6 Kate de Medeiros


[Note: What follows is a lightly edited transcript of the interview. The complete interview can be found here.]

Alex Bixhop

I am with Dr. Kate de Medeiros from Miami University in Ohio. Dr. de Medeiros is the O’Toole Family Professor in the Department of Sociology and Gerontology and is an expert in qualitative inquiry and narrative gerontology. We’re going to learn a little bit about that today as we speak with her. If you don’t mind would you share a little with us about your current role as a gerontologist or aging expert? How did you come to be interested in the field of or aging? Or, perhaps, how did gerontology find you?

 

 

Kate de Medeiros

Sure. You know, looking backwards it all makes sense although going forward it made no sense at all. My initial undergraduate degree was in English Literature. I love language and I love how stories work and how devices in literature work to make us feel and think certain ways. But I knew I didn’t want to pursue that as a career because I didn’t want to spend my life being the Number Two Faulkner scholar or something like that. So, fast-forward, I ended up in Texas working at the University of Texas Medical Branch at Galveston. I had gotten hired to work with University Relations. Basically I was a grant writer on call. They would send me out to help departments who were working on grants. I had the chance to go to the Institute for Medical Humanities and met with Dr. Tom Cole, who is a cultural historian best known for his The Journey of Life: A Cultural History of Aging in America, an amazing book. I became fascinated by the program and enrolled in it, but the demands of life and everything else started to take a toll. One day Tom said “You know, I have a feeling that you’re going to drop out of this program but before you do, why don’t you take an independent study with me. What I’d like you to do is see what people are doing as far as writing groups for older people. Find out what they’re not doing and let’s do a project.” And I thought, “That sounds horrible.” I had no desire to work with older people. I thought it would be sad or boring or whatever but Tom’s a pretty persuasive person so, anyway, that’s what I did.

 

I found that my background in English helped me realize that a lot of stories we hear are the stories we expect to hear, that narrative forms like memoir have an evolution such as to extol virtue and accomplishment. I won’t bore you with the details but essentially when people do story work with older people, often what they’re hearing are the stories that participants are supposed to tell and the ones we want to hear, not the stories that are the participants’ lives. That became a fascinating insight to me, so much so that I withdrew from Tom’s program and I enrolled in the gerontology program at UTMB. I worked with Professors Barbara “Bobbi” Yee and David Chiriboga and earned my master’s in gerontology. Later, I relocated to the DC area right about the time that the Ph.D. program was starting at UMBC, University of Maryland-Baltimore County. There I got to work with Dr. Robert Rubinstein, a cultural anthropologist who studied aging. He did a lot of interesting work on topics such as the meaning of suffering in old age or generativity and childlessness in later life. I learned a lot and was able see different sides of later life. Fast-forward to my post-doc at Hopkins, where I worked on research on dementia in long-term care. Alot of  the storying work I had been interested in did not immediately apply. However, I found that really, spending time with people living with dementia within long-term care, you see how their lives unfold in ways that many people don’t bother to pay attention to such as through conversations and  friendships with other residents. You might hear people having a conversation and to you it might seem nonsensical but then you realize there’s a lot going on in the communication that is beyond words alone. I was able to get some funding to take some additional courses at Georgetown and Johns Hopkins in discourse analysis and anthropology to look at language in different ways Overall, I would say that understanding the way we communicate values and aspects of ourselves is the undercurrent of everything I do. My main interests in gerontology right now are related to whose stories get to be told and why And what stories are we willing to listen to or not?

 

 

 

Alex Bixhop

A different route, a different pathway, trajectory to the field is pretty neat to hear. Now given your expertise, a lot of your expertise is in this kind of narrative aspect of gerontology. You’ve actually written a book, I believe, a methodology book on narrative gerontology. Can you define, what is narrative gerontology? That’s kind of a different concept.

 

 

Kate de Medeiros

Yeah, so, Jan-Eric Ruth andGary Kenyon first coined the phrase narrative gerontology back in the 1990s. Basically, when they envisioned narrative gerontology, it was the idea that we age biographically as well as physically and socially and that our biographies have a huge impact. I have a slightly different take. I do think that our biographies are important but I am also acutely aware that biography, autobiography, and memoir, have limits. I think about narratives as a way of unveiling some aspect of self. It could be through writing, it could be through language, but it doesn’t have to be. It could be through art, it could be through dance, it could be through movement. What we’re always doing is telling a story. A story could be that grand story of “Here’s my entire life” or it could be “Here’s this single moment in time that changed who I am” or “Here’s something that happened to me yesterday that affected my day” We all tell all types of stories.

 

I’m particularly interested in small stories that emerge in the larger context of research interviews, stories that sometimes seem like an after thought or an aside. For example, a colleague of mine – Dr. Gwen Etter-Lewis — and I,wrote a paper a couple years ago about the small stories that we found in our interviews with underrepresented older people in Ohio. We found that a lot of people told small stories lot of stories about place The reason we knew that these were stories is that sometimes people would say “Let me tell you a story about that” or “Let me tell you this little thing about what happened.” There were these discourse markers that we were able to pull out and say, “Wait a minute. These are all about place and how sense of place or belonging or not belonging had a huge impact on people’s lives. What does this mean?” We’re often very concerned about these big things that happened but not these little teeny things that make a huge impact on people’s lives.

 

 

Alex Bixhop

Yeah and these little teeny things, these little cues, in the stories. You talked just a minute ago about how we share those stories. Is there a most effective approach, do you think? Is it, like, do a play, do a media is it, in today’s world we have so much accessibility to storytelling on film, even. Is there one best way to take these little cues these little stories, and share them?

 

 

Kate de Medeiros

No, I think any way is a good way because any way you choose will elicit a very particular kind of story. And not the true story or real story since there’s no such thing as true or real. Right? So if I asked you to do a TikTok video about your life, you would immediately say “Ok, what’s in a TikTok video? It’s about two minutes long…” And you would decide, based on what you thought should be in a TikTok video,  what you would want to tell. The story would be really different if I said “Write a song about your life.” Because then you’d say “Oh, ok, a song…” Then you might choose a memory or a situation that you think would make a good song. And so on. Regardless of what kinds of medium we use, that medium helps us filter what we’re going to say and not say.

 

My thing is, don’t just rely on one way. Rely on a lot of ways. Even if you’re doing a qualitative interview, for example, and you tell someone “Tell me a story about your life.” And then they tell you. Then you might say, “Ok, if they were making a movie about your life what would it be called? Who would star in it? What would be the biggest thing in the movie?” In these ways, you can shift the focus and present people with different ways to tell their stories. A person might think, ‘Well, would be appropriate for a movie? What’s would be worthwhile for a poem? I think that multiple ways of eliciting stories are best. We learn different things regardless of what way we use.

 

 

Alex Bixhop

Yeah, I mean, I hear stories all the time in my work and it’s just amazing. I sit there and I’m sure you do too, when some of the older adults…I’ve interviewed centenarians who are talking, actually, my mind goes wandering when they’re telling their story and I’m in a movie theater watching their life. I’m like “Gosh we can make millions on the side, right?” Some of their stories are just amazing. Now a lot of your experience in gerontology has really focused on, as you mentioned, underserved populations and you have a keen interest in this and really looking at the diverse not only populations but the contexts surrounding aging and the human condition. Whether that be caregiving or LBGTQ relations, stories from African-American populations, each of these seem to resonate what I would call a humanistic kind of gerontology. And in your work in cross-blending gerontology with the humanities how would you define humanistic gerontology or humanities of aging?

 

 

Kate de Medeiros

I would saypeople  use “humanistic” in two ways. Some people use it to mean the humanities and some people use it to mean humanism, which is a branch of philosophy. Both may sound the same but they are a little bit different. From the humanities perspective, I would define humanistic gerontology as being very concerned with the cultural messages that we receive that tell us how we should or should not age. Whether it’s reading about the history of aging by scholars such as Andrew Achenbaum, Thomas Cole or Pat Tane  or at the literature that we read, we receive messages about how to view aging. A great example is that we know that in Western culture, living with your adult children is not a preference in many, many countries with a few exceptions. We know that one of the plots in King Lear is a cautionary tale about giving up your autonomy to live with your adult children.  Of course, the play is about much, much more but it does repeat a message about precarity in depending on others.Literature and history can help you understand certain ways we think. They can also help you empathize with an experience in a way that scientific work can’t. I mean, we’ve all seen a movie where we’ve cried or feel very moved. We typically don’t experience that when we read scientific papers. Humanities perspectives can be a way of bringing an experience to light. It’s also important to keep in mind that humanistic gerontologists don’t ask “How does it work?” They ask “What does it mean?” It’s a different framing of questions than from scientific perspectives.

 

I think that the humanities allow questions to be asked that can’t necessarily be validated through a study, but by raising the imagination, can help scientists think of new questions which can be tested. A great classic example is Jules Verne’s 20,000 Leagues Under the Sea So Verne is writing about this fantastical idea that you could live underwater, and it ends up driving science to be able to ask, “Well wait a minute, can we do that?” Certainly an over simplification but imagination and science go really well together even though they tend to come from different camps of thinking. I think when they can come together and share knowledge, that’s where we get innovation.

 

 

Alex Bixhop

Absolutely. And sometimes you think stories take on a life of themselves or they are part of life and you can really see that. Now across the years that you’ve been a gerontologist, this is kind of a tough question perhaps. And the research you’ve done, and the projects you’ve done, all the things you’ve managed to be engaged with and conduct. What’s that one discovery, do you think, or that one finding that has really intrigued you the most that perhaps has advanced the field in certain ways or perhaps you just didn’t expect?

 

 

Kate de Medeiros

I would definitely say it was the friendship study among people living with dementia in long-term care.It was a study that was funded by the Alzheimer’s Association but it really started because the Copper Ridge dementia care facility staff wanted to know how to better integrate residents when they moved in. That was the research question: “How can we identify people who get along well together?” My research team and I spent six months observing 20 people in one particular assisted living unit in a large, 167-bed facility. When we asked the staff who was friends with whom using a matrix of all the 20 people, we found they were really bad at identifying friendships. Instead, they tended to rely stereotypes: “Oh, the men at the men’s table. They love to laugh.” After six months of observations, and we rarely saw the men talk to each other. They also missed many of the friendships that we did see over the course of the study. An important lesson for me was that often, people think that the social life of a person living with dementia depends on people who do not have dementia. The mindset that a lot of people have is “I need to be the one to facilitate these friendships” I saw a lot of friendships spontaneously occur among the residents. One person might not remember their friend’s name, but when they saw that friend, they knew that person was a friend. We also asked residents about what was important in their friendships and they clearly told us things like reciprocity, trust, and intimacy..

 

The whole idea of how can we get people who are socially isolated, whether they have dementia or not, to make meaningful connections is important. We found that staff tended to interrupt people living with dementia, as if their conversations didn’t count.We also found that it was important to enrich an environment so that there items, such as new flowers or something novel,  that could help spark conversations . You don’t need a sterile environment that gives  you nothing to be able to say. Finding ways to enrich communities of care is so important although it’s often hard to convince others. People will often say “Well, but we need to worry about health.” Health and safety are certainly important. However, most of us, if we were given a choice of being safe and healthy but having nothing to live for, or having ten good minutes along with safety and health, we would pay for ten good minutes, right? You would say “My health is important but I don’t want to just be healthy. That’s not the point of just being alive.” Anyway, I’m still working on making that argument and getting funders to support it.

 

 

Alex Bixhop

Well you wouldn’t think about friendship with persons with dementia. You mentioned there were some things that were markers or that they said makes for friendship. Did you, was there anything in particular that these individuals with dementia said or even that the caregivers noticed?

 

 

Kate de Medeiros

No, to me the caregivers were very well-intentioned.I don’t mean to speak disparagingly of them. But for them, it was all about managing people and time. They have a fixed amount of time to get their work done. I get that. There was one resident, for example, who yelled a lot and who couldn’t communicate in any other way. I thought, for the first two months, that her dining partner was also unable to communicate. But that wasn’t true. Her dining partner was able to have a perfectly coherent conversation but couldn’t because she was seated next to someone who only yelled. So why were they sitting together? Because the dining partner didn’t get upset when the other woman yelled. So as opposed to allowing the dining partner to sit with someone with whom she could have a conversation, staff took the path of least resistance. So here was this opportunity for someone to be able to engage with another person and she wasn’t given that opportunity.

 

 

Alex Bixhop

That makes sense. Management of behavior in a facility.

 

 

Kate de Medeiros

Right, and I get it. I do get it. I know the people that do that work are under a lot of pressure to get a lot done.

 

 

Alex Bixhop

Have you done work in terms of, I’ve read in the past, it’s just kind of a side question I guess that pops up and makes me think, of this idea of taking stories in narrative gerontology, narrative aging, taking the narratives of older adults and particularly those with dementia or memory loss. We do a lot, as you mentioned in a roundabout way, we deconstruct stories quite a bit. But I’ve read recently, and this has been something that’s been around, reconstructing the stories of those with memory loss or dementia. Have you done any of that type of work? I know there’s sort of like memory, I think there’s time slips or something like that, or there’s programs out there. But the idea of trying to take bits and nuggets of a story but you don’t have the full story of one’s life and you try to reconstruct it.

 

 

Kate de Medeiros

Not per se, because again, the problem with that becomes that there isn’t really a story. All memory is person-related, so, the challenge when you get when you try to reconstruct someone else’s story, you can get facts but there are nuances. For example, you could have a spouse who might see the same situation very differently than the individual. The same applies to children, or friends, or whomever. The beauty of programs like TimeSlips, which I have worked on with its founder Anne Basting, is that the TimeSslips program is not based on memories. It’s a type of joint storytelling that’s not grounded in anybody’s past per se and does not rely on memory. It allows for what Basting calls failure-free storytelling. It’s those kinds of stories that are absolutely fascinating even though they may or may not have anything to do with somebody’s biographical past.

 

 

Alex Bixhop

Well one final question: Our class is really focused on successful aging and components of successful aging. But there’s a lot of debate, and there’s been a lot of debate in the past, and currently on this whole concept surrounding successful aging. What is your take or perspective on Rowe and Kahn’s framework and how do you define successful aging?

 

 

Kate de Medeiros

So, Rowe and Kahn, to me, hijacked a concept that was very, very different if you look at its evolution. What they were able to do is catch on to an imaginative idea that really resonates with people. It’s kind of like, you probably have experienced this, once you mention disengagement theory, that’s all anybody wants to talk about, even though we know it’s not validated. The same holds true for successful aging as a concept. What Rowe and Kahn wanted to do is to create a way of understanding how to create interventions for people to help them age with better health and cognition. Doing an epidemiological study where you set criteria to identify problem points and development interventions is what the original purpose was. But Rowe and Kahn’s model has just grown into something completely different.

 

If you back up though, and look historically, the whole successful aging concept started in response to a paper in the forties about the “unsuccessfully aged.” That original paper asked, why are some people faring worse in old age than others? Then Havinghurst in the 1960s turned that question around and said “Well let’s ask the question of why are people aging better?” But in Havighurst’s conception, personal assessment was a really key part. Personal assessment has  no part in Rowe and Kahn’s model, but Rowe and Kahn are using successful aging for for a different reason. Then if you look at Baltes and Baltes, their concept of successful aging later becomes selectiv with compensation. Again, they’re looking at a person’s ability to compensate not labeling them because of physical and cognitive ability. The whole term “successful aging” has really irritated a lot of people because it seems to imply that you’ve failed aging somehow. I would argue that the successful aging concept is linked with the the third and fourth age constructs that are somewhat popular now. Basially, the third age describes being older and in good health. The fourth age implies decline. It’s sort of the same as successful aging, yet different.

 

 

Alex Bixhop

Well I appreciate your time, taking the time to answer a few questions and spend some time with you learning a little bit about what you do and some of the concepts that you engage with and just the pathway, the trajectory that you’ve had, is really unique in terms of getting into the field and the contributions you certainly have made and continue to make.

 

 

Kate de Medeiros

So thank you very much. Thank you, thank you for taking with me, it’s my favorite subject to talk about.


Unedited Transcript of Kate de Medeiros Interview

Alex Bixhop

I am with Dr. Kate de Medeiros from The Miami University of Ohio from the Department of Sociology and Gerontology. Dr. de Medeiros is the O’Toole Family Professor in the Department of Sociology and Gerontology and is an expert in qualitative inquiry narrative gerontology and we’re going to learn a little bit about that today as we speak with her. If you don’t mind would you share a little with us about your current role as a gerontologist or aging expert? And, really, how did you come to be interested in the field of gerontology or aging? Or, perhaps, how did gerontology find you? If you don’t mind. And kind of explain a little bit about how you became a gerontologist and what your interests are.

 

 

Kate de Medeiros

Sure, well, you know, looking backwards it all makes sense although going forward it made no sense at all. But my initial undergraduate degree was in English Literature and I love language and I love how stories work and how devices in literature work to make us feel and think certain ways. But I knew I didn’t want to pursue that as a career because I didn’t want to spend my life being the Number Two Faulkner scholar or something like that. So, fast-forward I ended up in Texas working at the University of Texas medical branch at Galveston and I had gotten hired to work with University Relations and basically I was a grant writer on call. So they would send me out to help departments who were working on grants. So I had the chance to go to the Institute for Medical Humanities and met with Tom Cole, who is a cultural historian best known for his Cultural History of Aging, an amazing book. And I became fascinated by the program. I enrolled in it but the demands of life and everything else started to take a toll so Tom said “You know, I have a feeling that you’re going to drop out of this program but before you do, why don’t you take an independent study with me and what I’d like you to do is see what people are doing as far as storywriting groups for older people. And find out what they’re not doing. And let’s do a project.” And I thought “That sounds horrible.” I had no desire to work with older people. I thought it would be sad or boring or whatever but Tom’s a pretty persuasive person so, anyway, that’s what I did.

 

I found that my background in English helped me realize that a lot of stories we hear are the stories we expect to hear. That things like memoir have an evolution from this form that was made, really, to extol virtue and accomplishment. I won’t bore you with the details on the evolution on that but essentially when people do story work with older people often what they’re hearing is the story that they’re supposed to tell. And the story we want to hear. Not the stories that are their lives. So that became fascinating to me. I loved the first writing workshop so much that I withdrew from his program but I enrolled in the gerontology program at UTMB. So I worked with [NAMES] and got my master’s in gerontology, and did a lot of education in the Galveston community. We relocated, my husband’s NAVY, so we relocated to the DC area right about the time that the Ph.D. program was starting at UMBC, University of Maryland-Baltimore County, and there I got to work with Robert Reubenstein who is a cultural anthropologist. So they did a lot of work on things like the meaning of suffering in old age. Or, he had a large study on childless older women and their views of generativity so I got to see a different side of things. Fast-forward then, I did a post-doc at Hopkins and started doing dementia care. So a lot of  the storying work I had been interested in applied not so much (I work with clinical psychiatrists) so not exactly as easy of a connection you might think, but really, spending time with people living with dementia and long-term care and seeing how their lives unfold in ways that people don’t bother to pay attention to. Conversations. Friendships. So, if you spend time in… this facility held 167 beds, all the people with moderate to advanced dementia. And you might hear people having a conversation and to you it might seem nonsensical but you realize there’s a lot going on in the communication. So, I was able to get some funding to take some additional courses from Georgetown and Hopkins in discourse analysis and other things to, again, look at language from a different way. So I would say that even though I often don’t do things that apparently look like they’re related to the way we communicate, I would say that it’s the undercurrent of everything I do. And my main interests in gerontology right now are whose stories get to be told and why? What stories are we willing to listen to or not?

 

And, also, listening is a key thing that we often don’t do. We’re really good about telling people what they need but we’re not really good about listening to what they want or what would make their life better. And when I say they I don’t mean other older people but I mean just when we’re studying people we tend to think of ‘them’ and an ‘us’ and I’m just acutely aware of how those conversations unfold. So that’s kind of it in a nutshell.

 

 

Alex Bixhop

A different route, a different pathway, trajectory to the field is pretty neat to hear. Now given your expertise, a lot of your expertise is in this kind of narrative aspect of gerontology. You’ve actually written a book, I believe, a methodology book on narrative gerontology. Can you define, what is narrative gerontology? That’s kind of a different concept.

 

 

Kate de Medeiros

Yeah, so, [NAMES] first coined the phrase narrative gerontology back in the ninetiess and basically when they envisioned narrative gerontology it was the idea that we age biographically as well as physically and socially and that our biographies have a huge impact. I see it a little bit different and again I do think that our biographies are important but I, also, am acutely aware of, again, that biography and really, autobiography and memoir implies a certain kind of thing. So I think about narratives as a way of unveiling some aspect of self. And so it could be through writing, it could be through language, but it doesn’t have to be. It could be through art, it could be through dance, it could be through movement. But what we’re doing is we’re telling a story. And by story, that could be the grand story of “Here’s my entire life” or it could be “Here’s this single moment in time that changed who I am” or “Here’s something that happened to me yesterday that affected my day” We call those big stories, which are the grand, or small stories just those little things. We all tell these. The key about a narrative is it’s more than just talk but there are different ways you can define what constitutes a narrative. Usually there’s a plot and there’s some kind of action. So I could have a two-sentence narrative. I could have a three-hour narrative.

 

But those are the kinds of things that I’m interested in from a narrative gerontology standpoint I look for those especially small stories in the larger context of interviews to find out what is it that we’re missing.  Case in point, a colleague of mine, [NAME] did a paper a couple years ago. We were interviewing underrepresented older people in Ohio, so predominantly people who identified as African-American, hispanic, and then there was actually a small population of post-Soviet era Russians and Ukranians in the Cincinnati area, and what we found were that without asking, or soliciting this, is that a lot of stories about place were embedded in what they were telling us. So we went back and did an analysis on small stories of place. And the reason we knew that these were stories is that sometimes people would say “Let me tell you a story about that” or “Let me tell you this little thing about what happened.” And so there were these markers that, then, we were able to pull out and say “Wait a minute these are all about place and how sense of place or belonging or not belonging had a huge impact on people’s lives.” So it’s taking those little moments like that and then trying to figure out what are they telling us in the bigger picture of things about what we know about aging? Why don’t we stop and think about those little moments? We’re often very concerned about these big things that happened but not these little teeny things that make a huge impact on people’s lives.

 

 

Alex Bixhop

Yeah and these little teeny things, these little cues, in the stories. You talked just a minute ago about how we share those stories. Is there a most effective approach, do you think? Is it, like, do a play, do a media is it, in today’s world we have so much accessibility to storytelling on film, even. Is there one best way to take these little cues these little stories, and share them?

 

 

Kate de Medeiros

No, I think any way is a good way because any way you choose will elicit a very particular kind of story. And not the true story or real story when there’s no such thing as true or real. Right? So if I asked you to do a TikTok video about your life, you would immediately say “Ok, what’s in a TikTok video? It’s about two minutes long…” And you would decide based on what you thought should be there about what you would want to tell. And it would be really different if I said “Write a song about your life.” Because then you’d say “Oh, ok, a song…” Then you might choose a memory or a situation that you think would make a good song. And so I find that… or a play. Is it a play about your life? Is it a combination? So regardless of what kinds of media we use, that media helps us filter what we’re going to say and not say.

 

So my thing is, don’t just rely on one way. Rely on a lot of ways. Even if you’re doing a qualitative interview, for example, and you tell someone “Tell me a story about your life.” And then they tell you and then you say “Ok, if they were making a movie about your life what would it be called? Who would star in it? What would be the biggest thing in the movie?” So you can even, in those kinds of ways, shift the focus because then, again, you’d think ‘Well, what’s worthy of a movie? What’s worthy of a poem?’ And worthy, I think that’s people’s words, not my words. People stop and think, like, “Oh gosh, we would never say that in this situation.” Or in dance you can express different things than you can in language. So, I think that multiple ways are best, and we learn different things regardless of what way we use.

 

 

Alex Bixhop

Yeah, I mean, I hear stories all the time in my work and it’s just amazing. I sit there and I’m sure you do too, when some of the older adults…I’ve interviewed centenarians who are talking, actually, my mind goes wandering when they’re telling their story and I’m in a movie theater watching their life. I’m like “Gosh we can make millions on the side, right?” Some of their stories are just amazing. Now a lot of your experience in gerontology has really focused on, as you mentioned, underserved populations and you have a keen interest in this and really looking at the diverse not only populations but the contexts surrounding aging and the human condition. Whether that be caregiving or LBGTQ relations, stories from African-American populations, each of these seem to resonate what I would call a humanistic kind of gerontology. And in your work in cross-blending gerontology with the humanities how would you define humanistic gerontology or humanities of aging?

 

 

Kate de Medeiros

I would say, I work a lot with people who are humanities scholars who study aging. And so I would say that humanistic…so there’s two kinds of…People use humanistic in two ways. Some people use it to mean the humanities and some people use it to mean humanism, which is a branch of philosophy, which is… they kind of look the same but they are a little bit different. So from the humanities perspective, one of the things that I think is important. I would define humanistic gerontology as being very concerned with the cultural messages that we receive that tell us how we should or should not age. So whether it’s reading work by Andrew Ackenbaum and looking at the history of aging, or Thomas Cole or [NAME] or other people. Or even the literature that we read. So, a great point is that we know that in western culture, living with your adult children is not a preference in many, many countries with a few exceptions. We know that King Lear is all about why you shouldn’t do that. I mean, it’s got a lot of other, obviously, issues as well but it repeats a message that you can see throughout literature in history. So if you know the literature it can help you understand certain ways we think. But it can also help you empathize with an experience in a way that scientific work can’t. I mean, we’ve all seen a movie where we’ve just probably cried or we can really relate or it moves us. And we don’t do that when we read scientific papers typically. We don’t have the same feeling. I don’t! So it can  be a way of, also, bringing an experience to light. So there’s multiple aspects of that. But they ask different kinds of questions. So people who do humanistic gerontology don’t ask “How does it work?” They ask “What does it mean.” And so it’s a different framing of questions. And when you think about this kind of questioning, how does it allow scientists to understand aging as a part of being human, or the human experience?

 

I think that the humanities allow questions to be asked that can’t necessarily be validated through a study, but by raising the imagination can help scientists think of new questions. A great classic example is Jules Verne’s 20,000 leagues under the sea was the imagination that led to nuclear submarines and a lot of other things. So at the time, it’s this fantastical idea that you could live underwater, and yet, it drove science to be able to say “Well wait a minute, can we do that?” Not exactly that simple of a relationship but, when we start saying things like, like the interest right now in social determinants of health. We can look at literature and writers who have been arguing about this for a long time and have produced novels where those wouldn’t be their words, but really they’re saying it’s not just about …your surroundings really matter. So I think that imagination and science go really well together even though they tend to come from different camps of thinking. But I think when they can come together and share knowledge that’s where we get innovation.

 

 

Alex Bixhop

Absolutely. And sometimes you think stories take on a life of themselves or they are part of life and you can really see that. Now across the years that you’ve been a gerontologist, this is kind of a tough question perhaps. And the research you’ve done, and the projects you’ve done, all the things you’ve managed to be engaged with and conduct. What’s that one discovery, do you think, or that one finding that has really intrigued you the most that perhaps has advanced the field in certain ways or perhaps you just didn’t expect?

 

 

Kate de Medeiros

I would definitely say it was the friendship study among people living with dementia in long-term care. So, it was a study that was funded by the Alzheimer’s Association but it really started because the Hopkins facility staff wanted to know how to better integrate residents when they moved in. So it kind of started with that. That was the research question. “How can we identify people who get along well together?” And so myself and my research team spent six months observing people in one particular assisted living unit in this large facility. And if you asked the staff who was friends with whom, we went through a whole matrix, they were really bad at identifying friendships. So they went with stereotypes: “Oh, the men at the men’s table. They love to laugh.” Six months and I never saw the men talk to each other. So that was out. But they did not identify people who were friends. And so, understanding that it’s not the person who doesn’t have dementia who is the required person to make something meaningful. And that’s a mindset that a lot of people have. “I need to be the one to facilitate these friendships” I saw a lot of friendships spontaneously occur. Now you might not remember your friend’s name, but when you saw that friend you knew that person. And you could ask people about what was important in their friendships and they could tell you. Even though people, often, others don’t think of people living with dementia, especially with profound memory loss, as being capable of having those kinds of moments or being a worthwhile effort to try to cultivate those communities of care. And it’s something I still feel very strongly about.

 

The whole idea of how can we get people who are socially isolated, whether they have dementia or not, but new ways of thinking about what is it that makes our connections important. And what we found was first of all, time. Stop interrupting people. Secondly, make a setting that has things that people can talk about. If you’ve got dementia you have enough trouble remembering things. You don’t need a sterile environment that gives  you nothing to be able to say “Oh look, there are flowers. I like flowers. Do you like flowers?” And then you can start a conversation with a friend. That, to me, still is something that I count very very profound and it’s hard to convince people that it’s important. Because people will often say “Well, but we need to worry about health.” And those are all important things But I think, most of us, if we were given a choice of having ten good minutes we would pay for ten good minutes, right? You would say “My health is important but I don’t want to just be healthy. That’s not the point of just being alive.” Anyway, I’m still working on making that argument and getting funders to support it.

 

 

Alex Bixhop

Well you wouldn’t think about friendship with persons with dementia. You mentioned there were some things that were markers or that they said makes for friendship. Did you, was there anything in particular that these individuals with dementia said or even that the caregivers noticed?

 

 

Kate de Medeiros

No, to me the caregivers were very well-intentioned and I don’t mean to speak disparagingly of them but for them it was all about management. And they have a fixed amount of time and I get that. So there was one resident, for example, who yelled. Who couldn’t communicate. She yelled a lot. I thought for the first two months that the person they sat with her at lunch also couldn’t communicate. But that wasn’t true. That person was perfectly able to have a perfectly coherent conversation. So why were they sitting together? Because she didn’t get upset when the other woman yelled. So as opposed to allowing the second woman to have a conversational partner, they just took the path of least resistance. So here was this opportunity for someone to be able to engage with another person and she wasn’t given that opportunity.

 

 

Alex Bixhop

That makes sense. Management of behavior in a facility.

 

 

Kate de Medeiros

Right, and I get it. I do get it, and I know the people that do that work are under a lot of pressure to get a lot done. But if you could come in and and then… so we couldn’t predict that because that wasn’t how the decisions were made. It was a marketing department, it was a management issue. So, sadly, no.

 

 

Alex Bixhop

Have you done work in terms of, I’ve read in the past, it’s just kind of a side question I guess that pops up and makes me think, of this idea of taking stories in narrative gerontology, narrative aging, taking the narratives of older adults and particularly those with dementia or memory loss. We do a lot, as you mentioned in a roundabout way, we deconstruct stories quite a bit. But I’ve read recently, and this has been something that’s been around, reconstructing the stories of those with memory loss or dementia. Have you done any of that type of work? I know there’s sort of like memory, I think there’s time slips or something like that, or there’s programs out there. But the idea of trying to take bits and nuggets of a story but you don’t have the full story of one’s life and you try to reconstruct it.

 

 

Kate de Medeiros

Not per se, because again, the problem with that becomes there isn’t a story. All memory is person-related, so, the challenge when you get when you try to reconstruct someone else’s story, you can get facts but there are nuances and you could get a spouse that might see that situation very differently than the individual or the same with children, or friends, or whomever. So I haven’t done that. But the beauty of time slips which I have worked with [NAME] a lot is that time slips allows you, it doesn’t, it’s not based on memories. So it’s kind of joint storytelling that’s not grounded in anybody’s past per se. And so it does what she calls failure-free storytelling. So it’s those kinds of stories that are absolutely fascinating but they may or may not have anything to do with somebody’s biographical past.

 

 

Alex Bixhop

Well one final question: Our class is really focused on successful aging and components of successful aging. But there’s a lot of debate, and there’s been a lot of debate in the past, and currently on this whole concept surrounding successful aging. What is your take or perspective on Rowe and Kahn’s framework and how do you define successful aging?

 

 

Kate de Medeiros

So, Rowe and Kahn, to me, hijacked a concept that was very very different if you look at its evolution. So I think that what they were able to do is catch on to an imaginative idea that really resonates with people. It’s kind of like, you probably have experienced this, once you mention disengagement theory that’s all anybody wants to talk about. Even though we know it’s not validated. But that, it’s like, it’s the bane of our existence. Like, “It’s not disengagement! Stop it!” And same with successful aging. Because what [Rowe and Kahn] wanted to do is to create a way of understanding how to intervene with people who were having issues. So, doing an epidemiological study where you set criteria and that way you can better find where the challenges seem to be and then you can have interventions. But it’s, that model has just grown into something completely different. But if you back up though, and look historically, the whole concept started in response to a paper in the forties about the unsuccessfully aged. So it’s this paper about why are some people aging worse than others? Then having [NAME] turn that around and said “Well let’s ask the question of why are people aging better?” But in having [NAME] conception, personal assessment was a really key part which has no part in Rowe and Kahn’s, but they’re doing it for a different reason. Then if you look at Baltus and Baltus, there’s successful aging that is later the selective with . Again, they’re looking at a person’s ability to compensate. But Rowe and Kahn are saying the medical model, we want to know what’s going on here. And so I think it’s really irritated a lot of people because it seems to imply that you’ve failed aging somehow. You know, “Oh, you’re unsuccessful” or what happens if you’re unsuccessful. I would link this also with the third and fourth age constructs that are kind of the same but new retelling of it. You know, you’re healthy when your older, and then you’re not. And I think that that’s what we’re really getting at. But I think the idea of successful makes it sound like you can fail aging. And it really rubs people the wrong way but I do not think that was at all their intent. I really believe that they were trying to have a model that would help provide insight into, really, there’s something going on with this group of people. What is it? How can we then intervene to help? Not, like, “Oh well you’re unsuccessful. Too bad.” There is a line from the book though that really irritates me very much, and it’s when they say that they applaud Stephen Hawking’s efforts but he could not be successfully aged. And things like that you think, really? I mean, I don’t think Stephen Hawking would agree with you.

 

 

Alex Bixhop

Yeah, I mean he aged well.

 

 

Kate de Medeiros

Yeah! He did a few things, you know.

 

 

Alex Bixhop

Well I appreciate your time, taking the time to answer a few questions and spend some time with you learning a little bit about what you do and some of the concepts that you engage with and just the pathway, the trajectory that you’ve had, is really unique in terms of getting into the field and the contributions you certainly have made and continue to make.

 

 

Kate de Medeiros

So thank you very much. Thank you, thank you for taking with me, it’s my favorite subject to talk about.

 

License

Icon for the Creative Commons Attribution-NoDerivatives 4.0 International License

Successful Aging by Alex Bishop is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License, except where otherwise noted.

Share This Book