(film reel clattering) - Welcome, everyone to today's Ethnic Media Services' Zoom news conference.

[background organ music] I'm Sandy Close, EMS director.

I had the great privilege of listening to our first speaker present an extraordinary talk about the many stages of elderhood at the Stanford Medical School several weeks ago.

And, I felt like kidnapping her and holding her for ransom so that we could put her on our media briefing today!

It was such a timely topic as people were debating back and forth, is Senator Feinstein too old?

Is President Biden older than Trump, and does that make him less qualified?

Everything seen through a chronological lens.

And, here was Dr. Aronson presenting an entirely different way of understanding the aging process.

So, I am very pleased [background music fades] to be able to present our topic today, the many stages of elderhood, what Americans, including myself, don't get about growing old.

In addition to Dr. Aronson's presentation, we're also going to look at ageism from the standpoint of the remarkable master plan developed by the California Department of Aging to take on ageism.

And, we're gonna look at the different stages of Alzheimer's, which I think will help change the way we think about and report on the issues of older adults.

Our experts today include Dr. Louise Aronson, University of California- San Francisco, professor in the Division of Geriatrics.

Dr. Aronson is also the author of "Elderhood: Redefining Aging, "Transforming Medicine, and Reimagining Life," which was a finalist for the Pulitzer Prize in 2020.

And, Dr. Barry Reisberg, professor of psychiatry at NYU Langone, McGill University, I'm sorry.

At NYU Langone Health, and adjunct professor at the Centre for Studies in Aging, McGill University, Montreal.

Now, I'm happy to turn the microphone over to our health editor, Sunita Sohrabji, who will be your moderator for today.

Sunita?

- Thank you, Sandy.

And, thank you to all the speakers and reporters who have joined us for this call today.

Why don't we begin with Dr. Aronson?

- [Dr. Aronson] So, I'm gonna talk about "Aging, Ageism, and a Better Way Forward."

So, how do we define ageism?

It's "a process of systematic stereotyping "or discrimination against people because they are old, "just as racism and sexism accomplish with skin color and gender," and this was defined in 1975.

Age is the key variable.

In 1975, Dr. Butler said, It "allows younger people to see healthier and frail people as different."

I would say this actually allows older people to see less healthy and more frail people as different.

We know that ageism continues into old age, and that doesn't do anybody any good because you're actually less healthy if you're aging.

If you have ageism, you are more likely to have earlier heart disease, more likely to have dementia, less likely to be happy in your life.

The Global Report on Ageism is pretty terrific.

It talks about how aging affects how we think, feel, and act about ourselves and others.

It talks about how ageism affects all of us at all ages.

I know I'm old enough now that I sometimes have ageist thoughts about younger people and I check myself.

But, just because something is natural and normal and we all do it, does not make it right, and we need to acknowledge the ways it influences our institutions, relationships, and ourselves.

This also from World Health Organization, "One in two people worldwide are ageist against older people."

That actually seems low (ahem) according to numbers I've seen in the U.S.

The economic toll.

Sandy talked about, you know, how we look at a politician's chronologic age; not their functional status, what they're able to do.

This happens.

For a Black woman, she is considered too young until she's 35, and too old once she's 40.

That gives her five years!

(Louise laughs) You know, if we are not hiring, promoting, encouraging people on either side of those five years, shame on us.

That takes a toll on society.

It clearly exacerbates disadvantages that come from ability, race, sex, gender identity, and everything else.

And, it affects us through life, as I said earlier.

So, given my time, I'm going to very briefly show you how this plays out in medicine, because that's where I come from.

In medical education, we spend about-?

It's a four-year process to make a doctor.

People usually get three to five months training on kids, and one to three, on very rare occasions, six weeks' training on older people, and the whole rest is on adults.

Older people are about 17% of the population, but 35% to 70% of people in hospitals and outpatient settings.

So, we do not train people to take care of the people they will be taking care of.

Medical research required the inclusion of women, minorities, and children in research in the '80s and '90s.

There was only a mandate from the government to include older people in research about diseases of old age, and diseases that affect older people in 2019.

That's ageism.

The healthcare system has hospitals for adults- this is my own institution- and hospitals for kids.

But, what does it have for older people?

It has something called an age-friendly health system, which just means that a few people at your institution think about whether an older person can move, think, what matters to them, and what medications they're taking.

If I were to show this more proportionally, it would look a little more like this.

You may see the tiny dot where the age-friendly health system was.

That's actually too big!

(Louise laughs) The proportion is so out-of-whack in how much more resources we give to adults and kids than older people that you literally could not see what we give older people.

In public health, you're not meant to be able to read this, but we give vaccines based on people's biology and social behaviors.

There are 17 subcategories for children, three for adults between the ages of 19 and 64.

And then, everybody age 65 and up is lumped into a single category, even though a child walking down the street would instantly see the physical and assume the social differences between a 64-year-old and 104-year-old.

So, this literally is not based on scientific evidence about our immune systems or our lives that has been available for centuries.

Again, at my own institution, we welcome all races, religions, countries of origin, sexual orientations, genders, ethnicities, and abilities, but we don't welcome all ages.

And part of me thinks, like, "Well, at least they're telling the truth, because institutions are ageist."

And, part of me thinks that ageism is so baked into our lives that even people who care deeply about diversity, equity, and inclusion, leave it out.

We're also, in medicine, not allowed to use words like "aged", "elder", "elderly", and "seniors", because they're associated with negative stereotypes.

So, we battle the language instead of what is causing those stereotypes.

We're only allowed to say the words "older adult."

Now, I am an older adult.

I have a 90-year-old mother, and she is just straight-up old.

In fact, lately, she is elderly.

Ontario Human Rights Commission did some great work on ageism.

And, what they said was, "From a human rights perspective, a lack of a sense of moral opprobrium"- so, moral outrage- "linked to old-age discrimination"- that there is this lack- "which in comparable circumstances "would generate outrage if the ground of discrimination were something else, like "race, sex, or disability."

Tough that we do so well on that.

So, "what if the greatest limitations of aging "come from our funding priorities, imaginations, and policies and not our physiology?"

I actually have a little more, but I recognize that I'm over time.

So, I am going to stop.

- Thank you so much, Dr. Aronson, and I hope you'll share your slides with our reporters.

There's such rich data there.

We move to Dr. Reisberg.

Dr. Barry Reisberg, who will discuss the Global Deterioration Scale.

So, welcome, and we'd love to hear about the GDS, and your comments on ageism as it relates to Alzheimer's.

- Okay, thank you.

What I'd like to do is describe the 16 stages very briefly (he laughs) in the course of this process.

And, you know, I'd be pleased to answer any further questions subsequently.

So, the first stage appropriately is stage one!

(laughs) And, that's a stage in which persons-?

We're talking about generally older people, but people at any age, have no difficulties either subjectively or objectively in terms of their functioning and thinking capacities.

This, in a large proportion of older people, is followed by a stage in which persons have subjective deficits.

And, functionally, the most common subjective deficit is that people begin to complain of not remembering such things as names as well as they could 5 or 10 years previously.

And, they also develop-- they also commonly complain of not recalling where they placed things as well as 5 or 10 years previously.

And, our research has shown that in otherwise healthy elderly people, this stage of subjective complaints lasts a mean of approximately 15 years.

When the condition advances, it goes on to a subsequent stage, and this subsequent stage is sometimes referred to as a stage of "mild cognitive impairment."

And, the clearest way to describe these stages is in terms of the losses in functioning.

And, in this third stage, there's a decrease in job functioning, which begins to become evident to coworkers.

And, at this same stage, people who engage in such activities may demonstrate difficulties in, for example, their ability to travel the way they formerly could, and they may get lost seemingly for the first time.

And, also at this stage- again, we're speaking about a third stage now- there's a decrease in organizational abilities in people.

And so, we have already mentioned the second stage lasting approximately 15 years.

Well, this third stage with decreases in job functioning, lasts a mean of approximately- and difficulties traveling and organizing, and so forth- lasts approximately seven years in otherwise healthy persons.

And as this condition proceeds, appropriately, persons go on to a fourth stage in which persons begin to have difficulties in performing complex tasks.

And this might include, for example, planning dinner for guests, and also very importantly, the ability to pay their bills properly and to manage their personal finances.

Also, at this stage, there's- in people who engage in such things- there's a decreased ability to market properly, to buy-- to go to the grocery store and come back with the appropriate items.

And so, this fourth stage lasts in otherwise healthy persons approximately two years.

And, as the condition progresses, persons go on to additionally require assistance in choosing the proper clothing to wear, given the weather conditions, given the events of the day.

And, that's the fifth stage, and that fifth stage lasts approximately a year-and-a-half.

And, as the condition progresses, it goes on to a sixth stage.

And, in the sixth stage, we're able to identify a series of functional losses.

A total of six successive functional stages and substages in this process; this process that we call Alzheimer's disease.

And so, initially, in the sixth stage, people begin to have difficulties in putting on their clothing properly.

They may literally put their shoes on the wrong feet.

They may have difficulty in buttoning their clothing.

Of course, as the stage progresses, more and more overt difficulties occur.

And, subsequently, and now we're in a stage that we have numbers and letters for all of these stages.

There's a stage subsequently where people begin to have difficulties in handling mechanics of toileting.

And so, what that means is that they may, seemingly for their first time, forget to flush the toilet.

And, as the condition progresses, it goes on to a 6d substage in which persons develop urinary incontinence.

And, this incontinence is initially occasional and it becomes more frequent without assistance.

And then, there's a substage in which persons become incontinence of feces.

In substages that I just described is the sixth stage of the disease is about 2-and-a-half years.

And, subsequently, as this process advances-- So, some people develop what's called "verbigeration", and they'll repeat words or phrases over and over again.

So, that they may say, "Okay, okay, okay, okay."

Again, they may repeat phrases over and over again.

(pauses) So, persons emerge in the final seventh stage with speech ability limited to only a half dozen words or fewer in the course of an average day.

And then, and that's the beginning of what we call the seventh stage, or the final stage and substages of Alzheimer's disease.

And, as the condition progresses, we can frequently identify the 7b substage where speech ability becomes limited to only a final single word in either a situation where you're asking the person questions over and over again and you're only able to get a single word.

And then, as this condition progresses, even that limited speech ability begins to disappear.

And, subsequently, with the advance of Alzheimer's disease, ambulatory ability is first compromised and persons need assistance with walking.

And then, ambulatory ability is lost and they can't walk without assistance, and the process goes on.

And, after the ability to walk is lost, the ability to sit up is lost.

And, what that means is that unless there are armrests on the chair, then the person will fall off.

But, if there are armrests, then they can still sit up.

And then, as the disease process progresses, the ability to sit up without assistance is lost.

And people subsequently lose the ability to smile, and they can only grimace.

And, in the final part of this process, persons lose the ability to hold up their head and their head falls down, and sometimes contractures develop and they can no longer use their head.

And, each of these substages in the final seventh stage of Alzheimer's disease lasts-- it varies; a year, a year-and-a-half, two years.

- So, Henrietta Burroughs?

Please ask your question of Dr. Aronson, I believe.

- [Henrietta] Thank you so much, Sunita.

When you were talking about DEI and equity issues, are there more women in nursing homes because they're discriminated against or because they live longer?

(Henrietta laughs) Or, is it that the men are kept more at home?

And also, do we really have to get frail as we grow older if we're weightlifting, taking supplements, getting enough exercise to keep our bones strong?

- So, the first one was-!

(Louise laughs) I was gonna say that stage two of Alzheimer's and menopause have a lot in common!

"Healthy aging" or "good aging" are terms, sometimes also "successful aging" was a term that was coined in the '70s.

Those have somewhat fallen out of favor for two reasons.

The problems with them are two.

One is if "successful aging" is the ability to, you know, do and think just as you did previously, we all fail in the end.

And, that seems like not a good way of framing old age as, like, the path towards failure.

The second and more important argument is that, as I mentioned, people have different-?

Are set up for "success", you know, or failure more so based on where they live, the color of their skin, their gender, their sexuality, et cetera.

So, what I prefer as a term is "optimizing aging", which means that you try to make it the best and most personalized, culturally appropriate experience, for the person, whether they are hale or frail.

Part of it is women on average live longer than men.

The other is that the majority of care, even today, is provided by women.

So, a female spouse is much more likely to care for the male at home than vice versa.

Although I will say over my career, I am seeing many more male spouses stepping up and sons stepping up.

So, we are definitely seeing progress there.

Being in a nursing home also correlates with poverty, and women make less money in their lives.

They also, previously, often did not work if they could afford not to.

But, the pension plans for men would have this small print that would make the man pick more money earlier, and then that would give his spouse less money once he died.

So, again, a structural thing that most guys didn't realize they were signing up for.

In terms of do we have to become frail?

I think I succeeded!

I got three-for-three.

I'm feeling very pleased with my brain!

Do we have to become frail?

(Henrietta laughs) If we live long enough, yes, we all become frail.

But, can you delay frailty?

- We have a question for Dr. Reisberg that came through.

You describe a process that goes on for, you know, approximately 20 years or longer.

At what stage, Dr. Reisberg, and I realize that this requires a little bit of editorializing, but at what stage do you see people still being able to participate in the workforce?

- Yeah, it is a 20 year process, or longer, as you say.

(pauses) Well, you know?

Of course, it depends on (chuckles) the kind of work that one is doing!

But, so we said that in stage two there are subjective deficits only.

So, people can see that they have a problem, but it doesn't have to affect what they do.

In other words, others are not seeing it.

And, in the next stage, of the stage of "mild cognitive impairment", stage three, things happen to people.

So, people may get lost for the first time, for example.

Now, does that interfere with their work?

Well?

At that stage, you know, coworkers begin to become aware.

And so, the question is, you know, is that a problem or not?

[soft background music] And, of course, that depends on the kind of work that one's doing and how delicate it is, and how much it-?

You know?

Well, basically that: how delicate it is.

And, again, in that third stage, you know, people may get lost and so forth, and that may precipitate a problem.

But, many people can go on working in that third stage.

As the condition advances, [soft background music] there's-- Well?

Again, it depends on the kind of work that one is doing.

- Sandy, any final remarks before we close?

- No, I just think the call to action is we have to think about very carefully how we cover ageism.

And now, I'm reluctant to use the word "older adults!"

(laughs) Just "older people."

It was very helpful.

Thank you.

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