Nov. 4, 2003

Advancing an Alternative Perception of Aging

By Rachel Muir

The dramatic increase in life expectancy — from 47 in 1900 to 76 today — along with the advancing age of tens of millions of baby boomers, expected to double the number of Americans aged 65 and older in coming decades, are forcing the nation to confront a host of issues related to aging. It’s necessitating a rethinking of not only the health care and social networks to care for the elderly but also of the expectations and assumptions about aging — who older Americas are and their limits, abilities and possibilities.

“Society is at a sea change when for the first time in history we are seriously considering what is possible with aging,” said Gene D. Cohen, director of GW’s Center on Aging, Health & Humanities. “There is no denying the problems that can accompany aging — what has been denied and under-recognized is the potential.” It’s an imbalance that the center’s scholars are working to correct.

Founded in 1994, GW’s Center on Aging, Health & Humanities spearheads research aimed at understanding and accessing potential in later life for the benefit of older individuals, their families and their communities. Key to the center’s approach is creativity — whether it’s examining the impact of cultural arts programs, challenging literature’s stereotypes of the elderly or developing interventions for Alzheimer’s patients.

The center, which operates out of Iona Senior Services in DC’s Friendship Heights neighborhood, is part of GW Medical Center’s Department of Health Care Sciences. While its full-time staff numbers only two, the center collaborates with faculty across the University as well as with government agencies, including the National Institutes of Health (NIH), and nonprofit organizations, such as the American Association of Retired Persons.

Cohen, who also holds the position of professor of health care sciences and of psychiatry and behavioral sciences at GW, is no stranger to the field of gerontology. He served as the first chief of the National Institute of Mental Health’s Center on Aging and acting director of the NIH’s National Institute on Aging. Cohen also has authored the book “The Creative Age: Awakening Human Potential in the Second Half of Life,” which upon publication in 2000 sparked international interest and appearances on Good Morning America, CBS News, The Today Show and others.

Dealing with Dementia
Sufferers from Alzheimer’s disease experience a progressive loss of self, finding it increasingly difficult to remember their personal histories and to communicate. Friends and family members can unintentionally accelerate patients’ downward spiral. Cohen explains that relatives’ fairly typical feelings of discomfort and anxiety during interactions with Alzheimer’s patients result in less frequent visits, causing further isolation for patients — not to mention feelings of guilt and helplessness on the part of family members.

To help ease these interactions and to maximize the ability of dementia patients to recall their histories, the center developed intergenerational “biographical interventions.” One approach uses video biographies that families create with the help of volunteers. The biographies are filmed in what Cohen dubs “Ken Burns fashion,” with running commentary over old photos and images.

The idea, Cohen explains, came from his own search for a way to connect with his father, who suffered from Alzheimer’s. While his father remembered little from recent decades, his 1930s stint in the Navy was far more lucid. Cohen filmed old photos and simulated a boat rocking on the waves, tapping into a “pocket of memory” for his father and evoking a rare emotional response.

The center also has developed a therapeutic board game that uses biographical flash cards developed by families with volunteers’ help. The cards, which come in categories such as people, places and animals, have photos on one side and questions on the other. The center has made more than 30 each of the games and videos.

The interventions can’t — and don’t try to — stem the progress of Alzheimer’s. Instead, their main goal is “to create more interaction,” said Michael Lewis, executive coordinator of the Center on Aging, Health & Humanities. He adds that the process of creating the tapes and games can be therapeutic in and of itself for family members, who, rather than feeling helpless, are able to “do something.” And they leave families with ways to remember their loved ones.

The reception from relatives has been overwhelmingly positive, said Cohen. “In the words of one family member, ‘The biography and game development for Alzheimer’s disease helped bring our family together as the disease was tearing us apart.’ ”

The interventions earned the center and Cohen the Society for the Arts in Healthcare’s 2003 Blair L. Sadler International Health Arts Award (First Place) for “measurably improving the quality of the health care experience for patients, families, visitors and staff.”

Arts and Aging
The center has teamed with the National Endowment for the Arts to document the effects of cultural programs on older persons’ physical and mental health. The project examines the experience of older Americans in three cities — DC, New York and San Francisco — who participate in structured creative arts programs, including singing, painting, poetry and drama. According to Cohen, it goes beyond previous studies by assessing mental health and social functioning outcomes in addition to physical ones.

The preliminary results, said Cohen, have been impressive. The data point to maintenance of health and functioning in the groups that participated in the cultural activities — considered significant given the participants’ average age of 80 — and lower rates of depression and loneliness than in the control groups.

As an illustration of the cultural programs’ life-altering potential, Cohen cited a 94-year-old woman who approached him after a concert she performed in and exclaimed, “When I started this program, I wasn’t sure I could keep up. To my astonishment and great sense of satisfaction, I find I can do both — well. And now all I want to do is go, go, go!”

“The empowerment this woman felt led to further independence, in the process, lowering risk factors in her case for long-term care,” said Cohen. He adds that the structured cultural activities studied not only provide a sense of empowerment but their sustained, interactive nature also enables participants to form meaningful relationships — another factor key to mental well-being. Final results won’t be available until 2005, but Cohen said many in the field feel the study is on course to being a landmark one.

‘A New Era of Fairy Tales’
As part of a new project, the center is counteracting what Cohen dubs the “wicked, weird and weak” portrayals of older people in children’s literature. From wicked witches and the “old as the hills” villainess of Hansel and Gretel to Cinderella’s stepmother and Rumpelstiltskin, older characters in fairy tales — the few times they do appear — are depicted negatively.

Even in more modern literature, grandparents are often depicted as frail, bun-wearing, cane-toting octogenarians when the reality is that most people become grandparents in their early 50s, far ahead of their twilight years.

To provide an alternative to these portrayals, the center has partnered with the American Library Association to develop a reading list of 100 books for children pre-kindergarten to sixth grade that highlights positive images of older people. The center expects the list to be made public by the spring of 2004 and distributed through schools, public libraries and Web sites. Lewis cautioned the list isn’t an effort to replace fairy tales, rather its purpose is “to present a more balanced picture or even to introduce a new generation of fairy tales.”

The list is the first initiative of a new GW-based research program named the Program for Societal Education About Aging for Change (SEA Change Program). According to Cohen,the lack of positive older role models in children’s literature is evidence of a greater dearth of public education about aging for children — a gap that the SEA Change Program hopes to bridge.

It’s all part of the center’s multipronged efforts to recognize and harness the promise of aging for the benefit of older Americans and society at large. “Not to understand potential and possibilities with aging is to undermine the motivation of older individuals to participate in programs that will promote their health and independence,” said Cohen. “Similarly, this lack of understanding interferes with creative community planning and social policies that could improve the quality of life for older adults and their families. The research and programs of the center are designed to increase our understanding of what is possible with aging as well as how to help it happen. In so doing, we hope to enhance both individual and societal strategies for improved aging and intergenerational relationships.”

Send feedback to: bygeorge@gwu.edu