: My name is Patricia Bloom. My academic title is that I'm an associate professor in the department of geriatrics at Mt. Sinai. It's actually called the Brookdale Department of Geriatrics and Palliative Medicine. But then my working title is that I'm the director of integrative health for the Martha Stewart Center for Living at Mt. Sinai Medical Center.
Question: What are some of the major issues elderly people face when it comes to sex?
: Some of the major issues are, I think, stereotype-y, especially younger people. I mean, there’s all kinds of jokes about that. Whatever... I guess I won’t cite the jokes, but just the humorous view that old people would be sexually active. But for older individuals themselves, I guess one of the biggest issues is having a partner because you know, if you know anything about the demographics of aging, it’s a predominantly female population. I think when you get to age 100, it’s about 10 to 1, I think, females to males. But even younger than that, you know women live longer than men. So for a lot of people who have lost their partner, just having a partner is a big issue. So that’s one issue.
Then I think what people think about mostly when they think about sexuality in the elderly is if you lose the ability to be sexually active, and that is an issue; for men it’s erectile dysfunction, and for women having other problems at night arise with the actual act of sex. But what’s interesting—first of all, there’s ways to deal with that, you know, now in this day and age there are numerous interventions that are very successful. There are erectile dysfunction drugs for one thing that have kind of revolutionized male sexuality in older years. I think education is important. I think for older people to understand that their bodies undergo certain predictable changes which might change the actual physical act of sexual intercourse, but which don’t preclude it. And sometimes just knowing what those changes are... for instance, for men, just that they need to have actual—they don’t get an erection just by thinking about things the way they might have in the past, there has to be actual physical stimulation, it can take longer. Certain phases of the sex act cycle are prolonged. So, I think more knowledge can be helpful.
But for a lot of older people, it’s really not the sexual intercourse part that’s so important, it’s really the intimacy. The ability to touch, to be physically intimate, as I said, to have a partner. So, there’s a lot of issues, but what’s interesting is that a lot of older people are interested in having some aspect of sexual expression, whether it’s intercourse or not. So, that’s coming out a lot more. I think the Baby Boomers aging are kind of throwing a whole bunch of things up in the air. You know, they are determined to do it in a different way and they don’t want to be that frail person that everyone thinks of when they think of getting older. So, they are really kind of pushing the envelope in terms of physical activity, staying healthy, aging well, and you know, being sexually active into late years is I think part of that. So, probably it’s going to just become more prevalent that older individuals are interested in being sexually active. Question: Does sex have the power to prolong a life?
There are actually some data that suggest that, for instance, men who have—and I can’t give you the exact numbers—but men who have two climaxes a week add so many years onto their life. I don’t know how good that research data is. It may very well be that men who are able to have sexual activity tend to be healthier, and therefore they live longer. But having said that, whether it’s true or not that having sexual intercourse a certain number of times gives you a certain number of years of life, I think it’s very true that the engagement, the social engagement, the interaction, the meaningfulness that sex and social engagement and being connected brings to life, that’s definitely been shown to not only prolong life, but also to greatly enhance the quality of life, however long it is. Question: How are aging and creativity related?
: I mean, certainly there are representative artists in all the fields who did blossom in later life. I think the ability to express one’s self artistically... again, it might be a worry and a question about social stereotyping, people might assume that people as they get older are going to decline in their capacity to be creatively expressive. So, if you talk to older actors about the ability to get roles in acting as an older actor, I think they would see that as greatly declining opportunity because our society has been bias against the older person in media and the arts. So, there’s a worry about being able to continue creative expression depending on the field that you’re in.
But having said that, with aging comes great life experience and there’s a lot of interest in what happens to brain function as people get older and a lot of worry about loss of memory and dementia. But there’s real data that wisdom that is something that is accrued with life experience, and so there’s that whole field of experience and wisdom which would kind of feed into creativity and the older person being able to manifest their life experience and their wisdom.
So I’d certainly like to believe that one’s ability to be creative and to grow... I mean, I think growing in new directions is kind of a hallmark of successful aging. So, some of the historically interesting figures who really aged well took up new forms of creative expression as they got older, like Grandma Moses, the artist. Albert Einstein I believe took up playing the violin late in life. And so, exploring new routes of creativity is one of the hallmarks of people who age well. Question: What can people do to maintain their memory function later in life?
: One of the most effective ways of keeping your brain function as you get older is to stay healthy in general. We know that, for instance, all of the risk factors that you hear about for heart disease, for instance, high blood pressure, diabetes, smoking, you know having an inactive lifestyle. All of those things that put you at risk in other realms of health are also risk factors for brain disease and Alzheimer’s disease. So, staying healthy... it’s all the things that you kind of wish you didn’t have to do because they’re not the easy things to do. We all want to be able to pop a pill and that’s going to preserve our memory, but it’s really eating a healthy diet, staying physically active. If I had to say the one thing that people really should try to do beginning in early life that will have huge payback as they get older is creating habits of physical activity. You know, being an active person. That’s just... I call it the real fountain of youth. It really is. Exercise has been shown to prevent many diseases that are associated with aging and it’s also been shown to really maintain brain function as well.
So, eating a healthy diet, staying physically active, continuing to be mentally and socially engaged. Continuing to be involved in whatever is your passion, to really be engaged with life. Those have all been shown to really promote preserved brain function.
We still don’t know what really causes Alzheimer’s Disease and that is just a subject of a huge amount of research going on. So, of course it’s true that brilliant people get Alzheimer’s Disease and, you know, it’s a very tragic disease. But if you look at the whole population, if people pursued healthier lifestyles, that would be a big plus in terms of preserving brain function across the population. Question: How does keeping active help?
: There is just reams of research data that prove that point, that physical activity is, as I said, it plays out as preventing many diseases. It’s a strong predictor of mortality. If you look at, and this has been shown in numerous research studies. If you look at people’s exercise capacity, how able they are to be vigorously active, it’s a very strong predictor for how long you live. And for each increment up on the scale you are for physical activity, the longer it would predict for your length of life.
The good news is that you don’t have to be a marathon runner. People get discouraged, they’re like, "Well I’ve been a couch potato all my life." But if you even go from the lowest quartile of physical activity to the second to the lowest quartile, you really improve your health status. And as I said, just a broad range of diseases, whether it’s hypertension, heart disease, colon cancer, depression, diabetes... I mean, I could read a long list, but all of those things are reduced in incidence in people that are physically active.
And I mean, that’s the tragedy too of what we’re seeing now. I really look at young people now, even kids. As a geriatrician, I’m really coming to see more and more that everything begins in early life. So, the fact that kids now aren’t active. They’re not going out to ride their bikes and explore the neighborhood. They’re sitting at home behind their computers. Which... there is some benefit there too, I think that modern day access to information is just remarkable. But kids not being physically active, recess being done away with at schools and the rate of childhood obesity is just terribly frightening. It’s considered one of the leading public health issues in this country, is the rate of childhood obesity. Because that is just going to play out into adults being obese. It’s already a huge number.
And it’s said that now, this next generation, as the Baby Boomers move into the elderly age group, it might start to be true that people start to live less long than their parents, and that’s going to be because obesity... which really a big part of it is that obesity will be leading to type II diabetes, and all of the problems with diabetes, and premature death.
So, you know, it’s really scary. So I kind of really applaud all of the efforts that are going on now too who try to turn that around. To reduce obesity, to get kids to be more active. I think that’s really going to be a key to what we’re seeing down the line in terms of the elderly. Question: What will be the recession’s effect on the health of Baby Boomers?
: Well, there’s a plus and a minus side to that I would say. I mean, yes, of course it’s a huge concern that, you know, the numbers are really frightening of what percentage of people have saved enough to retire. And now with the recession, it’s only added to that and people have seen what they thought was enough to retire on shrink. So, that’s all very worrisome and you know, the whole economic situation is a worry.
But having said that, I think that we’re going to come to think about work differently as people get older and older. And what I said earlier about engagement, for a lot of people they do find that in their work. So, personally, I think the ideal situation is if an older person can cut back in their work requirements, they’re not locked into that nine to five, you know, hectic lifestyle anymore, but that they do have the ability to pursue something that they find meaningful, and that might be in the world of work, or it might be outside of a paying job. But as I said, it’s a plus and minus type answer. I think some people are going to have to keep working longer, but the silver lining there is, if you have to keep working longer at something that is meaningful to you, that I think is actually good for your health. Question: How can yoga help promote healthy aging?
Yoga is really, I think, a great pursuit. First of all, it’s really beneficial physically and you probably know there are many different schools of yoga, so you can probably go down the block here to a gym where they’re doing power yoga, and it’s extremely physically taxing. Or a lot of people have a kind of idea about yoga. They see pictures of yogis in these terribly complicated pretzel-like poses and they just know that that’s just not for them. They could never do that. And that’s a certain approach to yoga, which I think is especially prevalent in our society because we tend to be very competitive athletically and we want to do those complicated poses. But the kind of true roots of yoga are yoga as a meditative practice, as I said, it falls under the umbrella of mind/body medicine because yoga is really a way of bringing the mind into focus. That’s how it originated. The ancient yogis developed yoga both as a preparation for sitting medication so your body would be able to sit for long periods of time, but they also conceived of it as a form of meditation. So, meditation really is just focusing your mind. So in yoga, you focus your mind on your body and you really bring your full attention to body movements.
But so the physical aspects of yoga are extremely beneficial. And we’ve seen that. We’ve offered yoga at the Martha Stewart Center now for about six years. And you would just be amazed at some of our patients who started with yoga quite a few years ago with us and we literally have people in their 70’s, 80’s, and 90’s who could barely get down onto the ground, they couldn’t get down onto the ground when they started, and they just enormously improved in their flexibility, their strength, their mobility, and they love it. It’s a great form of social engagement as well. So, it’s extremely good physically and there’s a lot of new and interesting research in a whole lot of different ways that yoga is beneficial. And you start to see yoga studies creeping in even to the conventional medical literature. Not very often, but if I pick up my Annals of Internal Medicine, which is the leading journal in internal medicine. I remember, I think it was last year; there was a study showing that yoga was more effective than standard physical therapy for low back pain, for instance.
So, there’s more research going on to document the benefits of yoga. I just did a small study with a great yoga teacher; her name is Nancy Elks, who was recommended to me by one of our lung specialists at Mt. Sinai. He said, "You know, my patients with emphysema,"—which is a terrible disease—he said, “One of them said to me, ‘You know doctor DePalo, I love you, but yoga has done more for me than all of you medicines have.’” And so he got interested and started referring his patients to this young woman, Nancy Elks, who I had the great opportunity to work with recently. We did a little yoga study on having people with serious lung disease, these are people with really pretty major league emphysema learn yoga techniques that helped their muscles in breathing and then importantly improved their strength and endurance, and they loved it and benefited. Question: What are healthy ways of dealing with the dying process? Patricia Bloom
: What has been true to too a great extent to conventional medicine—in this country, and I think in a lot of places—is that death is seen as the ultimate failure against which you fight with big guns all the way to the end. And we see that for a lot of people that’s not appropriate. I don't know what the experience was with the author's friend, but for many people, it becomes appropriate at a certain point that is most appropriately determined by that person themselves, or in conjunction with their loved ones and under the advisement of the medical profession when to make the transition away from the aggressive interventions and go more for quality of life, dignity, having a peaceful death.
But I think a really important point is that that line is different for every person. There was just an article on the front page of The New York Times the other day about a patient who was at Mt. Sinai and was one of the patients of one of our palliative medicine doctors, and the patient herself was a palliative medicine doctor. That is what was so interesting. And she herself, although she had been involved in the field of helping people make that transition... she herself found that she had to fight, to keep fighting for herself. She continued to pursue aggressive therapy up pretty close to the end, and so the important point was that that was her individual decision.
And so what some people might have taken away from the article was, "Well here was a palliative medicine doctor who wasn’t doing what she preached." That really wasn’t the message. It was the message that for every person, they should be empowered to make the right choices based on their personal preferences. But they should... I think it’s the role of people who are interested in seeing the experience of dying changed to a much, you know, better death. That’s a question: "Is there such a good thing as a good death?" And I think, yes, I have seen good deaths, and I think there can be much better deaths for a lot of people. So we have a long way to go, even relieving pain and suffering. We don’t do a good job of that. So, this woman’s friend, she may not have had adequate treatment of her pain. As the medical profession, we frequently fail in that regard. So, we really need to improve on people’s knowledge about and ability to relieve pain and that would change the face of dying as well. I think a lot of patients—and there’s great interest in assisted suicide, and that’s a whole big area of discussion. But it would probably be true that for a lot of patients who were interested in assisted suicide, maybe the point of that decision would change if they had better treatment. If they were more comfortable with the process that they were going through.
Recorded on April 14, 2010