Monday, May 7, 2018

Adapting to Ageism


Everyone credits Robert Butler with coining the term ageism in 1969. He later expounded on this concept in his Pulitzer prize-winning book Why Survive? Being old in America in 1975. But this follows from a seminal study The Coming of Age by Simone DeBeauvoir in 1970. A detailed analyses examining the dystopian condition of older adults in modern day France. Using techniques from multiple disciplines but especially from feminist perspective of her 1949 book The Second Sex,

There was a swell of human awareness of how our industrialized world discards older people. Margaret Gullette, in her book Ending Ageism, Or How Not to Shoot Old People, suggests that credit for first articulating the construct of ageism should be attributed to Ralph Waldo Emerson in his 1862 essay Old Age.  But ageism has been around since early history.

Getting old is something to shun, and older people are shunned. This discrimination continues to this day, across all countries. No one is immune from ageism. Ageism has severe and negative consequences—health, income, work, insurance, life expectancy—least of which is the denial of older people from employment. Theoretically there was a great animated debate in gerontology on whether this is society shunning older adults or older adults themselves. Some consider it normal, adaptive and natural for older adults and society to withdraw from each other.  It is considered functional for society to transfer power and responsibility to younger persons, and for older persons to remove themselves from the workplace.  This disengagement theory, developed by Elaine Cumming and Warren Earl Henry in their 1961 book Growing Old received a severe backlash from a competing theory  by Robert J. Havighurst and later promoted by Bernice Neugarten.  This activity theory although fills an important role in promoting older adults and reducing ageism, is however idealistic. The truth is different for each individual., but that society does not have a right to prejudge you just on the basis of age.

This was also recognized much earlier by U.S. Congress before the word ageism come to the world in 1969. Although the 1964 Civil Rights Act left out age as one of the protected groups, this was remedied in the 1967 Age Discrimination in Employment Act (ADEA). This act protected anyone over forty from discrimination from work practices. The ADEA is enforced by the Equal Employment Opportunity Commission (EEOC). In addition, in 1975 the Age Discrimination Act was passed which prohibits discrimination on the basis of age in programs and activities receiving federal financial assistance and enforced by the Civil Rights Center Department of Labor. Both acts are well-intentioned, but they have been watered down by the courts so as to make them ambiguous and ineffective.

The EEOC in 2017 had 84,254 new workplace discrimination charges filed. That year they resolved 99,109 charges, handled over 540,000 calls and more than 155,000 inquiries in field offices. Most of these related to retaliation: (48.8 percent) followed by Race: 28,528 (33.9 percent), Disability: 26,838 (31.9 percent), Sex: 25,605 (30.4 percent) and then Age: 18,376 (21.8 percent). National origin, religion, color equal pay and genetic information filling the rest of the complaints. For age discrimination in 2016 only two of the 86 lawsuits the agency filed were based on age discrimination. Two, out of tens of thousands charges.

Age is a difficult category to prosecute. Your employer can fire you based on your seniority, say to save money or other business practices, without being liable. The fact that all senior management are older workers is immaterial to the business decision. At interviews, employers can ask your age, although they are not supposed to use that against you. But the easiest way to implement discrimination without any recourse to litigation is simply not to respond to job applicants who seem “old.” In 2016 the Eleventh Circuit Court of Appeals ruled that job applicants cannot sue for age discrimination because they are not employees. The Acts protect employees only. Anyone who tried to apply for a job in their fifties and sixties has experienced this strategy well. Laws are only effective if they are enforced. A 2017 AARP survey found that nearly two-thirds of workers age 55-64 report their age as a barrier to getting a job.  An earlier comprehensive study in 2015 by Patrick Button, economics professor with Tulane University using resumes for workers at various ages found significant discrimination in hiring for female applicants and the oldest applicants. You just do not receive an interview. The sad part about ageism is that it adds to other existing discriminations. Older minority populations, especially women and those with disabilities, are the most discriminated category. They are pushed to the bottom.  We have known this for more than 45 years. 

As early as 1973 Duke University professor Erdman Palmore and his student Kenneth Manton, demonstrated that it was ageism, rather than racism, that was the primary concern of older people. They argued, that although people routinely confront racism throughout their lifetime and for which they developed coping mechanisms, ageism is something that creeps up on you unexpectedly and without any recourse for defense.

Since stereotypes exist for everyone, some more prevalent and negative than others, because the experience of ageism is experienced fast and compounds other already existing stereotypes (ethnicity, gender, disability, religion and categories that makes you the “other”) it is much more difficult to counteract.

Addressing Ageism
We cannot separate ageism from age. Although theoretically these constructs are different, age is the main cause that triggers ageism (whether you look old or not). And there are two broad solutions, the traditional approach has been to try and reduce stereotypes among the general public. This will eventually seep through, like other kinds of “-isms” the world is becoming more accepting.  The second approach is to build resilience among adults before ageism starts. Both these strategies would be meaningless unless we have a strong policy support to harshly and relentlessly prosecute ageism in society. Removing the ambiguity in the 1967 and 1975 laws would be something that Congress can accomplish without much political fanfare. But as individuals we can focus on resilience.

Resilience is more like judo than boxing. In judo the energy from the other person is used to your benefit. Using their strength and momentum to propel them further along away from you. Unlike boxing, requiring pummeling into an opponent which entails fighting everyone all the time, judo is learning a few techniques that you practice. Building resilience is using stereotypes to your own advantage.

Age is a privilege and an honor. Start early to appreciate this. Nature has selected you above others. However frail and diminished you might feel there is no alternative. Embrace your life as it is now, not as it should be. That is the foundation for adapting to ageism, a good core. The rest is throwing off stereotypes, judo style.

Throwing off Stereotypes
Don’t ascribe everything negative to old age. Sometimes you are not as efficient as you used to be because you do not practice or exercise as often. It might have nothing to do with age. Separate age effects from lack of practice. You can change your behavior and increase practice, but you cannot change your age. Ascribing a deficit to age eliminates the possibility for change.

Don’t accept ageist jokes and don’t make them yourself. Acknowledge them when you hear them, you might react to them or not, but be aware when someone is trying to demean you because of age. They might be funny but they reduce you to one dimension.

Highlight something that you like about yourself and practice that and make full use of it. Music, writing, talking, comedy, whatever it is. Be exuberant and fearless in pursuing this talent to the extreme. This is your time. Dress well and present yourself. Remember that you have many ways to present a better aspect of yourself, without trying to look in your 20s or 30s. Good hygiene and clothes that present you well. Whatever your style, or comfort, be the best within your means. Being careless about yourself invites others to do the same.

You have amassed many experiences, identify the salient ones and use them. Speak up and show compassion. Don’t dwell on failures or your laurels. Stop talking about your health. Although you experience them as unnatural and an aberration, this is your reality. Move on. There is no lesson to learn, for anyone including yourself.

Be open to change. Only dead things don’t change. Celebrate your life by going out of your way to learn new things. When you come across something new, stop and learn. Failure means that you need more practice. Hopefully this strategy will protect you from dementia. Maybe not. Most of us fear this more than anything, and we fear it for our partners. Remember that most people with dementia tend to regain their well-being after a few years. It is the caregivers that suffer increasing decline in wellbeing. After eliminating all possible causes (medications, infections, behavior) there remains nothing that we can do to stop dementia.  Focus on what we still retain, music, emotional connection, a nice meal. Dementia is not a joke or laughing matter. Educate people that memory loss is not dementia. It is a spiritual exit to life Embracing ageism takes these stereotypes and addresses them head on. First our own fears, and then other’s flippant comments by addressing both the fear mongering and the glibness.

Ageism will always be around. Promoting laws to eliminate it is central to progress. We can educate ourselves to be better ambassadors for our age, now or for our future selves. We need to be the examples that break the mold. We are privileged and it is time to express it.

© USA Copyrighted 2018 Mario D. Garrett

References

Butler, R. N. (1975). Why survive? Being old in America.

Gullette, M. M. (2017). Ending Ageism, or How Not to Shoot Old People. Rutgers University Press.

Kastenbaum, R. J. (1973). Reverse ageism: a temptation. International journal of aging & human development, 4(4), 283.

Palmore, E. B., & Manton, K. (1973). Ageism compared to racism and sexism. Journal of Gerontology, 28(3), 363-369.

Saturday, April 7, 2018

Dementia is not a Normal Part of Aging

Dementia is not part of the normal aging process. Except that the main factor and predictor of dementia is age. Seeing my physician when I complain that I cannot walk/run/climb steps (choose your specific complaint here) the physician always says well “…its your age.”
And then with dementia, all of a sudden it becomes a disease. No one told me that my bad knee is due to a disease, they just put it down to age. But dementia, all of a sudden is not part of the normal aging process and yet age is the main contributory factor to dementia and Alzheimer’s disease.
As a scientist, I am perplexed.
How can one of the most prolific and frightening of disease not be due to old age and not part of the“normal aging process," when the main predictor is age?
Source: awareness_for_epilepsy/flickercreativecommons
Mission control: We are shutting down.
Brain: Shit.
Mission Control: We will start slow.
Brain: Do you have to?
Yes.
Why?
Because it is time.
Time for what?
Time for other people to have a chance, it is our strategy to replace old generations with new ones
Perhaps a little bit longer
How long?
….
Ok
Shutting down
First we will close down recent memories
Make it easier to detach
I am worried, will it change me?
Yes. You are dying. You will no longer be.
Did you watch the Monty Python skit with the parrot?
….yes

Ok
Shutting down
Recent memory being erased
Any pain
No…but I am worried
Why? We are shutting down, there is no pain
I miss who I was
Who “were” you?
I don’t remember
You see, trust me, I know what I am doing, I am nature
Erasing further histories
More memories erased
Oh No…please stop
Stop What?
I do not know…but my wife/husband/daughter/son/lover/helper is worried…they keep asking me to return to who I was before
That is not possible
We are shutting down
Are you in Pain?
No
Ok
Shutting down
Please stop it is hurting THEM
Hurting whom?
Those that love me
Well, did you tell them that you are shutting down
No
Why not?
I did not want to hurt them
And they are hurting now because you did not tell them?
…yes
But it is reality, it is the truth and it is ordained by Nature
I know
So you didn’t tell them
No
They want me to be healthy
And alive?
Yes
Is that even possible
No
So why did they expect it with you?
Because…
OK
Shutting down
Removing social constraints
Wait wait
…yes…
How do I deal with my family?
That is your domain…I deal with the timeline
Yes but can you help me?
Sure…ask them....how many people have escaped death? Does everyone expect you to die? How do they want you to die?
Hello?....
OK
Shutting down
___________

Note: A third of people with dementia regain their subjective quality of life, especially after settling into a nursing home. Main predictor of lowered quality of life is depression which is exacerbated by what Tom Kitwood calls  "malignant social psychology” where a caregiver’s relationship negatively affects the care-recipient. It is telling that  caregivers negatively evaluate the person with dementia's quality of life.

Some comparisons:
http://take-your-vitamins.blogspot.com/2012/04/dementia-gender-assocation.html
British Cancer Society Data:





 © USA Copyrighted 2018 Mario D. Garrett
References
Bosboom, P. R., Alfonso, H., & Almeida, O. P. (2013). Determining the predictors of change in quality of life self-ratings and carer-ratings for community-dwelling people with Alzheimer disease. Alzheimer Disease & Associated Disorders, 27(4), 363-371

Aging Is Not a Genetic Dustbin

Nature designed us to age for a reason.

Harmful genes that cause Huntington’s disease — a disease that attacks the neurons in the brain — only show up between ages 30 to 50, in some cases after the birth of offspring. There are many other diseases that accumulate later on in life, dementia being the main one. In 1952, Peter Brian Medawar tried to explain this by suggestion that older adults accumulate mutations and become a "genetic dustbin."

In Medawar's theory, there is no advantage to aging, nor are there any benefits for older people to live. Aging is simply the result of declining functions before death. This biological interpretation proved popular.

To explain aging, biologist George Williams in 1957 came up with the "antagonistic pleiotropy hypothesis" (named by Michael Rose in 1982). Pleiotropy is the phenomenon where one or a few genes control more than one trait. The antagonism part comes from the negative effect that emerges later on in life. As an example, testosterone in men might result in an attractive, muscular body in youth, as well as masculine features, such a deep voice and facial hair, but it also increases the likelihood of prostate cancer in older age, hence the antagonistic part of the pleiotropy. Although it is the positive aspects of the pleiotropic gene that are selected for in natural selection, the antagonistic aspect also sneaks into the gene pool. Aging is seen as an invisible cloak that sneaks bad genes into the gene pool by cloaking them under positive traits when young. Aging, in this view, has subverted the whole process of natural selection by disguising itself as a positive attribute in early life and then transforming — in a Jekyll-and-Hyde metamorphosis — into an aging liability. Somehow nature has been hoodwinked into allowing people to get old. Aging becomes a problem, a genetic dustbin of humanity. From here, it is fairly easy to see the approach: We need to cure aging, because nature made a mistake. The hubris of judging that nature made a mistake ignores that nature might have a different perspective from ours.

As a species, survival is nature's only ambition.

The only way that successive generations prosper is if they are a good fit with their environment. Each generation must survive long enough to create another generation. Nature keeps our genes immortal, and it has two extreme methods to achieve this single aim. One way is to produce an enormous number of offspring and hope that a few survive to then pass on their genes (known as r-selection). Another approach — one followed by humans — involves having few children whom we nurture until adulthood and beyond (known as K-selection). Therefore nurturing — protecting and supporting others — is our survival strategy, not competition.

Nurturing involves having things to teach and living long enough to be able to teach them. Which is why humans live long and have such a big brain; the two go together. Some 1.6 to 1.9 million years ago, our brain grew very fast; some say — not without contention — that brain expansion mirrors the development of cooking. Cooking, making food more easily digestible, resulted in greater availability of nutrients for the hungriest organ in our body — our brain. Nature engineered us to have both a big brain and longevity; they are intricately intertwined. We can see this through mathematical models that show a leap in predictive value when older people are included in the equation. Whether or not older people have a disease, the presence of older people in the family predicts longer-living children and grandchildren.

In the wild, most mammals die once they lose their ability to reproduce. Humans are different. We continue to live well past our capacity to reproduce, especially females. Is nature wrong again, or does nature have a special role for older people?

What the genetic dustbin proponents do not appreciate is that older people, especially grandmothers, have a statistically positive effect on their community. In 2004 while examining the “grandmother effect,” Mirkka Lahdenperä of the University of Turku, Finland, and her colleagues found statistical evidence that a grandmother has a decidedly beneficial effect on the reproductive success of her children and the survival of her grandchildren. Older adult humans promote the survival of the species. Unlike any other animal, we also transfer wealth, capital, and wisdom to our successive generations way past our reproductive period. When gene survival includes the broader community, then older people have a positive effect on their chances of survival.

By 1973, John Maynard Smith and George Price introduced game theory to evolutionary problems. While classic game theory sees players making rational choices on the basis of individual gain, evolutionary game theory posits an awareness of what others might do and the development of strategies to counter that decision. It is a social decision mode, not a purely individualist one. Maynard Smith argued that since everyone dies, evolution does not benefit individuals. Evolution is designed to benefit the community. In this interpretation, it explains that the strategy humans employ is based on benefits to the community, rather than benefits solely to the individual. Such a model fits the outcomes we see in reality. This insight was revolutionary and transformed the argument from one where aging is seen as a genetic dustbin to one where aging becomes part of a package for survival — a package that includes older adults contributing, in as yet unknown ways, to the promotion of our species.

There are instances where antagonistic pleiotropy of dementia has some really beneficial effects. For example, the Apolipoprotein E Variant 4 that is strongly associated with Alzheimer's disease might have beneficial aspects, such as reducing the rate of age-related macular degeneration, lower testosterone, and although there is no evidence of apoE isoform reducing infectious diseases, there is evidence that apoE could play a role in reducing our susceptibility to viruses, bacteria, and protozoan parasites. Such polymorphisms — having multiple expressions — are abundant in nature.

Despite this insight, in 2002, 51 renowned scientists — including such luminaries as Jay Olshansky, Leonard Hayflick, and Bruce  Carnes — published a position statement in Scientific American stating that “aging is a product of evolutionary neglect, not evolutionary intent.” Again, we are telling nature that it made a mistake, or at least was ignorant of the consequences. When Albert Einstein first confronted quantum physics, he said that “God does not play dice with the cosmos.” What is not reported frequently is the response from Danish physicist Niels Bohr: “Einstein, don't tell God what to do.” It seems that we are telling nature what it should do or how neglectful it is, rather than appreciating the biological system we call life as complete and perfect. We might guess at the intent of evolution — survival of our immortal genes — but we might not understand its methods.

Aging and having a big brain go hand-in-hand. It is nature’s plan for our survival. Older adults improve the survival of both their children and grandchildren. Looking at aging in a broader context allows us to view some of the wonders of nature. We have a lot to learn if we listen.

© USA Copyrighted 2018 Mario D. Garrett

References

Browning PJ, Roberts DD, Zabrenetzky V, Bryant J, Kaplan M, et al. (1994). Apolipoprotein E (apoE), a novel heparin-binding protein inhibits the development of Kaposi's sarcoma-like lesions in BALB/c nu/nu mice. J. Exp. Med. 180:1949–54

Bojanowski, C. M., Shen, D., Chew, E. Y., Ning, B., Csaky, K. G., Green, W. R., ... & Tuo, J. (2006). An apolipoprotein E variant may protect against age‐related macular degeneration through cytokine regulation. Environmental and molecular mutagenesis, 47(8), 594-602.

Hogervorst, E., Lehmann, D. J., Warden, D. R., McBroom, J., & Smith, A. D. (2002). Apolipoprotein E ε4 and testosterone interact in the risk of Alzheimer's disease in men. International journal of geriatric psychiatry, 17(10), 938-940.

Lahdenperä, M., Lummaa, V., Helle, S., Tremblay, M., & Russell, A. F. (2004). Fitness benefits of prolonged post-reproductive lifespan in women. Nature, 428(6979), 178.

Mahley, R. W., & Rall Jr, S. C. (2000). Apolipoprotein E: far more than a lipid transport protein. Annual review of genomics and human genetics, 1(1), 507-537.

Olshansky, S. J., Hayflick, L., & Carnes, B. A. (2002). Position statement on human aging. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(8), B292-B297.

Pianka, E. R. (1970). On r-and K-selection. The American Naturalist, 104(940), 592-597.

Roselaar SE, Daugherty A. 1998. Apolipoprotein E-deficient mice have impaired innate immune responses to Listeria monocytogenes in vivo. J. Lipid Res. 39:1740–43

Smith, J. M., & Price, G. R. (1973). The logic of animal conflict. Nature, 246(5427), 15.

Williams, G. C. (1957). Pleiotropy, natural selection, and the evolution of senescence. evolution, 11(4), 398-411.