Frailty and Stereotypes

We are careful about language here at Time Goes By. We don’t allow such words as coot, geezer, biddy, fogey and fossil to be used because they perpetuate negative stereotypes that are all too prevalent anyway. We don’t much like golden-ager, third-ager or even senior either because they are euphemisms invented to hide the actuality of growing old.

We prefer the substance and truth in the word “old” and we have adopted “elder” not in the old definition of wise advisor (although it can be applied in that sense to those who have earned it), but as a general descriptor of people of age.

Governments know how important language is; they use it to obscure. “Collateral damage” doesn’t conjure the mental image of bloody, mangled bodies that “dead civilians” does, thereby making war more acceptable. And a biddy is just a crazy old woman whose needs – even existence - can be ignored.

Until recently, medical studies of elders focused on disease and debility. Now, more researchers are working to determine what keeps many elders healthy into their 80s and 90s. New York Times reporter Gina Kolata has been writing an excellent series on aging and how people grow old. The latest installment concerns frailty and language.

“Frailty, Dr. [Tamara] Harris [chief of the geriatric epidemiology section at the National Institute on aging] explains, involves exhaustion, weakness, weight loss and a loss of muscle mass and strength. It is, she says, a grim prognosis whose causes were little understood…

“Now, though, scientists are surprised to find that, in many cases, a single factor – undetected cardiovascular disease – is often a major reason people become frail…

“Dr. Anne Newman, a professor of epidemiology and medicine at the University of Pittsburgh…thought of undetected cardiovascular disease [as a cause of frailty]. The idea was that blood flow to the heart or muscle or brain could be impeded even if a person had had no overt signs of cardiovascular disease…

“If they are right about frailty, Dr. Newman and others say, then the condition may be prevented or delayed by not smoking and keepiing cholesterol and blood pressure levels low and by staying active.”

- The New York Times, 5 October 2006

Another finding, writes Ms. Kolata, is surprising to scientists (although I can’t imagine why):

“…Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effect. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path…

“’I am changing my initially skeptical view,’ says Richard Suzman, who is director of the office of behavioral and social research programs at the National Institute on Aging. ‘There is growing evidence that these subjective experiences might be more important than we thought.’”

Dr. Robert Butler who, at age 79, is president and chief executive of the International Longevity Center in New York and a professor of geriatrics at the Mount Sinai School of Medicine, coined the term “ageism” decades ago. Ms. Kolata spoke with him for her story:

“Dr. Butler noticed the [pervasive stereotypes of old age] when he was a medical student. He recalls the private names doctors had for the elderly like crock and old biddy. In the decades since, he says, attitudes among doctors and the general public have not really changed. And, he adds, the stereotypes have an effect. ‘My experience with older people is that they certainly do get cowed by this,’ he said.

“But how much, and to what extent people get cowed surprised even researchers. It is hard to avoid seeing or hearing demeaning depictions of the elderly. There are greeting cards that make old people the butt of jokes. There are phrases like ‘senior moment’ to describe memory lapse. There are the ways older people are treated. For example, researchers find that people use ‘elderspeak,’ speaking louder and using simpler words and sentences when talking to old people.”

Dr. Becca Levy of Yale University has been studying the effects of stereotypes on elders for years.

“It turned out that people who had more positive views about aging were healthier over time. They lived an average of 7.6 years longer than those of a similar age who did not hold such views, and even had less hearing loss when their hearing was tested three years after the study began…

“Still, Dr. Levy and others say it can be difficult to resist the pervasive stereotypes of aging. Many people may accept them without realizing it.

“’Then they become a self-fulfilling prophecy,’ Dr. Levy said."

In other words, prejudice against elders and negative stereotypes can making people sick and even kill them before their time. And that is why, at Time Goes By, we speak up about prejudicial language whenever it turns up no matter how small the transgression seems.

I’ve been reading about Dr. Levy’s and others’ studies for ten years and writing about them here for nearly three, but only recently are they being disseminated in the mainstream media which reaches a far larger audience than this little blog. The New York Times and reporter Gina Kolata are to be commended for this ongoing series about aging and for making it permanently available online without a subscription.

Comments

[ml]

Thank you for this post, Ronni. This research confirms the importance of the story we tell ourselves about aging. I find my very balance as I walk is affected by moments when stereotypes of frailty creep into my thoughts. Our suggestibility as a species affects our health and longevity.

[Rain]

Good post and I read that article in NYT too and thought it was a good reminder. One point that I particularly liked is one I have always believed but was nice to see it confirmed-- move as quickly as you can when doing things. They found that the elders (70s somewhere) they tested felt they could walk 1/4 mile but what they could do was amble it. Walking faster was a challenge that many couldn't do.

What I am observing personally is that when I let my abilities slack off, take it easier, walk slower, exercise less, it's getting harder to get it back to where I was (even at 63. I can imagine 73 that will be more so). It's so easy to put off going for a brisk walk but after a week of that, when I do it again, it's more of an effort. I have to make myself do it regularly to keep everything working, and should add working with weights to the menu as I know I don't get enough upper body with the walk alone. Should was the key there as I have never enjoyed exercising but it's not about enjoying it, is it.

[Dee]

My 91 year old mother is a striking example of Dr. Levy's findings. She is totally independent, walks into town to the bank & deli, reads, etc. & does it all with a wonderful positive attitude. She long ago threw out the sterotype of an aging person & did as she pleased. BTW, I still seek her advice & she invariably is correct so I do as she says. I guess no one told her that 91 is old! Dee

[joared]

This is an excellent piece, Ronni, which reflects everything I have believed and researchers are finding more and more to be true. As I was told many years ago, "We live what we believe." Those negatives messages can become reality.

Thanks, too, for the link to the New York Times series, reporter Gina Kolata. Just as I sometimes write those who have portrayed elders poorly to make them aware of the problem, this is an instance where I think I should let Ms. Kolata and the NYT know how much I appreciate this series of articles.

[Sheryle]

I wrote about this research, too (www.brainreserves.blogspot.com) because it is just so true: we are only as old as we think we are! Boomers will, I believe, rebel as a group against these cultural stereotypes and our sheer numbers will pave the way for many more people to continue living life to its fullest--in every way. And so often in research about aging, we are finding--heart and mind go together.

Thanks for your insights and choices.

I also appreciate Ms. Kolata's writing. She has a long string of excellent articles on related topics.

[Cowtown Pattie]

The brain is an undeniably powerful organ.

I have a friend who is not quite 4 years older than I, and whose recently deceased husband was older by 13 years.

Odd, but the age difference between us is much wider than the physical 4 years; she has the same mindset of someone her husband's age - 69. They were married for 32 years, and so I suppose she easily fell into a pattern of "older" thinking. He was in ill health for many of his last years, and as a couple, their whole existence was overpowered by his medical needs.

My daughter commented the other day about how strikingly different my attitude and general health is from this friend who has decided she is too old and too sick to do most things (to be fair, she does have a fairly significant onset of arthritis).

Understandably, she is depressed about the loss of her husband, but more puzzling is her self-imposed aging and refusal to attempt anything remotely different from her daily routine.

We have tried to coax her to participate more in life, but so far, that has not been successful (more than a year). Depression is a big factor, but so is her resignation and attachment to being "old".

[Chancy]

Thanks for posting this article Ronni. I found it to be informative and pertinent.

[Maya's Granny]

I have found the best response to elderspeak is to pull out my most erudite vocabulary in response. If that doesn't work, I switch the subject to something I understand and they don't.

I know, I'm an evil woman. But it is a lot of fun.

[Verna Fisher]

By the way, this is my first time here and I'm delighted to see all the great interest and passion for aging well.

I remember one of the most important pieces of wisdom I have received on the whole idea of aging: Old Age is 10 years past where ever you currently are in age. In other words, most of us will not ever really think of ourselves as old...no matter what name we apply to ourselves...senior, elder, old coot, etc.

In her book, The Denial of Aging, author Muriel Gillick, MD tackles the problem of our “collective denial of aging” and encourages us to begin to ask the difficult questions around getting old. She tells us that it is in all our best interests to begin to recognize that as a society we have limited resources and that we must determine where those resources will be allocated. She encourages us to look beyond just the physical effects of aging, but the emotional, spiritual, and social dimensions as well.

As an elder coach, and as a social worker who has worked with hospice, I am aware of the lack of conversation around what happens when one really is beginning to "die". Dying doesn't usually happen suddenly and yet we have no language for or inclination to initiate conversation about what's important to the dying person.

I'm not talking about dying young, but rather the conversations that would be so helpful when independence begins to wane, when importance turns inward, and when the focus narrows to that which lies beyond the physical plane.

I do find myself disagreeing with the idea that we are only "as old as we thing we are." While I understand the importance of having a positive image of aging I also am aware of the big move towards "positive thinking" in our culture, which tends to blame being ill, unhappy, etc. on a negative outlook on life. The movement didn't necessarily intend for that to happen, but it has been a by-product.

While it is true that some individuals are more pessimistic by nature, it is also true that there comes a time when life brings pain, suffering, and sorrow. Our culture has a tendency to push these emotions away, deny them, or label them as diagnoses for sickness. Instead of seeing the wide array of human emotions we are capable of, we decide to choose the "good" ones as the only viable ones.

What happens is that if we do experience loss, pain, sorrow or sadness, others don't want to see that. They sure don't want to focus on it. Elders who are moved into assisted living find very few places to talk about the changes, the loss, the struggle. It is only if they can move past it, get on with life, etc. that others feel comfortable.

It is my belief that if elders had their own coach, someone to run ideas past, someone to listen to them for the umpteenth time, someone who was not afraid to have the difficult conversations, they would find a much smoother transition into dying...when it was time.

And, contrary to popular belief, this is not something that belongs to hospice. Hospice usually arrives much too late to offer any real use to the dying person, other than to alliviate physical pain.

Let's begin to imagine a conversation around aging that includes a "good death". Eventually we will all be there.

I'd love for you to come visit my blog at www.beforehospice.blogspot.com

[Darlene]

Verna Fisher makes valid points and I agree with much that she said. However, attitude is extremely important; especially as our pysical body wears out. My brother, who is 13 years younger than I am, has been fighting cancer for many years. He was labeled terminal nearly a year ago but he still maintains he "will lick this thing" and he refused to give in to the diagnosis. He just made a long road trip and did most of the driving. His attitude has undoubtely been the source of his ability to surmount the obstacles of pain, weakness and his death sentence.

[Gerrie]

Excellent post - thank you!

[Sereneambition]

Great post... I work with how language shapes our worldview and becomes part of how our culture perpetuates the past. In my blog today

(www.sereneambition.wordpress.com)

I point to the AARP issue with Sally Fields on cover and how I believe that promoting 'young stereotypes' of aging indivuals who happen to be celebs can also be part of what perpetuates our negative stereotypes.

Welcome your thoughts.

[Brian]

Being called fossil, fogey by the younger generation which does happen,(doesn't bother me because I know I have reached the 'young' age of 54 and 'they' haven't). As for 'senior' or 'senior citizen' doesn't worry me either. When I get to that 'ripe age' as long as I still have my health and my 'much older' friends are still around for me to enjoy their company I know I will STILL BE ALIVE!

[Elena]

I always knew you wer a genious, Jim Selman. Here again you created a space for sharing, contibution, and dignity.......