The Physiology of Wisdom
Dr. Hal Atkinson
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| Hal Atkinson, MD|
Affiliation with the Medical School: Associate Professor of Internal Medicine, Section on Gerontology and Geriatric Medicine
Place of birth: Sumter, SC
Where you grew up:
College and Medical School Attended: Wofford College, Spartanburg, SC; Medical University of South Carolina, Charleston, SC
Major in College: Biology
Lifelong Goals: To be a caring and competent physician to my patients and an attentive mentor to students of medicine.
Personal Philosophy on Life and/or Medicine: Always strive to treat every patient like I would want my own family to be treated.
Favorite Quote: “One of the first duties of the physician is to educate the masses not to take medicine."
–Sir William Osler
I got into geriatrics because I wanted to help old people maintain dignity and independence in old age. I knew they needed people who were devoted to making their lives and their healthcare as good as it could be. I had seen poor healthcare in my own senior family members who faced complex combinations of diseases with all levels of providers who did not have the training, or perhaps desire, to sort through the complexity and work for their best interest. The few healthcare providers that I saw working for the interests of older people gave me a glimpse of what might be possible.
But, that was not the only or perhaps even the main reason that I decided to become a geriatrician. I think that some of my reasons are entirely selfish -- I like to be around wise people who prompt me to think about the way I approach life. It is fascinating to talk with people who are at a place in life that I might someday have the privilege of being in myself -- old age. I have personally found that most old people have a great deal of wisdom to offer to those of us that are in our youth or middle age. Some of this comes from their experiences which are naturally more abundant than those of a young person, but, although difficult to prove scientifically, I submit that some of this may come from the physiology of aging.
We think of aging physiology as a process that results in increased vulnerability. One of the main effects of the aging process is that old people think and move slower than they did in their younger days. This is not just a cohort effect reflecting that they were always slower because of the pace of life in their youth. Much more than that, the change in speed with age is a physiologic fact of life. Old people react to a sudden stimulus more slowly, they don't process new information as quickly, and they even walk slower. There are different rates of deceleration, with some having a much more gradual slowing and others more rapid. Some of the differences in the rates of deceleration that we see in old people might be explained by the burden of diseases that they deal with, some by their lifestyle choices, and a great deal by their genetic backgrounds. Slowing down at any rate, but especially the more rapid decline, concerns us as their families and healthcare providers. We try to do good things to attenuate the decline in speed like treating comorbid conditions and encouraging social and physical activity. We do this because we know that speed, commonly measured as walking speed, predicts many things -- falls, loss of independence, and death. Some geriatricians have even proposed that walking speed be included as the fifth vital sign because it is such a strong measure of risk for these poor outcomes.
The good things that we encourage people to do to prevent slowing down are done with the intent to help older people to maintain independence and vitality in old age, which is certainly appropriate. The founders of the field of geriatrics have articulated that we want to add not only "years to life" but also "life to years". Most of my medical practice is in this pursuit, and this is definitely the goal for the majority of older people and their families. However, even though we might attenuate the rate of deceleration, there is still a slowing down that progresses with aging. And, although we fight it, this deceleration might actually have some advantages.
The fact that old people slow down as they age is based partly on disease burden and partly on the physiology of aging. Much of the physiological explanation of this is that neurons don't transmit signals as quickly, likely due to genetic programming and accumulation of metabolic and environmental insults over time. As a result, most, but not all cognitive functions decline to some degree on detailed testing. In fact, on average, a few measurable aspects of cognitive function like vocabulary actually improve with age.
Wisdom, unlike vocabulary, is likely impossible to measure accurately. I and other admirers of old people have observed that, in the absence of cognitive diseases, old people seem generally wiser than young people--that is, they often have better judgment and decision-making capability for important things. But, they are a lot slower. I also see young people every day, and I am moving into middle age myself so I have some personal experience with youth. Some young people are wiser than others, but many drive automobiles fast and recklessly, use handheld devices to stay in contact continuously at the dinner table and in the car, stack up things to do to fill every bit of their time, and make quick decisions without considering the consequences that they will ultimately regret. I don't think this is just a cohort effect due entirely to the culture of the current younger generation, but it may reflect a more timeless inverse relationship between speed and wisdom. Life is fast for the young, and so is their neuronal transmission. Things are more reflexive.
What good things come with the inevitable slowing down of aging? Maybe increased vulnerability itself breeds wisdom through making the old person more cognizant of what is truly important in life. On another physiological level, perhaps thinking more slowly, less of an ability to focus to exclude so-called "irrelevant" information when concentrating on a task, and moving more slowly through the day allows the old person to think things through to a greater degree and more broadly than a younger person. Although nerve conduction may be slower, perhaps the old brain is more capable of seeing the big picture of a problem and can integrate life experiences in a more purposeful way into any given decision. The slow old person may be less likely to jump to a false or inconsiderate conclusion than I would -- in part due to my faster neurons and quicker reaction time.
I had two main reasons for dedicating my life to geriatrics: one was for me to have an impact on the healthcare of those who are vulnerable and the other was because I enjoyed being around people that were wise and whom I admired. Now that I know a little more about the aging process, I think that vulnerability and wisdom may have a common physiologic mechanism, and we younger people have something to learn from that. While we try to help old people maintain their walking and thinking speed to reduce their vulnerability, we should also recognize and respect the merits of slowing down.
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