How to Talk to People - How to Define Old Age

Episode Date: May 5, 2025

In 2021 Dr. Kiran Rabheru, a professor of psychiatry at the University of Ottawa and a geriatric psychiatrist, found himself at the center of a medical debate. The World Health Organization wanted to officially designate “old age” as a disease, but with more than 40 years of work with aging populations, Rabheru saw this as another example of ageism that needed to be challenged. Dr. Rabheru talks with Yasmin Tayag about how he fought the WHO and about the impact such designations can have on research and our understanding of growing old. Learn more about your ad choices. Visit megaphone.fm/adchoices

Have you ever had the urge to sneak behind the cordoned-off areas of a museum? Or roam the halls after closing time? The Smithsonian's flagship podcast, Side Door, will sneak you behind the scenes of the world's largest museum and research complex. Come learn about the ghosts that supposedly walk the museum halls after dark, how a train robbery gave rise to criminal forensics. Why leeches are actually the coolest thing ever. And how to get away with murder in the Arctic.

Maybe. You'll discover stories of history, science, art, and culture you won't find in a display case. You can listen to Side Door wherever you get your podcasts. Or find us online at si.edu. Almost almost anything delivered with Uber Eats. Order now. Alcohol in select markets. See app for details. I'm Natalie Brunnen, producer at The Atlantic. And I'm Yasmin Tayek, a staff writer with The Atlantic. You've reached how to age up. Leave us a voicemail after the beep. Hi, I am 60 years old.

Most people think I'm 45, 50, but I'm actually going to be 63. beep. Hi, I am 60 years old. Most people think I'm 45, 50, but I'm actually going to be 63. And I am 60 wonderful years old at 61. Yasmin, over the last few weeks, we've been asking people to call in and tell us their age and about some of their experiences of aging. I'm 75 years old. Thank God I'm Italian and I don't wrinkle. So I don't look my age. And I feel 20. My age is almost 80. So I am actually aged, not aging.

I'm 88 years young. I'm only 88 and married to a younger woman, only 85. So one of our secrets is youthing. We're not aging, we are youthing. And we eat well, exercise, and looking forward to getting older, but we're getting younger. So that's it, bye bye. Youthing, I like the sound of that. We're getting younger. So that's it. Bye bye. You thing.

I like the sound of that. Not wrinkling because I'm Italian. I like the sound of that. But as I was moving through the collection of voicemails, I noticed a pattern. We also received a lot of callers sharing very similar anxieties about the unknowns of what could lie ahead. And what aspects of aging am I nervous about? Living to a very old age and not being very healthy.

I am nervous about feeling older, just all the aches and pains and failures of organs and body parts. The things that make me nervous about aging are just physical breakdown. Like, I don't want to break a bone. I don't want to get cancer. I'm really afraid of getting dementia. I mean, it just seems like a terrifying thing. And the older I get, the more afraid of it I am. Yasmin, you know, we asked about aging and we heard a lot about disease and decline.

Yeah, I mean, I'm not totally surprised to hear that people are worried about getting sick as they age. I do think culturally we conflate aging and disease. It actually made its way to the center of a debate in the medical field. A few years ago, the World Health Organization tried to connect aging and disease more officially. How so? Well, they proposed defining aging itself as a disease. To make aging a disease?

A classified disease in the ICD, the International Classification of Diseases. What benefit would that have? Well, the idea is that if old age is officially considered a disease, then drugs can be developed to treat it, the way we already have drugs to treat diseases like diabetes and cancer. So a lot of it comes down to funding. But how do you treat old age? Aging is time passing. Yeah.

How do you stop that? You make a good point. And these kinds of details are exactly what I wanted to know more about. We don't have a good clear definition of old age, and that is still up for debate. What is old age? Natalie, that's Dr. Kiran Riberu. He's a professor of psychiatry at the University of Ottawa and a geriatric psychiatrist. He's been focused on aging populations for over 40 years, and he spearheaded the team

that challenged the World Health Organization when it wanted to officially designate old age in the ICD. But before we get to that, it can help to know more about Dr. Riberu and why he's so interested in aging populations. That's an easy one. My grandmother. Oh, tell me more. So my parents, they were around, but they were busy.

They were setting up a business and so on. And when I was growing up, my grandmother was the main sort of person in my life. She had a huge amount of influence on me. She was not educated. She couldn't even write her own name, but she was, in my opinion, totally biased. Probably the wisest and smartest person I've ever met in my life. And every time I see an older person, I see a bit of her in them.

That's lovely. So, how did that shape your view of older people? You had what sounds like the privilege of getting to know a grandmother, but that hasn't always been common, right? So aging historically was like, I just want to go back a century or two. If you look at the numbers, if you were walking on the streets in the year 1800, most people would not have been old. You would hardly see an older person. Most people died by the time they got to the age of 30. Yikes. I would have been long gone. If you fast forward 100 years, if you were walking around the streets in 1900, most people

would be no more than 40. So there's a difference of 10 years in that 100-year span. But if you fast forward another 100 years, the year 2000, that number went from 40 to 70. So now, even across the lower and middle-income countries, most people live to an old age. So on one hand, we've increased the lifespan of people. But on the other hand, we have devalued that population.

And therein lies the crux of the matter that we're talking about. And that is the way people think and feel and behave or act towards the whole aging population. So it sounds like there have been some big positive improvements for aging, but that may have led to an increase in the disparaging thinking we call ageism. It's very subtle and it's largely unconscious and it's institutionalized. It's part of our policies and laws, and it's part of our processes, it's structures in every sector, and that's embedded as an unconscious bias.

Sure. The COVID-19 pandemic really shone a light on the gaps we have in our system, particularly towards older people, and ageism became so much more rampant. The future is not about young versus old, although our government sometimes tried to pit the old versus against the young. But it's about designing a society where everyone at every age can live together with dignity and purpose and opportunity. One thing that I think makes those conversations difficult is that we don't have agreed upon

language to talk about age. And our society's perspective seems to reflect that. Like, to me, our conception of age seems very rudimentary. Old and young are relative terms. I understand that one of the attempts to assign a definition to old age came when the World Health Organization wanted to classify it as a disease in the ICD. Can you explain what that actually means and the implications for how we think about age and illness?

Oh, Yasmin, absolutely. I used to teach the course on classification diseases. Huh. I used to teach the course on classification diseases. And classification is really important. It's not perfect. We have to adapt it as societal values change and our thinking changes, and we gather more data biologically. The environment changes, and we need to change the classification system to match it, right? The ICD is not published every year. It's published every 10, 15 years apart. So, once it's in there, it can change a

whole generation of people going through the treatment and through the hospital or clinical system. You know, I'm thinking, for example, of alcohol use disorder. It used to be seen as this moral failing, a failing of willpower. And then it was classified as a disease, and that seemed to change some of the cultural thinking around it. So, that's an example of defining a disease that really helped the culture find more empathy and also more investment in the recovery and success of many people. Could you give me an example of a condition, you know, that went through the process of being considered and classified as a disease but is no longer considered to be one?

You know, we've gone through diseases like homosexuality classified as a disease. And think about the stigma associated with those terms. We don't use them anymore. And words matter. It tells people what value you place on that human being. Mm-hmm. It's so obvious to me that these official classifications matter. Absolutely. You know, it makes me think of the legalization of marijuana in Canada where I grew up. My parents were always super strongly opposed to it. But ever since it was legalized,

I've noticed their tone softening a little. It's not like they've gone and flipped and started using it, but now they talk about it as a thing that some people do, and that's okay. And it's been fascinating to watch that shift just because there is some sort of like binding declaration of this being legitimate. Yeah, exactly. So I want to talk about disease classification specifically in relation to aging. In December

2021, you found yourself in the middle of some very high stakes deliberation. Set the scene for me. It was the most fascinating experience, I've got to tell you, Yasmin. As part of my work, I've worked with a lot of people across the world that lead different organizations in aging. And it came to our attention that the WHO was updating the International Classification of Diseases, the ICD. And part of the changes that they were proposing was to include old age as a disease. Wow. Just old age. Just old age, quote unquote, as a disease.

And, you know, look, the WHO is highly respectable, but it's an unconscious bias. And this is an example of ageism within WHO. Now, in March of 2021, the same organization put out the global report on ageism, to combat ageism. It seems a little hypocritical. In the same organization, yeah. So we wrote, we got together and we organized a campaign. There were like eight or ten different organizations that all wrote to the WHO. And collectively, we represented millions of people across the world.

Our team and the people that I work with immediately thought aging is a privilege. That's not the disease. And you know, look, as a clinician, I know that it's not always easy. The older people are much more challenging to see and treat because of the multiple medical and psychosocial conditions they have.

Having a diagnosis of old age would automatically just lead people to put them into that category, that this person's just old and they move on to something that's easier to deal with. Well, one of the big questions that the proposal to call aging a disease brought up for me was, where do you draw the line? Where does aging start? It's not the age. Like, Yasmin, if you have a car accident and you can't walk tomorrow because of a spinal cord injury, you would have the

same level of intrinsic capacity as someone who's at a stroke at the age of 80. So the number chronologically is not that it's not important. It is a risk factor, of course. Every organ ages over time. So it is definitely part of the risk factor, of course, but it's not the main driver of functional capacity. And so what happened next after you wrote to the WHO? They did in fact give us four hours of their time.

It was Thanksgiving Day. Thanksgiving Day? And we went through it in a systematic scientific way. And we explained we understand what they're trying to do. And they want to go after the biological aspects of aging, which absolutely we need to do. There's no question. There's a lot of pathology that we can

either reduce the risk off, etc. But to call old age a disease is not going to play well in society. Okay, so it sounds like it was a worthwhile way to spend your Thanksgiving that year. Totally, totally, 100%. Yeah. So how did it turn out? They came back to us a few weeks later saying they've met several times and then they've decided to change it. We were very happily shocked that they rescinded it, and that was the right thing to do. We were very pleased. Aging is universal and should not be pathologized.

And it's time to reframe aging in a more positive way. Okay, Yasmin, I want to work through some of this tension that I'm feeling. I can see the wheels turning. I'm having a hard time because hearing Dr. Riberu talking about challenging the WHO, it does sound like a win for how health professionals and society in general think about older people. And as we know, this perception has tangible effects on the care and treatment that people receive. So that's a win. Yeah. But I'm still trying to work out if treating aging

is a worthwhile pursuit or not. On the one hand, I'm like, okay, if we think about aging as time and time has a physical effect on ourselves, building up damage, getting worn out, I could understand a world where we're working to heal or repair that damage. And if we were able to do that, I'm guessing it would relieve some of the anxiety that

we heard in so many of the voicemails we received. But at the same time, I'm like, what does treating aging even look like? Well, there are existing drugs that are being repurposed to maybe slow aging. Okay, so what does that mean? Metformin is used for diabetes. Rapamycin is an immunosuppressant. And researchers are trying to determine if those or other existing drugs could slow the passage of time for cells or clear out old cells or the molecular junk that time leaves behind.

I have Timothy Caulfield in my ear from episode one telling me to assume nothing works. I'm skeptical about the ability to achieve these things and I'm just immediately wondering if something else is going on here. I mean, a lot of this does come down to money. There's a hope that there will be more investment in research on slowing aging, which in turn will save money in the long run because if people get sick less often as they age, it'll bring down the cost of healthcare. So that's one argument for exploring it. There was a report in 2021 from the Medicare Payment Advisory Commission showing that much older people

tend to be the most costly to the government, healthcare-wise. Right. I guess what I'm trying to understand is, although aging is not a disease in and of itself, and should not be classified as such, it is associated with disease, right? disease in and of itself and should not be classified as such. It is associated with disease, right?

And we could work harder to address the concerns that people have when it comes to aging. Exactly. So aging is a risk factor for disease, but aging itself isn't a disease. This was something I was really trying to work out too when I was talking to Dr. O'Beru. It's a risk factor. Aging is a risk factor. In fact, the strongest risk factor for cognitive impairment or dementia, barring, you know, all other illnesses. So if you have a stroke or a genetic predisposition, that's different. But if you're healthy and you're getting older, the biggest risk

factor is aging. One in three people by the time you're 80 will have some form of dementia, regardless of any other conditions. And that should be, the biology of that should be explored to mitigate it. Being a science journalist, I'm always looking at new research going on, and it does seem like there's continuing research that still treats aging like a disease, even though the World Health Organization decided not to classify it that way. One thing I saw recently was an effort to delay or stop menopause altogether, which is complicated, right? Because on the one hand, the symptoms of menopause

can be really tough to deal with, and not to mention the way that post-menopausal people are treated in society. And so I can understand why there's a desire to delay menopause or stop it altogether. But on the other hand, menopause is a part of aging. It's just a normal life stage. Exactly.

And it's in these sorts of questions that I'm really not sure where to fall. The solution depends on what your agenda is, like where you put your values. So, for example, if your values are coming from the financing side of things, you know, the aging industry, the anti-aging industry is huge. are coming from the financing side of things. You know, the aging industry, the anti-aging industry is huge. Oh, yeah. I have been victim to a lot of face creams. There might be things that you can do from a scientific point of view, from a medical point of view, to make the person's lives better,

but to completely alter the course of a human being, just because you can doesn't mean you should, right? We don't really understand the medium and long-term implications of doing some of those things. And the science is advancing so quickly with AI and with technology, but the long-term ramifications of what it does to humans and our society are not well studied. Okay, so we don't know if reversing or stopping aging is even going to work, and you're saying it's something that maybe we shouldn't pursue. Yet we still have this problem of people assuming that old age means they will get sick.

But, you know, I think a lot about my grandfather-in-law. assuming that old age means they will get sick. But, you know, I think a lot about my grandfather-in-law. He's 96 years old and walks two miles every other day. Good for him. He's my hero. He is awesome. And so he's definitely old in numbers, but I would never think of him as unhealthy.

Nobody would. Or worthless. Or worthless. Or worthless, exactly. The older population is growing. We'll have billions of people by the year 2050 who are older. And that's a resource. That's not, it's not a burden. If we keep them safe and healthy and happy,

they can provide support for the world. Okay, Yaz, I have to admit, when I hear those statistics about risk for disease as you age, I do pretty immediately tense up. Disease does still sound so inevitable to aging. I hear you. I mean, when I think about my family's heart health trajectory, I feel like it's inevitable that I'm going to get all the same diseases as my parents as I get older.

Oh, my God. I hope my dad isn't listening right now because I had slightly high cholesterol this year and I could not bear to tell him after years of me pestering him about this. I mean, here I am on my little lentil and sweet potato high horse and I still had slightly high cholesterol, meaning the same genes that came for his heart might just come for mine. You know I have been on this same spiral lately. Yeah.

But have you heard of the concept of health span? I have not. So it's what comes to mind when I think about my grandfather-in-law and all the other older people who called in telling us how they're thriving and living their best lives. Healthspan is the idea of extending the period that a person is healthy.

And that's different from lifespan, which is about how long you actually live. Okay. So instead of trying to live longer, until 105, it's about making it longer in your life without disease. Exactly. Just like staying healthy for as much of your life as possible no matter how long you live, which is the case for a lot of older people. Okay. How do we do that? How do we extend healthspan? So we don't know how to guarantee an extended lifespan yet, but we do know how to increase health span.

Eat well, exercise, sleep a lot, connect with people. It's all the stuff we've been talking about this season. And did Dr. Riberu have any more advice, too? Well, I thought you might ask. So I asked Dr. Riberu what his advice to his patients is. So for many, many years, I have given the same prescription to every single patient I see. That's after the break. If you're enjoying this podcast, you

should know that you can get more from your favorite Atlantic Voices when you subscribe to The Atlantic. A subscription gives you access to all our award-winning journalism, and you can listen to as many articles as you want online or in the Atlantic app. Your subscription helps fuel our journalism online, in the magazine, and on our podcasts. So subscribe today at theatlantic.com slash pod sub. Dr. Riberu, I have one last question for you. As a person who is aging yourself, like all of us are, what is one piece of advice you think we could all benefit

from? Well, I'll tell you. So for many, many years, I have given the same prescription to every single patient I see. When you leave my office or clinic or hospital, when you go home, here's my prescription for you. It's the rule of 20s. So I need you to give at least 20 smiles a day, okay? Because as soon as you're smiling, it changes the way your brain works.

Second is to do 20 minutes of activity of some sort. And I usually say walking. Because physical activity is really important for health, right? Of course. But try and get 20 minutes of walking. And thirdly, socialize for 20 minutes a day and not just with the person you're living with, that's fine too, but try and do something outside of yourself. So those are three basic things you can do and then all the treatment I give you will

be much more effective. I love it, the 20 rule. I'm going to do this today. It seems easy enough. I'm smiling a lot after this conversation. And so, I smiled a lot. I've talked to you for way more than 20 minutes. And I guess I just have to go on a walk later. Dr. Riberu, thank you so much. Likewise, Yasmin. Thank you. Yasmin, I do think that a really important part of this conversation is making sure we

highlight the aspects of aging that people are excited about. When we asked listeners for those voicemails, we didn't just ask what people were nervous about as they aged. What are you looking forward to? Well, the biggest thing is no more shoulds. I'm tired of shoulds. You should do this. You should do that.

I don't care about shoulds anymore. And the freedom of doing what I want when I want to. What are you looking forward to as you age? Well, staying mobile and fit and able to get around, and I really do get around. Despite my age, I can shovel snow for two hours, I ride bikes 35 miles at a time. I just basically feel like I'm 40. Is there someone in your life who has made you excited to get older? And yeah, it's this girl from high school. I married her and we have a great time together. I wanted to leave this message for all the women who are nervous about aging.

At age 30, I started my own business. I've raised two children and was widowed by age 59. At age 60, I started weight resistance training and cycling. I am slowly backing out of my company towards full retirement. I moved part-time to another state, something I wouldn't have dreamed of when I was younger. I do stand-up comedy.

I do all sorts of weird and wonderful new sports, whatever really takes my fancy and I kind of enjoy that. I can just like head off in whatever direction I feel like. All of it is about that, just that desire to continue to grow. The next question you had was who do you hope to be like when you are older? That phrase that I think Clint Eastwood is known for, don't let the old man in. And I think that's really where the secret life is.

I see so many people who just let the old person in, and I don't want to do that. So I admire anyone who really doesn't allow that to happen. Don't let the old man in. Or maybe better, change your idea of what the old man is like. Right. My dad is on a 70-plus senior basketball team. Amazing. And I like the old man they let in.

Like, they're just always looking forward to the next game, the next tournament, and just getting to hang out. And they're still so excited for what's to come. Yeah, I think for me it's like health span, life span, I want to extend my curiosity span. Zest span. Droid de vivre span. Exactima. Looking forward span. Droid de vivre span. Exactima. Looking forward span.

I want to see them land on Mars. I want to see them land and live on the Moon. I want to see all the new things that are to come and we're going to get to see. That's all for this episode of How to Age Up. This episode was hosted by me, Yasmin Tayyad, and co-hosted and produced by Natalie Brennan.

Our editors are Claudina Bade and Jocelyn Frank. Fact check by Ena Alvarado. Our engineer is Rob Smirziak. Rob also composed some of the music for this show. The executive producer of audio is Claudina Bade, and the managing editor of audio is Andrea Valdes. Next time on How to Age Up. Looking to the future doesn't always feel easy when climate issues loom large.

It's not about taking shorter showers, it's really about kind of setting up your brain when you consume this information. How to age up in a world affected by climate change. We'll be back with you on Monday.