Dr. Mia talks with Dr. Rosanne Leipzig, a trailblazer in transforming the way we approach aging individually and as a society. In her 40+ year career, she has treated thousands of patients and trained hundreds of doctors and practitioners in all specialties of medicine. She is the Gerald and May Ellen Ritter Professor and Vice Chair, Emerita of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York City. We talked about her new book, Honest Aging: An Insider’s Guide to the Second Half of Life.
* Rosanne's inspiration for writing the book
* Ageism, both external and internal
* What is normal as we age and how to talk to loved ones about it
* How old is too old to hold public office
* Sex! No, older adults don't just stop having sex when they get to a certain age
You can purchase Honest Aging book from the publisher, on GoodReads, Bookshop, and Amazon.
Transcripts on www.miayangmd.com.
Opinions expressed are exclusive of Dr. Mia Yang and not reflective of her or guest speaker's employers or funders.
Ask Dr. Mia Conversations on Aging Well Transcript Ep.8
Welcome to ask Dr. Mia podcast, conversations on aging. Well, this podcast is for educational and informational purposes only and solely as an educational tool for your own use. Dr. Mia is not providing medical, psychological, or nutritional advice. You should not use this information to diagnose or treat any health problems or illnesses without consulting your own medical practitioner. For more information, including transcription, please go to miayangmd.com. That's miayangmd.com. And now our host, Dr. Mia.
Dr. Mia 00:36
Welcome to ask Dr. Mia podcast, conversations on aging. Well, today I have an internationally recognized geriatrician Dr. Rosanne Leipzig. She's a trailblazer in transforming the way we approach aging individually and as a society. In her 40 years plus career, she has treated thousands of patients and trained hundreds of doctors and practitioners in all specialties of medicine. She's the Gerald M. May Ellen Ritter professor and vice chair emerita of the Brookdale department of geriatrics and palliative medicine at the icon school of medicine at Mount Sinai in New York City. And today, we're discussing her new book called Honest Aging, an insider's guide to the second half of life. Welcome, Dr. Leipzig. Why don't you tell us a little bit about your inspiration for writing this book?
Dr. Rosanne Leipzig 01:33
Thank you, Mia. It's great to be here. I think my inspiration for writing this book is everything I've been doing for the past 45 years and probably before that. Okay. I grew up with my grandmother in the house, and she was a major influence on my understanding of aging and trying to understand what to expect as you get older. And that's really why I wrote this book wherever I go. And you probably have the same thing happen to you as soon as somebody hears what you do for a living, that you're a geriatrician. They want to know, is this normal? If it isn't normal, what should I do? Okay, and is there anything I can do about it? And I find it fascinating that there's no simple place you can go to and get that information.
Dr. Rosanne Leipzig 02:24
And there are many of us aging, and it's really important that we know it and that our doctors know it. So that's why I wrote the book.
Dr. Mia 02:33
And I'm so glad that you're the one to tell us what is normal and not because I find it sometimes hard to even distinguish what is normal versus not. I love how you wrote in the preface about what is normal doesn't mean that it's not a source of concern or that there's nothing to do about it. Can you tell us more about that?
Dr. Rosanne Leipzig 02:54
Yeah, I think that's a critical point. The way that you find definitions and dictionaries is more than 50%. Okay? And there are a lot of things that happen to over 50% of older people, but if you let them go untouched, they can cause trouble. So one of my favorite lines is, 90% of 90 year olds have high blood pressure. Okay. Systolic hypertension. It's kind of a shock to some people to have gone that long, and then all of a sudden, what do you mean? I got high blood pressure when I was in training. We did not treat that. We were taught that if we treated that, we would sink their blood pressure and cause a stroke.
Dr. Rosanne Leipzig 03:36
And then a few years later, studies were done that showed that people have 30% fewer strokes and 30% less heart failure if their systolic blood pressure is treated okay, even if they're 80 and 90. So I think we're learning a lot about that, and we need to recognize that it can be common, it can be normal, and it still may be something that can harm you. The converse is also true, though. It can be normal, and it's okay. So I get people who come in to see me really upset about their pot bellies, and I'm like, sorry, that's part of normal aging. You have a shift in the distribution of fat in your body. You get a little pot belly, and you get flabby arms, and there's not a whole lot you can do about that. I guess you can do liposuction, but in general, there's not a whole lot that you can do about that.
Dr. Mia 04:32
Yeah, and I think the changes in our bodies, we're always changing. But I think particularly as people get older with ageism, just such a dominant, underlying influence in our society, I find that there are a lot of people who don't necessarily accept that they are aging and are incredibly upset, that their bodies are almost like betraying them in some way.
Dr. Rosanne Leipzig 04:57
I think that's true, and I think part of it is the way that we have conceptualized aging, that it's a decline. And yeah, you lose a lot of things, a lot of things that are very important to you. Sometimes you lose people, you can lose work, you can lose your environment. Things change, but you also gain a lot of stuff. And I think we don't emphasize that the most. I mean, I will be 72 soon. And one of the things I like the most about this is I'm saying what I'm thinking a whole lot more that's a gain. Okay, I'm not putting it in. When people have looked at this, there's something called the paradox of aging, which is that older people, even though they have all of these losses, are far less likely to have negative outbursts. Not that they don't.
Dr. Rosanne Leipzig 05:51
Okay, don't get me wrong. I can get just as mad as everybody else, but it doesn't last as long. And whether that's that I have a perspective that says there's not that much time, it's not worth it, or I've learned things over the years that have taught me better ways to deal with this, I'm not sure, but it seems quite true. So I think we need to get a societal shift at how we look at getting older and that it's just another piece of the puzzle, another stage that we're all going to be going through.
Dr. Mia 06:23
Yeah, because the alternative is to die young. Right. Which nobody wants either. What general principles would you suggest to some of the folks who listen to this podcast who are dealing with either themselves or older adults in their lives, who are having difficulty thinking of aging as something to gain and are really stuck on thinking of losing all the things that they used to do or friends that they are lost or the work that they have spent decades doing. What kind of advice would you have for those listeners?
Dr. Rosanne Leipzig 06:59
It's tough to change somebody else's view of the world. But I think one thing that is very helpful is to let people know that they're role models for you in certain ways. And I do that with my patients a lot because they are, they don't think of themselves that way. But what I hear is what they're doing and how they're spending their time and the volunteering that some people do with their family members. It's really amazing to me and I think the thing that we all have to recognize is that we've been given this gift of 20 to 40 years where the kids are gone, the work is over, you can reinvent yourself and try to think about this as a second chance instead of just what you've lost. So I think that's really important.
Dr. Rosanne Leipzig 07:51
I think another thing that's important is putting yourself in the shoes of whoever it is that you're talking to because it can be tough. And a lot of these issues are hard and there are areas of conflict, particularly in families. I want to protect you, I don't want you to go out by yourself because you might fall and hurt yourself. On the other hand, if you're not going out and you're not having a life, then what's the purpose? I've kind of come up with this way of thinking about growing older is working to have a more engaged and meaningful life for me, that's what I want to do and I think that's what a lot of people want to do. It's hard when we have these perceptions that you're on the last rung.
Dr. Mia 08:41
Yeah, that's not a very motivating thought by any means.
And it's not real, most people get to old age in very good shape in this country, and even if you don't, if you're open and creative, you can still have a very good old age.
Dr. Mia 08:59
Well, I wonder, how are you planning on reinventing yourself in your second stage of life? I know I'm going off script a little bit.
Dr. Rosanne Leipzig 09:10
I'm working on that right now. The pandemic, I think, changed all of us in terms of how we think about work and what we're doing and all of that. It came at a quote, unquote, good time. I mean, there's no good time for a pandemic for me because I was writing the book. And it gave me a chance to really do that while still doing my responsibilities. And it gave me the ability to see a future for myself where I didn't do the work that I had been doing for 40 years. It gave me a chance to realize that I could step aside and allow a lot of other people to move up the ranks and do the work that they wanted to do, and probably in a much better way in this day and age than I was doing it.
Dr. Rosanne Leipzig 09:59
So it allowed me to think of myself a bit more as a mentor, as a role model, if you want to use that. And it made me realize that a lot of my work has been on the individual level. And that's what this book is. It's really for individuals to figure out for themselves and their loved ones what's normal, what's not, and what you can do about it. But that's only a piece of the problem. We live, as you mentioned, in a society that is rampant with ageism. I mean, if you open your eyes to it, you will see it constantly, okay? And getting rid of that, changing that takes a number of things. It takes changing the way that we portray older people everywhere. But, we also have to recognize that aging is not a solitary activity.
Dr. Rosanne Leipzig 10:52
We have a very independent spirit in this country. Lift yourself up by your bootstraps and all of that. Independence means different things at different times of life. And when you're a teenager, it means doing everything by yourself and not letting your parents help. All right? But when you get older, you really need to reframe what independence is. And so what I started doing is reframing it for myself and for others as doing whatever needs to be done so that I can have that engaged and meaningful life I was talking about. So whether that means wearing hearing aids, which I do, and I love them, okay?
Dr. Rosanne Leipzig 11:31
Or it means taking classes or doing volunteer work or whatever, it also means trying to get society to recognize that this is not an individual problem that we have to have, not just services that people get, whether they deserve them. They don't deserve anything like that. It's all our responsibility. It's our responsibility to build a world where you can age safely and have as good a life as possible. So just as an example, there's a New York City aging task force. They go around and they talk to different neighborhoods about what are the problems, what keeps you from being able to do what you want to do. And one of the things that they came up with was that New York people don't drive. They use buses and subways. And it's really hard to use buses and subways as you get older.
Dr. Rosanne Leipzig 12:26
And one of the problems with the buses was that people didn't want to wait in the bus shelters. One, the bus shelters were opaque, so nobody could see what was going on inside. And number two, they had benches where people could lie down. And that made it feel very uncomfortable for a lot of older people. So what did they do? If you come to New York now, you will notice that it's translucent and that the benches have seats, they have bars, so you can't lie all the way down. The other thing that does is to help an older person get up from sitting because sometimes you have to use the arms of the chair. So that makes it much easier for people to use the bus or to want to wait for the bus. So I think we need to think outside the box, about ways that we might be able to improve life for everybody.
Dr. Mia 13:19
Yeah, that's such a great example of going to the person who is taking the bus and asking what it is. That's the barrier to not taking the bus and restructuring our environment in ways that help everybody. Because I don't think younger people like to have an opaque bus stop either because you don't know what's happening. Is it safe? Is there someone hiding behind there? Yeah. So it benefits everyone, not just older adults.
Dr. Rosanne Leipzig 13:47
Right, exactly. And I think that's the other thing. People think it's an entitlement type of thing, whatever we do for older adults. And I don't think that's true. I think it does as you're saying, it benefits the society as a whole.
Dr. Mia 13:59
Yeah. Well, coming back to the book, I was really impressed by the level of detail and diagrams and just kind of nonsense, simple way of explaining things that you have put in. And I love that you have divided each chapter into what is normal, what is not normal, ways to seek more help and I think you also have specific sections for loved ones who are in the aging journey with the older adult and what to do based on your 40 plus years of experience. So I was just so impressed because I feel like there really isn't any other book out there that puts things into such simple and easy to understand terms. I think it's really empowering for the readers.
Dr. Rosanne Leipzig 14:51
That's actually my purpose. I think that particularly as you get older, most older people have to change doctors. The doctors retire, they die, they become concierge. Whatever they're doing, they're stuck going to somebody new and then there's the question of what's my relationship there? And I think the more empowered you can be to know what's going on with your health and what might help, the better it will be for you. And I also think, as you know, there's a lot of information in geriatrics that is relatively new. We didn't know a lot of this. I mean, when I started, we taught everybody the same five things, okay? Whether you were a patient, a student, a resident, an attendant. And as time has gone on, we've really learned a lot of things about what's different about 80 year olds from 60 year olds, for example.
Dr. Rosanne Leipzig 15:50
And I think that's the kind of thing that it's important that our doctors know whether they're being taught it or not. So you as a patient, can bring in some information and some questions that help your doctor recognize what might be going on with you.
Dr. Mia 16:07
Absolutely. And I still think that unfortunately, a lot of healthcare practitioners still think of a 65 year old the same as an 85 year old, and those two could not be more different.
Dr. Rosanne Leipzig 16:19
Absolutely. And 85 year olds can't be more different from each other. Okay. I mean, some are in incredible shape and some not so much. I mean, we see this playing out around us with Biden's question if he's going to run again. And I think that's a great question. It's a great way for us to start thinking about our own ages. You might not want to vote for him because you don't like his policies. You may not want to vote for him because you want somebody in office who is going to be around for most of the results of what the policies are. You might want someone younger for that reason. But is there a reason not to vote for him because he is 80 years old and will be 86 should he be reelected? And I did a lot of thinking about this. I don't think there's a flat answer because we don't know who he's running against either.
Dr. Mia 17:16
Dr. Rosanne Leipzig 17:17
But I do think we as a society have to start recognizing that looking, quote unquote, old is not a terrible thing. It seems to be the one thing that you can still make fun of. If you look at the late night shows on TV, they show some of the older congress people and how they're walking. Well, that's normal for older people. You walk more slowly. You are a little pitched forward. Oftentimes you have a senior moment. So if you're going to elect someone who's 80, you have to say, this is going to happen, and it's okay. We're not talking about having a stroke. We're talking about the normal things that happen as people get older. And then you have to talk about the possibilities. Yes, it's more likely that something will happen with his health when you are 80 than when you are 50.
Dr. Rosanne Leipzig 18:09
That's real. And they get physical exams every year and now the question is, should there be some sort of a mental competency exam? And I don't know what that would be. I know some hospitals have started doing that. My friend Mary tonight just told me she had a two hour one at Yale. Okay. I asked her if she passed.
Dr. Mia 18:34
Well, that's kind of scary because I don't think we really know. Like you said, an 85 year old. I call them snowflakes because they're all a little bit different. Just like geriatricians, roles are all a little bit different. To come up with norms of what an 85 year old should be able to do, I think that's incredibly challenging.
Dr. Rosanne Leipzig 18:56
I think it's very challenging, and I think what's even more challenging is what matters to hold that position. I mean, I want to know that you're competent to reason, but I would ask that of anybody who's running for president. I'm not sure that we need to say it's only people who are 75 or 80.
Dr. Mia 19:13
Right. I mean, there are some younger people who are not reasonable, right? Oh, man. Well, politics can be a taboo topic, but I like to transition to another potentially taboo topic, which is sex. And chapter 16 of your book is, quote, unquote, the Sex Talk and I know as a clinician myself, I have some hesitancy to bring this up with my older adults, and I'm sure my patients have some difficulty in bringing this up to their doctors. What advice would you tell our audience in terms of empowering them to bring things that are not working for them up for discussion?
Dr. Rosanne Leipzig 19:55
I think it's really important that we as a society recognize that older people can still have sex if they want to. And I think we have a lot of difficulties with that. I mean, you see it over and over again when adult children have to deal with another marriage for their parents. And it's like it's really hard. Okay. My parents had been dead for a long time. I used to say they had three kids, they had sex three times. That was it. So I think it's something we have to get more comfortable with. So that's one, two. I think things are different. And so if you're not having the kind of sexual experience, whether it's by yourself or with someone else that you used to have, it's really something you should talk to someone about. And there are many reasons. There are physiological reasons.
Dr. Rosanne Leipzig 20:57
You need stronger stimulation as you get older. You get stimulated less by thoughts and visions than by actual stimulation. There are positions that are just not comfortable. You may need a lot more lubrication than you did. And it's okay not to want sex, too. I mean, I read somewhere that if sex was important to you when you were young, it's going to be important to you when you're older. If it wasn't so important, it probably won't be so important. So I think it's important for you to figure out what's normal for you. I was just looking at stuff that talked about things that people did for the first time late in life. And so they were talking about the writers who got their first books published at 70 and all of this.
Dr. Rosanne Leipzig 21:49
And there is a guy who became a woman at age 90 after his wife died who he had taken care of for years, and he loved her dearly, but he felt like he had never been able to be his true self. And at 90, he transitioned. I think that's pretty amazing when we talk about second chances and what you can have in your life that you didn't have before. So I think it's just really important to be open. And for older people, the world is much different than it was when we were younger in terms of dating and mating, what's acceptable, what's talked about is just a whole new world, and it's something that people might want to try and should be encouraged if that's what they want.
Dr. Mia 22:33
And I think you said you even have an exact question in here that says, I haven't dated in 45 years and it's a whole new world. How do I start? And your answer was plenty of places to meet some new people. Local book club, church, synagogue, fitness center, senior center, senior travel program. All of those are really great places. And you're never too old to fall in love. I think that is probably one of the harder challenges for loved ones to get used to, is having known your parents or grandparent, being with the same spouse for so many years, to suddenly quote unquote, now they're interested in someone else. That's quite a change.
Dr. Rosanne Leipzig 23:17
And I think it seems abrupt because people are thinking of how long they would have together. So long engagements are not the norm, at least among my patients.
Dr. Mia 23:28
Right. They're not waiting around.
Dr. Rosanne Leipzig 23:30
No, not at all.
Dr. Mia 23:34
What advice would you have for, say, older adults where their parents do want to explore their sexuality or date again.
Dr. Rosanne Leipzig 23:46
I think you need to think of them as adults and not your parents. What would you want for somebody you care about who's not your parent? You would want them to have companions. You would want them to not be lonely, to have someone to share things with. And if they want to have sex. To have sex with.
Dr. Mia 24:05
Right, yeah, that's very true. Because we're all human and our parents are not human just because they're parents.
Dr. Rosanne Leipzig 24:11
That's right. Although to us, right.
Dr. Mia 24:15
They can't possibly be human. They're my parents. Right, exactly. Well, anything else you would like to add for our listeners? Obviously get the book. Where can people get the book? Honest Aging and anything else you wanted to add, Rosanne?
Dr. Rosanne Leipzig 24:31
Well, it's on, I think, a number of websites, of course, Amazon, but some of the other I think it's on GoodReads, if I'm not mistaken, and bookshop, just to give some chances to our independent bookstores and I think the only other thing I could say is, whatever age you are, try and look forward to the next years of your life with delight as something that could surprise you. You have no idea what could come in if you open yourself up to it. I have had patients who, sadly, I can think of one in particular. She just stopped. She was an acting coach. She was marvelous. She still had students who cared about her, but she wasn't getting the 18 she used to get, and she just stopped. It wasn't worth it anymore. And she lived another 15 years, but she didn't do anything.
Dr. Rosanne Leipzig 25:57
I mean, she really got herself a bed in a nursing home. Okay. It was just in those days, it was a lot easier and then I compare her to this guy who's a patient of mine who is now 95, who says, life didn't start until he was 80. He had a wife who was ill. He cared for her for many years. She died. He didn't have the greatest of jobs. But then he got in the match. He met this woman who was a writer. He started writing plays, and became a poet. Okay. She unfortunately died. He got back in the match. He met somebody else who he's with now. He's doing computer stock, chain exchanges. Okay. He's just having a wonderful life.
Dr. Rosanne Leipzig 26:13
And I'll tell you, he has had more coronary stents than probably anyone in the world because he can tell each time there's something wrong. He's got his own cardiologist. He goes in, he gets a stent, he comes back out, and for the most part, he goes back to where he was. So I think its attitude is so important. Don't sell yourself short and don't sell your parents short.
Yeah, absolutely. Mindset is so important. I think that's really the difference between people who are doing extraordinary things and living life to the fullest versus people who have sold themselves short. In some ways.
Dr. Rosanne Leipzig 26:54
They do. One of my lines that I say to everybody is, never say never. You have no idea what's coming. And with my patients, as I say in the book, I have like a six month thing. For many of them, I suggest something. No. And about six months later, we came around to it and we tried it out. Doesn't always work, but we try it out.
Dr. Mia 27:13
Yeah. That's great. Well, thank you so much, Roseanne. And for everyone listening, please go get honest. Aging and insiders guide to the second half of life. Take control of your health and well being by Dr. Rosanne Leipzig. Thank you all.
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