All Episodes
Previous Next
March 28, 2019 - Dr. Oz Podcast
38:08
What Is the Aging Formula?

In this interview with Dr. Robert Butler, Dr. Oz discusses the link between our youth and the way that we age. Dr. Butler describes how our community can also affect the aging process and what we need to know. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

| Copy link to current segment

Time Text
Well, a significant number of older people, especially women, are living alone.
Alone.
And managing to do very well.
In fact, centenarians, it's quite amazing that 75% of centenarians, when you look back in their history, were still independent at 95 years of age.
So the ability to be independent is really quite striking among the older population if they've been reasonably sensible about the way they've taken care of themselves.
Hey everyone, I'm Dr. Oz and this is the Dr. Oz Podcast.
We'll see you next time.
Of course, everyone in my field of medicine knows Dr. Butler.
He's one of the fathers of the movement in geriatrics and caring for or thinking about the field of geriatrics among the lay public.
So most of us within the field are well versed in his work.
And so we've asked him to come to the studio today.
Thanks for joining us.
Thank you.
I generally don't spend a lot of time on the resumes of folks, but yours is so impressive that I thought I'd mention just a few points, just to get folks grounded in who you are.
From 1975 to 1982, you were the first and the family director of the National Institutes of Aging at the NIH. I grouped it as a very powerful entity now.
I didn't realize it was created that recently, and I didn't realize at the top of our panel that you actually created it.
You then created the first department of geriatrics in a U.S. medical school.
You co-founded the International Longevity Center, which is a policy research and education center.
You've got them all over the world now.
Again, reflecting the fact that these centers are in many countries that appreciate the importance of understanding longevity around the world.
And you wrote a book called Why Survive?
Being Old in America.
They won a Pulitzer Prize.
Now, there are very few physicians who write about health who win Pulitzer Prizes.
Were you surprised when you went to Pulitzer for that?
Was I surprised?
Absolutely.
It was the first day on the job as the new and founding director of the National Institute on Aging.
I'm talking on the phone with a journalist who's interviewing me about the first day on the job.
Right.
And suddenly he says...
You know, something just came across.
You won the Pulitzer Prize.
So, I'll never have another day like this in my entire life where you both have a great new job to create a whole new research enterprise and at the same time get a Pulitzer Prize.
Did you just ask for a raise?
The pay was not very big, considering the fact that you ultimately, like now it's a billion dollar institute.
And you know, these government jobs.
I think I got $75,000 a year or something like that.
It's a litmus test.
You're going to be dedicated.
Tell me about the book, Why Survive?
And then we're going to come talking about the longevity revolution, a book you've got coming out early in 2008. But why did you write Why Survive?
And what was the element of it that captured the public's attention?
Well, I was impassioned.
At that time, and to a degree still today, there were so many problems that made old age not exactly what you would aspire it to be.
Poverty, inadequate housing, the still unperfected Medicare, problems of Social Security.
There were just so many problems.
So I was really quite impassioned.
And I had a drawer full of material about each of the chapters, and I sat down and wrote the book with an advance, which allowed me to ask my patients to only call me if there was an emergency.
So I had a half a year to write the book.
At the end of it, when I turned it over to my editor, she said, well, you've told the public about a third more than they really need to know about this subject.
So at that point, I had to go back and practice.
So I had six months to cut the book down.
And get it back in shape, which I did.
And off it went.
What was the big takeaway message for the average reader of the book?
Well, it was really a positive book.
The title was intended to be provocative.
Why Survive, Being Old in America was simply meant to be a deliberate provocation.
But the answers were really quite positive, and the book ends on a positive note because it's filled with policy recommendations for improvements in nursing homes, improvements in Health care delivery, the creation of geriatrics, the need to have an astronaut, an agent which didn't exist when I wrote the book.
So it was a positive policy book, but surprisingly it seemed to resonate with the larger public than one would have thought.
So what's changed?
I mean, 30 years later, what's different?
Well, it's a little better.
We do now have a National Institute on Aging.
We now do have efforts to understand Alzheimer's disease, which really didn't exist until, forgive me, I don't mean to sound unhumble, but I decided to put it on the map when I had this incredible opportunity to start the National Institute on Aging.
And we knew that half of the people in nursing homes suffered from so-called senility.
And we knew that this rare neurological disease, which was the way Alzheimer's was defined, was really the same thing.
As the back war had seen outpatients, so we decided to put it on the map.
So that's happened since the writing of the book in 1975. There's somewhat less poverty, but there's still terrific poverty among older people, especially affecting women.
We still haven't solved the problem of long-term care, which, you know, today, before the day's over, we'll have 12,000 new baby boomers hitting 61, and they're beginning to see problems for their parents, and those that are a little more farsighted are beginning to realize they themselves might have some problems.
So we really need to have long-term care.
Let's go to that for a second.
What does long-term care mean to you?
I'm sorry.
Long-term care not only means institutional care in a nursing home, but for most people, they really want to live in their own home as long as possible.
So it really means the provision of home care, the opportunity to have first-rate, well-trained home health aides come into your home and assist you as needed toward the end of your life.
So...
Again, I'll be provocative.
I love challenging you because you actually have answers to these questions.
My family's Turkish.
There are no home health days in Turkey.
It's expected that you'll take care of your parents.
My father's joking Barb to me, which he still delivers periodically.
Have you picked up my nursing home?
And he's 82. He would never think of going to a nursing home.
In fact, I'm quite certain he would not survive very long if he went to one.
He's in good health, thankfully.
It's not an issue.
But it just would never cross anyone's mind.
Well, sometimes we give the American family a bum rack.
In fact, about 70% of all care of Alzheimer's patients is accomplished by the family.
It is.
The person stays at home.
That's great.
And you have to know that half of the people in nursing homes have no significant living family member.
And that about eighty percent of the people in nursing homes are women and they've outlived their husbands because women in general live over five years longer than their men in their lives.
And, you know, during the 1930s, during the Great Economic Depression in the United States, 20% of American women did not have children.
And 22% only had one child.
And they may not have all survived.
So what we're talking about when we talk about nursing homes is frequently people that really no longer have a significant family member and are largely women.
So, in theory, would that problem get better?
Because the boomers certainly were born with siblings.
They all survived, pretty much.
They all had children.
The boomers themselves may have a problem because they don't have as many kids.
But people like me, who fathered three boomers, are in really good shape.
I have four daughters, to be personal for a moment.
They're in touch with me all the time.
So I know I can rely on them.
But, you know, they themselves have two each.
So their situation may not be as promising as mine is.
And the nurse's aids movement that will theoretically provide some support, you don't have to actually be a nurse, you could just be a home health attendant, right?
You could be someone who's capable, caring, and able to go into a home, make sure there's enough food there, boil some water, and just take care of some basic issues around the home.
But it's tough work.
I mean, you have to lift the patient frequently, take them to the bathroom, clean their private parts, check the medications, make sure they're taking them on time.
It's not an easy job.
And these people are wonderful.
I've had personal experience with them, both professional and personal experience.
They're often extremely dedicated, hardworking, but they're not treated very well.
No.
They get very low pay, and the agency from which you may obtain that home health aid, let's say, gets $19.50 an hour, but the aid may get $7.50 or $8.50 an hour.
And they don't get health benefits.
So one of the main, not the only, but one of our major efforts in the International Longevity Center is to deal with the American caregiving crisis.
And we've had funding toward a $4 million effort.
Number one, to achieve certification.
Because many of these people in states like California, the only thing that's really checked is whether they have a criminal record or not.
Not their training level.
The second thing is we've been developing curricula, which will help train them so that they have a certain number of hours of real experience in numeracy, dealing with numbers, dealing with the use and way in which medications are given, and the other many efforts.
Number three is to give them a career ladder opportunity.
So we just had support from the Metropolitan Life Foundation.
We created with 12 colleges through a competition.
Opportunities for...
Often young people may not really have very many financial opportunities to go to a community college and become trained as an in-home health aide.
And we hope that will also give them a shot at becoming an LPN or becoming a registered nurse or...
Let's say they become fascinated with radiology, becoming a radiology technician.
In other words...
We want to give these people a chance for career development so they stay in the field of health and they become productive contributors to the aging of our country.
Just to be specific, because I've actually never thought about at this level of detail, does a typical home health aid visit one patient an hour?
Is it two a day?
Depends.
Now, under hospice care, they may get four hours of coverage for a family, but you're hitting Mehmet on a very good point.
Namely, frequently these people have to move, let's say, from one part of Queens, if they're in New York, to another part, but they don't get any portal-to-portal pay.
So they may spend a couple hours with one patient, an hour with another, and have a couple hours vacant in terms of any income whatsoever.
It's a tough job, and these people have big hearts, and a lot of them are wonderful people.
Speaking with Dr. Robert Butler, one of the fathers of the study of longevity and geriatrics in this country, I interrupted you.
You were giving me a short list of changes that have occurred in the way we think about older people since the publication of your Pulitzer Prize reading book, Why Survive?
Well, I originally described what I called ageism, which is the counterpart of racism or sexism.
That's to do with the prejudice with respect to age.
In fact, that's how I became interested.
I went to a wonderful medical school, Columbia.
Yep.
No wealth.
You have something to do with it.
No wealth.
But still, my professors, revered professors, were treating middle-aged women and older people like they were boring, and they called them crocs in those days.
And that's You know, I was just young enough and idealistic enough to think, this doesn't make sense to me.
I went into medicine to be helpful to people, and here my professors are referring to older people and middle-aged women with big, thick charts as boring, nothing patients.
So I got more and more fascinated by the nature of aging.
I became sort of dimly aware that they were growing in number.
So I decided I really wanted to understand what the heck aging was all about.
So ageism was one of the points in the book Why I Survive, and there's been some improvement since 1975, but we still have prejudice in the workplace.
We still don't include older people in clinical trials for medications that's not required by the Food and Drug Administration.
On any given day, there are twice as many people in nursing homes than there are in hospitals.
And yet that's a neglected part of medicine, which is part of my animus, part of my passion about the need to really introduce proper care of older people.
To just isolate over a million people in nursing homes without appropriate care and the meeting of standards, to me, is not conscionable.
No, not at all.
And I must say, we deal with it in the acute care facilities because they come back to the hospitals.
Yes.
And when we don't have a safe place for the patient to go back to, we end up with similar scenarios recently profiled actually on 60 Minutes where you're dumping patients.
Yes.
More questions after the break.
Any Pulitzer Prize book by a medical author about medicine is worth reading.
This one in particular set the stage for a transformation that's occurred over the last three decades in this country.
His new book, The Longevity Revolution, which is going to talk about some of the big myths that surround aging today.
And let me jump into that if I can a little bit.
Some of the big myths.
It is not true that longevity is an overwhelmingly problematic problem, much like a tsunami.
That is what I hear all the time.
The boomer's gonna hit.
It's gonna make a wave hitting our coastline.
It's gonna destroy Social Security, devastate other social programs.
We can't possibly keep up.
Why is that not true?
Well, the paradox is that despite this incredible human achievement that we gained 30 additional years of life in the last century due to folks like you in terms of the contributions of cardiology, the 60% reduction in deaths from heart disease to stroke, despite this great human achievement, there are the pundits, the politicians, and the economists who are gloomy.
How are we going to be able to afford all these older people?
Well, I think the most exciting single answer, and there are multiple answers to your question, is the findings in a variety of economics departments, including the most conservative, University of Chicago, Harvard, Yale, RAN Institute, the RAN Corporation, I meant, and the Belfast, and our own center, is that wealth is actually created by health and longevity.
When you look at nations that have a five year advantage in life expectancy, they are actually more productive and wealthier.
And that goes against our traditional thinking.
I mean, we think of the unsustainability of Social Security and Medicare.
But as a matter of fact, productivity is the real key.
And nations become more productive.
And the reason for that is the fact that if you follow the life of a child, if that child is kept healthy, they're more apt to be educated.
They don't have as much absenteeism in school, nor later at work.
And they remain productive longer in life.
So that in itself is generative of greater wealth.
And then, of course, there are the huge industries that have evolved around longevity.
Just as we had a youth market, we now have an old-age market.
Financial services, healthcare, pharmaceuticals, hospitality, travel, living arrangements, they all generate wealth.
So that's one of the biggest, I think, answers to the question, can we overcome this so-called tsunami?
How about Social Security?
I mean, that's, I think, a legitimate concern by our government leadership that we may not be able to pay a bill.
That's just basic accounting.
It is a legitimate concern, but it's doable.
And in fact, I would refer to David Walker as the Comptroller General of the United States.
That means he's head of the General Accountability Office and is a Republican and the appointee of President Ronald Reagan.
And he points out that Social Security is easily handled because it's predictable.
You know how many people there are.
You know the arrangements of the future.
So different from health care, which you and I know is much more complicated.
And that all you need to do in his formulation, to which I agree from our analyses, and I have economists who work for me, so I'm not just talking blindly as a physician, is if you were to bring up the wage-based tax From $97,500, which is the present basis for the wage-based, $250,000 a year, you would solve 60% of the Social Security problem.
To explain what I mean is that there's a wage-based bond which taxation is made.
It's the only tax in the United States where there's a ceiling.
We don't have a ceiling anywhere else.
So you gain 60% of the solution there.
If people work longer, which since they're living longer is not a bad idea, that generates huge increases of contributions to Social Security.
Should we bag the retirement age?
I think we already have.
As you may know, we moved it up from 65 to 67. There are discussions in Washington to move it up in accordance with any increases in life expectancy, or maybe even now up to 68 or even up to 70. And that would make a huge difference.
All I'm saying is the Social Security must be dealt with, but it's not an insurmountable problem.
Medicare is much more complex because all the time we have wonderful new innovations, more new devices, more new expensive medications, and it's not as predictable in terms of what the costs are going to be.
So much chronic illness.
Is so expensive.
Diabetes, for example.
As we predicted in a recent paper we wrote in the New England Journal of Medicine, we could wind up with children, marked children today, living less long than their parents because of obesity and diabetes.
I used to argue before Congress that Alzheimer's disease is the polio of geriatrics and the nursing home is the iron lung.
If we can solve Alzheimer's disease, we no longer hear the thump, thump.
Of the iron lung, do we?
No.
In the spring.
We don't have parents scared to death their kids couldn't go into a swimming pool.
So we've got to end this terrible disease, this affliction called Alzheimer's.
And so I think that those are the, to my mind, the kind of considerations that have not been given to the restructuring of our healthcare system.
We talk about the financial side, which we should, but we also have to look at structure, we have to look at health promotion, we have to look at a real investment in research.
I'm here with Dr. Robert Butler.
His institute has done a lot of the groundbreaking work, the International Longevity Center, in helping Americans, especially physicians like myself, keep up with what's going on in longevity research.
Let's talk about biomarkers.
One of the myths that you wanted to bust, if I understand correctly, in the longevity revolution was that we have valid ways of carbon dating you.
We have been struggling to find the blood pressure cuff, you might say.
The way of measuring fundamental biological changes in aging for a long time has been very elusive.
When I ran the institute, we devoted a huge amount of resources to try to figure out the biomarkers.
We haven't got them.
So the FDA doesn't really have a way of determining whether a putative agent that is said to interfere with aging can be demonstrated to be so or not.
Now we'll get there, but it's a hard struggle.
So before we get too carried away by what's called anti-aging medicine, for example, we have to realize we don't have a way of measuring aging at the fundamental level.
We do know, for example, that physical activity ability is well correlated with longevity.
We know that if you can't walk a quarter mile in five minutes, you're going to have a problem, odds are, within the next year or two.
We know that your ability to perform a stress test, not because it shows us that you have cardiac problems, but because it shows us you're able to exercise, is a harbinger of good short-term prognosis.
These are tools that we probably could use, but yet I see us...
Well, these are clinical measures of longevity biomarkers.
That is how long you will live.
Right.
But they don't speak to the underlying biology of aging.
But there's no question.
If you see a leukemic cell, it says something about longevity.
Yep.
If you see a VO2 max, which is a measurement of oxygen consumption...
And it's not good.
You know that's going to be related to longevity.
If you see excess cholesterol, similarly.
So we have biomarkers of longevity, but we don't have the underlying biological markers of what it is that predisposes us as a consequence of aging to so many diseases, like heart disease, Alzheimer's disease, and the like.
I must say I was intrigued at how little information is out there to help seniors exercise.
And I must say, as someone who's tried to teach their parents exercise, the only thing I can really get across is walking.
As soon as my dad tries something out of the ordinary, I get calls about the knee pain and whether we should, oh, you have a pedometer.
He's got his pedometer he's wearing.
So I do think we have more opportunities to build communities that make it easier for all of us, young and old, to walk.
I did a survey recently asking, we do these Hay House events on weekends.
We were in Washington this past weekend.
You know, Washington is a fairly urban area, but a lot of people who live in Washington are from rural areas.
And I had, there were, I don't know, 1,500 people, at least I think in the room, for our Hay House event.
So I asked everybody who had walked to school when they were a child to put their hands up.
And almost everybody, you can't tell for sure, but it was well over 90% of people put their hands up.
And then I asked them, how many of you have kids who walk to school?
You could count the hands.
They were very few.
So we built communities that make it almost impossible for us to stay physically active, which I'm very concerned when we look at longevity issues are important because when you look at the societies that live the longest, they seem to have, because they eat different foods in different parts of the world, but the one thing they seem to really share is a family unit, which we're going to talk about.
Let you and I start a national walking movement, getting people to walk together, families to walk together, neighbors to walk together, friends to walk together.
I've had now for almost 20 years a walking group in New York.
Oh, you do?
And, you know, we meet on either side of Central Park.
The east side is at 79th, the west side is at 81st, and, you know, we do five or six miles on Saturday and Sunday.
Now, during the week, we're all so busy, but we can use our treadmills or we can use other means to keep physically active.
But if we could get the country to walk, we would save a fortune in terms of health care dollars.
Not to mention the quality of life that would be advanced.
So let's start, you and I, let's start a national walking movement.
Done.
And then the other thing is to get people to do squats.
You know, the quadriceps is the best predictor we presently have of later life frailty.
And, you know, the number 12 cause of death of people over 65 is falls, for heaven's sakes.
So a few simple measures that are not expensive.
Which people can do themselves, but they have to get disciplined or they have to get motivated.
We could change the country.
I'm behind you.
You led the first time I followed.
I keep following.
Now, how about WARP? Here's the American Association of Retired Persons.
This is thought by many to be the most powerful lobby in Washington.
I know that the leader of the organization is solid people with a lot of good insights.
Yet you argue they're not as powerful as we think they are.
Well, it's a great group.
And they certainly have voting power in terms of their size.
But when you look at the numbers of the actual amounts of money that are made available in promoting policies or ideas, they're way down the ladder compared to banking, insurance, pharmacies, oil industry.
So in that sense, they have been overrated in terms of their power.
It's run by a very good man named Bill Novelli.
I think that the organization has genuine interests on behalf of older people, but I think that it's an exaggeration to call in the most powerful lobby in Washington.
Do you think that, whether it's through AARP or other governmental agencies, that we can make some of the large-scale changes that are required in our social structure to deal with a population, not just the boomers, but the fact that hopefully all of us will start to live into our 80s and 90s even, maybe even longer, depending on but the fact that hopefully all of us will start to live into our 80s and 90s even, maybe even longer, depending And as you've already highlighted, the acute death rate from heart attacks has gone down.
So we're actually becoming a country of survivors.
Yes.
Well, may I riff off what you said, because I agree with you completely, but one of the wonderful things to realize is that we have to have a lifespan perspective.
That the so-called diseases of old age were often generated at the beginning of life.
Not only the genetic things that you're born with, but...
You know, osteoporosis is really a pediatric disease.
You should lay down your bone when you're in pubescence and adolescence.
Or you risk, specifically if you smoke or drink too much or don't take any calcium in the rest of your life.
And we know that, unfortunately, if you have an autopsy on two or three-year-old toddlers, you may find atherosclerotic.
That's the fatty streaks already in the aorta.
So we really have to look at it from a lifespan perspective, not just in terms of aging, because it really requires us to be comprehensive in our view of what life is all about.
Kids will become old people.
Old people were once kids.
The unity and continuity of life is what's so beautiful, and the thing we have to understand.
There's lots more when we come back.
Walk me through, by the way, before I get into the old, old and young, old about this longevity paradox and how rapidly this change has occurred. old about this longevity paradox and how rapidly this change
Well, what strikes me is the fact that we have made this 30-year gain, and probably more to come in this century with genomics and regenerative medicine and adjuvants to the immune system and so forth.
Despite all that, there are all these gloomy people.
And that's the real paradox.
And that's what our book, my book, The Longevity Revolution, will deal with.
We'll also have a science section on the prospects for further longevity in this century.
Which is really quite real because we began to find ways to slow aging, not reverse it, not stop it, but ways to slow it.
But what are you most optimistic about in that arena?
Well, I think if we understand better the underlying basis for what's called caloric restriction, I mean, we can't, many of us, probably cut back 30% of our calorie intake and survive.
Not palatable.
But if we can understand the mechanism that accounts for why caloric restriction works, and that may be around genes that are called sirtuins and the development of a variety of possible medications like resveratrol, That we may find that we get both a delay in death and, perhaps even more important, a delay in the onset of diseases.
Well, if I understand correctly, a good portion of calorie restriction, which historically has been gained in rodent models by cutting down calories by 30%, is also obtained in mammals with maybe a 15% reduction in calories.
So maybe we don't have to be quite as extreme, and that might be achievable.
It might be, and there are now at three universities, at Tufts, at Washington University, in St. Louis, and at the Biological Laboratory in Shreveport, in Louisiana, efforts to examine people in relation to caloric restriction.
We still don't have yet the information on the studies in non-human primates, on monkeys, at Wisconsin and at the Pullsville Lab, but there are suggestions, what are called surrogate markers, That there may be a real promotion of a longer life and a healthier life among the non-human primates.
So, as you say, it could be.
It doesn't have to be quite as restrictive as it seems.
In the human studies, as you mentioned, the three universities, how do they actually do that?
How do they restrict how much people can eat?
I think they are a little bit moderate.
To me, it's not down to 1,500 or 1,700, but I'm not absolutely sure about this.
I should check my own data.
I think we're down to 1,800 and thereabout from the American diet, which is, as you know, is very heavy caloric.
So it's a reasonable, palatable diet.
And as I say, they're looking for markers that may be substitutes for the real thing.
Let me ask you a sort of provocative question.
What do you think is a rational life expectancy for us to expect with these advances that we are anticipating over the next quarter century?
If someone born in 1980, how long should they theoretically be allowed to live with some kind of confidence?
Well, that's a very scary question.
You know, the oldest survivor, authenticated, was a 120-year-old woman.
Yeah.
Ordinarily, though, those of us in gerontology say probably the maximal life expectancy is more in the range of 110 years.
And, of course, there is always going to be variation from the mean.
So that would mean, since we now have an average life expectancy combining men and women in the Western civilization about 75, that we've got 35 years to go.
So, I'm not that optimistic, but I do think that we may gain another 5 to 10 years within the next century.
You mentioned mean 75. What's the current difference between men and women?
Men live 5 years, 5.3 years less long than women do in the United States.
So, they're 73 and women are 78 roughly?
Women are almost 80, men are about 74, on average.
And of course, women tend to marry men a few years older than themselves, so in terms of the socioeconomic aspects, there's the likelihood of widowhood for more than just the difference in life expectancy.
Okay, now, young, old, old, old.
Well, the notion is that there's an increasing vital population of people used to be said between, say, 65 and 75. Now, to tell you the truth, I think it's more like 65 to 80 of the young old.
And then problems begin to more likely emerge between 80 and on.
But even at 85, 51% of people are still independent.
So we're beginning to see a loosening up of those older designations of young old and old old.
I can remember in practice in Washington, D.C., used to admit older people to nursing homes to 65. Is that right?
Yeah.
Now the average admission is 80 or more.
So it's a very different ballgame.
So they're living by themselves till 80 or they're living with their families till 80?
Yeah.
Well, a significant number of older people, especially women, are living alone.
Alone.
And managing to do very well.
In fact, centenarians, it's quite amazing that 75% of centenarians, when you look back in their history, were still independent at 95 years of age.
So the ability to be independent is really quite striking among the older population if they've been reasonably sensible about the way they've taken care of themselves, plus having a good gene pool.
Is there any benefit of getting older folks to live together?
I must say that just from personal experience, we had two older women in the family live together.
One had worked for the other, by the way, for years.
They both lost their husbands.
And they lived together for two decades, Lisa, three decades?
Long time.
And they've provided some support for each other throughout that period.
I would think that there might be partnering up opportunities.
I think partnering is terrific.
And you know, whether it's marital partnership or another kind of partnership, we know from studies of married couples versus single that married people live longer.
And probably some of it's practical, that is fetching a medication, preparing a meal if one of them is sick, taking them to the doctor, and some of it is probably the emotional tie of real strength.
I think even if it doesn't necessarily have to be two older people living together, it can be an older person in the commune with younger people.
Any kind of relationship, a social network, which is probably part of why women live longer than men, is that women, I think, do a much better job than men do in terms of intimacy, closeness, relationships, social support systems.
In the longevity revolution, the draft that we have so far, you talk a little bit about the baby boomer population being at this axis point, that they may be more unhappy in old age than their predecessors were, but they also have the opportunity to fix the system.
Yeah, I'm worried about the boomers because they haven't really focused yet, in general, on old age.
And, you know, half of them don't even have 401ks, and the half that do have about $40,000 saved.
So I worry about them financially.
I worry about their emotional preparation for old age.
And I worry because our system, our healthcare system isn't prepared for them.
As I've mentioned, we don't have an effective home care system.
People want to live at home as long as possible.
We don't have the kind of long-term care system we should expect.
We haven't solved Alzheimer's yet.
So my feeling is that the boomers, I hope, will suddenly discover that old age is an important matter for them and that they will help galvanize change.
And I think they may be the transformative generation but the beneficiaries may not be so much the baby boomers as generation X and Y. You mentioned Alzheimer's several times and you put a lot of emphasis on our need to be able to address that.
A lot of us within medicine see Alzheimer's not necessarily as polio but as cancer.
You know, a multifactorial process that's not going to have one magic bullet that treats it.
So what do you think the solution will look like for Alzheimer's?
Is it going to be a pill?
Is it going to be some preventive action, some toxin in the environment that we start to avoid?
What's it going to look like to you?
I think it's going to be a cocktail in terms of treatment.
The brain is so complex, and we have growth factors to deal with.
We have memory chemicals like acetylcholin to deal with.
So I think we'll wind up with kind of a cocktail dealing with many...
Of the neurotransmitters and neuroregulatory elements in the brain, plus growth factors.
It's going to be a complex treatment, I think.
How far are we away from meaningful change?
Because right now, when you go see a doctor to seek advice on Alzheimer's, we're often talking about marginal benefit and often a slowing of the process, not a reversal.
You're right.
I mean, the drugs we have now really deal with acetylcholine, which is the memory chemical, and trying to replenish it.
And it has marginal, modest, short-term effects, which is not to be sneezed at, but it's not where we need to be.
I always hesitate to make a prediction because 30 years ago, when I first articulated the need to study Alzheimer's disease, I was constantly asked by the media, you know, when will we solve it?
They wanted me to say five years or ten years.
And remembering what happened with the cancer war, I was very reluctant to make that prediction.
And I still am reluctant to make the prediction.
I think we're a lot further along.
Maybe we're on the 40-yard line, but we're not at the goalpost yet.
Let's talk about your childhood.
You were obviously living with your grandmother, I gather, from what I can tell in your biography, from a very, very young age.
How did that happen, by the way?
How did that color your thought process about geriatrics?
Well, I never knew my father.
My parents were divorced, and it was the depth of the Depression, and my mother was working in New York, and I was brought to a small community in southern New Jersey with my grandparents, grandfather and grandmother.
My grandfather died when I was seven, and that left an indelible mark in my life, and it was at that point that I decided I'm going to be a doctor, because I thought, you know, he's a great person in my life, and I thought, if there had been better medicine, why, maybe he would have lived longer, and I wouldn't have lost him.
So it was a selfish, narcissistic thing of wanting to keep my grandfather alive.
And there was this great Dr. Rose, our family doctor, with wonderful white hair and a terrific demeanor, and I'm going to be a doctor.
So even though we were very poor, that settled it.
And I diverted a little bit in college, at Columbia College, and I got a bit interested in history and journalism, but I caught myself in action.
I made it into PNS, made it into the Columbia College of Physicians and Surgeons, and I've never regretted it.
I've loved medicine.
I've never been so fortunate in my life.
I gather that, in part, colored your thoughts about how we treat the elderly.
Very much so, because when my grandfather died, and he'd always been very active, my grandmother was a real survivor.
And we were struggling in tough times.
I mean, this was a period in American history where 25% of working men had no jobs.
This was a tough time.
So we managed to...
I went to work very early, and she worked hard, and we survived.
I had a very positive view to older people and their survivability and their intellectual vitality and their willingness to be motivated and do things.
So what age do you think most folks start thinking about death?
Death?
Death.
I think people think about death almost all their life.
I think...
Unless they're totally able to commit, create terrific denial, death is part of what motivates at least a third of us, I think, to go into medicine, from some studies that demonstrate that.
And death is probably one of the motors and motivators to creativity, to leave a mark, to be contributory.
I think death is a very powerful force in human experience.
And finally, a tool that maybe everyone could use.
You helped create something called the Life Review.
How would folks actually be able to apply that to their lives today, the listeners right now?
Well, it's interesting.
The great movie director, Igmar Bearman, died.
And his whole life and all of his great films were all motivated by a review of his life.
He called it his door into childhood.
And all of his experiences motivated his creativity.
I think that it's very important for people to come to grips and come to terms with their past.
▲
Export Selection