Have You Heard?

Have You Heard?

Aging Essays Featured Psychology Science

 

The old and the young hear an entirely different world. And that’s becoming a problem.

From EIGHTEEN BRIDGES MAGAZINE, Summer 2018     Robert Carter illustration

In 2005, the owner of a convenience store in the tiny Welch town of Barry had just about had it with loitering teenagers driving away customers. So he installed a prototype gadget lent to him by an inventor friend. He booted it up. The kids scattered. “It was as if someone had used anti-teenage spray around the entrance,” one reporter observed.

The device, called the Mosquito MK4, burped out a loud, rhythmic chirping the kids couldn’t stand. But customers over the age of 25 came and went as before. Most of them didn’t hear a thing. That’s because its sonic pulses are in the 17 kilohertz range — well beyond the reach of people suffering even mild forms of age-related hearing loss, called presbycusis. This affliction, which the World Health Organization estimates will affect half a billion people worldwide by 2025, gradually shaves off the higher end of the aural spectrum. Presbycusis is one of the obvious physical signs of aging. The Mosquito MK4 is a Boomer’s revenge fantasy: the greybeards turning the young’s own faculties against them.

What happened next you can guess. A group of young coders took the Mosquito signal and worked it into the customized phone app Teen Buzz. High school students started using it to send text messages in class, under the noses of their oblivious teachers and supervisors.

The elders returned serve. There are now numerous apps that spit out high-pitched squeals with no purpose but to annoy young people. Some of these apps have been built by young people themselves. (The profit motive will usually trump tribal affiliation.)

This whole saga, while funny, is troubling. The wondrous human sense of hearing, weaponized for intergenerational warfare? If anything hearing ought to bind us together, not drive us apart. We have to hear to listen, after all. And hearing is the most social of the senses.

“When you lose your vision, you sever your connection to things. When you lose your hearing, you sever your connection to people,” Helen Keller said. That quote meant little to me when I first encountered it in high school. But stored in the dark potato bin of memory, it put out shoots not long ago when my own hearing began to fail.

The first signs were the mishearings.

“What’ll you be doing on your Quebec exchange?” I asked my daughter over breakfast.

Well, it’s the Winter Carnival,” she said. “We’re going to visit the Plains of Abraham and pee on them.”

That’s very disrespectful,” I said.

What she actually said: We’re going to visit the Plains of Abraham and ski on them.”

Likewise, my weary wife, Jen, who is a teacher, did not reply when I recently questioned her weekend plans to “return to the grave.”

What she actually said: “Return my grades.”

The top end of the sound spectrum is where consonants live. As we age, it becomes hard to distinguish a “v” from a “d.” So in every sentence there’s at least one word that’s a flat-out guess. Without context you guess wrong a lot. But that’s not even the most irksome thing about presbycusis – as Jen would no doubt attest.

One day the dog got into the bird feeder, which held half a pint of seed and suet. That night she whined every hour or so to be let out. Or so I was told. I heard nothing. Jen kept getting up, while I lay in bed wondering, What else am I not hearing? It was – how else to put it?—an emasculating thought. Men who can’t hear, can’t help. We are firefighters with no alarm, sleeping peacefully while the town burns. Not much later, after some prodding, I got checked out. Two hearing tests confirmed everyone’s suspicions. Full-on presbycusis. My hearing through the top third of the normal aural range was basically shot.

Now, if its consequences were limited to annoying family members by passing them a fork instead of the corn, presbycusis could be ignored as a minor irritant. Eventually, though, hearing loss becomes a mental health issue. It’s correlated with depression, born of that creeping sense of isolation. Losing your hearing is like sitting on an airplane in coach. You’re aware of the boozy hubbub coming from the other side of the first-class curtain. There’s a party going on and you weren’t invited.

But the news gets worse. Mild hearing loss, as the Johns Hopkins researcher Frank Lin discovered, doubles your chance of developing dementia. Moderate hearing loss triples it. No one knows precisely why, but there are two main theories.

The first is behavioral. Cut off from the world, people with hearing loss withdraw even further, thereby starving off the experiential input the brain needs to grow. The main stimulus to brain health is interaction with others.

The second theory involves the physics of the brain. Call it the cognitive overload theory. Your mind is working so hard to understand that it’s sucking resources from other regions, including the hippocampus, where memories are consolidated. It’s as if you’re spending every cognitive dollar trying to hear, and putting nothing in the memory bank. When memories aren’t stored, they can’t be retrieved.

Whatever the cause of the correlation, doing nothing about hearing loss is a bad idea, because we are also learning that once our hearing degrades beyond a certain point, no hearing aid can fully bring it back. Not because the machinery of our inner ear is toast (though dying hair cells are part of the story), but because the brain has changed, and can no longer accurately decode the incoming signal.

That’s the gist of the work coming out of Bruce Schneider’s Human Communication Laboratory at the University of Toronto. Schneider, a professor of psychology, leads a multi-university research group investigating sensory and cognitive aging. That includes the social implications of a dialed-down world.

“Hearing loss is a wedge between the old and the young,” Schneider told me during a recent tour of his lab, at the U of T’s Mississauga campus. A starting place for repairing the disconnection, Schneider finds, is to help people experience what it’s like on the other side.

In his undergrad class, Schneider plays an audio clip of a man talking. But the clip has been adjusted. The high-end frequencies in the signal have been dampened by as much as 70 decibels. So the students hear the clip the way an 85-year-old with significant hearing loss would. They can still hear the speaker. But no one can understand him. The consonants are anybody’s guess.

Then Schneider starts to add back the higher frequencies. “Raise your hand when you start to understand,” Schneider says. A few outliers do, followed by the rest of the class at once: the faux-elderly recovering their youth.

Not long ago, a student came to see Schneider after class. He said the exercise had brought him closer to his grandfather.

Later that morning, Schneider ran me through a couple of the same hearing tests he gives his older experimental subjects.

I took a seat in a soundproof room, between two speakers. This is the dreaded auditory interference test. If you’ve ever tried to listen to two conversations at the same time, you know how hard it is. And this task gets tougher as we age. That’s because “it takes a second or two to segregate the voices,” Schneider said.Whereas in younger people it happens almost instantaneously – within 100-200 milliseconds.” The brains of older people are always playing catch-up. Presbycusis makes things worse. You feel like you’re constantly a beat out of step, like a guy in a football crowd standing to do the wave, hot dog overhead, after everybody else just sat down.

Schneider told me I would hear two stories: a “target” story and a “mask” story. But in this diabolical trial, both would be told by the same person and would issue from the same speaker. My job was to listen to the target and ignore the mask.

Within thirty seconds I was in the weeds. I got sucked into the mask story about Mark Twain. Afterward, given a test on the target story, I failed. The whole thing left me exhausted—the way you feel at the end of a day trying to navigate in a foreign city.

Schneider is sympathetic. At 77, he suffers from the hearing loss he investigates. He knows what it feels like to be on the wrong side of that social divide.

“I was at a cocktail party a few years ago, just circulating around,” he told me, “and I thought I heard somebody say, ‘Joseph Fourier changed Canadian Society.’ I thought, Oh, I know him!’” Fourier, the French mathematician who discovered the Greenhouse Effect, also did pioneering work on harmonics. “I thought, ‘This’ll be an interesting conversation to join.’ It took me awhile to realize they weren’t talking about Joseph Fourier; they were talking about Wilfred Laurier. I got two or three minutes into the conversation. Nobody said anything to me. They must have been thinking one of two things: Either Schneider is so obsessed with signal processing that he can’t talk about anything else, or he’s going demented.”

I laughed with him at the conclusion of this story, but its implications are profound. Consider the stakes for an older person going in for a psychological assessment. Many such tests includes verbal instruction. You think exam-taking was stressful in college? Here your performance may determine where you’re going to spend the rest of your life. You’re ushered into a curtainless room with a hard floor — a reverberation chamber. You miss a couple of consonants at the beginning of words, which leaves you fishing for the meaning of whole sentences. You fail the test. A hearing issue has been mistaken for a thinking issue. And your story just acquired a new ending.

One of the strangest and most disturbing things about the early stages of hearing loss is there are times it seems your hearing is perfectly fine. In a quiet room, looking directly at my wife, I cam make out every syllable she says. Crystal clarity, ample volume.

The senses help each other out. Visual cues are vital to accurate hearing. Watching someone speak yields a fourfold improvement in comprehension. Indeed, looking into a speaker’s face is so important to perception that it can trick us into actually “hearing” a different sound than we think the lips are making. This is known as the McGurk Effect.

But get us hard-of-hearing into a crowded restaurant and even visual cues can’t save us. It’s the ambient noise – the chaos of acoustic interference — that does us in.

And interference is the new normal. The open-plan architecture our culture has decided is the most visually appealing creates a sonic environment only a whale could love. Sound pinballs around. At a recent work lunch at a Thai restaurant in downtown Vancouver, I was reduced to cupping my hands behind my ears like Mr. Magoo. I could hear my young colleagues well enough, I just couldn’t tell what they were saying.

There is a reason commercial spaces like restaurants and bars are so loud: it works. Loud works. A 2008 French study found that when bar owners turned the music up, customers drained an equal measure of beer almost 20 percent faster. The retail environment ups the ante. Hip retail chains oxygenate the air with tunes. Some of the loudest stores in the United States are Urban Outfitters, and Virgin, Katherine Bouton reported in her book Shouting Won’t Help.“Adults come out reeling, she wrote. “Kids, the target market, pull out their credit cards.”

The electronic soundscape of modern life—a chorus of the pings and whooshes of handheld devices—is optimized to the hearing of the young. “Someone who’s 80 and someone who’s 12 are going to have different responses to a sound,” Oberlin music theory professor Will Mason said recently. (Google, on this score, is more ageist than Facebook: it has higher-pitched UI sounds.)

All this ambient noise has a side effect. It doesn’t only make it hard for older people to hear, it clouds their memory. Schneider runs his test subjects through a “paired associations” test. Older people “aren’t as able to store unrelated items in memory while there’s noise,” he says. By tailoring built environments to the young, designers are handicapping the old, unwittingly or not. And so the divide widens. One could argue that the biggest architectural change in recent times is the move from physical to online communication. We no longer see who we’re talking to. Which means the McGurk Effect, the Boomers’ ace in the hole, is out of play.

A few months ago, with a heavy sigh, I signed the paperwork for a brand new set of Oticon Opn 3s, made in Denmark. They are so expensive I’m paying for them in monthly installments, like a car.

Back at home, I popped in their tiny batteries and slid the devices behind my ears. And just like that, the aural bridge between the world of the old and the world of the young was magically restored. Although not so gracefully.

Ka-runnnnnch! Whoa. Did I just run over something? No, that was my wife in the passenger seat biting into an apple. We took the kids to the multiplex to watch A Wrinkle in Time. It was hard to tell if the film was any good. All I heard was a riot of rustling Twizzlers bags and snarky comments from the teenagers two rows back.

Home life has become chockablock with the kinds of sounds foley artists insert into movies post-production. Open the freezer door and something’s crackling in there. I can hear the “ultra-quiet” new Blomberg dishwasher from the next room. I can hear body sounds I should not be able to. The dog basically gurgles nonstop. It occurs to me how annoying my casual whistling must be to everyone else.

The Bee Gees have returned to the grocery store. I’d stopped hearing them five years ago. Now here they are again, with their unconscionable falsettos. For once, I feel an affinity for rocker Ted Nugent, who offered to buy Muzak for $10 million, so he could shut it down.

The hearing aids have been, at best, a mixed blessing. I’m coming to appreciate the high-tech listening devices I already owned. They’re called ears. They pair well with that other high-tech listening device, the brain. Even the best hearing aids aren’t nearly as good at filtering what you don’t want to hear. Like the whine of bicycle brakes. The menacing grind of escalators. Your spouse filing her nails. By boosting the signal, hearing aids introduce distortion. Things sound tinny. Your own voice sounds miked. It’s like Dylan going electric in your head.

On the positive side, I’m more alert. Booting up hearing aids in the morning is like guzzling a cup of coffee. The London-based experimental artist Caroline Hobkinson found something similar when she started playing with different tones. “Staccato sounds,” she concluded, “make you much more aware and much more appreciative.” The aging brain is lulled into a kind of stupor as the senses diminish. Restoring the top third of the aural spectrum is like throwing open the blind to sunshine. The stimulated brain suddenly has more to do.

Unexpectedly, since getting the hearing aids, I’ve also lost a bit of weight. Maybe a co-incidence. But maybe not, suggested the Oxford experimental psychologist Charles Spence, when I reached him via Skype.

Spence is best known for his crisps study. When test subjects ate stale potato chips, paired with the sound of a lusty crunch as they bit down, the chips tasted fresh. It turns out bland or bitter foods taste sweeter and better when you accompany them with high-pitched sounds. He calls the phenomenon “sonic seasoning,” and it has implications for design soundscapes from restaurants to elder-care facilities.

When you pump music into a coffee shop, and boost the signal in the upper register, customers put less sugar in their coffee, Spence found. I told him of my weight-loss-following-hearing-aids theory. Could be true, he said. On the other hand, one might also expect the opposite: restoring full-spectrum hearing makes eating fun, a crunchy, slurpy, multi-sensory party. So you might eat more.

Oh yes. Those mis-hearings? Gone. But strangely, I kind of miss them. The world is now a little dis-enchanted. No more “pepperoni tree” in the neighbour’s yard. My daughter’s feet are no longer hot in her boots on account of her “flammable socks.” And that tailback for the Raiders I’d heard a broadcaster call “Buffalo Wildwings”? No mention of him lately. Maybe he retired.

I’d been quite enjoying the Snow Falling on Cedars soundtrack of my pre-hearing-aid life. It seemed a benediction: nature’s way of granting the middle-aged some earned peace and quiet. In the accreting stillness of wisdom, the little true voice inside you – the “target story,” not the “mask” story — emerges. And maybe that’s something you really don’t want to fix. I began entertaining the notion that I’d spent almost five grand I didn’t have to make my life worse.

“How are the hearing aids working, Dad?” asked my 13-year-old daughter one day.

“A little too well,” I said. “I hear things I wish I didn’t.”

“Welcome to our world,” she said.

Thus far, scientists’ efforts to find a cure for hearing loss – from hair-cell regeneration to hormone pills – haven’t yielded much. But that could change. “Hearing loss is becoming more prevalent,” says the North Vancouver registered audiologist Katie Daroogheh. “The next generation is going to start experiencing hearing loss in their 30s and 40s.” That’s because aging isn’t the only culprit. Environmental noise is, too. As a species, we might be at peak noisiness right now. The electric machine revolution that will, many believe, make life quieter, is likely decades away from its full expression.

If the young start needing hearing aids en masse, innovation will surge. And so will marketing. “When enough people wear hearing aids it’ll probably become something like eyeglasses,” says the Harvard psychologist Ellen Langer. Perhaps teams of marketing creatives are assembling already, charged with making hearing aids not just less uncool but actually cool. Not “nearly invisible,” as high-end units like my Oticons are pitched now, but fashionably obvious. Even sexy.

I’d like to be listening through the wall on that ad campaign:

Who’s hard of hearing? Every peacekeeper in a war zone, every cowboy on a cattle drive, every member of your favourite rock band. Being hard of hearing means you have lived. You didn’t run from the lion. You stuck your head in its mouth as it roared.

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Adrift

Adrift

Aging Essays Featured

from NEW TRAIL magazine, July 2018. Illustrations by Hugh Syme

In June 2015, Megan Strickfaden and her grad student Nicole Gaudet arrived at a little village on the outskirts of Amsterdam with a Harry Potter-ish name: De Hogeweyk. An octogenarian gentleman was visibly thrilled to see them.

This called for wine.

He took Strickfaden by the arm and squired her into the village grocery store, she recalls. He found a nice red and brought it to the till. He pulled a handkerchief from his pocket and paid for the wine with it. The clerk accepted the payment, bagged up the wine and gave the man back his handkerchief as change.

To its residents, De Hogeweyk — a dead-ringer simulation of a traditional Amsterdam village — isn’t a cutting-edge experiment at the frontier of humane dementia care. It is simply home. They cruise on tandem “cosy cycles” down the cobblestone streets. They munch pastries in the café, catch films at the cinema. They wander among gardens so cunningly designed as to appear limitless. They return to family-sized living spaces that closely match the tenor of the household they grew up in, whether country-cosy or artsy-cultural, full of music and light. Trained geriatric nurses and caregivers form a kind of stealth army of invisible support. They’re dressed not as authority figures but as shopkeepers, neighbours, friends, perhaps relatives.

De Hogeweyk’s reputation rests on what its residents don’t do, says Strickfaden. Based on her observations over two extended visits to the village, residents don’t fall as much or night-wander as much or take anti-psychotics nearly as much as comparable populations elsewhere.

“The place itself is medicine,” she says.

The discovery that environmental “nudges” can boost psychological well-being is one of the triumphs of the last quarter-century of social science. (One of its founders, Richard Thaler, won the Nobel Prize in 2017 for contributions to behavioural economics.) And design elements are psychological levers. By manipulating colours, furnishings, acoustics or the layout itself, architects can send the human mind back in reflection or forward in aspiration. They can slow a frightened heart or stoke curiosity or foster human connection.

Dementia is a syndrome, a deterioration in the ability to process thought beyond what might be expected from normal aging. It affects memory, thinking, language, behaviour and the ability to perform everyday activities.

Source: World Health Organization

People with dementia, it turns out, are especially good candidates for such interventions. “A person with dementia is suggestible,” Strickfaden says. “You work with that.”

Elements similar to the De Hogeweykian approach are being introduced in care facilities around the world. One of these is Canterbury Lane, the dementia wing of the Canterbury complex in west Edmonton. Strickfaden, a design anthropology professor in the Faculty of Agricultural, Life & Environmental Sciences, has been hired to consult on the multimillion-dollar revamp. It will include features such as a garden that allows residents access to the outdoors without having to be escorted. Hallways that don’t dead-end, but loop back into the heart of the action. Little designated spaces for purposeful activity, such as folding laundry. And a cottage system of living spaces divided by theme or feel, matched to the residents’ upbringings.

The renovations will take close to four years. Unfortunately, the resident in one room is unlikely to live to see it completed. That’s just my guess, knowing that resident quite well.

She is my mother.

 

More than 50 million people worldwide are afflicted with dementia right now. And since the human lifespan is increasing more quickly than medical science seems to be closing in on a cure (which is to say, not quickly at all), dementia will be part of all our stories: your story or the story of someone you love very much. “Its shadow lies over us all,” writes Jay Ingram in his book The End of Memory.

So what to do — beyond saying a prayer and giving power of attorney to your most trustworthy blood relative? As recently as 20 years ago, people living with dementia who could no longer manage in their homes were simply institutionalized. In that setting, doctors were authority figures and patients were the passive recipients of meds, directives — and very little in the way of treatment.

But another paradigm is emerging. Dementia treatment is coalescing around the idea of patient-centred care.

In an analysis of dementia care studies published in 2015 in the Journal of the American Geriatric Society, researcher Hannah O’Rourke, an assistant professor in the Faculty of Nursing, found four things are of central importance in working with people with dementia. A sense of place. Connection to others. A sense of purpose. And shoring up those three poles of the tent supports the fourth, which is linked to physical well-being: a sense of wellness.

So, while scientists continue their search for ways to prevent and treat the disease (See The Elusive Cure), caregivers are doubling down on tactics that promise benefits right now. Call it the “3 Ws” model of dementia care: focusing on the Where, the Who and the Why of the subjective experience of this devastating syndrome.

Our questions are everybody’s questions: what must it be like to be her? And what can we do to help make this a little more bearable — for everyone?

To family members, the hardest part to fathom about dementia is the staggering difference between Good Days and Bad Days. Good Days make you second-guess your decision to move your loved one out of their own home into extended care. Bad Days grimly confirm it.

On a recent visit, my mom positively lit up when I walked through her door. We spent a great day together, at the end of which I promised I’d be back tomorrow. Ten-kilowatt smile. But when I walked through her door the next day, she greeted me with a face that looked as if a bad fish needed taking out. “What are you doing here?” she snarled.

Mom was officially diagnosed with Alzheimer’s when she failed the “mini-mental” exam 10 years ago, at age 84. Though in truth, we noticed her slipping as early as her late 70s, one “W” after another. The “where” seemed to go first. On an Alaskan cruise, to celebrate her “80th year,” she struggled to find her way back to our cabin and had not cracked the nut even by our last day at sea.

Then the “when” became wobbly. On a visit to the West Coast, she became deeply concerned that we’d miss our flight if we didn’t leave right now. So I raced us to the airport, only to hear upon our arrival: “Why the heck are we here so early?”

Social filters fell away. Mom started making derogatory comments about people standing right next to her. She began repeating herself every 30 seconds. Sometimes she noticed herself slipping. “I feel like … I’m … not right in the head!” she’d say and she could barely contain her terror.

The changes in her reflected the brutally quixotic nature of the disease. Like a tornado through a trailer park, it destroys some faculties while leaving others bizarrely intact. On a recent visit, I told Mom it was our dog’s birthday — we were having a couple of the neighbourhood pooches over to celebrate.

“Penny,” she said, remembering the name of an animal she’d never met. “How old is she, again?”

“She’s four.”

“So, our 28,” Mom said instantly.

Sometimes my sisters and I leave the facility feeling gut-punched, yearning for the sweetness we know is in Mom to surface more often. And our questions are everybody’s questions: what must it be like to be her? And what can we do to help make this a little more bearable — for everyone?

 

Are We Our Memories?

Who are we without our memories? For people with dementia, recovering even some of the experience they have banked is a crucial part of feeling, well, like themselves again.

One theory of dementia-related memory loss is that it’s a retrieval issue, rather than a data-loss issue. In other words, the memories are still in there, only their tags have fallen off. In recent years, researchers have experimented with using sensory triggers to call some of those memories up.

In Scotland, aging soccer fans living with Alzheimer’s are exposed to reconstructions of big games. In North America, people with dementia are supplied with iPods loaded with personalized playlists. Out of Sweden comes an ingenious invention called the BikeAround: a stationary bicycle attached to a wrap-around movie screen onto which a moving landscape is projected. Plug in the client’s childhood-home address on Google Street View and suddenly there they are, back in the old ’hood, cruising down streets they probably haven’t since they were a kid on a Schwinn.

Reminiscence therapy, this kind of intervention is sometimes called — and preliminary research suggests it can not only boost happiness levels but improve cognitive function. This year, the Canterbury Lane staff tried a simple version of it in the run-up to Mother’s Day with a scrapbooking activity. Family members were asked to contribute photos of mom or dad through the years, surrounded, if possible, by the people they have loved the most. “You’re really trying to get them to live in those moments,” activities supervisor Mbalia Kamara told me. “And then to really validate the feelings that emerge.”

For Mom, it was pretty profound. As she turned to a snapshot of her and Dad circa 1980, both of them tanned and smiling in Hawaiian sunshine, she began to cry. A staff member allowed her to sit with that sadness for a few moments, and then steered her toward the light. “He must have been a great guy,” she said. “Tell me about your wedding day.”

The tonic here, as much as the memory work, is the attention. People with dementia often lose their voice as the disease progresses. The world stops listening. “People used to think that because there was cognitive impairment there wasn’t insight — but that’s not true,” says nursing professor and researcher Hannah O’Rourke. “People with dementia still know what they like and don’t like.” To pull that insight out is not that difficult, she says. “You ask. You just ask.”

A couple of years ago, Elly Park, a post-doctoral fellow in the U of A Faculty of Rehabilitation Medicine, undertook a project with researchers from Simon Fraser University and the University of Toronto on digital storytelling. Facilitators helped people with dementia create a digital story with photos, music and narration by the participant. “Storytelling is a tool,” writer Ursula K. Le Guin put it, “for knowing who we are and what we want.” People with dementia are no different from the rest of us in this way. Park’s research found that encouraging participants to think about and share meaningful stories enhanced relationships with caregivers, increased communication and interaction, and gave participants a sense of accomplishment. “In several cases, participants said they surprised themselves with the stories they were able to remember,” says Park.

With Mom, I have found that if I press her too much for family history, she often clams up. For her, the fact-finding is stressful. This is not uncommon. That’s why University of Wisconsin theatre professor Anne Basting received a MacArthur Fellowship, sometimes called a genius grant, for her invention called TimeSlips. It replaces “the pressure to remember with the freedom to imagine,” as she puts it. TimeSlips is like a book club where no one has read the book, except in this case it’s a photograph. Each photograph is striking and mysterious. It looks as if it has a story to tell, so everyone makes one up. There’s no way to be wrong, which seems to loosen tongues. “The absolute key to the entire process,” Basting says in a video about TimeSlips, “is that we validate everything they say.” This sounds like — it is like — improv theatre.

Something a little magical happens when we start telling stories to each other, whether they’re true or not. Neuroscience has shown that it boosts the sense of connection between the teller and the listener. As the story unspools, the brains of teller and listener sync up — a phenomenon psychologists call “linguistic alignment.” Another bonus: for people who can no longer have out-there-in-the-world adventures, storytelling is an excellent proxy. It stimulates many of the same parts of the brain that light up when we are actually experiencing things — just as reading does.

For the scrapbooking exercise at Canterbury, not all the families contributed photos. So those residents instead received pages of their scrapbooks with stock photos of a random family. Which sounds a little sad but turns out to be a perfectly serviceable alternative. “Just the idea of family can get people talking about their own,” says Kamara.

For some reason, my own earliest memories of Mom are all tagged to scents: the cinnamon-y Bee Bell Bakery, the chlorine of the Y swimming pool, the baseball-mitt smell of Jack and Jill Shoes. We’d march into these places hand-in-hand and, invariably, she’d spot someone she knew and tractor-beam them in with her smile. She’d let go of my hand — she needed both of hers to talk — and that would be it. I waited beside her as ice ages came and went. Eventually she’d track me down in some corner of the facility. I could smell her coming.

But wait: how many of these details are true? “Every act of memory is to some degree an act of imagination,” the neurologist Oliver Sacks wrote. We’re all unreliable narrators. That doesn’t mean we all have neurodegenerative disease; dementia in its various forms is a syndrome with specific physiological signatures. But it does mean that people with dementia cannot be dismissed as Other. Every time we call our kid by the dog’s name or drive off with our coffee cup on the roof, the difference between the two worlds, practically speaking, grows moot. And somewhere a busker plays There but for Fortune.

Our Purpose, Our Selves

“If the residents here were able to describe their biggest frustration, what would they say?” I asked Wendy King, executive director of the Canterbury Foundation, not long ago. “I think maybe they would say, ‘You don’t understand me,’ ” she replied.

Hence, a recent trend in dementia care toward what you might call deep client profiling. In the old days, staff received an incoming resident’s medical charts, some basic biographical data and not much else. Now, families are often asked to flesh out the story of mom or dad. The more data, the greater the likelihood a resident ends up where they belong, doing things that pluck the strings of their hidden enthusiasms.

A “sense of purpose,” as O’Rourke discovered in her analysis of dementia studies, can involve many things: the feeling of contributing to others; a belief in a higher power; some control over how your day unfolds. From a caregiver’s perspective, restoring a sense of purpose is about reconnecting people with who they used to be — placing them back in the vicinity of that intersection where, as American writer and theologian Frederick Buechner put it, their deep desire meets the world’s deep need.

Strickfaden recalls one man at De Hogeweyk who was restless and searching, and a bit aggressive and hard to approach. Staff went back into his file and discovered he’d once been a farmer. “So one day they hid a bunch of eggs all around the courtyard. And they said, ‘We need you to go collect the eggs in the morning.’ And he’d do that. And then he’d be wonderful for the rest of the day. It was something that validated who he was.”

Alzheimer’s disease is the most common cause of dementia, accounting for about 60 to 70 per cent of cases. Dementia can also be caused by stroke, injury or other diseases.

Source: World Health Organization

At Canterbury, one resident used to be a millwright, so he’s routinely given things to tinker with. Another was a homemaker who raised a big family. She struggles to find words and can get frustrated and withdrawn, but she positively melts when handed lifelike “Baby Sophia.” She dresses the doll in tiny clothes warm from the dryer, whispering and cooing to her and, after a while, “she’s more open to the activities the rest of us are doing,” says Kamara.

But there’s purpose and then there is purpose — something closer to what the Japanese call ikigai. Roughly: the sense that life is worth living because we are needed here. Japanese research has found that people with ikigai live longer. A study published in JAMA Psychiatry in 2012 found that people with Alzheimer’s who are animated by purpose staved off cognitive decline longer. No one knows quite why it matters to feel as if we matter — only that it does.

“Feeling you matter is at the core of being a person,” British dementia consultant David Sheard often says. “Knowing you matter is at the heart of being alive.” Sheard is the founder of Dementia Care Matters, better known as the “butterfly” model of dementia care. I could see its principles in action the day I visited Copper Sky Lodge, in Spruce Grove, Alta., Canada’s first butterfly facility. Copper Sky’s CEO is Phil Gaudet, well-known in Alberta as the former head of the Good Samaritan Society, a long-running non-profit care provider. But the lodge is mostly run these days by his daughter, Nicole Gaudet. The same Gaudet who, with her thesis advisor Strickfaden, was embedded at De Hogeweyk.

As dementia advances and individuals turn inward, they’re less able to seek out the multi-sensory stimulation they may need. So the stimulation must come to them — as butterflies come to flowers. “Even things like this soft sweater I have on are part of it,” Gaudet says of the fuzzy sweater she’s wearing. “I’ve been getting lots of hugs today.”

At the centre of the butterfly model is emotion. The theory: people will forget what you say, and even what you do, but they will never forget how you made them feel. That’s because feeling is processed in a more primitive part of the brain; it’s protected, in a sense, from the damage to the neocortex that dementia causes. And so the staff at Copper Sky are trained to circulate, alighting here and there, touching, affirming, offering a cup of tea or a taste of mint, introducing short activities. “Ultimately, we are all feeling beings,” says Gaudet. “So if you can connect to what somebody is already feeling, you’re four steps ahead.”

But there’s research and then there’s practice. Changing how we care for people with dementia isn’t easy. After their experience at De Hogeweyk, Strickfaden and Gaudet were gung-ho to update legislation around dementia care in Canada. They soon discovered they were facing frustrating headwinds, some of which were cultural.

A country’s dementia care can reveal a lot about its values. China, for instance, is a culture of service, notes Strickfaden. “But that can actually get in the way of good elder care. People are literally served to death.” The Netherlands is big on personal liberties. How far you want to push your limits is up to you, within reason. Quality of life reigns supreme.

Canada has made a different choice. Here a dementia-care facility gets accredited or not based in part on how safe it’s deemed to be, says King, head of Edmonton’s Canterbury Lane. So De Hogewykian elements like cobblestones, public fountains, accessible barbecues and knives, unfenced kitchens are red flags. In Canada, safety trumps freedom. So does efficiency. Funding here is task-based. “Staff have a task list and a limited amount of time to do it,” says King. “So if a resident puts up resistance, it creates stress — because the staff person knows, ‘I’ve got to go to Mrs. Jones next.’ ”

The task-based funding model is, predictably, frustrating for more progressive voices in dementia care. “You’re regulating to the point of strangulation,” says Gaudet.

After Copper Sky received a poor grade in its first effort to become a certified butterfly facility three years ago, Gaudet spearheaded massive staff retraining. The first thing she impressed on caregivers is that human connection comes first. You are not going to be fired if you don’t get this task and this task and this task done, she told staff. Even though by some measures the extra TLC means more work for them, there’s evidence that such an approach leads to lower burnout, since it puts caretakers’ actions more in line with the reasons they got into this work in the first place.

“I would abolish long-term care in Canada and start over,” says Gaudet, “because I think we’ve got it wrong. We need to be given the freedom to deliver new kinds of care in inspiring environments.”

O’Rourke is cautiously optimistic about the future of dementia care in Canada. “If we — clinicians, researchers, community members, society — can set aside our own fears, assumptions and stigmas about the disease, there is hope. People with dementia have identified many ways to achieve a good quality of life. We just need to listen.”

one recent wednesday afternoon at Canterbury Lane, residents sat drowsing in easy chairs in front of an old Jimmy Stewart movie on the big-screen TV. My mother wasn’t among them. She likes the privacy of her room and to pick her own shows — and to crank up the volume.

On this visit, I had a plan. Having steeped myself in the Alzheimer’s literature and the best ideas of countless experts in multiple domains, I was eager to try a few things. I wanted to help Mom grasp where she is, who she is and why she is. I’d brought an artifact: a tennis racket. Not one of the fancy big ones people wield now but a vintage wooden one. This is what you used in the era when Mom learned to play, gliding around the shale courts of Garneau tennis club, not long after she and my dad met. People can see it on the wall and ask Mom about tennis. And maybe some of those locked-up memories — a serve tossed into the sun, the fitz of a new tin of balls, my dad so gentlemanly out there that he actually cheated against himself — will come rushing back.

Not long ago my sister Lynn noticed Mom paging through a magazine that had a big splash about the Royal Family. Mom pointed to a gentleman in a waistcoat. “That is the man I’m going to marry,” she said. A few years ago Lynn might have laughed or corrected her. But we have learned that it’s not our job to pull Mom back into this world. Our job is to meet her in hers. Lynn raised her eyebrows in enthusiasm, nodded and asked for details about the wedding.

These days Mom’s eyes reveal a lot. There’s not much reminiscing going on. Nor is there planning. The headlights reach to the next bend in the road and that’s it. But this is what people with dementia have, most profoundly, to teach us. They are champions at living in the now. The question, for all of us, is how can we make the now better?

I believe the answer is to just be there. Or in the case of my own too-infrequent visits, make sure I’m therewhen I’m there.

So Mom and I go for silent wheelchair tours to check out the action over in the nearby manor — past the kitchen, down the long, carpeted hallways. Little bios outside each resident’s door tell of their unique strengths. That’s right out of the David Sheard playbook: “Search for the treasure in each individual.”

“I’ve learned that if I attach too much to whether she remembers my visit, I’m going to be bitter,” Lynn told me on the phone recently. So you shift the bar. A cup of coffee, a stab at a cribbage game, a trip to the atrium to hear the piano player plink out Moon River: that is a win. We are not our memories.

Even though it sometimes feels that way.

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The Ed and Earl Show: a Tortoise-and-Hare Tale for our time

The Ed and Earl Show: a Tortoise-and-Hare Tale for our time

Aging Essays Featured

ed1

from THE GLOBE AND MAIL, May 6, 2017

Ed Whitlock, a quiet gentleman of wry British wit, an iron will and a body seemingly purpose-built to run marathons, held 36 age-group world records. He was the oldest person ever to run a marathon in under four hours, and the only person aged 70 or over ever to run a marathon in under three hours. “Ed was really my hero,” said Earl Fee, two days after attending Ed’s funeral in Milton, Ont., just west of Toronto. On March 13, Ed succumbed to a cancer only his close friends and family knew he was battling. He was 86.

Earl, who turned 88 in March, is similarly decorated in his own, shorter-distance events. He holds 15 World Masters Athletics world records. At age 66, in Buffalo, he ran 800 metres in 2:14, so demolishing the world record that officials drug-tested him twice. He is one of so few runners his age who still does hurdles that at the world championships in Costa Rica three years ago, there was no one for him to run against. So race organizers ended up pitting him against world-champion sprinter Christa Bortignon from West Vancouver, then 77. (Earl led for the entire 200-metre race, but Christa pipped him at the post. She leaned in.)

Ed and Earl, Earl and Ed. Two white guys of similar vintage and background – both loners; coincidentally, both engineers – who ran their way into sports history at an age when most of us are comparison-shopping for walkers, if we’re lucky . The two friends present a kind of natural experiment. For beyond these base traits that throw them in the same sample hopper, they are a study in contrasts – and the differences may be telling.

Earl is a devotee of HIIT – High Intensity Interval Training. He hardly ever works out for more than 20 minutes at a time, but he makes those 20 minutes count. He goes for it, typically in a series of sprint bursts – between short breaks – that leave him gasping for air. He is fastidious in his training habits – timing his intervals, salting in weight-lifting and cross-training, tweaking his regimen according to the evolving sports science. What’s more, he gets fairly frequent medical consults, eats half a pound of steamed vegetables with dinner, and takes six supplements.

Ed had long followed a program of LSD – Long Slow Distance running. He tallied endless training laps under Evergreen Cemetery’s tree canopy, patiently building a “race base” – “drudgery,” he called it, but all that mileage was money in the bank which he could draw on round about mile 22, when other guys were crashing. In 2004, in the run-up to the Toronto marathon, Ed put in three-hour training runs, more days than not, for months. Then he duly turned in what was arguably the greatest marathon ever run – 2:54:48, in Toronto, at age 73. Decidedly unfastidious in his training habits, he sometimes stretched on race day, and had seen his family doctor for a check-up exactly once since Trudeau came to office – Pierre Elliott Trudeau. His diet? Ed ate “whatever they’re serving,” he once told me. At meets, he sometimes seemed to subsist on coffee and grilled-cheese sandwiches.

Ed and Earl, Earl and Ed. They were, in a sense, the hare and the tortoise. And their approach to fitness may hold lessons for the rest of us mere mortals – who aren’t aiming to topple world records, just trying to stay young – whether our working definition of that is hanging on to our muscles or our marbles or our sex drive, or even, potentially, keeping cancer at bay.

**

Youthfulness, Part 1: In their only laboratory matchup, Ed takes the lead

Certainly Ed looked older than Earl – at least off the track. But when the starting gun cracked and he broke into a run, he became almost supernaturally youthful, gliding so gracefully, so gossamer-lightly, he looked as if he could run through freshly poured cement without leaving a mark. Earl is all power on the track, but no less “youthful” for that. On appearances alone, you could call it a wash.

But was Ed younger on the inside? Or was Earl? To get a bead on that, it won’t do to look from the outside in. You have to look from the inside out.

In 2012, Tanja Taivassalo and Russell Hepple, then kinesiology professors at McGill (both are now at the University of Florida) did just that. As part of what has become known as the McGill Masters Study, involving more than two dozen participants, aged 75 to 93, they invited Ed and Earl separately into their lab. This allowed for a rare head-to-head comparison of the two athletes, who along with their fellow subjects were submitted to a battery of tests that assessed everything from cardiovascular health to muscle composition, flexibility to brain density.

Unsurprisingly, both men crushed it. More surprising, given the differences in the way they lived and trained, was that their “numbers” were often pretty similar. Both had roughly twice the mitochondria in their muscle cells as did the sedentary controls. That means twice the ability to suck in fuels such as glucose and fat, to make energy – and twice the anti-inflammatory protection against chronic disease in the bargain.

Both men also had NASCAR engines in their chests. Ed’s heart showed no signs of the hypertrophy (dangerously enlarged left ventricle) or arrhythmia (irregular heartbeat) that ultra-distance runners are often heir to. His blood pressure was a little high, but that was no surprise to him. “My own theory is that my heart is a bit too strong,” Ed once told me – the pushing power maybe exceeded the width of the plumbing in there, he ventured. “Or it could just be all the salt in my diet.” (Indeed, it is Earl, not Ed, who has inexplicably developed a heart hiccup in latter years. He has tachycardia, a scary condition that can cause the heart to rev for no apparent reason. The times that happens, he says, are the only times he feels his age.)

At one point in the McGill testing, Ed and Earl were ushered into a hospital room, and a scientist brandished a gleaming instrument that looked a bit like a wine corker. He extracted a little plug of muscle from each man’s thigh. (Earl, particularly, had some trouble recovering from that procedure. Back in Toronto, he visited the storied sports-medicine doctor Anthony Galea, who fashioned a little artificial divot out of Earl’s own blood plasma, and plugged the hole with it, to speed healing.) Earl, it turned out, had somewhat more “fast-twitch” fibres in his leg – which provide explosive power, but fatigue faster – than Ed. That’s understandable, since he’s a sprinter and Ed was a distance man. Fast-twitch muscle ratio could be considered a metric of youthfulness: We are young, one might argue, to the degree that we can really bring it on when we need to – even if that just means sprinting for the bus. Then again, endurance may also signal “fitness,” at least in the Darwinian sense: Back on the veldt, it may have been the most important attribute of all.

The biggest difference was their VO2 max scores. That’s a measure of the highest rate that the body can take up and use oxygen. Earl’s score was high. But Ed’s score was literally off the charts – the highest ever recorded for someone his age. VO2 max scores correlate not just with longevity but with basic health – youthfulness, if you like. So much so that a paper published in the Journal of the American Medical Association last month suggested that one’s VO2 max score should be considered a vital sign, as basic as blood pressure or pulse.

Score a point for Ed.

*

Youthfulness, Part 2: Earl catches up

Not so fast, says HIIT devotee Earl: “I believe that to stay young, intensity of exercise is more important than volume.”

Until recently, evidence for that has been circumstantial at best. But last month, data emerged to give Earl’s assertion some real teeth. In a study published in the journal Cell Biology, researchers at the Mayo Clinic in Rochester, Minn., looked at how different kinds of exercise affect aging muscles at the cellular level. In one trial, three groups of older test subjects – 65 years and up – were randomly assigned to one of three experimental groups.

The first group trained like Ed – long, lower-intensity sessions with no breaks. The second trained like Earl – pulses of shorter, harder effort. (The third group did weight training alone.) Biopsies revealed that both kinds of running changed those aging muscle cells – rejuvenating them, in effect – by producing more (and better quality) mitochondria while dialling up the activity levels in certain genes.

But the interval training rejuvenated those cells more than the long, slow aerobics did. The intensity seemed to be a tonic that undid some of the cellular damage that naturally occurs when we age.

Score a point for Earl.

The brain: Ed surges ahead

One hallmark of how well we’re aging is what’s happening to us between the ears. How well are we managing practical things, such as recalling names at parties and remembering that we just put a full cup of coffee on the roof of the car? In our brain, that’s largely the job of the hippocampus, a seahorse-shaped region in the centre that helps us make and consolidate memories.

We know that exercise beefs up the hippocampus. But recently, researchers from the University of Jyvaskyla in Finland wondered whether any particular kind of exercise is better at building this part of the brain. In a study on rats published last February in The Journal of Physiology, they tested the effect of long, steady-state running (the Ed protocol) vs. interval training (the Earl protocol) vs. resistance training: weight-lifting. (The rats, if you’re wondering, pulled a weight up a ramp.)

The result? Both kinds of running grew new neurons in the rats’ hippocampus. But the Ed workout grew a lot more of them. The joggers’ hippocampus positively teemed with new neurons. The greater the distance the marathon rats travelled, the more neurons they grew. (Weight training alone, by the way, didn’t spark any neurogenesis at all.)

One point for Ed.

Wear and tear: Earl pulls up to the side

What about plain old wear and tear on the body, surely another sign of how well we’re staving off the ravages of time? Turns out, intense interval training – the Earl Protocol – does create greater “impact forces”: sudden compression that puts strain on joints and tendons.

But there’s a coda. “If you’re working out for less time in total, maybe the cumulative loading on the joints is reduced,” says Martin Gibala, head of the kinesiology department at McMaster University in Hamilton, and author of The One Minute Workout. In other words, when you work out like Earl, your moving parts get a rest and your joints are spared the sort of relentless pummelling that keeps orthopedic surgeons in Caribbean vacations.

The data are not unanimous on this, but they tip Earl’s way. Ed, says the science, was an outlier. He could do what he did because he was Ed: a 107-pound package of awesome mechanics. (He dropped to 105 in November, but generally hovered around 110.) And even Ed felt the strain – he had chronic arthritis in his knees. And the main reason he ran his training runs (relatively) slowly, he once told me, was that “my Achilles hurts if I go faster.”

Point for Earl.

Life expectancy: It’s a tie

Running is good. On average, every hour you run lengthens your life by around seven hours, a recent meta-analysis found. Aerobic exercise stresses the body, mostly in a good way. True, it does goose the production of “free radicals” – highly reactive molecules that damage our DNA (and whose accumulation is, according to one theory , the most potent driver of human aging.) But exercise is both the snakebite and the antidote: Exercise itself is an anti-oxidant, mopping up the free radicals it creates, and then some. Almost always, the medicine trumps the venom.

Almost always. Could it be that there’s some tipping point at which aerobic exercise becomes so exhaustive that it stops being protective, and hastens aging more than it slows it? Could it be that all the “oxidative stress” that Ed was subjecting himself to, with all that mileage, was aging him faster than Earl’s 20-minutes-and-done workouts are aging him?

Again, the data are murky. “The idea that oxidative stress is bad, that’s a very challenging thing to sort out,” says Dr Hepple, of the McGill Masters Study. Some studies say it is. But when McGill biologist Siegfried Hekimi increased oxidative stress in his lab mice by letting them run and run and run on a wheel, he found the opposite: They aged more slowly. “If there is a tipping point” where exercise stops rejuvenating us and starts aging us, says Dr. Hepple, “we don’t know where it is.”

Ed and Earl each score a point.

 

The cancer factor: No clear winner

Ed’s cancer diagnosis didn’t just surprise the grieving running community; it surprised Ed.

It wasn’t until last fall, around the time he was casually smashing the 15-kilometre world record for his age at a race in upstate New York, that Ed suspected something might be up. He was having trouble keeping weight on. Then, his shoulder hurt so much that he finally saw a doctor. The diagnosis: prostate cancer that, an MRI revealed, had moved into his spine and bones. “After that, things moved very quickly,” says his son Neil.

In a man with longevity in his family (his Uncle Arthur was actually Britain’s oldest man when he died at 108 in 2000), Ed’s death raises questions about the way he lived his life. Could there possibly be a link between the cancer and the training?

David Agus, a professor of medicine and engineering at the University of California, and a noted cancer specialist, is doubtful. “We know that there’s an association between some cancers and inflammation, but there’s no association we know of between strenuous exercise and prostate cancer,” he says. “Mutations happen. About half of the DNA changes in cancer just happen.”

In a 2008 study on potential links between exercise and cancer, scientists at Duke University in North Carolina found that prostate cancer grew twice as fast in mice that ran to their heart’s content as it did in sedentary mice. Exercise seemed to feed their tumours, perhaps by supplying more blood to them.

But that study comes with a very important caveat. “Those were human tumours that we planted in the mice,” notes Lee Jones, the clinical-exercise physiologist who headed that study. “The only way you can get a human tumour to grow in a mouse is if the mouse doesn’t have an immune system.” Exercise boosts the immune system, but it can’t work its magic if there’s no immune system to boost.

In a subsequent study, in which Dr. Jones’s team planted mouse breast-cancer tumours in mice – thus allowing the mice to keep their immune systems – the running rats showed the opposite result: Their tumours grew more slowly.

“If you life long enough as a man, you’re going to get prostate cancer,” Dr. Jones says. “Eighty per cent of men who are age 80 have prostate cancer. Seventy per cent of 70-year-old men have prostate cancer. The fact that Ed was 86, he probably had prostate cancer for years. But because he was in such a trained state, his body was very likely able to keep that cancer from spreading as long as it did.”

Quality of later life: Once again, a draw

We make a fetish of longer and longer life. But “lifespan” is not the most meaningful metric, argues Stephen Harridge, a respected physiologist at King’s College London. “Healthspan” is.

Actual time above ground means little if much of your Third Act takes place in the ICU. Something happens to our bodies around the eighth decade of life. Most of us tend to just start coming apart like a clock; afflictions compound, slowly choking off quality of life.

But for masters athletes, their slow, linear performance suddenly takes a discouragingly exponential plunge. Ed didn’t have “co-morbidity” issues. One single thing crept up on him right at the end. Like track-and-field legend Olga Kotelko, who died suddenly from a brain hemorrhage in the summer of 2015, just weeks after setting a passel of new world records at age 95, Ed was world-beatingly fit and feted – and then suddenly gone.

“Both of these folks” – Ed and Olga – “compressed their morbidity into a tiny, tiny fraction of their time on Earth,” says Dr. Hepple. And that might be the best definition of successful aging that we have. “Ever since Ed died,” adds Earl, “I’ve been thinking, it’s kind of a gift, what we do.”

In his heroically researched, 664-page book 100 Years Young the Natural Way he presents a kind of template for people to hit the century mark, following a protocol of exercise, stress reduction and strategic eating. Since the book came out in 2011, Earl has tweaked his diet a bit. He has almost entirely cut out fish and chicken, convinced by the data that vegetarians probably live longer. He avoids processed foods that create inflammation. He tends to his gut flora with foods such as sauerkraut and yogurt (although, he acknowledges, “some of that fermented food is not too tasty.”)

Will he justify his book’s title? He hopes so. “I’m still aiming for 100,” he says. “But life can be more fragile than you think.”

http://www.theglobeandmail.com/life/health-and-fitness/fitness/running/running-ed-whitlock-and-earl-fee-compared/article34897068/

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Behind the Cover Story: Bruce Grierson on Ellen Langer

Behind the Cover Story: Bruce Grierson on Ellen Langer

Aging Essays Featured Psychology

NYT

from the NEW YORK TIMES MAGAZINE

Bruce Grierson wrote this week’s cover story about Ellen Langer, a Harvard psychologist who has conducted experiments that involve manipulating environments to turn back subjects’ perceptions of their own age. Grierson’s last article for the magazine was about Olga Kotelko, a 91-year-old track star, which became the basis for his book “What Makes Olga Run?”

How did you first hear about Ellen Langer or grow interested in her research?

Ellen must have been hiding in my blind spot. She’s been doing her thing for almost four decades, but I didn’t stumble across her until I was researching my book, What Makes Olga Run? A chapter of that book deals with human limits and the role of the mind therein. I called Ellen up. She told me the story of her mother’s and grandmother’s afflictions. Then I learned she was contemplating this cancer study. It started to feel like a story.

Did she surprise you in any way?

About 20 seconds into a conversation with her, you know she’s different. She doesn’t sound like a scientist. She speaks in the rhythms of one of those old borscht-belt comics — punch, punch, punch, stop-me-if-you’ve-heard-this-before. There’s almost a narrative intelligence — if that’s a thing — that’s more obvious than her scientific intelligence. She’s an artist — literally (she paints) and also in sensibility. She’d surely agree with Einstein that not everything that can be measured matters, and not everything that matters can be measured. She’s fun to be around, but she kind of wore me out.

read the rest of this story here:

http://6thfloor.blogs.nytimes.com/

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What If Age is Nothing But a Mind-Set?

What If Age is Nothing But a Mind-Set?

Aging Essays Featured

from the NEW YORK TIMES MAGAZINE, OCT. 22, 2014

26counterclockwise2-master1050-v11One day in the fall of 1981, eight men in their 70s stepped out of a van in front of a converted monastery in New Hampshire. They shuffled forward, a few of them arthritically stooped, a couple with canes. Then they passed through the door and entered a time warp. Perry Como crooned on a vintage radio. Ed Sullivan welcomed guests on a black-and-white TV. Everything inside — including the books on the shelves and the magazines lying around — were designed to conjure 1959. This was to be the men’s home for five days as they participated in a radical experiment, cooked up by a young psychologist named Ellen Langer.

The subjects were in good health, but aging had left its mark. “This was before 75 was the new 55,” says Langer, who is 67 and the longest-serving professor of psychology at Harvard. Before arriving, the men were assessed on such measures as dexterity, grip strength, flexibility, hearing and vision, memory and cognition — probably the closest things the gerontologists of the time could come to the testable biomarkers of age. Langer predicted the numbers would be quite different after five days, when the subjects emerged from what was to be a fairly intense psychological intervention.

Langer had already undertaken a couple of studies involving elderly patients. In one, she found that nursing-home residents who had exhibited early stages of memory loss were able to do better on memory tests when they were given incentives to remember — showing that in many cases, indifference was being mistaken for brain deterioration. In another, now considered a classic of social psychology, Langer gave houseplants to two groups of nursing-home residents. She told one group that they were responsible for keeping the plant alive and that they could also make choices about their schedules during the day. She told the other group that the staff would care for the plants, and they were not given any choice in their schedules. Eighteen months later, twice as many subjects in the plant-caring, decision-making group were still alive than in the control group.

To Langer, this was evidence that the biomedical model of the day — that the mind and the body are on separate tracks — was wrongheaded. The belief was that “the only way to get sick is through the introduction of a pathogen, and the only way to get well is to get rid of it,” she said, when we met at her office in Cambridge in December. She came to think that what people needed to heal themselves was a psychological “prime” — something that triggered the body to take curative measures all by itself. Gathering the older men together in New Hampshire, for what she would later refer to as a counterclockwise study, would be a way to test this premise.

read the rest of the article here:

http://www.nytimes.com/2014/10/26/magazine/what-if-age-is-nothing-but-a-mind-set.html?_r=0

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Aging is an art. Meet three modern masters

Aging is an art. Meet three modern masters

Aging Essays Featured

jean.vanier

From READER’S DIGEST, January 2015

Dr. Ephraim Engleman is often asked for his advice. The American rheumatologist, who sees patients when he’s not at the prestigious research centre he heads up at the University of California San Francisco, will turn 104 in the spring. A common query: “What’s the best way to stay as cheerfully, productively, healthily above ground as you?” “Choose your parents wisely,” he quips back.

Like many jokes, it contains a grain of truth. Genes matter. But they’re not the whole story, or even most of it. Scientists say longevity is around 30 per cent DNA and 70 per cent other factors, including lifestyle choices and psychological strategies.

We now have reams of data from longitudinal studies and twin studies and analyses of the super-seniors who inhabit the world’s so-called “blue zones” — pockets were healthy centenarians thrive. To boil down all the wisdom found therein to one word seems folly, but here goes:

Adaptation.

Humans need to be challenged. Continually. When we are, everything in us becomes a little more durable. You could say super-aging is about finding ways to grow, even into our advanced years, to offset the forces of nature trying to diminish us.

The principle applies in all dimensions of our lives, even the ones not easily measured by a heart test or a brain scan. Wisdom, character, spirit: whatever these qualities actually are, pretty clearly they anneal in the fire of “just-manageable difficulty,” no less than a marathoner’s cardiovascular system or a chess grandmaster’s frontal cortex. People who find ways to live on what poet Sam Keen called the “green, growing edge,” in all they do, are youthful — no matter what their birth certificate says.

*

Betty Jean “BJ” McHugh’s adaptation involved flipping the usual parent/child motivational paradigm on its head. We try to inspire our kids. But McHugh’s daughter inspired her. Jennifer was a swimming prodigy, a butterfly specialist who competed for Canada in the 1972 Munich Olympics at the age 15. When Jennifer announced she was done with competitive swimming three years later, her mom — who had quietly jogged on the seawall while her daughter churned laps in the pool — realized it was now her time to see how far she could go.

BJ is 87 years old. She is the fastest marathon runner on the planet in her age group by an astonishing margin: during the 2012 Honolulu marathon, she crossed the line in five hours, 12 minutes, smashing the old record by nearly half an hour. (Whereupon she did not light up a smoke to celebrate – as she had after her first marathon almost thirty years earlier. Instead she feasted with her son and granddaughter, who were also in the event.) Since her first road race at age 51, the sprite-like mother-of-four from West Vancouver has set more than 30 world records.

Aging runners are no rare sight in big-city marathons. But there comes an age point—around 80—where the numbers drop right off. Not coincidentally, it’s around the same point that human athletic performance craters. For reasons scientists can’t quite pinpoint, the body starts wearing down in double-time. Muscle mass falls sharply. Lungs lose their elasticity. Mitochondria—the tiny power plants in our cells—degrade. Bones thin. Balance falters. Old age clamps around us like a suit of armour. Anyone who has found a way to stay youthful in the face of this formidable headwind—the BJ McHughs of the world—seem mystical.

So what’s the secret?

For starters, the very exercise that becomes such a struggle when we age. The marathons McHugh runs now are far harder than the first one she ran 30 years ago, even though she’s slowed the pace significantly. Round about mile fifteen, “there’s a little war going on in my mind,” laughs BJ. It takes a mighty will not to stop and walk.

The good news: for most of us, walking is more than fine. National health associations in both Canada and the United States recommend 150 minutes brisk walking — or its equivalent — a week. While some studies maintain that working up a sweat delivers outsized benefits, the secret is finding an exercise you will actually continue to do, one that is pitched at a level that’s challenging but not overwhelming. Most sports-medicine experts recommend adding resistance training as we grow older — to strengthen bones, improve balance, and combat frailty.  After her morning run, McHugh will sometimes peel away from the tight company of her training group and pop into a yoga class. There is a level of productive restlessness about her — the same restlessness that got her into running in the first place, rather than wait in her car for her daughter to finish swimming. And that shark-like need for constant motion may be as important a key to longevity as the exercise training itself. 

McHugh doesn’t park her body for long stretches. She doesn’t sit for long without changing position. The television never comes on before the six o’clock news. She prefers walking to driving, even to her bridge games, which are five kilometres away.

Increasing evidence suggests we need to just move around as much as we need to exercise. Joan Vernikos, the former director of life sciences at NASA and godmother of “sedentary studies” suggests the single best exercise we can do, bang for buck, is standing up frequently. Again, it’s about challenging the body—in this case, with gravity. And standing up repeatedly maintains circulation by keeping blood-pressure sensors in tune. With moving comes energy, and with energy comes, well, if not eternal youthfulness, at least the mojo to be a powerful role model.

“One day out running I saw a truck pull over,” McHugh recalls. “This guy got out and said, ‘You’re BJ McHugh aren’t you?’” She recognized him. A couple of years previous, he had stopped her as she was finishing a long run. “How old are you?” he’d asked. He’d looked rough. But this time he was beaming. He said: “I’ve changed my whole life around and I’ve qualified for Boston.”

Ephraim Engleman isn’t taking on any new patients, and has begun to feel obliged to suggest to his regulars that “perhaps the time has come that you ought to think of getting another doctor.” No thanks, they say: they’ll stick with him. Experience and wisdom are things you can’t just Google.

Engleman, who is likely safe in his guess that he’s the oldest practicing physician in America, enjoys dispensing slow, dry witticisms, eyes twinkling under storks’-nest brows. He recently renewed his driver’s license (“so I’m good now until 105”), but in a nod to his family’s wishes, he sometimes lets a driver take him the 30 kilometres to work at the Arthritis Research Medical Center at UCSF, of which he is founding director. Once there, “Eph” answers correspondence, consults with colleagues, and just generally bucks the odds surrounding aging and cognition.

The chances of an individual getting dementia double every year beyond age 65. Of those lucky enough to reach 100, only 15 to 25 per cent arrive with all their marbles. The brain of the average 90-year-old is about the same size as the brain of the average three-year-old: typically the shrinkage comes in the frontal cortex and the hippocampus, headquarters of planning and memory filing, respectively.

Very old folks like Engleman whose wetware is still high-functioning owe much to what brain scientists call “cognitive reserve”—renovations that keep the brain humming even as senescence sets in.

Cognitive reserve is the key to aging very well from the neck up.

There are a few ways to build it.

You eat a heart-healthy diet, because fatty plaques affect both the heart and the brain. Which Engleman does.

You exercise, preferably vigorously. Which Engleman doesn’t. (“I don’t even do the walking I used to do,” he says, because of increasing back trouble that’s led to his hunched-over gait.)

You keep the brain continually challenged with reading, writing, blogging, puzzling, bridge-playing, travelling, language-learning, storytelling. The more interventions you pile on the better: the benefits seem to compound. “The principle of synergy — you know, one plus one equals three — has been shown time and time again” to forestall dementia, says Richard Isaacson, director of the Alzheimer’s Prevention Clinic at New York-Presbyterian/Weill Cornell Medical Center. “Having more brain activities is good for the backup system,” Isaacson says. When the brain encounters novelty it’s forced to adapt. Neurogenesis, the hatching of new grey-matter cells, has no known age limit. So not only can you teach an old dog new tricks, it’s essential if you want that dog to stay sharp. (Engleman, among other non-work-related diversions, emcees at a local social club, at writes his own material.)

You go to school: education levels correlate with brain density. Then you keep going to school, even when you’re out of school. “Lifetime intellectual enrichment” seems to delay the onset of cognitive impairment, notes Prashanthi Vemuri, the lead researcher of a new study out of the Mayo Clinic in Rochester, Minn, published in the journal JAMA Neurology. By how much? Three to six years, on average.

So far, so good for Ephraim Engleman. But he may have a secret weapon on his side as well: music.

Engleman is a former violin prodigy. He put himself through school in the 1930s partly by playing in vaudeville orchestras. He still jams with a chamber quartet once a week in his San Mateo, CA, home, where he lives with his 99-yearold wife, Jean. “Playing music,” he says “is a real stimulus—and very, very good for the soul.”

The science bears out his statement—the first part, at least. Playing music seems to challenge brain in ways that offer significant protection from cognitive impairment and dementia, studies suggest. Richard Isaacson, of Cornell, rattles off five studies that have helped build the case: In one of them, six weeks of “music therapy” increased the level of neurotransmitters in the bloodstream of Alzheimer’s patients. “Right there is the biological basis for music, in some ways,” he says. In general, “the deeper your relationship with music, the better the effect.” Indeed, Isaacson was so persuaded by the data that he picked up his guitar again—and now plays bass in a band of neuron scientists. They’re called The Regenerates.

*

In the French village of Trosly-Breuil, just north of Paris, 86-year-old Jean Vanier lives a simple life. Each day, he walks from his house to the group home he established 50 years ago, where he eats, laughs and prays with his adopted family. This is the first L’Arche community. Founded on Vanier’s vision, the organization is built around the idea that if adults with mental disabilities were settled in private homes alongside non-disabled people, the result would be a boon to both sides.

The son of former Canadian governor general Georges Vanier, he had once seemed destined for a different kind of life. Having written his PhD dissertation on Aristotle, he briefly taught philosophy at the University of Toronto. But there was a spiritual curiosity in Vanier that academia couldn’t satisfy, and he followed his mentor, a Dominican priest named Father Thomas Philippe, to France, taking on a life of voluntary poverty and daily challenge. It irks Vanier when people call him, as many are inclined to, a living saint. The sacrifice he made is no sacrifice at all, he insists, since the disabled offer us a great gift: they teach us how to become human. More generally, having to accommodate the wishes and quirks and demands of others tests our patience and, in the bargain, strengthens it. Would he be the person he is now had he remained on that earlier trajectory? “God knows,” Vanier says. “All I know is I’m here now. I have grown. I still have things to grow into—to have fewer barriers, to be more open to people. The story’s not finished. I’m 86, but the story goes on.”

Unlike physical and cognitive aging, there is no identifiable point where people start to break down spiritually—and no reliable prescription if it happens. Studies have found that those who attend religious ceremonies live longer, although who can say for sure if the active ingredient is the spiritual part and not, say, the routine, or the power of social networks, or the fibre in the little wafers (okay, we can probably rule that one out).

We tend to think of spirituality in terms of meditation or perhaps prayer, a private inward journey. To Vanier, that is only half the story. A second current nudges us in the opposite direction, out of ourselves and into meaningful contact with others. In effect, at a phase of life when many people start closing themselves off, Vanier counsels opening up. Instead of spending our later years cementing our own comfort within tiny tribes, we should be reaching out. In what one could call an adaptation response of the soul, empathy begets empathy.

In his famous Grant Study, which began in 1938 and followed a group of male undergraduates from Harvard for the rest of their lives, psychiatrist George Vaillant found that the ones who thrived into old age were the ones who, among other things, figured out how to love and be loved. If there is a reliable prescription for aging well cordially—from the heart—it’s this: the company of people you care about, and who care about you.

*

It’s not quite fair to prop up B.J. McHugh, Ephraim Engleman and Jean Vanier in their respective shop windows as models of brilliant aging of the body, brain, and soul. The ways in which people age brilliantly aren’t mutually exclusive. Indeed, these three —as with spectacularly robust old men and women of all stripes — have a fair bit in common.

All have a strong sense of purpose that pops them out of bed every morning. And while all are extraordinarily conscientious, the drive is directed outward—all three were drawn to helping professions (McHugh is a retired nurse). When Howard Friedman, a psychologist at University of California, Riverside, was crunching the data for the famous Longevity Project—a study that was published in book form in 2011 and followed more than 1,000 American children to their dotage or their grave—he discovered a pattern. The hardest workers had the longest lives.

And so we return to the old formula: strive, adapt, live on. The kites that remain in the sky the longest are pinned there by resistance.

 

 

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