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As a PhD student of Clinical Psychology of the scientist-practitioner tradition, I am trained in the art and science of psychology. The art being clinical practice— the science being the research. Of course, and ideally, the primary purpose of this scientist-practitioner model is to produce clinicians who are consummate researchers and researchers who are also consummate clinicians. Because a good psychological science is one that studies what it practices and practices what it studies.
Few are actually scientists and practitioners in the pragmatic, material sense though. The more likely story is that many find their niche either clinic-zing or researching and eventually settle into one camp or the other. I’m not claiming that there aren’t a few half-breeds—I am (almost) one of them—who identify as equal parts scientist and practitioner, but I think we’re probably a growing minority for a host of reasons (post forthcoming). This is all to say, throughout my training, I’ve interacted with aging in both clinical and empirical ways—and these modes of interaction have yielded fascinating insights into the subtle, but real, ageist properties of both.
Youthanized Science
The inherently multidisciplinary nature of geropsychology differentiates it from other forms of applied clinical psychology. In many respects, competent gerospcyhologists must also be competent physicians, pharmacists, dietitians, and physical therapists in ways other psychologists are not expected to be. To illustrate, geropsychologists are uniquely positioned to help older adults with behavioral issues in maintenance or improvement of health and the treatment of sleep disorders— or to help elders achieve pain control and manage their chronic illnesses with greater adherence (APA, 2010). Though there are considerable individual differences in them, an intimate understanding of the biological changes accompanying aging is requisite for practicing geropsychology competently. It is useful for the psychologist, for example, to be able to distinguish normative changes of aging from non-normative changes – to determine the extent to which an older adult’s presenting problems are symptoms of physical illness or the adverse consequences of a medication.
Therefore, to practice competently—and I’d argue ethically—geropsychologists must survey and integrate various (often disjoint) health research literatures. Except it appears that these literatures may not be representative of older adults.
Most recently, the American Heart Association, American College of Cardiology, and American Geriatrics Society released a scientific statement on knowledge gaps in cardiovascular care of the older adult population (Rich et al., 2016). Their findings—however disheartening—were also largely unsurprising: despite the large impact of cardiovascular disease (CVD) on quality of life, morbidity, and mortality in older adults, patients aged 75+ have been markedly underrepresented in most major cardiovascular trials, with virtually all trials excluding older patients with complex morbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility (Rich et al., 2016). Consequently, there appears to be a pervasive lack of evidence orienting clinical decision-making in older patients with CVD, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients—like quality of life, physical function, and maintenance of independence.
We see similar empirical paucities in the areas of sexual and mental health among older adults—with only a handful of recent work recognizing sexual (dys)function (Lindau et al., 2007) among older adults and even fewer acknowledging the incidence of HIV in later life (Emlet et al., 2010). Further, there is an equally scare number of studies addressing the efficacy of specific therapeutic modalities (i.e. CBT) for late life depression and anxiety (DiNapoli et al., under review).
Undoubtedly, the reasons for gaps in this and other gero-relevant health areas are probably complex. Though nearly doubling adult life expectancy is an unquestioned triumph of the 20th century, a consequence is that science has only just recently begun to the study the stuff our own biology once precluded. Another reason is that there are few academic gerontological programs, and even fewer medical residents pursuing geriatrics as a specialty. This unique underrepresentation of gerontology both academically and medically has— to me— inevitable, intuitive implications for the data we aren’t seeing.
The obvious question is: What other factors explain these gaps in science and practice?
The not-so-obvious question is: Why do these gaps exist and persist?
Rest assured, I don’t doubt that as scientists and clinicians we are attempting to ask and answer questions about human aging. But the psychologist in me can’t help but to think that something deeper, more insidious may be operating here.
Critical language awareness
My graduate cohort includes students studying to become, among other types, child and geriatric psychologists. This is important because the lexicons—specifically, the verbs used to describe human growth over time— that are inherent to these perspectives reveal interesting but inconvenient truths about the biases of psychological science.
Forgive for a moment the intellectual detour. In linguists, critical language awareness refers to an understanding of the social, political, and ideological aspects of language, linguistic variation, and discourse (Romy, 1990). Implied in this understanding is the assumption that power is reproduced through language, and that it is insufficient to discuss language without considering why certain language is preferred and who makes that decision.
Following from this, it is interesting to observe how child and geropsychologists use language that subtly but surely leverages the power—the cultural ideal—of youth. I’m not so sure—however benign it appears—that this assignment of adults to aging and children to developing is so benign. Why are adults sentenced to the constrictive decrements of age—and youth—to the expansive promises of development and maturity?
To be sure, whenever undesirable physical and psychological experiences are coupled with youth, it is typically because they are strategically weaved into conversations about growth. What seem to be inconvenient signs of aging for adults appear to be developmental opportunities—almost blessings— for everyone else. For me, these gaps in research, practice, language—in all of it, are symptomatic of a youthanized culture, a youthanized science.
As a gerontologist- in-training, this strong proclivity towards youth is at once incredibly fascinating but terribly counterintuitive. By almost every measure, humans experience most of life’s good stuff—increased happiness, intimacy, financial security, overall stability—in later life (Carstensen et al., 1992). And yet it is youth, in all its awkwardness, naïveté, confusion, and uncertainty that wins the day. Young good; old bad.
But whether this is true or not—good or not—is of no material concern to this argument, which is: the youthanization of science happens subtly, but surely.
It happens when we measure outcomes of decline, disability, and depression when could just as easily (and surely more interestingly) measures constructs of thriving, resilience, and perceived usefulness (Pierpaoli & Parmelee, 2016). It happens when older adults are systematically underrepresented in clinical trials in spite of their disproportionate consumption of prescription drugs and therapies. Or when Western science questionably extols the benefits of feeling younger (vs. older) (Uotinen et al., 2005).
It happens—perhaps most insidiously—in the language we apply (or don’t) to our work and practice. When we discuss adults’ aging, but children’s development—the growing pains of adolescence, but the deterioration of age. It happens when we shirk discussions of sexual health and safety with older adults. Or when we describe older adults in infantilizing terms—as precious, adorable, or cute — terms that reinforce dependence vs. generative-based models of aging.
De-youthanizing science
These observations are made, not necessarily to be critical for the sake of being critical, but to remind us that context matters—that the questions and practices of science are contextual. As scientists and practitioners, recognizing that our processes cannot be truly teased apart from the social context in which they incubate invites us to examine—and when necessary— attempt to modify that social context.
So, again, calls for a de-youthanized science are not lofty, liberal political appeals; they are attempts to actually purify gerontological science and practice. A de-youthanized science means a more valid, generalizable science—a science, for example, that adequately samples older adults in the service of providing sufficiently evidence-based recommendations for diagnosis and treatment. A de-youthanized science means inching a declinist, medicalized model of aging toward a kinder, more accurate paradigm recognizing both the gains and losses of later life. Because if we recognize later life as a just another developmental period—rather than a cul-de-sac—we enlarge our repertoire of questions, improve the validity of our observations, and grow our arsenal of empirically-supported treatments for older folks.
References
American Psychological Association [APA]. (2014). Guidelines for Psychological Practice with Older Adults. American Psychologist, 69(1), 34-65.
Carstensen, L. (1992). Social and emotional patterns in adulthood: Support for socioemotional selectivity theory. Psychology and Aging, 7, 331–338.
Clark,R. (1990). Critical Language Awareness Part I: A Critical Language Awareness Part I: A Critical Review of Three Current Approaches to Language Awareness. Language and Education, 4(4), 249-260.
DiNapoli, E.A., Pierpaoli, C.M., Shah, A., & Scogin, F. (under review). Effects of home-delivered cognitive behavioral therapy (CBT) on anxiety symptoms among rural, diverse older adults.
Emlet, C.A., Tozay, S., & Raveis, V.H. (2010). “I’m not going to die from the AIDS”: Resilience in Aging with HIV Disease. The Gerontologist first published online July 22, 210 doi:10.1093/geront/gnq060
Lindau, S., Schumm, L., Laumann, E., Levinson, M., O’Muircheartaigh, C., & Waite, L. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357, 762–774.
Pierpaoli, C.M. & Parmelee, P.A. (2016). Feelings of Usefulness to Others Predict Active Coping with Osteoarthritis Knee Pain. Journal of Aging & Health first published online April 22, 2016 doi: 10.1177/0898264316645549.
Rich, M.W., Chyun, D.A., Skolnick, A.D., Alexander, K.P., Forman, D.E. […] Tirschwell, D.L. (2016). Knowledge Gaps in Cardiovascular Care of Older Adult Population. Journal of the American College of Cardiology, 67(20), 2419-2440.
Uotinen, V., Rantanen, T., Suutama, T. (2005). Perceived age as a predictor of old age mortality: A 13-year prospective study. Age Ageing, 34, 368-372.
