Assistant Professor of Gerontology Joseph Saenz joins Professor George Shannon to discuss his ongoing work on rural-urban differences in cognitive ability among older adults in Mexico, as well as whether certain personality factors make people resilient to the negative effects of early-life disadvantage.
On the focus of his work
I focus my research on looking at how it’s socioeconomic disadvantage throughout the life course relates with cognitive ability and late life. I’m interested in education. I’m interested in income, wealth and the resources that we have available to us throughout our lives and how this relates with better cognitive functioning, as well as lower dementia risk and the population of older adults of Latino origin here at the United States and also older adults in Mexico.
On demographics and differences between rural and urban populations in Mexico
One of the things that’s very important about the Mexican population is we’ve seen a lot of demographic changes over the past century. In addition to seeing rapid population aging with the share of the Mexican population aged 60 and over increasing rapidly. We’ve also seen a large urbanization process where people are going from rural areas to urban areas. For example, back in 1920, only about 70% of the Mexican population lived in rural areas, but by 2010, this had declined to only about 20%. So a lot of people have been going from rural areas to urban areas. And this is important because in Mexico we see a lot of differences of a lot of disparities between urban areas and rural areas.
Rural areas tend to be disadvantaged in several ways. They tend to have lower access to education. There’s fewer schools for people to go to. And the educational quality that people got, especially if you look at several decades ago was significantly lower quality than their urban counterparts. Also in rural areas, we tend to see higher rates of poverty and various measures of SES. And we also see that the rural population tends to have less access to healthcare. This as the gap between the rural and urban areas in terms of healthcare access has shrunk a little bit over the past couple of decades, but there’s still a disparity there. And so when you bring up the idea of the life course and where people live throughout life, I think this is especially important in Mexico, where we saw that rural to urban population shift, that many people who are living in urban areas now were living in rural areas as children.
On his research looking at where people live throughout their lives
In this more nuanced approach, what we see is that the people that had the lowest exposure to urban areas throughout life, those who lived in rural areas in early and late life, ended up doing the worst cognitively. And those who are doing the best are the people that lived in urban areas in early life and urban areas that late-life… And what we also see is that compared to people that stayed in rural areas throughout their entire lives, those who went from a rural to an urban area, also show advantages. So what it looks like we’re finding in our current studies is that both early life, urban-dwelling and late-life urban dwelling are related with better cognitive ability. And there is an advantage that comes from moving to an urban area throughout life.
On the negative impacts of indoor air pollution
And then the other reason that we could expect to see these differences between rural and urban areas is that in urban areas, we know that people have high exposure to air pollution from the outdoor environment. When we look at pictures, for instance, say in Mexico City, we see the smoggy skies and we see this high level of air pollution that people are breathing in urban areas. However, in rural areas in Mexico, a significant portion of the population relies on solid cooking fuels. So this could be wood and coal and Mexico is primarily coal if people are using solid fuels for cooking. And when people use these solid fuels for cooking, particularly inside the house, you can imagine how quickly the pollution builds up inside the home. So people in rural areas have greater exposure to air pollution inside the home from solid cooking fuels. And we know that that exposure to air pollution is associated with poor cognitive functioning. And in my own work, looking at the effects of indoor air pollution from solid cooking fuels, I find that people who cook with these solid cooking fuels tend to have lower cognitive functioning and also more rapid cognitive.
On the potential to improve outcomes
We’ve seen several large policy changes in Mexico in the past couple of decades that are aimed at improving access to healthcare and primarily in rural areas. And so improvement of access to healthcare, access to health insurance, and regularly seeing doctors are something that we could use to improve cognitive ability and cognitive outcomes of older adults in rural areas. And last on the topic of cooking fuels, we know that one of the challenges and one of the reasons that people in rural areas are more likely to use these solid fuels is because maybe there’s not the infrastructure to bring clean cooking fuels such as gas and electricity to more remote rural areas. Policy changes aimed at improving infrastructure to bring clean cooking fuels to rural areas and to educate people on how to cook with clean cooking fuels could be something very important to bridging these disparities that we see across rural and urban Mexico.
On the role of cognitive resilience and personality characteristics in overcoming the negative effects of early life disadvantage
What cognitive resilience is looking at is one’s ability to not show the negative effects of stress. So people who are cognitively resilient can experience stress but don’t show effects on cognitive functioning. They look like they’re doing okay, cognitively, even though they’re experiencing high levels of stress. In my work related to personality, I look at how personality characteristics are related with one’s cognitive resilience or one’s ability to overcome the negative effects of early life disadvantage. Early life disadvantage, being a stressor that I’m considering.
So the personality characteristics that I tend to look at include a locus of control, which is how strongly one feels that he or she has control over their lives. And people who have an internal locus of control tend to think that the things that happen to them are the results of their own work. That they’re the results of their own choices. Whereas people who have an external locus of control tend to believe it’s external influences that affect their life. And so they’re the ones that tend to believe that maybe the bad things or good things that happened to them throughout life are the example are, are the result of luck or of chance.
Now, the other personality characteristic that I look at is conscientiousness, which has one’s tendency to plan, one’s tendency to be goal-oriented and to delay gratification. And when we look at the locus of control and when we look at conscientiousness, both of these affect how people tend to cope with stressors. So in my work on personality, what I do is I look at how personality relates with one’s ability to overcome those effects. And we see that having an internal locus of control and having a conscientious personality are both independently related with one’s ability to overcome the effects of early life disadvantage.
On the importance of midlife research
We also see a lot of focus on early life, a lot of looking at early life SES, a lot of research looking at education and childhood, but I don’t think we see nearly enough work looking at mid-life. I think there’s a big gap in our understanding of the courses or the trajectories that people take throughout life. We don’t see enough about midlife. So I think this is another area that I’d like to go into more in terms of looking at midlife. So what are the specific occupations that people worked? What are the levels of cognitive stimulation and those activities also looking at midlife, we could also look at people’s marital histories when they got married, whether they were married multiple times. So I think there’s a lot of information out there on midlife that could be very valuable in predicting where people are going to be 10, 20 or 30 years down the road.
Instructional Associate Professor of Gerontology Paul Nash joins Professor George Shannon for a conversation on the impacts of ageism, intersectionality and LGBTQ+ issues in aging, and the importance of talking about sexual health with older adults.
On stereotypes and the impacts of ageism
Well, there’s some huge implications when it comes to ageism. So when we look on an individual level, we know that those people who have internalized ageism, so when they’ve acquired ageist attitudes across the life course, and then they reach older age themselves and they start to internalize those negative perceptions. We know that people that do that tend to walk slower, they tend to be more unstable on their feet, more likely to fall. They also have reduced cognitive functioning. So we actually start to see these stereotypes as we call it embodied. So we call it the stereotype embodiment theory, and we know that older adults have this more negative opinion of aging and being older themselves also have an average life expectancy that is about seven and a half years, less than those people that have a positive attitude about aging.
When we look at society, we know that older adults make a huge contribution to society. We talk about billions of dollars a year in things like informal caregiving, even in terms of paid work, but also within the volunteer sector as well. So older adults make a continued service to society and to the economy, but it’s often something that is not really discussed this often. So it’s not really met. And when we start to prejudice against old people, we actually discriminate against their engagement in society. And as such what we’re doing is actually making things an awful lot worse for ourselves. So what we need to do is start to actively embrace older adults and their diversity and understand accurate perceptions of aging rather than these stereotype myths that are widely held.
Ageism is essentially prejudice against your future selves. So if we set up an ageist society, now when we read later life for ourselves, then we’re going to be living and growing old in that age of society. So we need to start to challenge that younger people need to appreciate that actually having no wrinkles having gray hair or whatever, having wrinkles and gray hair is not a bad thing. Being older is not a bad thing. When we start to see all these anti-aging serums, well, that’s kind of a fallacy. It’s not going to stop you from aging. Every moment that we’re alive, we are aging. Therefore, really the alternative to aging is death. And I don’t think many people would like to wish that upon themselves either.
When it comes to the wider social problems and the stigmas and things that I think we need to try and do is we need to be very much aware of our own language. And language, as you know, is incredibly powerful. So for example, we might see ageist stereotypes in greeting cards, and we will have a bit of a giggle about that, but, well, that reinforces the stereotypes. That adds to the issues that older people think that well, okay, I’m 60, I’m 70 I’m 80 as well, I must have cognitive impairment. Well, indeed, what we need to do is start to challenge these stereotypes. We have this assumption, or we paint this mental image in our head that all older people are going to be frail. All older people are going to have cognitive impairment. That’s just not true. The majority of older adults, even the age of 80 are not going to be living with cognitive impairment. It’s a disease state. Yes. We understand that people who, as they age are more likely to develop dementia, but the majority still don’t.
On intersectionality and LGBT issues in aging
We know that the majority of older adults within the LGBT community are likely to be single. They’re also less likely to have a biological family, so children of their own. And they’re also more likely to be estranged from their own family, which has led really to the development of what we call family of choice, which is really where people surround themselves by friends and friends basically take that role of family within your own life. But that can be kind of challenging unless we have intergenerational family or intergenerational families of choice, because it may, be for example, that a group of people at the same age all start to require support and help at the same sort of times.
We have to be very, very conscious of this. And then as I mentioned before, with that intersectionality, when we look at how racism and sexism and homophobia has developed across the last 50 years, we can start to understand then why, for example, gay women of color, and especially trans women of color are subject to the most forms of discrimination, which leads to problems in terms of accessing services, because they don’t have faith in healthcare services, in support services, in any formal structure. So we have to make sure that there are targets and health messages. We need to make sure that we are removing some of these intersectional barriers so we can try and aim for a more equitable society.
One of the problems that we have within the LGBT community is that there are very few quote-unquote safe spaces. And these often revert around bars around nightclubs, around places, for example, that you might meet with loud music and as an older adult, that might not necessarily be your ideal situation, especially if you’re living with cognitive impairment, if you’re living with a visual impairment or indeed issues with hearing as well. So we find that older adults often feel slightly isolated from these particular groups, which leads to larger issues with their social network, having reduced social networks and indeed self-isolate. And we start seeing then the problems around social isolation and loneliness that you mentioned earlier, George. And these are huge issues, not just within the LGBT community, but within the older adult population as well. But before we go down that rabbit hole, it is worth mentioning that older adults are not the most lonely in society. Actually, that is something that we can pass off to the younger generation, which arguably is partly down to that social comparison with social media.
On the importance of talking about sex and older adults
One of the problems that we’ve got and this really pervades through research as well, is we have this wide standing assumption that older adults don’t have sex. So as soon as you reach 50 ok and say, you’re done, you never have sex again. We know this to be untrue, but research and mostly policy also stopped collecting data about older adults and their sexual health and their sexual behavior as well. So there’s a lot of data that we just don’t have on this population. So when it comes to sex and sexual health, what we need to do is make sure one, we’re engaged in the older adult population and saying, well, we know you’re having sex, but let’s make sure we can do it in a safe way.
We also need to make sure that sexual health screening is available for older adults because we have targeted interventions for youth groups, for hard-to-reach communities, but we don’t have sexual health screening that goes around residential care, for example. And there’s no reason why we build that. We also have to be very, very aware that older adults have different relationship styles. So gone are the days where every older adult is in the same relationship that they were in when they were 20 years of age. Indeed, now we’re seeing increased divorce rates. We’re seeing open relationships, polyamorous relationships, the same as we’re seeing across other age groups as well. So we have to be very aware that for example, condoms, aren’t just there to prevent pregnancy, but they’re also there for sexual health. And we can take that across to, for example, HIV, where we see now that over 50%, nearly 60% of all those people living with HIV are older adults. And within this population, those are people over the age of 50. And that’s been a real challenge, both in terms of healthcare providers also in terms of policy.
So really what we need to do is open our minds and address some of these ageist assumptions that we have around older adults, and actually start to work with older adults as well, rather than making these assumptions about this homogenous group, which is exactly the opposite. It’s the most heterogeneous group that you’re going to get and actually work with them to understand some of these intricacies and understand some of these challenges that have been faced. So again, what we can do is try to make sure that these health messages are targeted and available for these specific groups.
If we make these assumptions, the old people don’t have sex well, we’re automatically cutting them off from research or automatically cutting them off from health services. So really, I think one of the key lines is something that we used very, very widely in the UK. When working with older adults, we should be saying nothing about us without us. We should have that participating in inclusion work with older adults. Don’t make assumptions around them and what aging actually entails when actually we’ve got these experts in the field, as it were, that are largely ignored from social policy and from research.
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