The Human Odyssey

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The "Age 50 Effect" - A Shrunken Heart?

If you're 50 and you plan to give your heart to your honey this Valentine's Day, maybe you should first check to see whether it's gotten any smaller in the last year.  Researchers at St. Francis Heart Center in Roslyn, New York have determined that the human heart undergoes a particularly significant shrinkage around the age of 50.  Their study examined 218 normal individuals aged 20 to 80, who were free of illness, including any cardiac problems.  They used magnetic resonance imaging (MRI) to measure the size of the heart.  Dr. Nathaniel Reichek, director of the study, noted: "It has been recognized for some time that the heart chambers get smaller with age, but what pops out in this work is that there is an inflection point," he said of the 50-year mark, "where rapidly occurring change occurs."  The study leaves many questions, including whether or not it is possible to ameliorate this shrinkage through diet, exercise, or other interventions.  Still, for Valentine's Day, you might throw in a box of chocolates to make up for that extra cardiac shrinkage!

Midlife Crisis May Be Real After All!

In a Jan. 5, 2007 post ("Does Midlife Crisis Really Exist?), I shared information from the McArthur Foundation Research Network on Successful Midlife Development (MIDMAC), suggesting that midlife crisis was a relatively rare occurrence and that most people went through midlife just fine.  Now, however, a new study suggests that midlife crisis may be real after all.  In an article to appear in an upcoming issue of Social Science & Medicine, two researchers analyzed data from two million people in 80 countries, and discovered that depression is most common among men and women in their forties.  In fact, they suggest that happiness follows a U-shaped growth pattern, with young people and elders experiencing the greatest amount of life satisfaction.  It may be that during midlife, individuals feel regrets for not reaching some of their youthful goals (see my Dec. 24, 2007 post on "Lost Possible Selves").  In addition, many people often confront the deaths of friends or relatives in a significant way at this time of life.  However, with entrance into mature adulthood from age fifty on, people tend to embrace life once again.  "For the average person in the modern world, the dip in mental health and happiness comes on slowly, not suddenly in a single year," said one of the researchers, Andrew Oswald, as reported by Reuters News Service. "Only in their fifties do people emerge from this low period."

Concepts in Human Development: Lost Possible Selves

In Henrik Ibsen's play Romersholm, a middle-aged tutor named Ulrik Brendel brags to his friends about all the potential creative literary projects that he has inside of him just waiting to be let out.  But one day, he tells his friends that he has just come to a shocking conclusion:  "For five and twenty years I have been like a miser sitting on his locked money chest.  And then today, when I opened it to take out my treasure, there was nothing there.  The mills of time had ground it into dust. There was not a blessed thing left of the whole lot."  Brendel had waited too long to develop this possibility in himself.  Had he begun writing twenty-five years before, when the impulse to create had first impressed itself upon him, he would have over that period of time brought into realization his potential as a literary artist.  Now, however, he had to face what psychologists are calling these days a "lost possible self."  In the October 2007 issue of American Psychologist (a journal of the American Psychological Association), Laura A. King and Joshua A. Hicks write about how people deal with their lost possible selves in an article entitled: "Whatever Happened to 'What Might Have Been.'"  They note that many people have difficulty thinking about their lost possible selves because this often leads to regrets, distress, and a lowered sense of well-being.  These individuals pursue a strategy of not thinking about "what might have been" so that they are able to preserve a sense of happiness in life.  These individuals prefer to focus on the goals that they have chosen to develop in life, and to reap the satisfaction that comes from meeting these goals.  This represents one dimension of maturity in adult development.  However, there are other individuals who are able to handle more complexity in their lives, and these individuals can often reflect upon their lost possible selves and also experience a deep happiness in their lives, despite, or perhaps one might even say, because of, the difficulties and disappointments that they have had to face.  One mother in their study, for example, whose personal life goals were interrupted for a time by the experience of giving birth to a child diagnosed with Down Syndrome, said:  "I was on the road to self-discovery. . . . I was searching for a little more purpose. Being a mother, being a wife, being a nurse was not enough: I wanted to fulfill my destiny. I wanted to continue on the search for self actualization.  Well [my son] came along.  Everything was tested, values, beliefs, friendships, wedding vows, etc. Much growth, difficult growth, lots of confusion, but I am on the other side now . . . I am right back on track and could not be happier.  I'm stronger--I'm more experienced, and God knows, I'm much more compassionate and humble." (p. 630)   The authors of this study conclude that spending too much time focusing on what has been lost correlates to unhappiness, but for the individual who is willing to engage in an honest process of self-exploration, such disappointments concerning "lost selves" can serve as spring to a broader vision of oneself. 

If you are in your fifties, sixties, or beyond, take some time to reflect on one or more of your lost possible selves.  Perhaps you wanted to be a major league baseball player, a nuclear physicist, a surgeon, a best-selling author by the age of forty, a famous politician, a glamorous movie star, a world-class ballerina, or even less lofty but still significant goals:  reaching a twenty-fifth wedding anniversary, being the mother or father of happy and successful children, attaining the highest level at your place of work, maintaining perfect health into old age.  Perhaps you know now that it's too late, or simply not possible, to become that thing that you wanted to be so badly.  Are you willing to fully experience the regret of not having reached your goal, of not having fully developed this aspect of yourself?  And can you find a deeper meaning in this loss?  In a sense, losing a possible self is like losing a significant person in our lives.  We need to grieve this loss, but we also need to get on with our lives.  If we are fortunate, we can learn to view this loss as a deepening of our understanding of life's journey, and of how it has made us richer and more complex human beings.  The Germans have a word Torschlusspanik, meaning "the panic of closing doors," to refer to the process of freaking out when we realize it is too late to develop some aspect of ourselves.  Perhaps we need a new word that means something like "the wisdom that comes from closing doors."  The psychoanalyst and developmental psychologist Erik Erikson defined integrity in late adulthood as an acceptance of one's one and only life cycle as something that had to be (Erik Erikson, Identity and the Life Cycle, p. 104).  This encounter with our lost possible selves may help us toward this fundamental acceptance of life. And this, according to Erikson, makes it possible for us to face our death as well.

Medical Care Crisis Looming Up Ahead for Aging Population

I just finished this fascinating article that was in the April 30, 2007 issue of The New Yorker, on the looming crisis in care for the aged.  It was entitled (with a nod to Anthony Trollope) "The Way We Age Now."  Two things in particular struck my attention in the piece. 

First, was the observation that although the population of aging America is going to skyrocket in the next two decades, the practice of geriatric medicine is actually decreasing.  The number of certified geriatricians fell by a third between 1998 and 2004.  The reasons for this are very similar to the reasons for the decline in the practice of adolescent medicine in the U.S., an issue that I explored in a previous post:  income for geriatric medicine is among the lowest of any of the medical specialties and aging people are difficult to deal with (they complain a lot, their memories are bad, you have to be extra patient with them etc.).  A lot of work for little money.  But what's going to happen when there are millions of us needing medical care that recognizes our special needs as older people, and there are no doctors specialized in geriatric medicine around to fill the bill?

The second thing in the article that fascinated me was the observation that a geriatric doctor often pays more attention to small details than to big medical issues.  A case that was cited in The New Yorker piece was of an eighty-five year old woman who had glaucoma, arthritis, lower back pain, both knees replaced, high blood pressure, surgery for colon cancer, and a lung nodule that needed a biopsy.  What was important to the geriatric physician who examined her that day, however, was not these major medical problems, but instead what she'd been eating, what her feet looked like, how she got up out of her chair, and other relatively insignificant issues.  As the writer, a Harvard Medical School professor named Atul Gawande, pointed out, "The single most serious threat she faced was not the lung nodule or the back pain.  It was falling"  (p. 55).  The geriatric specialist was concerned with the quality of her daily life.  Without good feet, or the ability to get out of a chair easily, she could be only a short step away from a nursing home.  Without proper daily nutrition, social support, or nightly rest, she might lack the energy, interaction, or repose necessary to a functional life.

There was much else in the article that was fascinating (including a run-down of how the body breaks down as we age).  However, these two ideas - the fact that a shortage of geriatric physicians is in our future, and the idea that our lives as older people often hinge on small details - are worth pondering at some length.   

What's Wrong With Aging?

There's been so much in the news lately about anti-aging remedies from anti-wrinkle cream to human growth hormone that I just wanted to speak for the pro-aging side.  What's wrong with aging?   I see the faces of elderly people who have decided to deny their aging with chin lifts, botox injections, and facial implants, and I get this creepy feeling inside.  Why are they avoiding the natural wrinkles, creases, bumps, and sags that come with growing old?  I've always felt that there's something beautiful about the faces of aging people.  When I was a child, I'd see these photos of older Native American leaders in the National Geographic, and even at that young age I felt a deep beauty in their faces.  I'd look at the faces of my grandmother and great-grandmother (who I was privileged to live with for a year), and be in awe.  In some ways, I get the same kind of feeling when I look at ancient trees.  It seems that people in our youth-oriented culture have lost touch with the deep meanings that collect around being old.  It's as if they wanted to eliminate autumn and winter from the four seasons.  It's as if they were saying "let's get rid of the hideous autumn foliage, and withered leaves, so everything can be green all the time."  There's a life-denying quality to those artificially stretched cheeks and foreheads; a kind of tension there that wants to pretend time doesn't exist.  But it does.  What a great honor it is to be a part of this mysterious life process that unfolds, that has been unfolding for as long as there have been living things!

For some incredible photos of aged people, see the exhibition by Mark Story "Living in Three Centuries:  The Face of Age"

Young Adult with Huntington's Disease Gene Chooses to Visit Genetic Fortune Teller

In ancient times (and still today in many parts of the world) people consulted fortune tellers or astrologers to predict their future.  In the modern scientific era, however, people have stopped consulting the stars in the heavens, and instead are beginning to consult the genes in their bodies as a way of predicting their future lives.  A recent article in the New York Times, for example, talks about young adults who are choosing to take the test that will tell them whether or not they have the gene for Huntington's Disease (HD)  Huntington's disease is a rare neurodegenerative disorder that usually manifests itself in midlife and causes progressive loss of motor control, loss of intellectual faculties, emotional disturbance, and ultimately death.  The most famous individual who has had Huntington's Disease was the folk singer Woody Guthrie (see photo).  A child who has a parent with HD has a 50/50 chance of inheriting the gene, which means they will inevitably develop the disease.  The gene that causes HD sits on the short arm of chromosome number 4, where the letters of the genetic alphabet normally repeat C-A-G as many as 35 times in a row (C-A-G stands for the amino acids Cytocine, Adenine, and Guanine; these three amino acids along with thymine make up the alphabet of the DNA molecule).  In people who will develop HD, however, there are more than 35 repeats.  The more repeats there are past 35, the earlier the person will develop HD. A DNA test is available that will tell individuals whether they have the gene, and even when they are likely to develop the disease.  The New York Times article highlights a 23 year old female named Katharine Moser who chose to take the test.  Ms. Moser discovered that she has the gene with 45 C-A-G repeats, which corresponds to an ontset age of 37.  One of the reasons she took the test was to know early in her adulthood how to plan for her future life.  Before she took the test, she made two lists of life goals - one list if she didn't have the gene (marriage, children, Ireland), and one list if she did (exercise, vitamins, and ballroom dancing).  Opening a bed-and- breakfast made both lists.  One has to admire Katharine Moser's courage for being willing to find out about her future.  Many young adults thoughtlessly drink, carouse, abuse their bodies, and give little thought to their later development.  While she has, as she pointed out, only 12 years left according to the test, it's likely that these years will be fuller and richer than many individuals who will live far longer.  Kudos!  Blessings!  And also hope that a cure will be found during that time!

Lower Your Blood Pressure to Protect Your Brain

A new report in the journal Neuropsychology suggests that hypertension (high blood pressure) contributes to age-related declines in the brain and cognition.  They looked at two groups of adults:  one group remained healthy for 5 years; the other group either had hypertension at the start of the study, or developed it sometime during the 5 year period.  After 5 years, the hypertension group had twice the volume of brain abnormalities called white matter hyperintensities (WMH) compared to the control group (see accompanying photo which is not from the study but which illustrates the MRIs of a control brain and a brain with WMH). A larger volume of white matter hyperintensities is associated with cognitive decline, an increased risk of dementia, and accelerated brain aging, according to another study.  The authors of the Neuropsychology study write:  "Because vascular disease can be prevented, postponed, and ameliorated by established behavioral . . . and medical . . . means, recognizing its role as a modifier of brain-behavior relationships may be important in planning future interventions in cognitive aging (Neuropsychology, March 2007, p. 155).  So, folks, there's another reason to keep that blood pressure down through exercise, diet, stress-reduction, and/or prescribed medications!

 

Does Midlife Crisis Really Exist?

We're all familiar with midlife crisis from Gail Sheehy's bestselling book Passages, and all the references made to it in cartoons, self-help books, movies, ads, and jokes.  We've become so accustomed to thinking about midlife crisis, that many people cringe when they approach the age of 35 or 40, worried that they're going to be clobbered by the ravages of midlife madness.  However, research from the McArthur Foundation Research Network on Successful Midlife Development (MIDMAC) suggests that most people go through midlife without any great hoo-hah.  “Almost everyone over 40 claims to have it, or knows someone who surely has it, but I do not think more than one person in ten is experiencing a genuine midlife crisis,” says Orville Gilbert Brim, director of the MIDMAC project.  The findings from this research study suggests that for most people, midlife is not a crisis at all, but rather a series of gentler incremental changes that occur emotionally, socially, and physically over the course of several years.  For more information about their study, see their book How Healthy Are We?: A National Study of Well-Being at Midlife.