One of the great misfortunes of aging is the development of Alzheimer's disease. Some of us have patients who either have the illness or are perhaps showing signs of impending impairment because of Alzheimer's. Others have questions about how to best help these individuals.
The study under discussion revealed an interesting correlation between the sense of purpose in life that many elders have and a lowered risk for development of mild cognitive impairment and Alzheimer's. The Rush Memory and Aging Project involved more than 900 subjects who were observed and examined over a 7-year period. The study examined the individuals' cognitive, emotional, and physical changes–and many other aspects of their lives. Purpose in life was measured using 10-item scale derived from Ryff's Scales of Psychological Well-Being (Arch. Gen. Psychiatry 2010;67:304-10).
The concept sounds rational and is in keeping with our best geriatric care practices in which we try to inspire elders to see a purpose in life. Certainly, if the idea of maintaining purpose in life becomes part of how we conceptualize the patient with AD, we will be more vigorous in our efforts to inspire patients to see a value in their lives, to recognize the successes they've had during their lifetimes, and to do more with their hobbies and other social and interactive activities. So, this study could be a stimulus to work harder with elders who are sinking in a purposeless life.
Does Connection Really Exist?
I am skeptical, however, of the notion that purposelessness is an important contributory factor to AD. The concept of “purpose in life” is vague and likely very difficult to measure empirically. I think we would all agree that the feeling of purposelessness is not limited to the elderly. So many young people seem to have purposeless lives. So do others of all ages, such as the addicted, the directionless, the failures, and the abused–many of whom persist in their feelings of worthlessness prompted by their parents. It's a condition that we must recognize and work to change if such a person becomes our patient.
In middle age, we tend to see many people who suffer from depression, because they are confronted with a purposeless life as they review their years. The drab, dull, and useless lives of millions of people who have not fulfilled any of their dreams are a tragedy. Many movies have pursued this theme, and Woody Allen has made a career of portraying such types. All of this explains why it seems implausible that elders who seem to have purposeless lives would be more likely to develop AD.
On the last page of the study, the authors state, “An inherent limitation of this study, as in all epidemiologic studies, is the inability to establish causality with certainty.” I was very glad to read that acknowledgment, because this study reminded me of Dr. I.S. Ravdin, a renowned surgeon in Philadelphia who was considered the “God” of medicine back when I was growing up in that city. He practiced at the University of Pennsylvania and was highly renowned. I recall that when I was a child, there were doctors, diagnosticians, and Ravdin. Later as a medical student, I had the opportunity to make a site visit to a private psychiatric hospital in Philadelphia, and there I discovered Dr. Ravdin.
To my astonishment, Dr. Ravdin was totally lacking cognition during my visit. By that time, he was known to wander the halls of the hospital with the usual absence of the AD patient. I couldn't imagine a man of his stature and fame having no purpose in life. So I must admit to having cognitive interference while reading the study, created by my childhood experiences and Dr. Ravdin–who is long since deceased.
When Age Is Irrelevant
Today, I had an experience which, I think, reminds me of a central purpose in my own life. I was at a conference in which a delegation of 12 people from Ireland came to visit a community-based organization that, I believe, does extraordinary work in reducing youth violence. The Irish visitors were eager to learn about us, and I was there because I am a member of the board of directors and chair of the Oversight Committee of their most successful program.
As I do with most things that contribute to my life's purpose, I spoke with great passion about the program and answered their questions with equal vigor. Just before the meeting closed, one of the visitors asked me, very politely and tentatively, how old I was. They were excited that I was so committed.