in capability.
This is good news, as it means that outside of the chance of illness, by choice you can stay alert and bright to the end of your days. In particular, Cohen identifies five activities to sustain power, clarity and subtlety of mind:
· Exercise mentally
· Exercise physically
· Pick challenging leisure activities
· Achieve mastery
· Establish strong social networks
Improved thinking
Cohen describes 'developmental intelligence' in terms of three forms of thinking that actually improve with age:
· Relativistic thinking, where understanding is based on a synthesized combination of disparate views. Absolute truth is abandoned in favor of more realistic relative truths.
· Dualist thinking, where contradictions in opposing views are uncovered and opposites are held in mind at the same time without judgment. In this way, opposing views can both be accepted as valid.
· Systematic thinking allows the person to see the forest as well as the trees, helicoptering up to understand the bigger picture. The thinker is thus not trapped in personal and petty issues.
Age stages
To put all this into a developmental context, Cohen extends and deepens the common final 'old age' stage into four phases:
· Re-evaluation, from mid-thirties to mid-sixties, where we realize our mortality and reconsider our lives.
· Liberation, from mid-fifties to mid-seventies, where the question is 'If not now, when?' as people experiment with new ways.
· Summing up, from late sixties through eighties, where people seek to share, give something back and complete unfinished business.
· Encore, from late seventies onwards, where major life themes are re-stated and re-affirmed.
In summary
This is one of my favorite kinds of book: one that is rooted in sound academic research (as opposed to the kitchen wisdom of many other books) and which is written for the common person. The result is a readable and authoritative text that is easy to digest and includes many real-life examples.
Overall, then, this is a highly-recommended book for those interested in this area. It most definitely changed my mind and I hope it will change yours too.
3. THE MYTH OF ALZHEIMER’S: What You Aren’t Being Told About Today’s Most Dreaded Diagnosis
Peter J. Whitehouse, M.D. Ph.D
Imagine a scenario where we are all taken in by a plot perpetrated by pharmaceutical companies and perpetuated by the world’s press and stakeholders in the “dementia business”, all of whom are desperately trying to preserve the cash cow of government-sanctioned funds that will enable them to continue their scaremongering of a fearful and gullible public. You might think this is a plot worthy of this summer’s blockbuster movie or a posting on the blog of a conspiracy theorist’s website. But you could not be more wrong. Instead, this is the essence of the clarion call to action by a respected neurologist with more than 30 years’ experience of treating patients with Alzheimer’s disease.
In The Myth of Alzheimer’s: What You Aren’t Being Told About Today’s Most Dreaded Diagnosis, Peter Whitehouse and his research collaborator, Daniel George, set out their treatise for a radical rethink of the way Alzheimer’s disease is perceived and, consequently, how people who have dementia are regarded by their doctors, families, and by society as a whole. Following the centenary anniversary since the discovery of a rare form of dementia by a young psychiatrist, Alois Alzheimer, Whitehouse feels that it is high time that we explode the cultural myths and stigmas, some of which go right to the grassroots, that have been built up around one of the most devastating diagnoses a person could receive. Whitehouse and George expound that we are waging a hollow war against the inevitable consequences of age on our brains; and once we accept this, we can work towards building a “scientifically honest and humanistic framework of brain ageing” and are better able to protect our cognitive function into old age through making lifestyle changes early on.
Whitehouse might have the air of poacher-turned- gamekeeper, although he is upfront about the years he spent in the thrall of the pharmaceutical industry and his own gradual disengagement from the promulgation of the “Alzheimer’s myth”. And it is through his engagements with industry that he has acquired his insight into the profiteering from the so-called Alzheimer’s construct: pharmaceutical companies that claw back huge revenues from treatments that are modestly effective, and researchers with carte blanche to millions of dollars in research funding to investigate a disease that, to his mind, is not a disease at all but rather the manifestation of the natural ageing of the brain, which occurs at different rates and to varying degrees in different people. Add into the quagmire the press, which sells copy by preying on the paranoia of an ageing population and publicising the decline of a clutch of high-profile celebrity victims, such as Ronald Reagan, Rita Heyworth, and Iris Murdoch, and a monster of frankensteinian proportions has been created.
In the first two sections of the book, the authors summarise the current state of knowledge of Alzheimer’s disease and explain the science of memory and how it is perturbed in Alzheimer’s disease. The inadequacies of the diagnosis and current treatments and the limitations of the current thinking are also discussed. This section also includes a fascinating potted history of the discovery, and rediscovery in the early 1980s, of Alzheimer’s disease, and from here they explain how and why the Alzheimer’s construct has been created.
In the third section, Whitehouse and George set out their criteria for life with an ageing brain, hints and tips on how to interpret the symptoms of brain ageing and the alternative causes, how to make the decision to see a doctor, how to find a doctor, what to expect, and how to prepare for your appointments. The authors suggest lifestyle interventions, including dietary, intellectual, and physical, which might enable people at any age to increase their cognitive reserve. They then set out their nine-point action plan for implementing these changes. This is all good common- sense advice, even if the evangelical and reiterative way it is presented might make the reader feel patronised.
As an exposé, The Myth of Alzheimer’s falls short of revelatory: not since the days of the apothecary have pharmaceutical companies been cottage industries that are driven by altruism, and who has unstinting confidence in the probity of the press or the dark practices of government lobbying? This book will particularly appeal to baby boomers, who are the group most likely to ask “Why can’t we be cured?”rather than “What can we do to help ourselves?” And there are many tomes with “dog-whistle” messages that tap into the paranoias of this generation, even if the intent is to change attitudes.
Depsite the author’s efforts, it seems unlikely that the Alzheimer’s construct will disappear, and it is, in fact, an essential impetus to the search for more effective treatments. Many people take comfort in being diagnosed with a specific ailment, and such disease classifications underscore the work- ings of many health-related businesses. Nevertheless, the times are undoubtedly changing: existing treatments might only be symptomatic and have limited effectiveness, but many new drug classes are in the early stages of development; so too are our attitudes undoubtedly changing, and dementia is now regarded as a continuum disorder that merits a change in the tools we use to define it and the vocabulary we use to describe it. Regardless of whether prescience had a role in Whitehouse’s change of heart, he is assured of a place in the new order.
4. AGING WITH GRACE: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives.
David Snowdon, Ph.D
How do you ask a nun for her brain? Medical researchers like to study religious groups, as their similar lifestyles give a purer picture of a disease. Still, there is something inescapably yucky about asking a 75-year-old nun to sign up for an Alzheimer'sstudy in which she will be tested annually for signs of senility. When she does eventually depart this earthly realm, her soul will be headed one way but her brain will be raced across country, bundled into a plastic tub and freighted parcel express to a laboratory for analysis.
Could there be any more morbid subject matter for a book? Yet David Snowdon, a University of Kentucky epidemiologist, has written a wonderfully warm and illuminating account of his now famous Nun Study. Aging With Grace is lucid about the science of senility - what exactly are the chances of escaping dementia? And it is reassuringly honest about the business of doing such science - what happens when a nervous academic has to explain the nature of his work to a roomful of twinkly-eyed ladies all old enough to be his granny?
When he first met his nuns, Snowdon admits he did not even know what he was going to study. He was merely a young researcher desperate for a project that would get funded. A student introduced him to the local convent of the School Sisters of Notre Dame, and he realised that with their identical lifestyles and meticulous record-keeping they made an ideal group. Nuns had already contributed to important research into breast and cervical cancer, but he was not sure what fields that left him.
An answer soon became clear. In the 1980s, big bucks began to pour into Alzheimer's research. The western world's population was greying; the US Census Bureau predicted that there would be nearly 1m Americans over the age of 100 by 2050 - a 20-fold increase. This is an alarming prospect if great age turns the majority of us into drooling, incontinent, bed-ridden simpletons.
From his first visits to the convent, Snowdon saw the starkly contrasting fates that life can deal. Many of the nuns were in fine fettle, even into their 80s and 90s. He found them cheering the baseball on TV, working out in the convent gym, penning letters to their Congress representatives. The majority had worked as teachers at Catholic schools and remained mentally active in retirement. But a walk to the hospital wing told a different story. There nuns were slumped blankly in wheelchairs or gabbling in unintelligible "word soup".
As the nuns had similar education, health care, diets and much else, Snowdon eventually realised he could say something about what might determine an individual's neurological destiny. The only problem: he would have to ask the nuns for their brains. With great candour, Snowdon describes the bumbling way he broke the idea to the sisters, and their surprisingly selfless response. So far he has signed up about 700 nuns to the study, which has become a nationwide enterprise. He has already made some startling findings.
Alzheimer's affects over a third of people who reach 85. It is a degenerative disease marked by plaques and tangles - protein clots and twisted filaments - that gradually kill brain cells. In people with a genetic predisposition, these plaques and tangles can start to spot the brain even in their 20s. And yet Snowdon found that Alzheimer's is certainly not inevitable. One nun lived to 100 with no trace of damage. Even more astonishingly for conventional views of the disease, he found that about a third of the nuns had advanced Alzheimer's - their brains were riddled with end-stage damage - yet had tested as mentally normal until the day they died. Somehow, their minds had remained intact.
One factor was that these "escapees" had avoided other forms of brain damage. Snowdon discovered that concussion or even very small strokes can hugely amplify the effects of any existing Alzheimer's deterioration. One finding that was harder to explain was that the writing style of the nuns in their youth predicted their mental health in their dotage. When entering the sisterhood in their 20s, each nun had to pen an autobiographical account of her reasons. It proved that those who wrote in simple, list-like sentences fared the worst. Those who used lush, idea-dense prose turned out to be the chirpy octogenarians. This effect seemed independent of simple intelligence: perhaps a brain that begins life making richer patterns of connection can better survive the pock-marking effects of Alzheimer's? Snowdon has to admit that he doesn't yet know.
This is a rare book for the way it combines cutting-edge science with an inside view of how that knowledge is being won. It is as much a story of the individual lives of the nuns as of their eventual neurological fate. And the results are not yucky at all, but encouragingly heart-warming.
I found a pdf summary by Snowdon himself (attached)
Here's a link to a Guardian review of the book: https://www.theguardian.com/books/2001/aug/18/booksonhealth
5. BEING MORTAL: Medicine and What Matters in the End
Atul Gawande, M.D. MPH
“Being Mortal” by Atul Gawande is an accounting of the care and treatment of the elderly and the dying as it has evolved over the last century to what it is today and could become in the future. In the United States in the early 1900s, old people who were sick and poor – most were poor and many were sick – were institutionalized in poorhouses which provided little care and largely accelerated the decline of the sick and old. There was a great contrast between the treatment of the elderly in America and in Asia and India, cultures that revere their elderly and take them into their homes until they require advanced care.
Before the mid-century hospitals had been used mainly as custodial institutions. After World War II hospitals began to be equipped with antibiotics and monitoring machinery and became care giving centers. The elderly who were hospitalized quickly became a thorn in the side of medical staffs. Doctors and nurses were trained to treat and cure people, fix them. But old dying people weren't fixable and were taking up valuable time and space with no good results – at least for the doctors and hospitals who became heroes to younger patients who feel the system saved their lives.
There was no place to put these elderly people who were not fixable until the federal government awarded grants to hospital to augment their facilities with a wing for the elderly. This was the green sprout of what later was to become the nursing home. Grant money was only available to facilities that met the standards set out by the government. Financially-challenged southern hospitals had a difficult time meeting those standards but, no problem, the government changed the law to state that the hospitals had to come near in meeting those standards. What resulted from this ambiguous piece of legislation were substandard facilities that morphed into what later became nursing homes, cold-hearted facilities that the elderly feared and detested.
Dr. Gawande is a general surgeon who took an interest in the care and treatment of the elderly. He relates his own experiences with his elderly patients. including his own father and younger patients who had terminal diseases. He began to recognize that once a nursing home got hold of a person that individual's wishes, dreams and desires no longer mattered. He found that many other like-minded professionals in the health care industry existed and were determined to change things.
Dr. Gawande reports on improved facilities like those that follow the assisted living model which is somewhere between independent living and the nursing home. Gawande also gives voice to the Green Houses developed by Dr. Bill Thomas who believed that by interjecting life – real life in the form of plants, pets and children – into nursing homes that the elderly could only benefit. Palliative care which focuses on what a terminal patient wants the rest of his life to be like is coming into vogue with more and more health professionals adhering to its ideology. The palliative caregiver focuses on removing as much pain and suffering from the patient as possible and finding out what he'd like to do with the rest of his life and trying to help him achieve those aspirations.
Assisted suicide may become more of an option in the future. However, it should never replace the responsibility of health care professionals to make the end-of-life experience satisfactory and a fitting conclusion to a life well-lived. There is hope for the aging, a group that includes everyone on earth. Doctors are beginning to recognize that not everyone can be cured and that some people just need comfort, kindness, attention and understanding and the chance to have purpose. Death waits for everyone of us but the pathway doesn't have to be wrought with misery and a loss of independence and purpose.
I've downloaded the book (attached), but haven't read it yet. I found a video of him giving a talk at Google. (I've watched the first 23 minutes, which is his presentation, but I haven't watched the Q&A that follows. Here's the link:
https://www.youtube.com/watch?v=mviU9OeufA0&t=31s
6. WHO DIES? An Investigation of Conscious Living and Conscious Dying.
Stephen Levine and Ondria Levine
While many books have dealt with the 'stages of dying', and particularly the stages of acceptance of death, this is the first to demonstrate how to open the immensity of living with death. 'Who Dies?' shows us how to participate fully in life as the perfect preparation for whatever may come next, be it sorrow or joy, loss or gain, death or a new wonderment at life.
Stephen's work is magic. His work with the grieving and dying is amongst the most skilful and compassionate that I am aware of. Elizabeth Kubler-Ross
This book has addressed itself to the many aspects of the dying process with refreshing insight, candour, and lightness. It divests the incredible melodrama called 'death' of its frightful power, supplanting fear with calm, simple, compassionate understanding. from the Preface by Ram Dass
Here's a link to a youtube video interview:
https://www.youtube.com/watch?v=HyEsMMPS_OQ&t=72s
I looked at the book on Amazon, and when I clicked on the "look inside" option, it seems to make the whole book available to read. Here's a link:
https://smile.amazon.com/Who-Dies-Investigation-Conscious-Living/dp/0385262213/ref=smi_www_rco2_go_smi_g5171374337?_encoding=UTF8&%2AVersion%2A=1&%2Aentries%2A=0&ie=UTF8#reader_0385262213
