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(Robert Lipsyte) Coming up on "Life (Part 2)," a specially designed aging suit helps us understand what happens to our bodies as we get older. And later, Martha Stewart is remodeling heath care for our aging population. Plus "New Yorker" contributor Patricia Marx describes the stages of life with the help of a bowl of fruit. All coming up  on "Life (Part 2)."    

(woman) Major funding for "Life (Part 2)" was provided by The Atlantic Philanthropies-engaging many to improve the lives of and achieve health and economic security for older adults. And by MetLife Foundation-- celebrating the wisdom, talent, and experience of older adults. MetLife Foundation proudly supports "Life (Part 2)."   

[bass, & plucked strings play in playful rhythm; bright in tone]   

(Robert Lipsyte) Welcome to "Life (Part 2)," I'm Robert Lipsyte. A lot of Baby Boomers are in denial about getting old. That's why they're so interested in understanding the mechanics of aging; how the body changes over time, and what modern science and good design can do about it. And that's why we sent one of our favorite producers, Rich Collier, up to Halifax, Nova Scotia, where a very forward-looking teacher of product design is using empathy suits to give his students a sneak preview of old age.

(Rich Collier) Here at NSCAD University in Halifax, Assistant Professor, Glen Hougan has created a program that places an emphasis on designing products for seniors. To help his students understand some of the physical limitations we all face as we get older, Glen has come up with a pretty unusual research tool, the Empathy Suit.
(Glen Hougan) Welcome.

(Rich Collier) Thank you, Glen.

(Glen Hougan) Thank you for having us.      

(Rich Collier) No problem. Before we get to the empathy suit, I want to hear a little bit about your motivation for developing this program.

(Glen Hougan) Halifax and Nova Scotia, the providence, has a large aging population. The reality right now is, a lot of the products that are designed for the prewar generation, the Baby Boomer's parents, are badly designed. You've seen the tennis balls that they cut and put on the bottom of the walkers to make it slide. Now, great solution, but it's kind of ugly.

(Rich Collier) What role does the empathy suit have in all of this?

(Glen Hougan) Well, the empathy suit is a tool to understand what it feels like physically to be a senior, and it's basically restricting mobility, flexibility, dealing with loss of vision, so all of the physical problems that you get as you get older.

(Glen Hougan) This is actually just limiting the movement of your stride.

(Rich Collier) Yeah, it's already working its magic. [bass & percussive instruments play in bright rhythm]. I feel like a really sad superhero!

(Glen Hougan) This is just making it a little bit more difficult to grasp and manipulate objects and use the phone and things like that.

(Glen Hougan) Let's just muffle the sound a little bit. Let's zip you up, you're going out into the public, and we want to look presentable.

(Rich Collier) All right, let's head out.

(Glen Hougan) How are you feeling?

(Rich Collier) I feel horrible!

(Glen Hougan) Before we go down the stairs, I think I'm going to have you take off the shoes here because I don't want you falling. [guitar plays in soft shoe rhythm; person whistles.]

(Rich Collier) Yeah, you're setting me up, thank you. Oh!
I'm taking the elevator.
(Glen Hougan) Be very, very careful please.

(Rich Collier) And the limited range of motion with the legs, it's amazing! It's a workout.

(Glen Hougan) We'll reduce your lung capacity here by breathing through this straw because as you age, your lung capacity decreases.

(Rich Collier) I don't see a lot of seniors with pink straws in their mouth.

(Glen Hougan) Well, no, this was my little touch for you! [steady scraping of Rich's feetsliding on the concrete]
(Glen Hougan) This is your car, right?

(Rich Collier) Yeah.

(Glen Hougan) Drive carefully.

[Rich laughs]
(Rich Collier) I'm losing my shoes. [grunts]
[violins playin tango rhythm]
(Rich Collier) Nothing is easy.
(Rich Collier) Here we go.
[horn honks]
(Rich Collier) Oh geez! Did I do that?
[engine starts]

(Glen Hougan) We're going to try to see if you can do a shoulder check. Well, maybe not.

(Rich Collier) I really don't see where I'm going back there. Thank goodness, we have an empty parking lot! Just going for a ride around the block.

(Glen Hougan) And make a big circle, okay?

(Rich Collier) It's scary. And no, there's nothing in this parking lot, but... I can't turn my head. I'm still in pain. My vision is a mess. I can't hear well.

(Glen Hougan) How does it feel?

(Rich Collier) Like I shouldn't be driving.

(Glen Hougan) Yeah, and you probably shouldn't be. This is where we were, and we are home.

[screech of tires]

(Rich Collier) Oh! Sorry.
[guitars play bright light rock]
(Rich Collier) Let's find some reading material. I'm not a big Jonas Brothers fan, so, "Get fit and stay fit." Hurts my neck and my shoulders.

(Glen Hougan) Reaching up for anything, you think of yourself in the home, in the kitchen and you're going up for your can of food up there. It's very difficult in terms of reaching. One more time.

(Rich Collier) Yeah. Reaching is difficult. Oh geez. Oh my god! I need a nap! These goggles really are giving me a headache.

(Glen Hougan) Here's the ultra headache relief.

(Rich Collier) All right, let's pay for it!

(woman) Hello.    

(Rich Collier) Hello, how are you?

(woman) Good. How are you today?

(Rich Collier) I'm doing all right. Oh geez, sorry!
(Rich Collier) I'm going to leave that there.

(woman) Sure.      

(Rich Collier) Okay, thank you. All right, Glen, I want to thank you and all your students at NSCAD University for helping me out today. It was an exhausting day, but rewarding.

(Glen Hougan) And thanks for coming up to Halifax. I hope we gave you a little bit of an insight into what you may experience as you get older, and be a little bit more empathetic to some of the experiences that our senior population experiences on a daily basis.

(Rich Collier) I'll be a lot more patient with my mom! Can you help me open this?

(Robert Lipsyte) Now that we've seen the shape of things to come, let's find out why it happens and what we can do about it. Dr. Dennis McCullough is a family physician and geriatrician on the faculty of the Dartmouth Medical School. He's the author of "My Mother, Your Mother," a personal and professional account of his 3 decades of helping older people and their families make better decisions about care. John Cacioppo is a Professor in the Department of Psychology at the University of Chicago. His latest book is "Loneliness: Human Nature and the Need for Social Connections." Dr. Thomas Shives is a Professor of Orthopedic Medicine at the Mayo Clinic, so he's a good guy to know when you have trouble bending down to pull up your socks. Welcome everyone to "Life (Part 2)." Tom, why am I having trouble picking up my socks? And I'm not even wearing an empathy suit!

(Dr. Thomas Shives) Bob, it's basically the same reason that I have to wear these glasses to read that I didn't used to have to wear, and it's the fact that the tissues dry out, become less pliable, more brittle and more prone to injury over time. In the lens of the eye, it has become less pliable; thereby it can't accommodate and make it so that I can read fine print. And the same thing happens to the rest of the body. Things tend to dry out, they're less pliable, they're more brittle, they're more prone to injury, and our muscles get weaker as we get older.

(Robert Lipsyte) A pretty picture, to be sure! Other than this starts happening, Dennis, as soon as we're born, when does the process really begin of falling apart?

(Dr. Dennis McCullough) Well, there's some debate that goes on because, of course, the age 65 that we oftentimes refer to in relation to retirement comes out of an arbitrary kind of decision back in the beginning of the 20th century about Social Security in Germany when they assumed that they could give a pension to people because they didn't expect very many people to live that long. So we've arbitrarily picked that up. Now the thinking is that it's getting more towards 75 when middle age comes to an end, and there's some evidence coming from high-performance senior athletes that suggests that that's when performance begins to drop off.

(Robert Lipsyte) Except that people in their 40s, and you must see this all the time, begin to slow down, their muscles ache, they don't get better quickly.

(Dr. Thomas Shives) The important point here is about muscle, and muscle has a lot to do with how well you function, and all of us after the age of 40 lose 1% of our muscle mass a year unless we do something to prevent that. That's why everybody is emphasizing strength training over the age of 40. You have to do something to keep your muscle mass.

(Robert Lipsyte) John, one of the things that really struck me in "Loneliness," in your book, was the emotional component of all of this. I had no idea that the stress of isolation, of not being part of a community, could have such an effect on every aspect that we've talked about in health.

(John Cacioppo) It can, it affects everything from the brain to neuroendocrin to gene transcripts to the intracellular processes. Early in our history as a species, humans survived and prospered because they bonded together in dyads, in families, in tribes for purposes of mutual protection and assistance, and we've evolved to be very collective social animals.

(Robert Lipsyte) Talking about the impact of loneliness, the stress of loneliness on organs and things, can you die of a broken heart?

(John Cacioppo) You can, certainly you can grow ill and achieve death faster through a lonely heart. We've found that loneliness is associated with higher vascular resistance, which is the resistance, the blood flow throughout the body. In older adults, it's associated with higher blood pressure. In fact, prospectively, longitudinally, lonely individuals 4 to 5 years later are showing higher blood pressure than comparable individuals that are not lonely.

(Robert Lipsyte) Stereotypically, one of the things, your patients are younger, young enough to at least break a leg while skiing, but I was also thinking about this kind of movement to more replacement parts. At what point do we start thinking about new hips, new knees, new ankles?

(Dr. Thomas Shives) Obviously, if there's a reason to keep living, and it sounds like there is, you want to be in as good physical shape as you can be in, and you want to do it pain free. Some would consider total joints to be one of the most significant, successful innovations of the 20th century, and I think that's true. There's a problem, however, looming on the horizon, and that is there are so many people who are going to need knee replacements and hip replacements by the year 2030 that it will either bankrupt the system, the medical system, or we won't have enough orthopedic surgeons to do the operations. But with regard to age, you want to avoid that replacement as long as you can.

(Robert Lipsyte) You don't want to outlive your joint.

(Dr. Thomas Shives) Exactly. They do have a limited lifespan, and the older you are when you have it done the more likely it will last you a lifetime.

(Dr. Dennis McCullough) That's exactly the point, and geriatricians probably complicate your life, Tom, because what we do is say go for joint replacements earlier so you get a chance to really improve your functionality before you get slowed down too much and lose touch with very important things that are going on. So we use function as the best indicator, and maybe we should have orthopedic surgeons wear these empathy suits, so that they understand that the functional part of it for an older person is probably equally important to the pain issue.

(Robert Lipsyte)  He's making you work so hard. You have to put in that same hip twice now!

(Dr. Thomas Shives) No, that's okay. The only thing that we suggest from an orthopedic surgery standpoint is that you have tried medical management, and you have tried use of an assistive device like a cane or a crutch, and when those don't work, then certainly total joint replacement is an excellent alternative.

(Robert Lipsyte) Oh really? You see that as a last resort?

(Dr. Thomas Shives) Absolutely. If the potential complications postoperatively like a blood clot or pneumonia or a dislocation-- you always have to remember that this is not a 100% successful operation.

(Dr. Dennis McCullough) How about the high-functioning athlete though, who's 60 or 65 and whose tennis game is falling off. They're not having pain; their mobility is going down. That's the group that we try to get at and say it's more important to have an early joint replacement here to really stick with the things that you love and to the games that come naturally to you. You can bicycle, you can play tennis. You can do many, many things.

(Dr. Thomas Shives) But you should not play singles tennis if you have a total hip or a total leg.

(Robert Lipsyte) Oh, no, no, but I mean, we're talking quality of life here. That's the issue-- the issue is that if I'm a square dancer, I want that hip. If I'm not, if I sit in an ensemble, then I can have the walker.

(Dr. Thomas Shives) This is an operation for pain.  Function is a secondary goal.
(Robert Lipsyte) Really?

(Dr. Thomas Shives) Absolutely.

(Robert Lipsyte) What do you think about that?

(Dr. Dennis McCullough) From a geriatric point of view, I think that we're operating on more a functional level than a pain level in terms of helping people to make these decisions, and I must say, geriatricians tend to encourage several kinds of elective surgery. Cataracts as soon as they become limitations and joint replacements are the second.

(Dr. Thomas Shives) But why are the patients limited? They're limited because of pain.

(Dr. Dennis McCullough) Not necessarily.

(Dr. Thomas Shives) This is not an operation to improve motion. This is an operation to get rid of pain.

(Robert) But there are ways to get rid of pain. If you want that performance, if you want not to be lonely and isolated, that hip you're going to give me is going to get me back in the crowd.

(John Cacioppo) This is actually where I think the emphasis on function is important in the aging process because one can avoid that pain by just decreasing a bit the functionality. So I don't go for as long of walks. I keep just diminishing my activity level to keep the pain to a manageable level, or at a distance, but over a matter of years one can find themselves now leading a disabled life still being relatively pain free. I think it's important to emphasize, no, as an older adult, one can retain all the same functions,  and indeed we now have the medical procedures to perhaps avoid the pain that would otherwise be attendant to those activities.

(Dr. Dennis McCullough) John and I should declare that we're not being paid by the producers of artificial knees and hips. Usually it's the other way around. But here we are being advocates because we see an improvement of emotional, social life as a result of better functioning. It's an interesting issue.

(John Cacioppo) Indeed, if you stay active through exercise or motorically and you stay involved socially, cognitively, you're going to remain active. Talking to people, interacting around a roundtable are some of the most cognitively demanding things that people do, and so it's a very simple way to keep your cognition at a high level.

(Robert Lipsyte) So what I've really learned today is that I'm not going to any one of you singly. I want all 3 of you treating me at the same time. Thank you so much for joining us on "Life (Part 2)."

(Robert Lipsyte) Someone else we could all turn to for advice is Martha Stewart. That's right, Martha Stewart. She's already advised us on entertaining, cooking, and home decorating, but these days she's stretching the brand into geriatric care, a commitment that includes founding the Martha Stewart Center for Living at the Mount Sinai Medical Center in New York. Martha Stewart, welcome to "Life (Part 2)." I've been thinking about your geriatric center at Mount Sinai, which it seems to me kind of an extension of everything you've been doing, entertaining, food, survival with style, but also this kind of an implicit criticism that we haven't done it right yet. I mean, there's something wrong about the way we treat elderly in this country, isn't there?

(Martha Stewart) Well, I agree with you, and I think that the Center for Living, it's called The Martha Stewart Center for Living, it is a center really devoted to good care giving. People go there not only for medical advice and medical examination and medical care; they also go there for interesting information on aging, on how to get old gracefully, on how to eat, how to exercise, how to live, how to survive.

(Robert Lipsyte) As wonderful as I know The Martha Stewart Center is, it's one place in one city. It has to be a model for national franchise.

(Martha Stewart) Oh, that's what we're hoping, that we'll become recognized as a prototype for this kind of center in every hospital in the United States of any size.

(Robert Lipsyte) But I mean, you're also going to have to make being a geriatrician cool.

(Martha Stewart) Well, as doctors get older, maybe they'll get more interested in geriatric medicine.

(Robert Lipsyte) Would you bring back older or retired doctors?

(Martha Stewart) I would love to do that.

(Robert Lipsyte) What a great idea that is.

(Martha Stewart) Yes, that's one of the ideas that actually I just had-- while I was sitting here in this chair!

(Robert Lipsyte) Even though PBS is going to take 10% of it?

(Martha Stewart) Well, I hope so, but I really think that people shouldn't retire at set ages.

(Robert Lipsyte) Now, I glean that your interest out of all of this came from watching your mother, Big Martha, age. Now, she died at 93, my dad died at 100, and in both cases I wonder what could The Center have done for them? He was healthy till the very end as she was.

(Martha Stewart) Yeah, my mom was, well, pretty healthy. She did have her real aches and pains. She had a bit of arthritis, which affected her walking. She had a hip replacement, a knee replacement. She really needed some physical therapy, and she really needed some guidance in certain things that she was doing, certain drugs that she was taking to make her more comfortable. The Center was very helpful to my mom in that respect, and also guiding her to the correct specialists that would work together. I think the real reason my mother died is because she wasn't taking her medicine. She had high blood pressure, and I think she just either, I don't think she forgot, I think she just decided to stop.

(Robert Lipsyte) Do you think that she was making decisions along the way?

(Martha Stewart) I think she was.

(Robert Lipsyte) That she was coming to the end?

(Martha Stewart) I think she was, and it's a little bit private, but when she was finally in the hospital, and she died within 12 days of entering the hospital, and that was the first time she had any prolonged stay in a hospital for any reason, she actually asked me, or begged me, to let her go. I didn't want to let her go, but she wanted to go. So it was kind of a sad thing. And I really thought because her father had lived to 99, her mother till close to 90, I though mom with modern medicine and a good diet and good care, could've lived way longer than she did.

(Robert Lipsyte) In the larger picture, one of the things that I think that you're going to be struggling against is this Boomer mentality that we've been seeing-- the denial of aging, the denial of death.

(Martha Stewart) Well I think denial is good in a way.

(Robert Lipsyte) Really?

(Martha Stewart) Yes, about aging. I think it's okay. Men are always telling me they're 13 years old, in their mind.       

(Robert Lipsyte) We are?

(Martha Stewart) Yes. That makes me sick. But then they have to have a hip replacement. And then they have to have another hip replacement. Or they have to have their back worked on. Or they have to have something--and then they start to see that maybe there's another way to approach what's happening.

(Robert Lipsyte) Well, your next project is a book on caregiving, which we've seen so much of this on this show, the idea that in many ways caregiving is tougher than being the patient.

(Martha Stewart) I think that's very true, and I think that people are not prepared for the amount of time it takes to take care of an elder, how the problems that occur while giving care to someone, even a loved one-- and this book is called "Care Living." So it's both for the caregiver and for the recipient. I mean, I've written the homekeeping guide, how to take care of your house, and I think how to take care of yourself and your loved ones in a sensible, practical manner will also be very, very valuable.

(Robert Lipsyte) From the cradle to the grave with Martha Stewart. Thank you so much for joining us on "Life (Part 2)."

(Martha Stewart) Thank you.

(Robert Lipsyte) Patricia Marx likes to say that she writes comedy because she's too shallow to do anything else. She was the first woman on "The Harvard Lampoon," she wrote for "Saturday Night Live," and her work now appears frequently in "The New Yorker." But for Patty, growing old is not just a bowl of cherries.

(Patricia Marx) Life-- you start out so full of potential, you could be anything--a fairy princess, a fireman, a doctor, a kumquat. Here you are, an unripe youth barely out of the fetal position. You can't wait to get older. You want to drive, leave home, smoke pot. Then comes the age of pretentiousness. You think you're oh so sophisticated. You grow a beard. You wear a hat. You think you're immortal. You smoke. You drink. You start to notice that your friends are getting older. You go to a college reunion and someone who looks like your grandfather says to you, you and I are the only ones who haven't aged. Ai-yi-yi! Now what's going on? Your jeans don't fit. They must have shrunk at the dry cleaners. Are those age spots? And your skin, is that cellulite? People no longer say, "Really? You look half that age." You start to wonder, did you inhale too much pesticide. You take matters into your own hands. Well, the cosmetic surgeon's hands. Wow! Just like new! Where did the time go? You start to brag about how old you are. Hey! It's starting to shrink? Oh well. The End. Isn't life delicious? That Patricia Marx is a peach. Too bad we "can't elope."

(Robert Lipsyte) For now, that's it for "Life (Part 2)." Thanks for joining us. I'm Robert Lipsyte. See you next time, older and better.

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(woman) Major funding for "Life (Part 2)" was provided by The Atlantic Philanthropies--engaging many to improve the lives of and achieve health and economic security for older adults. And by MetLife Foundation-- celebrating the wisdom, talent, and experience of older adults. MetLife Foundation proudly supports "Life (Part 2)."

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