Jerry Jackson, a retired accountant, described the accumulation of losses that accompany old age in concrete, mathematical terms.
When he and his wife moved to Rydal Park, a Jenkintown, Pennsylvania, retirement community, they joined an informal breakfast group of about 10. “They were a great bunch of people,” said Jackson, who is now 90.
Seven years later, “I’m still in the same chair as when everybody was here, but there are only two of us left, and we eat at different times.” Among the empty chairs is the one his wife of almost 70 years occupied. She died in May.
Coping with the deaths of friends and family members and the inescapable knowledge that time is limited for remaining peers is among the great emotional challenges of ageing.
“It sucks, period,” said Dorree Lynn, a 77-year-old psychologist in Charleston, South Carolina, who recently lost two close colleagues. “It starts in your 60s and gets worse.” Not everyone can overcome it, but those who are resilient enough to navigate this dance with mortality well can find wisdom and everyday joy made sweeter by the depletion of time.
Jerry Jackson having breakfast alone at Rydal Park retirement community, in Jenkintown, Pennsylvania. Jackson said that he was part of a group of about 10 friends who ate together when he first moved there. All but two are dead now.
Thelma Reese, 85
A retired professor of English and education, she co-authored The New Senior Woman and The New Senior Man and is working on another book about seniors.
She’s a believer in “doing things that take you out of yourself enough to widen your horizon a little” to improve mental health and prevent focus on the physical problems of old age.
It’s tough to lose old friends, either from death or growing apart. “You feel like you’re losing part of your history when they go.” New friends can listen to your stories, but you haven’t “lived and breathed it together”.
She is “extremely” conscious of her mortality and has been reading about psychologist Erik Erikson’s stages of development. His last stage (65 and up) is the age of integrity or despair. That resonates with Reese. Once you have a “sense of an ending”, she said, “it can either make you despair or make you think: ‘I’ve got to do something. I’ve got to get it done somehow’.”
Interviewing other seniors who are leading active lives helps her open up. “I’m interested in these people because they’re doing things I’m not. I admire them. I find it encouraging that they’re in the world.”
There’s no doubt that many elders let their social world contract. “They sort of shrink into a box,” said Reese, who lives in the Bella Vista neighbourhood of Philadelphia.
Pain and joy
Scientific evidence that isolation and loneliness are harmful, both physically and emotionally, is mounting. “Being by yourself with the shades drawn and not interacting with other people can be deadly,” said Stephen Scheinthal, a geriatric psychiatrist who is chair of psychiatry at the Rowan University School of Osteopathic Medicine.
And yet research also shows that, as a group, older people in decent health score higher on measures of happiness than young and middle-aged adults. (Scores sometimes dip a bit as infirmities increase.) This is true even though deaths are not the only losses the aged face. Many have also lost their independence and professional prestige. Friends and family members have moved away or cut ties.
What allows some people to thrive emotionally at a time when losses are piling up? How do they find the courage to care when they have so much experience with heartbreak?
The answer, according to experts and older people themselves, is not as simple as “you have to keep making new friends”, although that is a common part of the equation. It also helps to embrace the idea that life can have meaning and purpose at any age, to treasure the people who are left, to cultivate gratitude and seek personal growth. A sense of humour is invaluable. Curiosity helps, too.
Marc Agronin, a Miami geriatric psychiatrist and author of The End Of Old Age, said that more of his clients in their 80s and 90s still have friends from childhood around now than in the past because people are living longer. But, he said, the concept of loss has also changed with modern life. Families are smaller and more scattered. Friends may also have moved. Travel becomes more difficult with age. Older people often feel less connected whether their friends are alive or not.
This can all sound pretty depressing to younger people, but Agronin said many of us make a crucial error when we imagine how it will feel to be older. We forget, he said, that “we will be different people”.
Young Bin Lee, 81
Raised in both North and South Korea, Lee came to the US for advanced medical training in 1964. He had planned to go back to Korea, but his wife, also a doctor, got cancer, and they stayed. She died in 2000. Two good friends died this year.
He works four half-days a week as a neuropsychiatrist and is active in his church and Korean organisations. He loves opera. He has had heart surgery and a kidney transplant. His kidney came from his second wife, Eulie, whom he married 10 years ago.
Young Bin Lee, a neuro-psychiatrist, listening to his wife Euli play the piano in their home. He stays young by maintaining a younger mindset and keeping busy. “I focus on now … I will do my best until I die,” he says.
Asked about grief, Lee, a resident of Medford, quoted a character from the opera Nabucco, who said, “Lord, give us the courage to endure suffering.” Notice, Lee said, the character did not say, “Lord, do not give us any suffering.”
Keeping busy and maintaining a younger mindset help him live with loss. “I like to think I’m still in my 50s and 60s. At that age, you work hard. You take care of your children and you think about your grandchildren and try to study and learn more. That kind of lifestyle, I like that.”
He keeps his eye on today. “I don’t think about how long I’m going to live. I focus on now. I have no fear of dying, actually, but I will do my best until I die.”
Along with loss and decline, Agronin said, old age can mean “a simultaneous process of growth and development”. Ideally, perspectives broaden and people become more resistant to adversity.
Caroline Wroblewski, 75
She retired at 70 as director of a counselling and treatment programme for women in Washing-ton, DC. Never married, she has lost a sister and moved to be near her brother. Close friends have moved to Texas and Massachusetts. She counts leaving her beloved condo near Washington as a loss. She volunteers with hospice patients.
Wroblewski is clear-eyed about her mortality now that she is well past the halfway point in her life. “I am healthy, but I know I’ve lived longer than I’m going to live.”
Caroline Wroblewski in her apartment at Normandy Farms Estates retirement community, looking at momentos from her past. She volunteers to work with hospice patients and with some residents who are having memory problems.
Her deepest friendships are those established long ago, but she is forming strong relationships at (retirement community) Norman-dy Farms, too. One, Pat, is in her late 80s. They do jigsaw puzzles and water aerobics together.
“I am coming to love Pat. She’s one of my trusted friends here. … Granted, she is at the end of her life, but she’s very alive in the moment.”
One of her hospice patients was 89 and able to communicate only with her eyes. The day before she died, Wroblewski told her: “I just want you to know it’s been a joy working with you, being with you. I believe you’re already in the hands of God.” Wroblewski felt lucky to have had time with her. “I learned the most from her. She was just a gracious receiver. She had no complaints. She enjoyed the moment.”
Wroblewski treasures hearing the stories of older residents. “They’re my mentors right now. They’re in places where I have yet to go, and they’re helping me choose how I want to go there.”
Therapists recommend volunteering as a way to do something valuable and meet like-minded people. Learn a new skill. Get involved in politics. Join a book club. Friendships will follow.
At Rydal Park, Jerry Jackson organised a show of his wife’s photos from their travels as a tribute. He does not expect to ever “get over” her death but said, “You have to go on.” He’s still making new friends and is well aware that they need to make the most of their time.
“They’re friends today and tomorrow, and that’s fine,” he said.
A new group is starting to form. “Maybe that’s the beginning of the next (breakfast) table,” Jackson said. “I hope so.” – Tribune News Service/The Philadelphia Inquirer/Stacey Burling
Ageing might be perfectly natural. But as experienced by the human body, it is beginning to look more and more like a disease – and a treatable one at that.
In a new study, scientists reveal ageing to be a process set in motion by the rise of malign forces called senescent cells, which progressively hijack the body and take it on a nightmarish joyride.
With advancing age, senescent cells take the wheel and the human body careens into disease states ranging from cancer and diabetes to arthritis, vision loss and dementia.
As senescent cells mount, our walking pace and cognitive processing speed slow, our grips weaken and disabilities mount. Eventually, driven by this accumulation of insults, we are driven off a cliff.
The final plunge cannot be avoided. But scientists are exploring a range of tantalising new ways to make the odyssey of sickness and frailty that precedes it a little shorter and less degrading.
They may even put the cliff a bit further in the distance.
It’s a science called senolytics – the dissolution or gradual decline of old age.
In research published on July 9, 2018, in the journal Nature Medicine, a group led by Mayo Clinic anti-ageing researcher Dr James Kirkland not only offers a clear look at the power of senescent cells to drive the ageing process, but also a pharmaceutical cocktail that, in mice at least, can slow, and even reverse it.
Even in mice who were already well along ageing’s path, the senolytic cocktail – a dose of the leukaemia drug dasatinib and the dietary supplement quercetin – drove down senescent cells’ numbers, tamped down the inflammation they cause, and reduced the level of disability that comes with age-related diseases.
When given to younger mice in which the ageing process was jump-started with a transfer of senescent cells, the anti-ageing cocktail forestalled the onset of age-related diseases.
And the anti-ageing effects of a single five-day course of the cocktail lasted for months, the equivalent in humans of more than a decade.
Compared to mice who aged normally, those who started getting the dasatinib-quercitin cocktail at an age equivalent to 75 to 90 years in humans ended up living roughly 36% longer, and with better physical function.
That extra lifespan did not come with an extra dose of misery either: in their final two months of life, the physical function of the treated mice was at least as good as that period in the lives of normally-ageing mice who died earlier.
That was seen in tests of walking speed, grip strength and hanging endurance given to the animals in their last weeks and months of life.
And after all the mice in both groups had died, Dr Kirkland’s team could find no difference in the mix of diseases that had caused their demise.
In human cells in a test tube and in mice bearing human senescent cells, the dasatinib-quercitin cocktail showed equally promising results, targeting senescent cells while leaving other cells intact.
The senolytic cocktail used on mice in the new study is already being tested in a human clinical trial aimed at gauging its safety in patients with chronic kidney disease, one of many diseases linked to ageing. The trial is expected to be completed by 2021.
Other proposed trials may test senolytic compounds using “optimised derivatives” of dasatinib and quercitin in patients with a variety of age-related diseases, the study authors said.
Those trials may also explore the usefulness of senolytic compounds in younger patients, including certain cancer survivors who tend to develop age-related disease prematurely.
Researchers are also exploring the use of the diabetes drug metformin as a senolytic agent.
Does this suggest the researchers have found a fountain of youth?
No, said Dr Kirkland, who is a geriatrician at the Mayo Clinic in Rochester, Minnesota. “And we’re not looking for one.”
The objective, he said, is not so much to extend the human lifespan as to extend the “healthspan” – the period during which a person can live a life largely free of disease or other impairments.
“What my patients want, and what I want for myself, my mother and anyone I care for, is a way to be independent and as healthy as possible in later years,” he said.
“Most people don’t want to live to 130 and feel like they’re 130. They’d rather feel like they’re 60.”
Dasatinib and quercitin appear to work synergistically to target senescent cells, which do not seem to develop a resistance to them over time, Dr Kirkland said.
He cautioned, however, that people hoping to forestall ageing should not start taking either the leukemia drug or the dietary supplement on their own.
“This is not a place for self-experimentation,” he said. Until safety trials are completed, he added, “we don’t know what’s going to happen.”
If they do prove effective, senolytic drugs could not only change the way many diseases are treated, they could change the way we age, Dr Kirkland said.
“You’re not playing whack-a-mole,” he said – treating a patient’s cancer, for instance, only to have heart disease strike her a few years later.
That, in turn, could reduce the social and financial costs of caring for the frailest elderly.
The appeal is obvious.
Compounds that target ageing’s basic processes “have now become the hottest thing” in ageing research, said Harvard University ageing scientist Dr David Sinclair, who was not involved in the new study.
“There’s a really exciting potential of senolytic drugs being used to treat a whole range of aging-related diseases,” he added.
In March 2018, a team led by Dr Sinclair published research linking frailty and other diseases of ageing to a decline in the production of blood vessels that feed the muscles.
In elderly mice, the team showed that administering a compound called nicotinamide mononucleotide (NMN) improved blood flow, increased endurance and reversed signs of ageing.
It did so by boosting the very cellular processes that are, in younger animals, spurred by vigorous exercise.
A handful of biotech firms are aiming to coax basic findings like these into human clinical trials.
One of them, Unity Biotech, is set to launch an early clinical trial of a drug candidate for osteoarthritis, one of ageing’s earliest, most ubiquitous and most disabling diseases.
The firm’s candidate drug, dubbed UBX0101, is described by the company as “a potent senolytic” that eliminates senescent cells by disrupting a protein interaction they need to survive.
Unity Biotech is also working toward clinical trials of drugs for glaucoma, macular degeneration and diabetic neuropathy – all considered diseases of ageing.
Dr Sinclair is advising another firm in Barcelona, Spain, in the development of senolytic compounds that would restore the body’s mechanisms of cellular repair, which falter with age.
One obstacle all potential senolytics face is the US Food and Drug Administration, which would have to approve such drugs for sale in the United States, but does not recognise ageing as an illness to be treated.
“Our biggest problem is regulation,” Dr Sinclair said. “It’s no more difficult to make an anti-ageing drug than it is to make a cancer drug.”
But the potential reward is great, he said.
“These drugs offer the possibility of keeping every part of the body healthier for longer,” he said. In the end, people will die quickly, perhaps when their heart or kidneys give out.
“The chronic, slow processes of death are pushed out and the fast ones take over,” Dr Sinclair said. “The last thing we want to do is keep people sicker for longer.” – Los Angeles Times/Tribune News Service