The taboo of getting old

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Alessandra Graziottin, MD interviewed by Hans van der Slikke, MD, PhD

Hans van der Slikke, MD, PhD:  It is the end of February 2004 and we are at the occasion of the Aging Male Conference in Prague. I am very happy I can talk here with Alessandra Graziottin from Milan, Italy. She is a gynecologist, oncologist, sexologist and a beautiful woman and she talked today about the taboo of getting old. My first question, what does the word taboo mean?

Alessandra Graziottin, MD: It is an old word, it is a Polynesian word, and it was introduced to Europe in 1777 by James Cook. The importance of this word is that it indicates “the prohibition of the contact with sacred and impure things”. This is very important because when you get old, you may experience both these dimensions. On one side, the “sacred” perception of an healthy body is insulted by a number of deteriorations, impairing your mental and physical integrity, your self–image and self-esteem. You are no longer autonomous and, critical in terms of perception of deterioration, incontinence may further affect the integrity of your body. When an “impure” thing, like urine or feces, spoils the body, this perception of feeling dirty may become devastating. Consider that urine or fecal incontinence has two other psychological implications: the loss of the adult control on primary functions, perceived as an insulting regression to infantile behaviours; and the moral stigma, as “incontinence”, in its broader meaning, indicates the failure to control negative impulses and/or inappropriate social behaviour.

When people, men, become incontinent, urinal incontinence or bowel incontinence, this is the most insulting thing a human being can perceive. It is devastating also for the caregivers: this is perhaps why it is the number one reason for institutionalization in the elderly.

Hans van der Slikke, MD, PhD: So by this you mean, they put them away?

Alessandra Graziottin, MD: Yes, and this is very sad, but in a way we understand the burden on the caregivers in the family. So the very first message is that we should delay this moment, by improving the preventive measures, both in terms of lifestyles and specific medical intervention. The endpoint of our medical and social care should be to make the health expectancy as near as possible to life expectancy. In the western society, we are seeing that we are increasing the life expectancy but not paralleling increasing the health expectancy. We are therefore increasing the number of years in disease, sorrow, dependence, illness and deterioration, and this is very, very sad for our community and each of us.

Hans van der Slikke, MD, PhD:  What can we do about that?

Alessandra Graziottin, MD: First of all, I insist on prevention and prevention is lifestyle first. I insist with my female and male patients that we should take full responsibility for the quality of our aging, starting very, very early in life. This means little alcohol, no smoking at all, maintaining an appropriate body weight, having an healthy diet and daily regular exercise, and sleeping adequately. This from the physical point of view.

But, as well, I stress the importance of having a rich emotional life, say, to take care of friendship, to take care of love, to take care of family relationships, because they will nourish the core of our identity, the core of our sense of belonging to the community, the family community first and then the social community, and this gives meaning to our presence in the world. When we have meaning, we become less vulnerable to the aging process. I remember my grandmother, my grandfather: they maintained such a strong role and meaningful position within our family, respect, love, they were looking after their house until they died and they were rich in teaching, helping and comforting and they were such a reassuring presence, rich of wisdom and tenderness as well. If I have such a positive outlook on life and aging, it is certainly because I experienced with them how aging can be the season of life where fulfillness can be rewarding, both emotionally and physically. So, until and since we maintain this meaning, we are less vulnerable to the aging process.

The third attitude that I recommend is maintain is interest in the world in terms of cognitive interest, so reading, paying attention to what happens in the world, listening radio, being involved in the social life of our community. I remember my grandfather reading three newspapers and I learned to read very, very young, because I was following the titles in the newspaper staying with him. So such a wonderful memory will never abandon me and it was also meaningful to him because you have time, you can look after your niece or grandchildren and this is a passage of wisdom that is so important for the generations. There is a wonderful book I would like to quote by a Jewish medical writer, a physician, it is Kitchen Table Wisdom, by Rebecca Remen. It is so precious that we maintain the wisdom of sharing memories through the generations within the family, this will maintain meaning and sense of belonging.

The fourth approach that I strongly recommend, also because we have prospective studies published in the New England Journal of Medicine showing that this is very important in delaying physical and mental aging, is dancing. Why dancing? Because dancing has a number of complexities that help in our aging process. First of all, if you dance, it means that your mental processing speed is quite good, that your body is fit, and you have regular exercise. Further, dancing is usually done in couple and this means maintaining the little bit of courting, even if you are 70, but it also means smelling a woman, smelling this attitude of not only a body, but an attitude to life. And you have music. Music has such a powerful enhancing role in mood and in memory flashbacks. So if you combine together the motor competence that dancing requires, the mental brightness that it requires to coordinate your movements, the emotional side of the story because you relate always to a woman and the fact that you dance in a context of friendship, this explains why dancing until you are 80 and beyond, will, again, delay the perception of aging that is insulting you.

Hans van der Slikke, MD, PhD: Thank you very much. I would say, let’s dance.

Alessandra Graziottin, MD: Let’s dance, yes. This is a wonderful way to look at the future.

Hans van der Slikke, MD, PhD: Thank you.

Alessandra Graziottin, MD: Thank you.