Washington National Cathedral

Dean Lloyd: Good morning and welcome to the Sunday Forum, our continuing conversation week by week at the intersection of faith and public life.

I don’t know whether there is anybody here who doesn’t much like the notion of aging. I won’t ask you to raise hands if you fall into that category, but if so, this morning’s conversation is for you. We’re welcoming our guest, Gene Cohen, who is an eminent psychiatrist, author, and founding director of the Center on Aging, Health, and Humanities at George Washington University. He is also something of a revolutionary; he wants to change the way we all think about aging and what it means to grow older. Dr. Cohen has shared his message on Nightline, Good Morning America, the Today Show, CBS News, and has finally arrived at the Sunday Forum—including a series of public service announcements with George Burns—and now he’s going with talk with us.

Gene, thank you very much for being with us today.

Gene Cohen: Real pleasure, thank you.

Dean Lloyd: Forty years ago a rock group named The Who famously sang “I hope I die before I get old” that says a lot about a view that has floated around in the culture certainly for decades. You have a different point of view; would you tell us what that is?

Cohen: Yes. That comment came at a time in our history where probably images of aging were at their low point. There were phrases such as “you can’t trust anybody over thirty.” And that was the late sixties early seventies. But then the first of two sea changes occurred. In the mid-seventies, scientists began to look at what was seen as inevitable, unalterable, negative changes of aging as potentially modifiable problems, and then that launched the field of geriatrics and a whole new approach to dealing with the problems of aging. And then, by the end of the twentieth century, the second of two major sea changes was occurring, and that was the public’s awareness of potential with aging. So a lot of my work is the rest of the story of aging, what’s possible. And the latest science is informing us about all of these positive changes that are occurring, not despite aging, but because of aging.

Dean Lloyd: So this is really a new kind of growth field of endeavor, this study of gerontology and what the whole nature of aging is.

Cohen: Yes. It really only became a serious scientific field in the fourth quarter of the twentieth century, and the major federal research programs on aging were only established, or appointed their first directors, in 1975, so it’s very recent.

Dean Lloyd: Well, let’s talk a minute about some of the stereotypes that do float around and certainly have in these decades. The notion that aging is all about decline, the body is breaking down, things aren’t working anymore, and we forget where we put the car keys, we process things more slowly, things are sort of unraveling. But that’s not the real story, you say?

Cohen: No, the new science is absolutely extraordinary. There is this very important study that was done in 2002 looking at how we use the two sides of our brain. Many people are familiar with the concepts of right and left brain, but this was formally studied in 2002 with comparing middle-aged persons with young adults in how we use our brain for different tasks. And what was found is that with the young adults, depending on the task, they would use the left brain more than the right brain, the right brain more than left brain. And they were doing these tasks while they were hooked up to brain imaging (functional MRI), so you could see where the brain lit up, so it was both sides were used, but depending on the task one more than the other. But then, in middle age, what was found was an extraordinary phenomenon. We begin to use both sides of our brain together, and I refer to that as “moving to all wheel drive.” So while there are changes that are going on, there is this built in reserve and resiliency, which is remarkable!

Dean Lloyd: Still, what other stereotypes, for example of declining number of brain cells, functioning, beginning to forget things, becoming more scattered. You say it’s not really so at all…

Cohen: Well, these are very over determined. When an older adult misplaces keys or wallet or forgets somebody’s name, you say, “Aha, the senior moment.” When your teenager, you give a list to go to the grocery store and they don’t even remember to go to the grocery store, you don’t say, “Aha, the teenage moment.”

Let me give you a very quick example of what I refer to as the new senior moment. This is a true story. It’s about my in-laws. They were at the National Gallery of Art here in Washington in January and they take taxis and what have you. They came out of the gallery and it was snowing, and they couldn’t get a taxi and they couldn’t reach us (this was before cell phones), my wife and me, because we were at work and we figured oh they’re going to have trouble they didn’t see the snow because in the gallery there were no windows. So they took… they knew the subway system, and they took the subway system to get closer to where we lived hoping to find a taxi there or to be able to reach us…. Still no taxis.

But then my father-in-law, in his mid-seventies, saw something across the street that brought a smile to his face, a Domino’s pizza parlor. He took my mother-in-law’s arm, crossed the slushy road, entered the pizza parlor, walked up to the counter, and ordered a large cheese pizza for home delivery. Then he said “there’s one more thing.” “What’s that,” they asked? He said, “I would like you to deliver us with it.” That’s the new senior moment!

Dean Lloyd: Now step back from that a minute and what is distinctive? What is happening that made them able and ready to do something as clever as that?

Cohen: It’s really an excellent question. And this gets into a major area of my work, which is that of psychological growth and development with aging, and I’ve studied this for over three and a half decades. Erik Erikson was one of my teachers when I was in college and… but there has been very little written about psychological growth and development in the second half of life. And I have described four phases, relevant to this story, which is described by many investigators… that phenomenon I described—not going into the pizza parlor but this creative insight, practical intelligence, and pragmatic creativity which is seen as increasing with aging. And this corresponds to the second of the four phases that I’ve described.

It’s called the liberation phase. It begins to kick in around the mid-fifties. This is a developmental phenomenon, psychological change, very strong, as we are entering the sixties and seventies, and what we experience stays with us. It’s as if we are hearing these friendly inner metaphorical voices that are saying, if not now, when? Why not? What can they do to me? And that “what can they do to me?” is very empowering!

So my father-in-law, looking at what’s the worst that can happen, what’s the worst they can say, and it empowered him to take a very creative step. So this is a very real and significant phenomenon, and then the brain moving to all wheel drive it really is giving us reserve capacity to deal with things and to look at things in a new way.

Dean Lloyd: If you were to describe the difference between a twenty-year-old’s brain and a seventy-year-old brain, is it this all wheel drive piece that you think is the big difference?

Cohen: Yes. Anatomically the big change is the all wheel drive. But then you have this ongoing growth of life experience, social intelligence, emotional intelligence, and more mature ways of thinking. All of these individual ways that the mind manifests itself socially, emotionally, cognitively; these are all individually maturing, but with aging they are becoming better integrated, and I refer to that phenomenon as developmental intelligence. That’s the mechanism and how it shows itself is wisdom.

Dean Lloyd: You’re able to have some judgment about what kind of analysis, what parts of your brain you’re drawing on, integrating signals from different parts of the brain, is it something like that?

Cohen: Exactly, the part of the brain that processes emotions, the amygdala, is right next to the part of the brain that processes new information from memories and they actually…the integration improves with aging. Part of emotional intelligence, that change and growth with aging, is our ability to deal with emotional issues in a more adaptive and successful way. You hear the phrase, the lengthening of the fuse: a person is much more likely, if something annoys them, to process that in a way that they are less likely to say something they will regret afterwards. And so that’s part of the emotional intelligence and then a better linking of how we think about things and how we feel about things. That improves with aging.

Dean Lloyd: I found the four steps you laid out, the four stages, a fascinating description. Could you just give a very brief, one sentence encapsulation of each of those?

Cohen: Sure, the first is mid-life reevaluation—not mid-life crisis, but now that the two halves of your brain are working together better, you have a greater capacity with a better left/right brain integration, to evaluate things in a new way. It affects your consciousness, your understanding. That’s followed by the liberation phase.

Dean Lloyd: At what ages do you often see that first phase?

Cohen: It’s actually over a significant period of time and I typically use the word phase because for many people stage implies something rigid and these phases can overlap by over ten years. So the mid-life reevaluation can go from approaching forty into your mid-sixties. And then around the mid-fifties, there could be a ten-year overlap, the liberation phase is occurring. So here, from the mid-life reevaluation phase, you have an improved capacity to assess your environment and to think about things. And this is actually… there is a change in consciousness, and for many people there is a change in spirituality at the same time. This is part of what’s happening in their brain. Then that feeling of “if not now, when? Why not? What can they do to me?”—these things start to combine. They’re very powerful.

Then that’s followed by… the liberation phase is sort of the mid-fifties into the mid-seventies, but what you experience stays with you. Then by the late sixties into the seventies, the third of the four phases, the summing-up phase, this is where you see a lot of people want to write memoirs, autobiography, and genealogy. They want to share their story. It’s a way of giving back this enormous knowledge from life experience, and you see a growth in philanthropy, polycentrism. Then you also see in looking at one’s life, what’s unfinished, so you see a lot of late-life conflict resolution.

Then the fourth phase begins… it’s moving by the late seventies through the end. I refer to as the encore phase. And I use that in the French sense of meaning still, continuing and there the person starts to take on a role even beyond themselves how they bring people together for reunions. Willard Scott on the Today Show used to have a centenarian every show, and it brought the community together. Barack Obama on his acceptance speech mentioned this hundred and six year old woman; it was a way of bringing community together.

And this phase I very recently have described as maybe the best example… Aging may be the best example of the whole being greater than the sum of its parts. You can look at all of these negative changes but yet people do remarkable things.

Maybe just a wonderful illustration, an anecdote. I was interviewing George Burns at 97. He said that he had begun to develop low back pain and his colleague said, “Why don’t you sit down when you do your routines?” He said, “How can I sit down? All my life I’ve been a stand-up comic,” and then he found it had no impact at all. Then he leaned over, grabbed my shoulder, whispered in my ear, and said, “You know, Dr. Cohen, if necessary I’m going to become a lie-down comic.” But when you think about that, that’s a beautiful example of the whole being greater than the sum of its parts. Despite the challenges he was fully prepared and competent to do what he was always doing and having the same effect, and there are many examples of that with aging. It’s quite fascinating.

Dean Lloyd: Then the whole phases of creativity and exploration, with part of what you’re saying is a richer resource in the aging brain, able to do more things, able to look at things freshly, able to allow you emotionally to step back from being hooked and drawn into a lot of things. So that does sound like a period of a lot of potential for people to do things, and think things, and experience things in ways they haven’t before.

Cohen: Yes, and that’s an excellent summary. There is no denying the problems that are associated with aging. But what has been denied is the potential. And even in the face of loss, there is this ongoing capacity for creative expression. Somebody like Henry Matisse: in his early eighties he became wheelchair bound, he didn’t have the energy that he had before. He had heart disease, lung disease, gastrointestinal disorder, and so he couldn’t paint the way that he did before. But that wasn’t good enough, and there is that part of the human condition where it’s not good enough for us to do things less well than we have. We try to transcend that in some way. And that’s how he… when he turned to cut-outs, he experienced it as if he were cutting pure color. The poet William Carlos Williams wonderfully described this in his late life poetry as “old age that adds as it takes away.” You know Handel had a stroke and five years later he wrote Messiah.

Dean Lloyd: Is that right?

Cohen: Yes. Old age that adds as it takes away.

Dean Lloyd: In fact, I think you mentioned in your book that some significant percentages of folk artists are people over seventy, over eighty, something like that, when they begin their work. Is that….

Cohen: Yes. That’s when my research on aging moved into its formal phase. I went to this show at the Corcoran Museum of Art here in Washington in 1980. It was a half-century retrospective of folk art in America from 1930 to 1980. They had the works of twenty of the best folk artists during that period represented. I went to the show not only with the eyes of somebody who appreciates art, but the eyes of a gerontologist, somebody who studies aging. And I saw something that neither the curator nor the art historian had described, certainly not emphasized, and that was, of the twenty bodies of work in the show—among the best of the half-century period—sixteen of these artists, eighty percent—only did their first work or reached a mature phase after the age of sixty-five; thirty percent after eighty. Grandma Moses was just one of a huge crowd. The artist on the cover of the catalog was eighty-five when he did his first work. So folk art not only profoundly illustrates that creative expression goes throughout the life cycle, but it’s the classic example of late blooming. This is an extraordinary number of late bloomers.

Dean Lloyd: Well, you paint a pretty exciting picture of what’s ahead for us. We didn’t know we had so much to look forward to. But we are also high achievers; we’d like to plan for it and make sure it happens on schedule. So what would be your recommendations if we want to maximize our aging process, if we want to do everything we can to keep as alive and fresh and productive and creative as possible. What are some things we ought to be paying attention to?

Cohen: Well, among the important things is the new recognition of how long we can live well, and the fact that a lot of these negative changes—although they can happen, they don’t have to happen. And the myths continue to be turned upside-down. One of the longest standing myths was that we don’t produce new brain cells after the age of three. We found that that is not true. Just before the close of the twentieth century, we found that we produce new brain cells, and the biggest factor influencing the formation of new brain cells is mental challenge and environmental stimulation. So what that is telling us is that what we ourselves can and do influence the vitality of our brain, just like physical exercise that can influence our muscles and our muscular skeletal system.

So we need to be in a physical fitness program, a brain fitness program, and a creativity fitness program. Because the latest research, and I’ve just finished a major multi-site national study on creativity in aging, in Washington, New York, and San Francisco. Average age in this study was eighty. It went from sixty-five to one hundred and three, eighty is greater than life expectancy, so most people would think if you do something… some kind of intervention for an eighty year old, if you see positive results, you would be happy to see less decline.

We actually saw an improvement in overall health. And this is the impact of creative engagement, and this has been found to have a positive effect on your immune system, you can effect an immune system boost. And so these are all things that I describe that we can do ourselves. And the time is substantial.

I have a boomer study that’s going on, and this really reflects one of the interesting phenomena of boomers. Boomers are the first group in history that have grown up with many of their parents who are doing very well, so they see in their own family what is possible. I was interviewing a boomer who had just turned sixty, and he was eligible for retirement. Then we were talking about it and I said,” When did your parents retire?” And he said both his parents are still alive, they are each ninety-five, and then in his stream of thought he said, “My goodness, that’s thirty-five years older than I am. Thirty-five years is how long I’ve been in the work place. I could have another thirty-five years. Do I really want to retire?”

And so this is what’s happening, is that people are really thinking about an opportunity to use time in a very meaningful way, whether work that they have always wanted to do, important volunteer work, community work. They want to do something that is meaningful and will make a difference, and they have the time and health to do that.

Dean Lloyd: You don’t mince words in your writing when you talk about how this isn’t… we have to be as disciplined and serious as we might be with our bodies, with our minds. It’s no light thing to decide to exercise the mind in a regular and disciplined way. What are some ways that you know that people do that? Give it that right kind of exercise. Is it a lot of Scrabble? Or are there other ways to do it?

Cohen: The New England Journal of Medicine, which is the leading medical journal, described a number of leisure activities that appear to have a role in delaying the onset of Alzheimer’s disease for those at risk. And basically the mechanism that we have found to be operating is, every time you challenge your mind—I mentioned about forming new brain cells, but the existing neurons sprout new branches and those resulted in improved connections among the existing ones. So activities that particularly challenge you in that way enhance the number of brain connections or synapses in the brain and the brain functions more efficiently.

So among leisure activities, they found a lot of creative activities like dance and music, reading, writing, Scrabble, word games, crossword puzzles. And many people ask me what’s the ideal activity, but this may vary. If you’re a theoretical physicist working with math may be like chewing gum, whereas that person may be challenged by taking up crochet. So the point I make is, you want to find something where, like with physical exercises, if you’re not sweating then you’re probably not getting enough. And so with mental exercise you want to feel as if you’re mentally sweating. You want it to be something that’s interesting because you need to keep engaged. No matter how great the activity is, if you don’t sustain it and keep it going, you lose its benefits.

We all know people, they got their new fitness suit: don’t I look good? Just came out of the fitness center, said I had a great day at the fitness center today just like eight weeks ago. You know that’s a problem, so you need something that is going to keep you engaged. Creative activities keep you engaged. They are sort of in the soul of the species, and now we know why they have positive health effects, they have this positive impact on the immune system which affects the body as a whole, including the brain.

Dean Lloyd: And I understand that you are an inventor of board games yourself, so you’ve been doing some creative things in recent years.

Cohen: Yes, that’s part of my work. And in Washington you to be very careful if you have a second vocation people think, aha! A CIA spook. But I began over ten years ago in developing challenging inter-generational board games that would bring older adults and younger adults together and challenge both in meaningful ways. And then my latest game is the first game for Alzheimer’s disease that the Alzheimer’s association is very interested in helping to disseminate.

Dean Lloyd: We are going to go to questions from the audience in just a moment, but let me ask you one more before we begin. There must be certainly some kind of spiritual dimension to the process of aging. Have you seen that at all? Do you look at that, the ways that people’s sense of themselves, sense of God, sense of the world, shifts in the aging process?

Cohen: Yes. This has been an area I’ve looked at very carefully in the boomer study. And there are two intersecting phenomena that I feel affect spirituality, the sense of spirituality with aging. One is that left and right brain coming together. It affects our sense of consciousness. We are bringing the left and the right brain together and that includes spiritual thinking. And then, from a physiological developmental sense, as we are approaching and passing forty, you really are entering the second half of life. And in an experiential sense, for the first time in your life, you’re profoundly thinking about time left. You are looking for the first time at sunset rather than the sunrise.

Teenagers, they have a sense of immortality. Their frame of reference is at the start. When you start thinking about time left, you begin to have a whole new sense of what’s important in your life, what’s meaningful in the world. And at that same time that you’re developmentally having those feelings psychologically, the brain is starting to work together. And so it affects your capacity for that type of thinking and so I feel that developmentally this is what’s going on, that for a lot of people it affects their spiritual awareness and interest.

Dean Lloyd: Questions?

Question: First I wanted to give you a word that a friend of mine coined for me a number of years ago, Which is “middle-heimers”; that’s for those of us who aren’t old enough for Alzheimer’s. But my question is: I have two people in my life, both of whom have serious physical limitations. One of them is as determined as my ten-month-old grandchild to walk again. The other has given up. And what is it? They are both… one is in her late sixties, the other is in her mid-seventies. Incidentally, the one who hasn’t given up is the one in her mid-seventies. But what is it that keeps some of us going and has some of us give up?

Cohen: Yeah, it’s a very good question. I mean why do some give up others don’t? What makes it hard for people to do things? And there are a variety of factors. One is the social structure and network. The role of significant nudging others: you know, you go throughout the entire life cycle and you’re always nudging your children, in the work place you’re being nudged by the supervisor. The nudging begins to drop off in later life. We need that nudging throughout the entire life cycle. And then at other times, depending on the nature of the challenge, the person can go through a grieving process or even depression where they begin to shut down.

The case history of Ebenezer Scrooge is a classic example of that. He had an undiagnosed depression. It affected his whole world and those around him. Then he had this wonderful intervention in 1843. These social workers and art therapists came and employed psychodynamic dream work. Fifty years before Freud’s classic work in the interpretation of dreams, a hundred years before the community outreach program of the twentieth century. And he had a spiritual awakening and a mental health makeover. And it showed that when you help older people—it can even be at the expense of other age groups—and A Christmas Carol, one of the things I find so uplifting about it is how powerful it is as a reminder that it’s never too late to change and never too late to get out of a rut.

And that should really be this image; and so the challenge is how to help that person think about things in a different way. And sometimes it’s finding who influences them the most? This is a sociological assistance approach. It could be a friend, somebody who they used to work with, a minister—you never know who that person is, but the search, who that is and try to motivate them to do that and go to where they are.

I would go on home visits for people who are stuck like that, to try to sort of help them think about alternative approaches or get them into programs that could help them. It’s not an easy thing, but when we see what’s possible and we see the effects of interventions that can move people who are stuck, that should redouble our motivation.

Dean Lloyd: I’d like to just add one piece to that. A question came in off the internet on really precisely this point. A chaplain working with… in a retirement nursing home with people in their nineties and spoke of how many of them didn’t want to live anymore and had lost their passion for living. So, anything else you would say for people in their nineties? It sounds like probably the same thing: keeping them connected, engaged, trying to nudge them into things. Anything else for people with that particular point?

Cohen: Yes. Often what’s happening with those individuals, apart from the challenge of illness that they have, is that their social sphere has shrunk, and they don’t have the same supports that they did before, or the inter-generational involvement. And so what a number of us have been doing are different types of approaches that allow these individuals to begin to tell their story. Now developmentally I mentioned they are in the “summing up” phase. They really want to tell their story and they often don’t have it; they don’t have an inter-generational environment. And so a number of us have been trying to structure programs where we bring different generations together with these individuals, but they are the center of attention. And recording their story, it could be videotaping it or doing a DVD. And this begins to allow them to come back in touch with what their life has been as a whole. It’s a very powerful technique. You see this with reminiscence groups, but there are a whole series of new approaches to help people tap into the life that they have had as a whole.

Dean Lloyd: Thank you. Question?

Question: Dr. Cohen, could you address the concept of depression in the elderly and how that relates to their housing or living arrangements?

Cohen: Yes, the depression story. In the past people used to think depression goes with the territory with aging, that it’s a normal part of aging. And this stopped creative policy deliberations. You saw this in Medicare: there is very little coverage for mental health problems. Finally that is changing significantly. But it’s typically missed in so many cases. And that was the whole point of the Scrooge story. But in depression, your thoughts are being shut down, your energy is being shut down, your emotions, and so you have less capacity to take the actions that you would have taken in a better frame of mind. So this affects everything that you’re involved with: managing the house, your home, social interactions and so at the same time we know, regardless of age, that depression is treatable. And the impact of that can be very significant.

And a lot of the research that I helped support when I was… that we supported when I was head of the National Institute of Mental Health was focused on more effective programs for the treatment of depression. And the opportunity to treat depression has grown enormously. I mentioned before William Carlos Williams, who wrote about old age that it adds as it takes away. He had a stroke in his sixties. And fifty percent of people who have a stroke develop a depression because of the turbulence of the neurotransmitters in their brain, but these are also treatable depressions. He was actually hospitalized for a year at the age of sixty-nine for depression. But then he came out of that depression, and ten years later he published his collection of poems called Pictures from Brueghel that won a Pulitzer Prize. And so again it’s a reminder as to what’s possible in regard to treating depression.

Question: I wanted to follow up on your comment about brain fitness. There is a lot of programs being marketed right now, and I wasn’t sure if it’s just an excuse to get an eighty-year-old to buy a Nintendo, or if there are some that are legitimate and worth investing in? Can you comment? Is there a source to go to where you can find out what ones are really legitimate and worth the investment?

Cohen: These are changing all the time. I think the main thing that you need to keep in mind is the basic principles: something that will challenge, that will be interest sustaining, but you also want diverse types of challenges. In childhood education, where we first became aware of this was from the work of Howard Gardner, who talked about multiple intelligences. These were verbal, visual, kinesthetic, and not just your eyes but your ears. And so these are the types of things: are they challenging different capacities in the brain? And so that’s another thing which is beginning to influence the design of these. So they have always been there, crossword puzzles, word games, and then you have the products that Nintendo’s working on, and then you have very sophisticated programs like what Positive Science is working on in San Francisco. But then you have many other things like learning a new language—Spanish, that’s next on my list. And so you’re immersed in that. It’s multiple challenges, and you get a great reward for doing that. So those are among the elements.

Question: This may be far off the mark, but I was struck when you were talking about the phasing and the integration of the brain. You know away from left and right in the beginning of the integration, and I was struck in the timing of that, with the timing of the diminishing of hormones! And whether there has been any research done on the relationship between, you know, being of child bearing age and this lack of integration of the brain?

Cohen: Cohen: Yes it’s a very interesting question. What dilutes the question a little bit is the much more significant change of hormones with women as opposed to men at that time. But this phenomenon is equal in men and women. The changing of what’s going on with the brain is actually starting prior to, let’s say, menopause, for example. It’s really beginning in the late thirties, and it’s when you’re turning forty. And menopause can start that young, but it’s typically later. But again it’s the difference between with the hormones in men and women. There are changes in hormones with men as well but not of the magnitude, the temporary magnitude, with women. There, it’s a very good question. But they are both developmental phenomena. They are both built in.

Question: Hi, doctor. Could you discuss how a normal brain shrinks by age seventy or eighty? And what Alzheimer’s association, omega-3 fatty acids, fish oil, flax seed oil do to help? And what do you take and do for your brain, besides ping pong?

Cohen: I used to play ping pong. People used to think that the size of the brain or the shape of the brain determines intelligence. But when the brain of the Nobel Anatole France was examined on autopsy, he was found to have an unusually small brain, and yet he was brilliant. The brain, like all of our organs, has great reserve. You can lose a tremendous amount of your liver and you can regenerate it and function. Same with your stomach. And so you can lose over ten percent of your brain without seeing any significant impact. So there is that built-in reserve.

The diet is an exploding area of research; it still is rudimentary. But the role of potential anti-oxidants, and among the foods that you mentioned, blueberries have become very popular for that reason, but that’s still going on. But basically the overall combination would be good health habits in general, physical fitness that I mentioned, challenging your brain, important social and creative activities that are going on. The social involvement in its own right actually turns out to be very good for your health, and then diet and nutrition. So it’s that whole combination.

So this is one of the reasons that people are speculative why dancing was at the top of the list on the New England Journal of Medicine study. There is the mental challenge of learning the steps, there is the physical activity, there is the creative involvement, there is the social support, there is typically music that’s there, and for their snack, if they are eating blueberries, they have the whole package! That’s perfect!

Question: Hi, Dr. Cohen. Could you talk a little bit about how we can integrate some of this positive information and hope with someone who has dementia? Not only Alzheimer’s but something like Parkinson’s or Lewy body dementia where it’s challenging for both the person and the caretaker to make those connections, and ways that we can integrate some of this hopefulness in with that sometimes hopeless feeling with those people?

Cohen: Right. This has been an important area of my research as well. I look at… The aspect that distinguishes my program from many others in the field of aging is the focus on creativity and potential. And we look at it not only in relationship to promoting health but in coping with the most serious of diseases and we have a new partnership with the National Center for Creative Aging to help broaden this focus, and then wonderful partnerships and funding ranging from the National Endowment for the Arts to the National Institutes of Health with collaborative funding. So this is a whole new approach.

But what I’ve developed, in the area of problems like dementia or progressive chronic illnesses, is a new way of looking at a comprehensive intervention plan. Medicine… this only goes back to the late 1960s, where they developed a comprehensive problem intervention approach. They are looking not only at what the chief complaint is of the individual, but how it affects that person and their social life and their family. So they begin to look at bio/psycho/social aspects for problems.

But when you get to conditions like Alzheimer’s disease, other dementing disorders, advanced Parkinson’s disease, focusing just on the problem is extremely important, but it’s not sufficient. Most of medicine focuses on what I refer to as “two S’s”, science and symptoms, and they do a good job. Science is what you see. So if the person is agitated, they are calling out, you can see that. They have lost weight, you can see that. Symptoms you don’t necessarily see, but it’s what the person feels like: if they are depressed, you may or may not see that, but they say “I’m depressed” or “I’m hearing voices,” you can’t see that or hear them, so those symptoms.

What I’ve done in looking at these more complicated, chronic, progressive conditions is add two more S’s. And those are looking at areas of preserved strength and areas of satisfaction where good social history you find these areas. Even in the face of loss of cognitive capacity, there are still areas that we have always done better at than others, and to find those and allow the person to tap into those.

The great abstract expressionist painter William de Kooning developed Alzheimer’s disease, couldn’t write a paragraph without it being edited, was hard to be in a conversation with him. His behavior was erratic, but for years after his diagnosis, he continued to do paintings that museums and galleries sought after. This was reserved strength. Somebody who played the piano or has always had an interest in art or cooking, they want to continue with those activities. It gives them great satisfaction. So it’s finding those, and then ways of helping people tap into pockets of memories through different approaches like with […] and these are part of the games that I’ve developed to do that. So this is all part of not just the problems but the areas of satisfaction, reserved strength. They affect quality of life.

Dean Lloyd: A last very brief question, very brief please.

Question: I wonder if you could comment on the cross-cultural dimension of looking at aging. I noticed at the end of your book on the mature mind, which I just picked up, in the very last part or afterword you had a comment on the importance of how cultures look at older people or don’t even notice them at all in some cases, and you quoted a cross-cultural study of some twenty-five hundred randomly selected fairy tales… So that surprised me, because in fairy tales I’ve read from outside the west, let’s say, they usually do have older people and often in a very positive role.

Cohen: Now with the explosion of aging populations across the world, this has become in the forefront with even developing nations, the number of old persons are soaring. And these are issues that confront all of these countries. New issues are emerging. In China, the home of Confucius, the ramifications of the one-child family, this changes the equation. In many cases they want a boy to work on the farms. And the girls, the women, have typically been so involved with caring.

So this is not just an issue in western societies. It’s all societies, because once industrialization occurred, that brought the young out of the home, that was the end of generic social security, large family together under the same roof, and it created a new challenge for older people. But we also find that now the East is looking at the West. And my book The Mature Mind that you mentioned, it’s being published in seven languages, three are Asian. So the East is looking to the West.

Dean Lloyd: This is such a fascinating conversation I hate to cut it off here, but I have to. Next week we hope you’ll be with us when we have David Abshire with us, who is the president of the Center for the Study of the Presidency. He has written an important book called The Call to Greatness: Challenging Our Next President. He has also been a strong voice for tolerance and bi-partisanship. So come join us for that conversation next week.

We hope you’ll linger for the service that begins at 11:15 today, and there is also coffee available in the west end, the entrance end, of the Cathedral where Dr. Cohen’s book is on sale.

Please join me now in thanking our speaker today.

Cohen: One last point…

Dean Lloyd: He won’t stop…

Cohen: In an interview that Dear Abby had with a hundred and five year old woman. She asked her,” What are the advantages of being over one hundred?” The woman paused and reflected and said, “There is less peer-pressure!”