Christina Pierpaoli || Aging Meaningfully

Christina M. Pure Pali on the show today. Christina is a third year graduate student in the Clinical Geropsychology doctoral program at the University of Alabama under the mentorship of doctor Patricia A. Parmali. Her research explores associations of chronic illness with psychological health and older adults, and she is, by a lot of accounts, a rising star in the field of psychology. Thank you for chatting with me today, Christina. Thank you so much Scott for having me and for

the gracious introduction. Oh my pleasure. I really excited to talk about your research today because you're doing some really fascinating work that we haven't highlighted yet on the Psychology Podcast and probably is just underrated work in psychology. In general, would you agree with that statement. I would agree that it is underrated, that it's poorly understood, that it's embryonic,

and that it's riddled with all sorts of stigma. I think people are very, very uncomfortable, especially in the United States and perhaps generally, talking about aging, because a conversation about aging necessarily invites a conversation about mortality and finite noess. But you know, probably more practically, we've nearly doubled the human life span over the past century, and so we are now able to study the things that our own

biology once precluded. So part of it is a social reluctance to discuss aging, But the other part of it is that we just haven't had a lifespan long enough to study until very recently. Yeah, you make a lot of really good points. Certainly old people. If I may say, what's the most political correct I think that's a great question. And there's actually a lot of debate about this. The old people not like being cold old people. It's like,

like what do they want to be called? So typically in the literature and in the discourse, we say older adults, something that's totally out of vogue and is the equivalent of committing an intellectual faux pas is referring to someone as an elder. I didn't do that, or elderly. You didn't do that at all, and in fact, I'm really impressed that you asked. And geriatric. Just referring to someone as a geriatric is perceived as a bit uh derogatory.

Sometimes people call me a geriatric, not like my students, and I'm like my thirties. One day, one day they will have more perspective. But in general the term is older adults or just adult. Yeah. Adult. I don't know when I'll ever become an adult. I don't know either any day now I'm hoping. Yeah myself, Well, you're interesting you study this, but I've also read some of your blog posts, your articles in this, and you're very you get personal in some of your articles. It seems like

you personally don't really have a fear of aging. Is that right? I have a curiosity about Yeah, that's what I get. I get more of like an intellectual curiosity. Then it's an intellectual curiosity. But to deny the anxiety around aging, I don't think I think is dishonest. I think it's something that is inevitable, and it is something

that does require contemplation. And I argue that the earlier you think about your aging, the earlier and more often you think about your own more time, the more gracefully you will live your life. I think young adults sort of have the permission to develop and mature, and for some reason, older adults have to age. It's that sort of language is very interesting. When we say that people are aging, I believe that we're sort of confining them to this sort of cul de sac where they cannot

emerge towards new and exciting potentials. And yet younger people can develop and mature, which suggests that there's room for growth and expansion. And I think that that is a linguistic, subtle way through which we propagate our fear of aging. I am not afraid of aging because I think I think about it, and because I am exposed to older adults all the time. And we know that through exposure, just mere exposure, we are able to deconstruct our anxieties

and stereotypes about ideas or out groups. Yeah. I mean that's just a fundamental lesson of life. The more you expose yourself to people that you fear or that seem so different from you, the more you realize they're really not that as different as you think. Well, right, it's sort of outports contact hypothesis, you know, the idea that under specific conditions, continued and positive meaningful exposure to an outgroup or an other deconstructs the discomfort that we bring

to the initial interaction. And I actually think that, and this is consistent with the gerontological literature, both the geropsychological literature and the gero sociological literature. Most people who elect or self select to go into gerontological vocations actually cite having very positive, meaningful early experiences with older people, grandparents, great aunts and uncles, even older parent and such as mine, who have sort of modeled the beauty and privilege of

human aging, you know, not the tragedy of it. I really like that framing of it. You know. I work in the field of positive psychology. You can almost see a field of called positive geropsychology. Yeah, yeah, well maybe you've heard of this. I'm sure you have. Or Carstensen is an esteemed geropsychologist at Stanford University, and she is actually credited with conceptualizing the idea of socio emotional selectivity, which is the idea that is, time horizons decrease naturally

among older adults. Cognitively, they are more likely to bias positive experiences in stimuli. And so the idea is that they realize that time is a scarce resource, and so how are they going to spend it? Are they going to spend it worrying? Are they going to spend it seeking out the approval and appraisal of their peers. No, They're going to spend their time fostering relationships, exploring new things,

creating meaning. And what we actually see is that among older people, their social networks actually begin to prone or to get smaller, because they become more discriminating in the sort of relationships that they maintain in foster in later life, if the relationship is negative or it's draining, they prune them out. Because wait, that's so interesting. So have you looked at this within like nursing homes, Like the social

dynamics of nursing homes. Like if you're like ninety years old and they're sowing, you don't like they'll just say screw you, right, I mean, like, what do you have to lose? What do you have to lose. I don't exactly. I don't want to essentialize here, but that's essentially the spirit of the argument is that I don't have time to waste on nonsense. My life too short, I don't

have too much time left. I ought to be doing the things that make me happy, the things that add meaning to my life, the things that are substantive and exciting, not the things that are draining and superficial. For sure. So there's a geropsychology, but you're actually in clinical geropsychology. So do you see patients. Do you actually see older

adults as patients? I do. I do, And so geropsychology, just as a definition for our listeners, is essentially the psychology of aging, and more specifically, clinical geropsychology is working with older adults clinically to assess, diagnose, and treat. And so in the service of that training, I work at a geriatric in patient hospital where we're dealing with severe

mental illness. But the patients who come to the clinic are presenting with a catalog of things, you know, anxiety and depressive symptomology, but most of them are coping or trying to manage their own aging process. Many of our patients have recently retired or considering retirement, have lost spouses, have had children move out, and so a lot of it is transitional and meeting making work, oh yeah, which is what we all go through through in our lives.

And there's kind of like a unique meaning making that happens towards the end of your life. What are some of the unique issues that older adults face that the younger adults do not confront as head on, so to speak. That's a great question, and I'm a bit reluctant to answer it because I think this is part of the issue. I think as a culture, we tend to otherise older people that what they go through is something that I

cannot qualitatively understand because they are different from me. And the truth of the matter is, you know, Scott, you're aging and I'm aging, and we've been aging since the day we were born. Only young people are allowed to develop and mature and older people have to age. But to answer your question, there are some obvious differences that we do need to recognize. For example, your body, your

body changes, you become more disabled with time. Deep interest of mine is every day quality of life with rheumatic diseases like osteo arthritis, and how knee pain and chronic disease like obesity affects necessary and discretionary activity patterns, And so older adults have to cope with losses physical losses, arthritis, chronic disease, pain, macular degeneration, hearing loss. These are the things that not only affect them physically, but also affect

them socially. For example, if you can't hear your loved one, or if you can't see anything, you're less likely to engage. So these are things that older groups tend to have to manage more often and more seriously than younger people. Another unique struggle is changes in cognition. You know, for example, older adults tend to have poor working memory. As people age, their fluid intelligence tends to decrease or their ability. But so even though there are these losses in certain domain,

we have to recognize that there are gains. So cognitively, for example, older adults will school you in terms of crystallized intelligence, in terms of understanding the world, facts, semantics, wisdom, experience. There's no vocabulary, there's no competing with older adults there. I mean, you don't see like ninety year olds on Jeopardy, probably because they're too physically impaired to make the trick to California. If we could do it remotely, I'm sure

we skype. We should skype a whole have Skype Jeopardy. I totally I love the idea. Well, I talk at them in from the nursing homes. Yeah, I bet they would school everyone. Oh and also just psychologically and just effectively in general, we get happier as we age. There is good research to support or to suggest that being a twenty something being a thirty year old is actually really uncomfortable because it's wrought with financial insecurity, relation instability,

vocational ambiguity. And as you get older, your relationships are more solidified, you are more financially healthy, you tend to have a better understanding of yourself and of your preferences. And again the socio emotional factor, the idea that time is scarce and you really need to be discriminating in the experiences that you're indulging. I really like that. If I may ask how old are you, well, I am

twenty five. I just turned twenty five. I asked this specifically for a reason because I want to ask you what is your subjective age? Yes? I knew you were going to do that. I am very interested in subjective age or felt age, and it varies. I'll tell you mine, yeah, tell me yours. How old do you feel right now? Twenty five? Yes? Why do you feel twenty five? And based reading your blogs, you say you feel older? I bet you feel my age. I'm older my whole life.

I know, I know you've said that. You've said that, God, I'm an old soul. Well, sorry, what do you ask me? Though you asked me so. No, I just asked you what your subjective age was and you shared it with me just twenty five? You know, I think I feel my age. I feel twenty five, but I do you look twenty four? If I may say, oh okay, I'm flattered, thank you. I like to get cheeky on the psychology podcast I did. That's why I love it. So it

really depends, you know. The literature suggests that subjective age actually increases when your health is poor, so there's an inverse relationship generally between your subjective age and your physical ability, for example. But I actually find the opposite. I find just anecdotally that I often and feeling my best when I'm feeling older, when I'm feeling wise and smart and prudent.

But I also as much as I find subjective age interesting, and I do think it's an important and an elegant economical sort of index of someone's health and well being. For example, if you ask someone how old do you feel, and they say, well, I feel ninety five and you know they're thirty, that means something that's clinically meaningful. That doesn't mean it's accurate, It just means that it's meaningful.

But I take umbrage with the concept at times because I think older adults are more likely to endorse feeling younger as a way of dissociating against the stigma that is attached to old age. So we have to really question to what extent it is a valid you know, index, or if it's a sort of defensive response. Yeah, you study the daily in variability and subjective age, like, have you actually stud like how that fluctuates within an individual

on a data basis? Yes, I'm using the Midas data set, which is the oh yeah, everyone uses that same data set. What loves Midas midlife in the United States? And what's fabulous about this data set is that not only does it have just the catalog of variables and it's rich and complete, but they have a There was a sub study that looked at daily variability and all sorts of

things physical pain, affect, busyness, leisure activity. And so what I did was create a different score between someone's chronological age and they're endorsed or subjective age, and used multi level modeling to see to what extent variability or discrepancy in felt versus chronological age predicted these daily health outcomes

like pain and fatigue and sadness. And we actually found what im and finding this is still being considered for conference and for a paper, is that feeling older or endorsing feelings of oldness was associated with more daily fatigue, sadness, and physical symptoms. So that's interesting. I'm not sure what it means exactly right now, but it is interesting. Conversely, feeling younger than one's chronological age was associated with more

positive outcomes like energy and positive affect. Okay, that's really interesting research. I'm glad someone's doing it. Well, I am, by no means the first one to do it, the first one I've heard of. Well, that's all. It matters. That's because you're not nosedeven the Gerald literature. But there are a few scholars at in North Carolina and Stephen Yanek who has sort of conceptualized the idea of subjective age and has started to look at daily variability in

that construct. Excellent, so idea. I definitely want to give props to them as well. So there are these different constructs. There's subjective age, chronological age, and then can I throw in a third one, there's biological age. I mean there's research showing that, like, you know, you can have the teleomere length of like a your chronological age. It doesn't really matter. Like, if you're really healthy, you could actually be,

for all intensive purposes, ten years younger than your chronological age. Right. Yeah, there is evidence to suggest that humans have the potential to live up to one hundred and twenty years? Oh is that right? Think about that for a second. You know that sounds horrible. I'll jug, yeah, I gotta talk to you after this. Oh my god, how many more fruit smoothies do I add them? But you know, think

about that for a second. You know, if that's really true, midlife would be sixty years old, right, which is fascinating because right now, sixty by no means an older adult, but you're by no means young. That's the start of retirement and thinking about retirement maybe, or you know, children moving. It's a time of transition. But if it's really true that we have the potential to live until one hundred and twenty, that means we've got a lot of life left after sixty. So yes, that would be a very

interesting prospect. I wrote a article called Confessions of a Late Bloomer a while ago. I'll send you the article that I think you'd appreciate. That's all about, you know, this extended lifespan and why there's so many more opportunities to even like change fields you know, later in life, you know, absolutely absolutely. I mean I'd probably if I knew I was living one hundred and twenty, I think I'd pursue my lifelong dream of being an opera singer.

I'd start that at ninety and have a good thirty year career. Is that real for you? Is that something that really interests you? Yeah? I was a voice major as an undergrad. Wow. I did some shows and stuff, but then decided to psychologies where I fell as I could have the greatest meaning and purpose in life. But you know, I mean, I feel like I would start dividing my life into different segments. Maybe, well, I mean

this is this could be possible. It's not like hypothetical, right, yeah, yeah, And that's again one of the benefits of getting older is this sort of benevolent irreverence, sort of disregarding what other people have to say or what they think about you, because you have to be discriminating with this very valuable resource that you have, which is your time. It's not uncommon for a lot of older people to pick up a new hobby or to completely shift vocations when they

get older. For that reason. Have you ever like fantasized about being a vampire. I'm not sure how it's relevant to No, I have to you know, vampires live forever. Vampires aren't actually real. Oh no, sorry to report that. Let's test it, okay. So another area that you study is your interest in how feelings of usefulness to others in later life predict active versus passive coping strategies with

chronic pain. This to me seems so related to the idea of meaning right and maintaining meaning in old age. Another really important research topic. Could you tell me a little more about that. Absolutely? Absolutely, so older paradigms of gerontological science have really adopted the viewer perspective that older adults are consumers of resources, that they are consumers of social services, that they are dependent, and that just isn't true. We know that older adults are generative and seek to

be generative in later life. We see that when we look at volunteer stats, almost most volunteers are older adults. And so modern, more modern paradigms of aging and of gerontological science are really embracing the idea that older adults are not consumers or not passive consumers. They are actors with agency and meaning and purpose who can and do contribute.

So Iva Kahana is a sociologist at Case Western and her work has been incredibly influential on me, and she posits that we need to start adopting more provision based attitude towards aging, the idea that older adults can contribute and have the ability to contribute in meaningful ways. And so the idea of usefulness is really interesting because we are finding that providing social support, rather than just receiving it, accounts for more variance in health outcomes, which is so fascinating.

There was a study done and it's in my payright, I don't have the citation, handy, but essentially, the question was what's better for people giving social support or receiving it, and among older adults in this particular sample, in this particular study, providing social support tended to account for more variance and positive affect and health than the opposite. And

in fact, there's not providing social support then receiving social support. Okay, So providing social support was essentially better than giving versus taking exactly. And so there's actually evidence to suggest that giving too much to older adults, which is giving in general, creates a sort of dependency based idea that actually makes older adults less able and you know, less healthy. Yeah, it's an issue of autonomy and meaning very much related

to the things we study in positive psychology. There probably could be better cross talk between the fields. Yeah, you know, it's funny because the idea of for this manuscript came not only from just doing you know, research and classic literature review. But I was talking to my father one

day after he had gotten his rotator cuff surgery. Mister Pier Plly, mister Pier Palley, and it was you know, it must have been a few days after his surgery and I called to check in on him and I was like, you know, what are you doing And he's like, oh, I'm doing my exercises. I'm exercising. I'm like already, like you just got this surgery. That's incredible. And he said, well, you know, your mother needs me. I got to be

useful around here. And you know, I had heard that many times before, but in that moment, it sort of just struck me. It's like, yes, Like to what extent does feeling needed actually motivate us to engage in behaviors that are healthy and adaptive. And so that question is particularly interesting in older populations because they are constantly bombarded with messages of opposite, like that you aren't useful, that you can't do anything, that you are actually sucking up resources.

And so if we could sort of leverage the idea that older adults have skills and experiences and resources that make the world better, well, then how can we use that to make their own lives better and healthier? And so what we found in this study was that adults who endorsed feeling more useful to their friends and family were more likely to adopt these active coping processes with their pain, so problem solving, exercising, doing research, staying busy.

That's a very exciting idea, very exciting. Indeed, can you explain to our listeners what a passive coping strategy would be? Sure? So, a passive coping strategy is essentially anything that you employ

psychologically to distance yourself from the thing that is bothering you. So, for example, if you just failed an exam, a passive coping strategy would be to wishful think, oh God, I wish that hadn't happened, or to ignore it to you tell yourself that it didn't really happen, denial or ruminating, or just expressing negative affect, oh god, this is terrible, catastrophizing. An active coping mechanism would be something like going office

hours or studying more and so putting that. In terms of pain and gerontology, we found that people who were experiencing knee pain who felt more useful were more likely to do the things that were healthy, like engage in exercises, get some information about their disease, which is a very exciting idea, very exciting, and in an addition to that factor, another factor that seems to be important from what I've read is, you know, loneliness is one of the biggest

silent literally silent killers. Terrible. Yes, absolutely? Is that intertwined at all with needing to matter? Oh? I think so? Let me think about this a bit more so. When you feel useful, just in general, you know, you feel like people rely on you, depend on you, need you. And more importantly, when you feel useful, you are embedded in a social network that keeps you accountable, that checks in on you. You know, how you doing? How's that knee pain? Missus Jones? What do you need? Do you

have access? I've got a mom who checks in on me every ten minutes, You've got social catch Can you ever have too much check in? Yes, especially if you're you come from an over zealous Italian or Jewish family, I think absolutely. But the point is, I think loneliness is probably terrible for a catalog of reasons. But I think it's terrible because you can get away with doing stuff that people aren't going to call you out on. So if you're alone, no one's going to stop you.

From smoking that cigarette. No one's going to stop you from overeating, no one's going to stop you from accountability. There's no one who you feel like you need to be your best self for. That makes so much sense. Yeah, it's also a little sad. What is just think about people who don't have that in their lives. I mean, just it breaks my heart. Yeah, yeah, it is. It's

very sad. And part of it is because I go back to this because I really do believe that it's true that we are just so afraid of aging and we want to avoid it. We want to avoid any reminder of our mortality. And there ain't no better reminder of your mortality than an older person. It's actually interesting because there's some research to suggest that when an older person develops Alzheimer's a dementia, particularly in a nursing home, their peers will avoid them as if the dementia is

contagious in some way. So if that's true within groups, if that is true within clusters of older adults, then of course it stands to reason that we avoid older adults like the plague. I mean, that's really sad, and that even creates more likelihood that person is going to be isolated. I mean, that's really I want to cry.

That's horrible. Yeah. Yeah, And it's just synergistic, right, because it's like the less socially engaged you are, the less positive experience, the less positive experiences you're accumulating, which creates more depression, which creates more isolation, which then creates more physical disability. I mean, it's just a terribly vicious cycle, and it's part of the reason why we need psychosocial interventions committed to this idea of usefulness to interrupt that cycle.

You know, just take the example of osteoarthritis. You know, it's like oway is very debilitating, it's very painful, and because it's painful, people engaged in sedentary behavior. They sit around, which means are not going out and fostering relationships, which means that they're getting depressed, which means that they're eating more and engaging in even more sedentary behavior. And you can just see how it sort of spirals out of control.

And so we need to learn how to interrupt that cycle through programs and research that really challenges this idea that older adults are liabilities and not assets. Yeah, it seems like these ideas need to propagate the nursing homes more than they do in terms of programming and stuff. Yeah. Absolutely, Well, I'm really so glad that you are in this field and that you get to contribute to this field, because it sounds like you've got you're obviously very intrinsically motivated.

Why are you so interested in older people? It's a great question, Like I alluded to earlier outports, you know, contact hypothesis. I was raised in a family with some really wonderful older adults. I saw how my parents took care their parents, and so that's just like this sort of emotional reason. I just continued positive, consistently positive exposure to older adults throughout my life, starting in childhood. But you know, more practically, you know, the world in the

United States are aging precipitously. You know, by twenty thirty, one in five Americans, or about seventy two million people, will be considered an older adult. And so, and of course this is compounded by the idea that not only are we living longer, but fertility rates are at a record low, and so demographically speaking, if you imagine it as sort of like an inverted pyramid, we have all the young people at the bottom and all the older

people at the top. And so we need a motivated and energized generation of scholars and clinicians and service people devoted to understanding aging. And I want to be part of that generation. And more interestingly to me, like I said, we are now able to study phenomena psychologically, biologically, physiologically that we weren't able to study one hundred years ago because our own biology precluded it. But now that we are living so much longer, we have so many more

questions to answer, so many more opportunities to exploit. It's one of the reasons, for example, I'm so interested in aging with HIV for example. I mean, like, twenty years ago, you couldn't live with HIV into your sixties. Now you can. That's just one example of very promising, excited, uncharted territory that the study of aging affords completely agree. Were there any other topics that you wanted to talk about today? Yeah, yeah,

thank you for asking. I really wanted to spend a few moments talking about my blog for Psychology Today called Engaging. The full title is Engaging a Millennial's Thoughts on Age and Aging, and I attempt to update the content monthly, and I try to weave in anecdotal and empirical information. You know. I think it was David Pull, a philosopher who once observed that writing an academic paper was like

the equivalent to throwing it into a garbage pail. And it's because most go on read, you know, so it's like there. It's been estimated that about two point five million papers academic papers get published annually, few go cited, and even fewer are actually read. And even if they are read, you know, it's typically by the authors themselves or referees in peer review journals, or editors. And so the problem is that science is not being disseminated in

the way that it ought to be. It's not actually reaching the people it's designed to reach. It's just sort of being recycled in our academic you know, echo chamber. And so I sort of wanted to play with an online platform like a blog because I wanted to reach older adults, you know, I wanted to reach my population of interest, absolutely, and I've really been able to do that in a way that I could not and would not have been able to do through my academic work.

You know, I've published papers and book chapters, and honestly, I can't even tell you if it's been cited but or any of them have been cited. But I can tell you that I get tons of visibility on this blog, and the most exciting thing is that I'm getting feedback in real time from older adults who are saying this is so spot on for me, or thank you for talking about this because no one else does, or wow, it's really refreshing to hear that a younger person is

thinking about these things. It makes me feel less alone. I most recently got a comment from a six year old reader about my recent piece in which I talked about rites of passage sort of punctuate the life course and how they're very bittersweet because things like getting married and having children are very exciting, but they also measure our time to our own mortality. And the reader was like, yeah,

that's exactly right. Like, I'm glad that you have given me permission to think about death in this way, because I think most people get freaked out when we talk about death. Oh absolutely, that's wonderful. That's so validating to be able to get those kinds of letters. I imagine a lot of people in nursing homes all across the country sit at their at dinner table with your blog printed out, discussing it with each other while they eat

their chicken noodle soup. I can only hope. So that's why I like to do it, you know, because I am able to access lay people. I'm able to assess the people who I want to reach, you know. And not only that. It's just like blogging and writing just makes me a better thinker, you know. I'm able to think more clearly and more creatively because I have more degrees of freedom. I'm not tethered to arbitrary word counts and formatting that a company's you know, a manuscript submission.

Those are important and that needs to continue, but I think it needs to be complemented by and supplemented with these more accessible platforms, so our science and our research is really getting disseminated and applied. I really hope that grad school advisors are a lot more accepting on blogs now than when I was doing it. I was one

of the first boggers for psychology. To day, wow, and I know, I'm like now I feel like an old That's awesome, And in grad school it was not accepted, and I kind of I felt like a rebel, like the bad boy, you know. Yeah, yeah, I hear that. I don't think there's quite as much stigma now in

the advent of all these social media platforms. But it is a bit irreverent because in some way I am criticizing the classic mechanisms through which science is disseminated, which is through peer review, and it's just peer review is

just woefully inefficient and it's impervious. People can't access it either because one they can't understand it because it's written in such a terrible boring way, or two because there are just other barriers, like you know, passwords that only people and you know who are ensconced in the ivory towers of academia I can get. And so I really

wanted to challenge that and interrupt that a bit. You go, girl, because you're doing such wonderful stuff, and I really encourage you to keep up the blogging and this spirit, the young spirit and the old spirit you have. It's an interesting sort of combination of spirits. And yeah, thanks for being on the show today. Thank you so much for having me. I really enjoyed it me too. Thank you so much for listening to the Psychology Podcast with doctor

Scott Barry Kaufman. I hope you found this episode just as thought provoking as I did. It's something you heard today stimulated you in some way. I encourage you to join in the discussion at the Psychology podcast dot com. That's the Psychology Podcast dot com.