Watch Out, Your Age Bias Is Showing
What’s missing in our discussions about aging?
It seems like everyone is suddenly an armchair expert on aging and cognitive health. It certainly has the attention of people around me. This article is not about politics in any way, and I have no interest in diagnosing anyone regarding age-related cognitive loss. I am not qualified to diagnose anyone, nor are most people. However, I am qualified to discuss aging and cognitive loss. I spent the last 15 years of my working life as a master trainer for a program entitled Savvy Caregiver®, and I was co-author of an advanced version of this training. This is an in-depth course for family members caring for someone with dementia, and it explores the myriad ways dementia expresses itself, as well as more effective ways of interacting with and supporting the person with the condition.
In a cruel twist of fate, while I was learning to teach this program initially, my Dad was diagnosed with Alzheimer’s. My experience with him became my lab, as I witnessed his decline and practiced the very skills offered by the program. During the same time period, I also worked directly with hundreds of family members individually to manage caregiving as well as the emotional stress and grief of being a dementia caregiver.
There has been no avoiding the recent commentary in the press and online about aging. From where I sit, we are missing two salient points:
- We are failing to fully examine our implicit biases, the deeply held thoughts, beliefs, and myths we hold about aging.
- We are failing to even recognize how extraordinarily ignorant we are about the distinctions between normal aging and debilitating cognitive loss.
Ask anyone who is a dementia caregiver and you will hear a dozen different versions of how hard it was to get a clear diagnosis. Cognitive loss is generally gradual and insidious, with waves of good days amidst the bad. Yet, there are some critical distinctions between a brain with dementia and the normal process of aging.
As we age, we slow down, in all ways. We are more sensitive to alcohol, caffeine, and medications because our body’s filtration system works more slowly. We don’t move as fast, as our cardiovascular system works more slowly, and our joints are tighter. We find we have more trouble recalling names, or even remembering why we walked into a room. This is all completely normal. Functioning slows, but it is still intact. Eventually, you rebound from the extra drink, and recall the name of that darn actor in that movie. We are still capable of making important decisions and navigating our way through the world.
With any type of dementia, brain functioning itself changes. There are tests that track this, but even without those, we can see changes in language, logic, reasoning, attention span, and judgment. Recognizing dementia starts with noticing lapses in memory, but that alone is not enough. The quality of thinking must also change and may be subtle to detect.
Then there are PET scans, which are often utilized as part of a complete neurological workup. There is a catch here. A well-documented research project entitled The Nun Study demonstrated that even brain scans can be misleading. This study followed nearly 700 Sisters of Notre Dame from the age of 75 until their deaths, and beyond as they donated their brains. These women were administered annual cognitive tests, and their lives were tracked retroactively, studying their journals, activities, and mindsets. Because they were nuns, their environments, diets, and lifestyles were consistent otherwise.
The most fascinating part of this study was the inconsistency that was found between the appearance of dementia and the brain scans. Some sisters had brains that appeared riddled with plaques and tangles, but they demonstrated no evidence of cognitive loss. Others had brains relatively intact but struggled with significant dementia. The study suggested other factors that may be at play, but ultimately it is clear, that we have an astonishing amount of work yet to do to understand this condition.
This brings me to my personal pet peeve, what are we doing about learning more? What are we doing to research the root causes of cognitive loss so that we have some chance of treating or curing dementia before our health care, home care, and family caregiving systems are even more overwhelmed than they are now? As someone who has been in the trenches with dementia for many years, the progress, such as it is, seems excruciatingly slow and meager.
Now, what about the ageist biases that have been creating daily headlines? Age is not just about a number. I have known many people in their late 80s and into their 90s who have certainly slowed down, yet have also remained not only intact but clear, determined, and vital. Using age as an excuse to essentially put someone out to pasture is cruel and short-sighted. There are other cultures where elders are revered for their wisdom. Think about all the experience that comes with each decade, and how valuable that can be to the younger generations. When did we decide there is an expiration date on our ability to contribute?
Regardless of what is happening in the news this week, this attitude of ageism seems to be rampant, with only those who are, or at least appear to be young, having value. We are missing out on a rare and important opportunity to examine how we think about aging right now. The topic is readily available but we are talking around it. Our core beliefs about aging are the elephant in the room. What will it take for us to confront ourselves, to continue to have discussions about aging after the current news cycle has passed? How do we not let this opportunity pass us by? What are we really afraid of here? I suspect it may be in the mirror looking back at us rather than out there in the faces of others.
Age and shame do not need to go hand in hand. The shame of looking older, the shame of being forgetful, and the pressure to maintain some facade of timelessness are all issues we need to question. Yes, we must attend to those whose cognitive changes demand support and boundaries, but not because of age alone. We need to acknowledge that we cannot distinguish between normal aging and dementia without the expertise of either training or spending 24/7 with that person. Determining a person’s cognitive status is not a spectator sport, despite the fact that spectators seem to be abundant.
There are difficult discussions ahead, within but also beyond politics. Let’s be sure we make the effort to keep the conversation alive and reconsider our views on aging. We will all eventually get old — if we are fortunate enough.
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