Aging-related research, news and information from the University of Pennsylvania’s Institute on Aging (IOA). IOA was established in early 1979 to improve the health of older adults through clinical and basic science research in aging as well as educational programs that focus on normal aging and age related disease at the Perelman School of Medicine and across the entire Penn campus.
The Institute on Aging (IOA) would like to extend its congratulations to IOA Fellow, Sharon Xie, PhD, Professor of Biostatistics in Biostatistics and Epidemiology at the Hospital of the University of Pennsylvania, on being recently elected as a fellow of the American Statistical Association (ASA), the largest professional organization for statisticians in the United States.
Dr. Xie was nominated for “excellent and sustained statistical collaborative and methodological research in the area of neurodegenerative diseases, exemplary mentoring of biostatistics graduate students and medical researchers, leadership and development of outstanding biostatistics core facilities with national impact in neurodegenerative disease research, and for service to the profession,” according to the official Penn Medicine News Release announcing the news.
“I feel extremely honored to receive this designation. This designation is not only a recognition of my achievements but also a recognition of the neurodegenerative disease research community at Penn,” said Dr. Xie. “I hope to continue to promote statistical rigor in conducting neurodegenerative disease research within and outside Penn as a statistician and data scientist.”
The designation of ASA fellow is highly selective and has been a significant honor for nearly 100 years. No more than one-third of one percent of the total association membership can be elected as fellows each year. ASA Fellow must have an established reputation and have made outstanding contributions to statistical science.
Dr. Xie is one of two Penn Medicine biostatisticians to be elected this year. Dr. Xie’s colleague and fellow Professor of Biostatistics in Biostatistics and Epidemiology, Mingyao Li, PhD, has also been selected.
For the full Penn Medicine News Release, click here.
Last week, the Institute on Aging (IOA) at the University of Pennsylvania hosted its 2018 Sylvan M. Cohen Annual Retreat and Poster Session in partnership with Penn’s Population Aging Research Center (PARC). This year’s theme was “Impact of Life Course Exposures on Aging: Longevity reflects our experiences from day to day,” and featured a keynote presentation by Kenneth Langa, MD, PhD, Professor, Department of Internal Medicine and Health Management and Policy in the School of Public Health at University of Michigan.
Dr. Langa’s lecture discussed trends in brain health and dementia prevalence in the United States and around the world and whether or not the risk for Alzheimer’s and dementia is declining. Looking at Dr. Langa’s data from the Health and Retirement Study (HRS), between the years 2000 and 2012, while the prevalence of diabetes, heart disease, hypertension and obesity increased, findings showed a significant decrease in dementia in ages 65+ with the biggest drop in ages 85 and older. Dr. Langa believes one of the most important contributing factors is the rapid increase in levels of education. In 1990, 53% of people ages 65+ finished high school. In 2010, that number increased to 80%. Similarly, in 1990 only 11% of people age 65+ finished college, with that growing to 23% by 2010.
In addition to Dr. Langa’s lecture, the event also featured three Penn Presenters, Hans-Peter Kohler, PhD, Professor of Demography, Courtney Boen, PhD, Assistant Professor of Sociology, and Irma T. Elo, Director of PARC and Associate Chair and Professor of Sociology. The presentations covered various topics on aging trends and how experiences in our daily lives affect the ways in which we age. A link to the full lecture series is below.
Following the talks, the annual poster session and reception took place in the Smilow Center Lobby offering small bites and refreshments to guests as they browsed the 40+ research posters on display. Posters ranged in category from Basic Science to Clinical Research to Education, Community, & Other Research with a wide variety of aging-related topics and prizes were awarded to the best posters in each category. See the link below for a few brief video interviews with some of our presenters.
The Ralston Center recently welcomed Lynette M. Killen as their new Executive Director. Killed previously served as CEO of Chandler Hall, a Quaker-based, long-term-care residential community and hospice in Bucks County, PA, as well as administrator for geriatric services at Albert Einstein Medical Center and director positions in social work for Philadelphia College of Osteopathic Medicine and Methodist Hospital.
Learn more about Lynette M. Killen in our Q&A below:
Q: Why did you decide to work in the field of geriatric services?
A: I decided at a very young age to work in geriatric services. My first job, when a high school student, was a nurse’s aide in a local nursing home. I kept that job for two summers while in college. I also worked a summer job at an Area Aging on Aging during college.
I was fortunate to spend my formative years around a grandmother and older aunts and uncles that I adored and learned from on a regular basis. As an only child, I was very comfortable with individuals older than me. I pursued a bachelors and graduate degree in social work. My internship experiences were in aging organizations, mostly community based. I enjoyed all my work and internship experience and knew that my early decision was the right one.
Working in geriatric services gives me an opportunity to both give and take in a society that does not always respect and offer dignity to elders. If I can make a bit of a difference in the lives of elders and the value of cross-generational engagement, I am happy.
Q: How has your thinking about aging changed over the years?
A: There is my personal aging, which I think has changed and continues to change my lens over the years. Specifically, I more fully understand that aging is a unique, individual journey. I believe that society does aging a disservice by making blanket statements about elderly; they are not a homogeneous group. They do not vote the same, live the same, or need the same from their medical and “home” communities. Also, what one cohort wanted and needed is not what the next cohort wants and needs (realizing that referring to a cohort does intimate that all are in the same basket).
I am particularly concerned about baby boomers, of which I am one, and the financial fragility of many of its members. False belief about the benefits of Medicare, Social Security, and Retirement Funds has led to being ill-prepared for longer life spans.
Another concern is the prevalence of Alzheimer’s/dementia –related diagnosis. My earlier years in the field supported the idea that all elders became confused and forgetful; in other words, these “conditions” were just to be expected. There was little research or education about what caused memory impairment, the financial and caregiver costs….. I am bolstered by the research, education, and focus on Alzheimer’s and dementia-related conditions, but know that our social policies, private and public dollars are not yet aligned with needs.
Q: In general, what areas of senior care do you think need the most improvement or should be more of a priority? (I.e. educating seniors on the importance of healthy diets and exercise, affordable home care and/or assisted living, etc.)
A: I believe that clinical providers that partner with elders for their care need more education so that they can care with a sensibility to aging issues. There are not enough geriatricians, geriatric nurse practitioners, geriatric psychiatrists etc. Therefore, other clinicians need to be up to the work of providing well informed care. They need to listen intently to their patients and their families and caregivers.
Affordable housing for elders is a huge issue and gets moderate attention from private developers as well as the federal government. Builders and property developers of single and community housing need to be aware of the environmental impact of “poor design” too. Bathrooms that only have bathtubs are one example of poor design.
I would like to see regulators reward providers of services and housing for doing the “right thing” – such as partnering with elders for person-directed care and amenities. Often regulations prevent creative work because of the many “DO NOTs” that leads their work. Instead, partnership with regulators that benefits providers and elders would be a win-win in a world that has very limited funding or no funding other than private pay from consumers.
Educated consumers of medical, lifestyle, and service information would be beneficial to quality of life. Therefore, I strongly believe that much of this education needs to begin during one’s adult years, not at the point of a crisis or a new diagnosis.
Q: What are your plans or goals as the new Executive Director of the Ralston Center?
A: As the new Executive Director, I want to leverage the place the organization is in its history. Looking back at its 200 years is helpful and provides some comfort to Ralston’s ability to continue to service elders, but I am excited about harnessing the opportunity to embark on new planning for its future. The transition made several decades ago from residential services to community services was wise, but with increasing demands of the “aging tsunami” – the baby boomers – a different lens is needed to look at communities that are age-friendly and to look at services that assist elders remain in their home, if that is their desire. I don’t believe that Ralston can be all things to all Philadelphia elders, but it can seek new ways of spreading its reach through collaborations (formal and informal) and partnerships.
On Tuesday, April 3, 2018, the Institute on Aging (IOA) at the University of Pennsylvania welcomed Dr. Edward Huey, Assistant Professor of Psychiatry and Neurology at the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, for their last scheduled Visiting Scholars Series lecture of the season.
Prior to his presentation on “Neuropsychiatric Symptoms of Frontotemporal Dementia and Related Disorders,” Dr. Huey sat down with IOA Digital Media Specialist, Nicolette Patete Calcavecchia, for a brief Q&A interview to discuss his work and research focus.
Q1:What is your general research focus as it relates to your talk today?
A1: My background is that I am an adult psychiatrist with training in neuropsychiatry and behavioral neurology and the reason that I have a job is because of the growing awareness that neurodegenerative disorders often have neuropsychiatric behavioral symptoms.
Back when I was in medical school, those conditions were considered rare. You had your motor illness like Parkinson’s disease (PD) and ALS (Amyotrophic lateral sclerosis) and your cognitive disorders like Alzheimer’s diseases – and sometimesthey’d have a little bit of behavioral changes. Now, I think most in the field can agree that we have rethought that.
Q2:How has this new idea shaped your specific area of research?
A2: Most neurodegenerative disorders really affect cognition, motor, and behavioral and psychiatric symptoms so my focus is really on that last category there; characterizing behavioral psychiatric changes that may occur in neurodegenerative diseases and then also how we can treat them.
More specifically, I’d say I have three areas of research interest:
Looking at the phenotypes and genetic forms of neurodegenerative disease specializing especially in Frontotemporal dementia and Huntington’s disease.
Trying to understand the neuroanatomical, genetic and structural basis of neuropsychiatric behavioral symptoms of neurodegenerative disease and
Treatments; how can we make these patients better with both pharmacological treatments and non-pharmacological treatments to treat the symptoms which, if you talk to the families, are really causing the main problems.
Q3:How do you define and classify these neuropsychiatric and behavioral symptoms?
A3: So, the argument that I am making is that we have a little bit of a problem. We inherit a lot of the terms that we use for these symptoms from psychiatry – and it has often been defined based on what is important to us as clinicians, but that may not actually associate very much with the biology of what is going on.
So, what I am trying to do is to think through models on how we might start to redefine how we measure and define these various psychiatric symptoms with the goal that by doing so, they might align more closely with the biology of the disease.
For example, I think those working in motor and cognition are way ahead of us with this concept. If someone said “this person has parkinsonism” in the description of a syndrome, there is really a lot of information in that. I could tell you where the damage in the brain is, what the associated symptoms are, the groupings of symptoms – but we don’t really have an equivalent to that in neuropsychiatric behavioral symptom knowledge and I’d really like us to move in that direction.
Q4: Why do you think this goal is so important?
A4: To re-emphasize a point I made earlier, these neuropsychiatric and behavioral symptoms are often very problematic for patients and their families. They can greatly increase the cost and increase mortality. And we do have some treatments, but not really great treatments.
So, the ultimate goal in all of this is to move towards better treatments and the one area I am particularly interested in is learning more about the neuro-anatomical basis of these symptoms to try to develop neuro-anatomically based treatments – so things like temporarily deactivating certain parts of the brain to try to alleviate specific symptoms, because I think we have hit a bit of a wall with pharmacological treatments. Most were developed 50 years ago and I think we just need to think more broadly about how we are treating these diseases.
Q5: What are some of the most common neuropsychiatric and behavioral symptoms that you see?
A5: What I think is probably the most common neuropsychiatric symptom in all neurodegenerative diseases is apathy. Apathy is where the patients just don’t feel motivated – they don’t want to do things as much, they don’t participate in activities as much – but it is notdepression and I think that is a very important distinction for families and caregiver andclinicians to understand.
They aren’t sad – you can ask the patient “are you feeling sad?” and no, they’re not – they are just not feeling very motivated to do things, but when they go out and actually do things they do enjoy themselves. The parts of their brain that are controlling motivation and initiative is the part that they are having trouble with.
This is an incredibly common symptom and we really don’t have good pharmacological treatments for it, so I think it is really important to recognize this symptom so we can educate families and caregivers about non-pharmacological strategies we can use to help the patients.
Another symptom would be agitation or aggression and this can come from many different pathways. It’s a very problematic symptom when people are becoming agitated or aggressive – lashing out, throwing things, etc. It can lead to issues in the home and increase the expense because you often have to use medications, which can then lead to undesirable side effects. The #1 cause of assaults in hospitals is actually dementia patients who have become agitated and aggressive, so this symptom is very important to recognize and very important to treat.
The third symptom would be psychosis which is having false beliefs or having fake perceptual experiences – things like seeing things that aren’t there, falsely believing people are breaking into your apartment or moving things around or stealing things because the patient doesn’t remember moving them. And as you can imagine, this often leads to the previous symptom of agitation and aggression.
According to Dr. Huey’s presentation, accurate assessment of neuropsychiatric symptoms such as these in dementia is important not only because of their prevalence — for example, they affect 85% of Alzheimer’s patients and 100% of behavioral variant Frontotemporal dementia (bvFTD) patients – but also because of their association with decreased quality of life for both the patient and the caregivers, accelerated disease progression and, as previously discussed, increased mortality, placement out of the home, and cost of care. He also shared that neuropsychiatric symptoms may be a prodrome, an early sign of disease onset or illness, and could be used to detect early cases of these neurodegenerative disorders to target for treatments.
On Tuesday, March 27, 2018, the University of Pennsylvania’s Perelman School of Medicine hosted its first Dean’s Distinguished Visiting Professorship lecture, co-sponsored by the Institute on Aging.
The lecture “Enhancing Quality of Life for Individuals Living with Dementia and Their Family Caregivers: The Role of Biobehavioral Interventions,” was presented by Penn Nursing’s Nancy Hodgson, PhD, RN, FAAN, Anthony Buividas Endowed Term Chair in Gerontology, Associate Professor of Biobehavioral Health Sciences, and Program Director of the Hillman Scholars Program in Nursing Innovation. Dr. Hodgson focused her talk around two main topics: 1) The considerations and challenges of caring for persons with dementia and 2) Her research and work aimed at addressing these considerations and challenges.
Some of the major factors to consider when caring for a person with dementia, as highlighted by Dr. Hodgson, are:
Lack of proper diagnosis
An unprepared workforce and lack of specialists in this area
Cultural beliefs and stigmas
And general lack of knowledge and/or access to care, services, and support
With this in mind, Dr. Hodgson and her team base their work heavily on evidence-based practices with the concept of personhood — essentially, person-centered care. This concept respects the essence of a person’s humanity and honors an individual’s and their family’s values and dignity.
The goals of their work through biobehavioral interventions is to improve caregiver support and skill building, to create tailored, individualized activities and structured routines, environmental modifications, exercise, and sensory based interventions.
For example, according to Dr. Hodgson, “circadian rhythm disorders occur in over 70% of community residing persons with dementia.” This can include late-afternoon/evening agitation, irregular sleep-wake patterns, daytime hypersomnia, or extreme sleepiness, and frequent night awakenings. However, research has shown that interventions delivered at strategic times may be an effective tactic for resetting disrupted circadian rhythms. Dr. Hodgson and her team implemented this strategy by using late morning cognitive activity, late afternoon physical activity, and an evening sensory-based, relaxing activity and found the following results:
Wake After Sleep Onset decreased 59 minutes in the intervention group and increased 32.8 minutes in the control group
An increase in total sleep time during the night for the intervention group
Fewer night awakenings in the intervention group
Aside from correctly timing activities, another important consideration for effective interventions is choosing the correct activity for each individual. The concept is very simple if you think about it — naturally, you will see better results if an individual enjoys the activity in which they are participating. For instance, if an individual was very athletic and enjoyed sports throughout their life but you initiate a card or board game, it is very likely that they will be much less engaged and you will not produce as significant results as you would if the activity was more relevant to their interests, such as ping pong or table hockey for example.
To learn more about Dr. Hodgson and her work to mend the widespread knowledge-practice gap for more effective programs, strategies and real world clinical and service practices, click here.
The “Dean’s Distinguished Visiting Professorship” is a program designed to recognize and engage rising members of the Penn faculty and to initiate collaborations and interactive opportunities amongst other faculty and trainees right here at Penn. “It is our hope that these seminars will provide fresh perspectives to all, will engage our community in excellent science done locally, and will begin to nucleate new ideas for cross-disciplinary activities,” said Lou Soslowsky, PhD, Associate Dean for Research Integration, Perelman School of Medicine, University of Pennsylvania.
As we get older, our heart and some of its basic characteristics naturally start to change. Most subtle changes are considered “normal,” while others may be a cause for concern. With this in mind, it is very important to know how you can maintain or improve your heart health as you age. On Tuesday, February 27, 2018, the Ralston Center and the University of Pennsylvania ‘s Keystone Center for Geriatric Care and Education hosted an educational program on this topic to help inform older adults in the Philadelphia area on the steps that they can take to better their cardiovascular health and overall well-being.
Keynote speaker, Elisabeth Collins, MD, a Geriatric Fellow in the University of Pennsylvania’s Department of Geriatrics kicked off her lecture by addressing some of the “normal” and not-so-normal heart changes that individuals experience as they get older. Dr. Collins explained that each of us has a “natural pacemaker” in our hearts that controls how fast or slow our heart can beat. As we age, that “natural pacemaker” becomes slower resulting in an overall lower heart rate, even when stimulated through vigorous activity such as exercise. She also said that our blood vessels and heart valves naturally become a bit stiffer over time, which could cause a slight increase in blood pressure or a slight heart murmur. While these are considered “normal” changes, they keyword is “slight.” If the spike in blood pressure or a new heart murmur is more significant, that may be a sign of a more serious issue.
Another change that is “normal” but could also raise concern is the enlargement of the heart. The heart tends to get a bit bigger the longer it is in use – or the older we age – however, too much enlargement can lead to some dangerous situations including heart failure. All of these changes are things that your doctor can easily detect and monitor through proper routine care and check ups, so it is very important to see your doctor regularly.
Some of the “not-so-normal” changes include conditions such as coronary heart disease, heart failure, and heart attacks. Coronary heart disease is caused by an increase of cholesterol and buildup in the heart. It becomes a concern when it builds up too much, ultimately depriving your heart of the oxygen that you need to keep it functioning properly. If your heart is not getting enough oxygen, it can result in a heart attack – which can range from mild to fatal. Heart failure – as you can probably guess – is a huge cause for concern. Some of the major warning signs to look out for are chest pain as you walk, exercise or move around, swollen feet, and shortness of breath, especially when laying down.
As important as it is to understand these changes and how to recognize whether or not something you are experiencing is normal, it is equally as important to know how to modify your risk factors for these diseases. Dr. Collins recommends you try to get at least 30 minutes of exercise a day, at least 4 days a week. It does not have to be in a gym. She suggests walking around a track or park with some friends, joining an exercise group class, or trying at-home instructional videos online or on your TV. She also suggests modifying your diet to include low-calorie, nutrient rich foods that are low in bad fats and sugars.
Many studies suggest that following a Mediterranean diet can be very beneficial for heart health. A Mediterranean diet is one that consists of healthy fats like olive oil instead of butter, and lean meats and poultry such as chicken, turkey, or fish instead of red meats. Such diets can help you reach or maintain a healthy weight and ultimately better heart health. Another big factor is smoking. Studies show that once you quit smoking, you will reap the benefits almost immediately. Within a couple of months — sometimes only weeks — your risk of heart disease drastically drops once you quit.
Dr. Collins concluded her talk with some updates on the new “blood pressure goal” that has been a topic of recent aging and heart health research. Studies show that in general, people live longer with lower blood pressure. With that in mind, Dr. Collins believes that many older individuals will soon be hearing suggestions from their primary care physicians to try to slightly lower their blood pressure, within reason; there is a caveat. Doctors want to lower their patients’ blood pressure if it will benefit them, but they don’t want to cause any potential harm. For example, when we stand up, our blood pressure naturally lowers. If it gets too low, you are at risk of booming light-headed and dizzy and potentially falling and getting injured. Also, there are certain medications that some individuals may be on that could have adverse reactions to trying to lower their blood pressure. In such cases, your doctor would likely advise against it.
You can learn more healthy aging tips at the Ralston Center’s next educational program, “Aging Well Through Good Nutrition and Movement,” on Tuesday, April 17, 2018. For more information and to register for the event, call 215-386-2984 or email email@example.com
There are often many misconceptions and myths around the idea of aging. As a result, it is sometimes easy to misconstrue whether certain physical, mental, and/or behavioral changes are “normal” or a cause for concern.
University of Pennsylvania’s Division of Human Resources, along with Penn Behavioral Health Corporate Services, recently hosted a webinar on “What to Look Out for as Loved Ones Age,” presented by Mary Ellen Rogers, a social worker and representative of E4 Health. The objective was to help individuals evaluate the capabilities of their aging loved ones and to recognize early warning signs that may point to cognitive and/or physical decline or limitations as well as potential environmental hazards.
Caregiving for elders is unique in that, unlike raising a child who is gradually moving more and more toward independence as they age, seniors often move in the opposite direction toward less independence. This is often very difficult for older adults to accept, especially if the caregiver is their child. The relationship and family paradigm shift as they are no longer caring for their child – their child is caring for them. In taking on that role as your parent or other loved one’s caregiver you become the decision maker and often a source of financial support.
It is important to remember that while taking on this new role as a caregiver is certainly a challenge, it can also take a very hard, emotional toll on the care recipient, so you must be very gentle and kind as you take on your new responsibilities, and ultimately, control. Many times older adults try to ignore these changes in their physical, mental, or emotional well being and try to hide it because of their fear of losing their independence and sense of self, which requires you to be very observant in your evaluations of your loved ones.
Mary Ellen Rogers suggests making “surprise” visits to your loved ones. In doing so, you are more likely to get a true sense of their current physical, mental, and/or emotional state and living conditions because they are unable to “prepare” and try to hide any indication that something may be off. Some of the main “categories of risk” as we age are 1.) memory loss and cognitive impairment, 2.) physical and environmental risks, and 3.) emotional health, said Rogers.
Below are some of the early warning signs that you should look out for when evaluating your loved ones for any of the aforementioned risks:
Memory and Cognitive Impairment
Physical Impairment and Environmental Risks
Recent accidents or new injuries
Slower recovery time from illnesses and/or procedures
Chronic health conditions deteriorating
Evidence that activities of daily living are difficult (personal hygiene, eating/drinking, getting around the house, etc.)
Red flags in the home:
A lot of clutter or hoarding
Piles of unwashed dishes or laundry
Bagged/Hidden valuables (paranoia and fear of theft)
Piled up unpaid bills
Signs of recent fires in the kitchen (check pot holders as they are usually a good clue!)
Full prescription bottles hinting that medications haven’t been taken
TIP: Get up close and give a hug! This can help detect:
Weight loss or weight gain
Body odor (indicating poor hygiene or other medical condition)
Stains in clothing
Changes in appearance (unkempt hair, etc.)
Notice nicks or dents in the car
Notice any tailgating, drifting, and driving below speed limit
Signs indicating whether or not the car is being maintained
Gas tank, oil changes, etc.
Adjusting the Environment:
Evaluate potential need for safety rails and grab bars in the bathroom and other frequented areas
Make sure all smoke detectors, CO2 monitors, etc. are in working order
Consider a “life call” or “life alert” button for automatic emergency services
“Safety check” rugs and pathways for potential fall risks
Hopelessness or helplessness
Lack of Motivation and energy
Signs of Insomnia (Ask: “How did you sleep?”)
Loss of interest in socializing or hobbies
Neglect of personal care
Grief: loss of loved ones and friends, as well as their own capabilities
Isolation and loneliness
Medications (blood pressure medications, sleeping pills, many Parkinson’s disease treatments, etc. can have the side effect of depression)
Some of these changes may be very gradual while others can come on very quickly so it is best to try to check in and evaluate your loved ones on a regular basis. Understandably, you will need to carry on with your own life and responsibilities too, and maybe you don’t live within a close proximity of your loved ones, so frequent check-ins are not always possible.
With this in mind, Mary Ellen Rogers shared some strategies for long distance caregiving:
Visit as often as you can, including “surprise” visits
Try out Skype or FaceTime visits
Find a friend or neighbor to keep you appraised on a regular basis
Consider hiring a geriatric care manager
Encourage your elder to consider adult day care or a senior center
However, one of the most important tips for caregivers is to always remember to take care of you. Maintaining your own social life and hobbies and taking respite is vital for successful and effective caregiving. After all, you cannot take care of a loved one if you neglect to take care of yourself.
If you had to decide the “right” time to die, which age would you choose? For Ezekiel J. Emanuel, MD, PhD, Chair of the Department of Medical Ethics and Healthy Policy at the University of Pennsylvania, that age is 75.
Dr. Emanuel brought this question to light in 2014 after publishing an article in The Atlantic titled ‘Why I Hope to Die at 75′; “an argument that society and families — and you — will be better off if nature takes it course swiftly and promptly.” As you might expect from such a provocative title, it received quite a bit of attention — and quite a few rebuttals from outlets such as The Guardian, Huffington Post, and the LA Times. Many people thought that as Dr. Emanuel got older, he would surely change his mind and maybe push this ideal age back some. However, almost four years later, he still feels just the same.
Dr. Emanuel recently visited Penn’s Center for Neurodegenerative Disease Research (CNDR) to give a lecture on this topic and to explain why he feels that 75 is “a pretty good age to aim to stop.” With an audience full of researchers whose work focuses heavily, if not entirely, on finding preventions, cures, and treatments for a variety of aging-related diseases with the goal of helping adults live healthier, and ultimately longer, lives, Dr. Emanuel certainly had a tough crowd to convince. However, he confidently defended his position, clarifying that he does not intent to intentionally end his own life at 75, but rather stop any and all medical screenings, treatments, or interventions that could prolong it.
So, why 75?
“By the time I reach 75, I will have lived a complete life,” explained Dr. Emanuel in his 2014 publication. “I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations.”
While research shows that Americans are now living longer than ever, with an average life expectancy around 79 years, Dr. Emanuel argues that after 75, the quality of life drastically begins to decline. “Over recent decades, increases in longevity seem to have been accompanied by increases in disability — not decreases,” said Dr. Emanuel. And while his article received backlash and rebuttals, he is not alone in questioning the recent spike in interest, if not obsession, with longevity. Penn Medicine News also covered this topic in a blog early last year; “Is Living Longer, Living Better?”
For the sake of argument, let’s just say he would be able to avoid all aging-related diseases that would drastically affect his physical and/or mental health — would Dr. Emanuel then change his mind and want to live past 75? The answer is likely no. His reasoning is about more than just his health. He also factors in “the loss of creativity” and ability to live a “meaningful” life as you get older, regardless of how happy you may be.
Studies show that happiness follows a u-shaped curve. Americans tend to be happiest in the early years of their adult lives, around ages 18-21, followed by a fairly consistent period of lesser happiness in the middle ages, before rising again to higher levels of happiness in the late 70’s – early 80’s. But Dr. Emanuel believes that “we should not care about happiness,” stating that “what counts is meaningfulness.” He claims “a life dominated by play, even if happy, is not meaningful.”
So, what makes life meaningful? According to Dr. Emanuel, it is the three-pronged ability to maintain relationships, play, and work – being able to make contributions to life rather than simply being a consumer in it.
“It is hard to name anyone in history who has made a great contribution after the age 75,” said Dr. Emanuel during his lecture, acknowledging that there are a few exceptions.
It is also important to note that Dr. Emanuel disregards this “happiness curve” for another reason. He explains that the older adults who are being accounted for in these types of surveys are not the vast majority — they are the exception, and not part of the 1 million people in assisted living, or the 1.7 million in nursing homes, or the 3.6 million homebound elderly. Furthermore, he claims that their ideas of happiness become skewed — adapting and accommodating to declining cognitive and physical function and accepting lesser activities.
“Let me be clear: I am not saying that those who want to live as long as possible are unethical or wrong,” wrote Dr. Emanuel in his article. “I am certainly not scorning or dismissing people who want to live on despite their physical and mental limitations. I’m not even trying to convince them I’m right.”
“What I’m trying to do,” he continued, “is delineate my views for a good life and make my friends and others think about how they want to live as they grow older. I want them to think of an alternative to succumbing to that slow constriction of activities and aspirations imperceptibly imposed by aging.”
While acknowledging that this view is subjective, Dr. Emanuel stands by it.
“Seventy-five years is all I want to live,” he concludes. “I want to celebrate my life while I am still in my prime. My daughters and dear friends will continue to try to convince me that I am wrong and can live a valuable life much longer. And I retain the right to change my mind and offer a vigorous and reasoned defense of living as long as possible. That, after all, would mean still being creative after 75.”
On Tuesday, February 6, 2018, the Institute on Aging (IOA) at the University of Pennsylvania hosted their 11th annual Vincent J. Cristofalo Lectureship. This year’s lecture titled “The Surprising Role of Nuclear Architecture in Aging” was presented by Tom Misteli, PhD, Director, Center for Cancer Research at the National Cancer Institute, National Institutes of Health (NIH).
John Q. Trojanowski, MD, PhD, Director, Institute on Aging (left) and Tom Misteli, PhD, 2018 Cristofalo Keynote Speaker, with the Cristofalo family.
Dr. Misteli is an internationally renowned cell biologist who pioneered the use of imaging approaches to study genomes and gene expression in living cells. His lab’s interest is to uncover the fundamental principles of 3D genome organization and function and to apply this knowledge to the development of novel diagnostic and therapeutic strategies for cancer and aging.
This lectureship celebrates the spirit and continuing research of our colleague, mentor, and friend, Vincent J. Cristofalo, PhD. Dr. Cristofalo, a pioneer in research in aging, is the founder of the Center for the Study of Aging, now known as the Institute on Aging (IOA), at the University of Pennsylvania’s Perelman School of Medicine.
“This annual tribute to Vincent Cristofalo is to acknowledge in perpetuity his contributions to aging research, his critical scientific thinking, as well as his commitment to mentees, colleagues, friends and family.” – Robert Pignolo, MD, PhD
To learn more about the Vincent J. Cristofalo lectureship, click here.
On Wednesday, January 24, 2018, the Institute on Aging (IOA) welcomed their visiting scholar, Anne Newman, MD, MPH, professor and chair of the Department of Epidemiology at the University of Pittsburgh, to the University of Pennsylvania for a lecture titled “What does it take to live a long and healthy life?”
This lecture covered topics on the importance of healthy behavior in the life course and other factors that promote longevity. It is well-known now that Americans are living longer. In fact, according to Dr. Newman, the most rapidly growing demographic is the “oldest old” which consists of ages 85 and older. However, the important thing to understand is how people are living longer and what is contributing to longevity.
While family history can play a role, longevity is only about 20-30% heritable. “I tell people, ‘no matter how good your genes are, don’t trash them’,” said Dr. Newman, explaining that one of the main factors really seems to be lifestyle. If you live a healthy lifestyle — eating a well-balanced diet, exercising regularly, abstaining from unhealthy habits like smoking and excessive drinking, etc. — you are, unsurprisingly, much more likely to live longer.
Dr. Newman also addressed the trend that women tend to live longer than men. She explained that there are several hypotheses on why this occurs. First, she suggests that perhaps women live longer than men due to male’s general history of engaging more commonly in higher risk behavior. She explained that another theory is that this could be caused by the factors that make men stronger and larger actually increasing the risk for disease and death — or maybe it has to do with a woman’s ability to become pregnant. Perhaps the “factors that allow women to tolerate pregnancy and survive childbirth may protect against disease,” suggests Dr. Newman. Another hypothesis is that there is a heterozygote advantage to having two “x” chromosomes as opposed to an “x” and a “y.”
In any case, Dr. Newman believes that aging is in fact modifiable. Through a number of
different methods — from caloric restriction, to genetic manipulations, to parabiosis or senolysis — the “potential to delay aging in humans is real.” However, she stressed that the real goal is to achieve a longer health span — a longer period of healthy life — rather than just a long life.