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Emily Silverman: This is The Nocturnists. I'm Emily Silverman. Today, I speak with Dr. Anna Chodos, a geriatrician, storyteller, and educator, whose work asks the question: What if the words we use to talk about aging are shaping the way we care for older adults? In her clinical practice, Anna hears certain words over and over again: Burden, old, dignity, putting someone in a home. These phrases can seem ordinary, but they carry powerful assumptions about dependence, caregiving, disability, and growing older.

Through a new project called Words on Aging, Anna is exploring how language both reflects and reinforces ageism, and how changing our words might change our care. In my conversation with Anna, we talk about the philosophy of geriatrics, the hidden resilience of older adults, the stories we tell about aging, and why every one of us has a stake in getting this language right. Take a listen to me and Dr. Anna Chodos. I am sitting here with Dr. Anna Chodos. Anna, thank you so much for coming on the show.

Anna Chodos: Thank you for having me. Most delightful part of my day.

Emily Silverman: We've known each other now for several years. You are a geriatrician practicing at UCSF, and we met through San Francisco General Patient Care Overlap. You were also doing some storytelling work before we were doing storytelling work. I'm trying to think where we should dive in. If we should dive into geriatrics, or if we should dive into storytelling, let's dive into geriatrics. Tell us a little bit about your path to geriatrics.

Anna Chodos: Oh, wow, this is a real treat. Thanks for asking. You get that question a lot. It's a small field. Like, why go into this field, what would draw you to it? I don't have an aha moment, which is like, this is bad storytelling right here, but I had a lot, I think, of positive exposure to older people and people working in the field of aging very early in life, and I think then, as I went on in training, a big motivator to go into medicine was the social justice element, or the part of it that's-- You have this unique role in helping people in a really vulnerable place in their lives.

I think then I realized older people were not as robust a part of the picture, and that underdog image of older people drew me into it. Then, of course, is that whole process of acculturating to medicine, having those experiences with amazing mentors and colleagues. The more time I spent with geriatricians, I have to say, same thing with primary care. It was like, this is what's fitting my image of what it is to be a doctor and what it means to help.

Of course, I think like yourself, I've always had aspirations of having a bigger impact in the field in a direction that's more compassionate, more caring, more meaningful for our patients, and in my case, that's really older adults. I'll just credit, though, I had wonderful grandparents, of course. I had interesting grandparents, and I had wonderful grandparents, but I had one in particular who was like a walking hug, just like a big marshmallow. To this day can remember his hugs and the love he would give, so that's definitely something I carry with me.

Something really important was he was in Canada, and my grandfather had dementia, and he went into a facility that my grandmother went to every day to spend time with him. I have this really specific memory of going to a birthday party for him, and he was really, really impaired. The person who was caring for him brought him out like red carpet. Absolutely, you could almost hear beautiful music playing in some sort of like-- Like he had aura, as they would say. He was so well cared for; he was loved.

His hair was perfect. He smelled great. He looked great, even though he was incredibly disabled at this point. He wasn't particularly verbal, and there was something so touching and relief-bringing, and just I didn't worry about. It was weird how, as a 10-year-old, I was worried about him, and that speaks a lot, I think, to of children and how more advanced they are, perhaps, and sometimes we give them credit for. I remember just he looked and appeared really loved. Anyway, for some reason, I carry that memory with me. It's like one core memory.

Then a caregiver I had who was essentially my nanny growing up, one of my nannies. It was a couple, and they were an immigrant couple from China. The wife and the couple was studying to be a nurse, and she ended up taking a job in elder care. The way she would talk about her patients was also incredibly loving, and she just had so much fun with them, and it was just a really good example, I think, of how much fulfillment you could get for being in work like this and with older people.

Emily Silverman: I remember when I was in medical school, one of my favorite attending physicians was a geriatrician called Thomas Finucane, and this was out at Johns Hopkins Bayview Hospital, so not the mega ship hospital, but the smaller, more community hospital. I just remember, in addition to having a really just gentle and thoughtful disposition, the way that he thought about patients just felt really different to me. I'm preaching to the choir here, but it was much more holistic. It was much more based on thinking about function, thinking about goals, and it was really striking.

At the Hopkins mega ship, there were also obviously fantastic attendings, but it was much more intellectual. It was much more academic. It was much more almost voyeuristic, like

getting just really excited about other people's diseases, which I don't think is a bad thing. I think if you're a physician, it's good to be excited about what you do and to love

what you do and to be intellectually stimulated by it. It was definitely just a different tone, and Finucane was just so great. I remember he ran an elective. I think it was called chronic disease elective or something like that.

I think we were all required to do that elective, and the elective also just felt-- I guess, it wasn't an elective if it was required. [laughs] I'll just call it a rotation. The rotation felt really different than typical rotations. Normally, we'd be in the ICU learning how to do central lines, or we'd be on the GI floor learning about GI bleeds, or it was obviously a lot of hospital-based-- Hopkins is a very inpatient place, and chronic disease, we would do home visits with the home visit team, and sometimes we would get out to someone's home, and all we would do was clip their nails, clip their toenails, and I remember a lot of medical students, and admittedly, even myself on some level, they were kind of like, "Oh, this is boring. This isn't the glamorous Grey's Anatomy style medicine that you see on TV.

This is a much slower type of medicine. It's more incremental. It's just so different, and I don't know. I just feel like the type of person who's drawn to that pace of care, that patient population, that way of caring is just really special. Anyway, I don't know if you have any reflections on any of that.

Anna Chodos: Oh, absolutely. Oh, I'll take special. It's like any specialty. There's definitely the exciting medical stuff. Older people do have a lot of medical problems. It just depends on where your practice is really focused, but the thing that was coming to mind as you were reflecting on that rotation, first of all, Johns Hopkins maybe known to be like a total mecca for geriatrics. It's amazing that you had that experience. That was one thing I was saying because a lot of students there's no geriatricians around. It's not a required rotation.

There's been a slight trend towards actually removing geriatrics requirements out of a lot of training, and just lumping it in with general medicine, which is, I think, a anxiety point for a lot of geriatricians and geriatrics educators who understand that the exposure is really important to have any sense of what we do. What I was thinking is, we have all those things that you would see in other general practice specialties a lot of the times, or sometimes intensivist or hospital specialties if you're doing acute care for elders units work, or ortho, geri consults in the hospital, but there is this way in which every single person is a different constellation of issues, and that complexity by necessity drives the patient-centeredness.

I think the patient-centeredness is also a driving reason for a lot of us going into it. Is like that focus is really never lost, but older people with their complex mix of organs and

needs and family dynamics and social resources and access to those things, it has to be super, super person-centered. As many of the folks who are listening probably have heard of the age-friendly health system movement, which is this rebrand, I would say, and making a little more concrete what geriatrics is about.

It really anchors on this concept of the Four Ms: so medications, mobility, mentation, and the last one is what matters. I think a lot of geriatricians would really want to highlight the what matters piece more than anything, to be frank, because it's the one that's lost, I think, a little more easily in other parts of medicine. The thing I really like about my practice is I'm almost always only talking to patients and families, and that's an outpatient thing too. For me, I realize that's my happy place.

About 80% of my time, at a minimum, is spent in a clinical setting, and when 20% of the time is okay, I got to work on the care coordination, but I think I can understand for people who the reason they went into clinical medicine is that profound depth and breadth of knowledge of medical. This is hard stuff we have to learn. It's complex, and there is a way we just geek out on it. My husband is not in medicine when he overhears sometimes the way we talk about the things patients are going through. He reflects, and I'll just say that that's the nicest way I can say it, but he lets me know.

It doesn't sound super patient-centered when we really get into the tumor over here, or this thing they were going through, and isn't it fascinating that it was this new-onset GI intoler-- just something ridiculous that we think super interesting. What's lost is the patient, and I think in geriatrics, because you can't force into the equation in a patient care situation the medical agenda. It's not even practical. It's not even possible a lot of the times.

There is a way in which older people can end up more empowered in healthcare because they're just-- This is not the typical way I think we think about it, but there is a way in which, like, "I'm not taking that. Sorry. You can try all day long to tell me to take that pill. I'm not taking that." You have to come up with a different plan. A different way to help them get to that goal, or say, "Okay, we're not doing this." All patients have that ability and that right.

I think there's a way in which older adults have earned it a little more, and they're just clearer about it, and they have less compulsions about just letting-- The example most recently was I had a guy in his mid-90s who we were trying to adjust some medications, and has great family support. I don't know that he would have had to do it all on his own or whatever, but he manages his own medical care. The reason I say this is because I was like, "Okay, well, let's make this one change."

Right now, when we're speaking, it's World Cup time, and he was like, "You know what? I just can't handle anything until the World Cup is over." It was one vacation change, and I was like, "Okay, sure, fine. We'll touch base in a month, and may the best team win," whatever. He was like, "This is my priority, and that's just the way it is right now."

Emily Silverman: I remember Dr. Finucane telling a story. He was just so memorable. I remember more about him than I do about most attendings, probably just because he was so fantastic. I remember he told a story about an old lady that he took care of, and she said to him, "Tom, you get five medicines. That's it. I'm not taking anything more than five. You can pick the five. It's up to you." I just thought that was so funny because it's a great reversal of the doctor-patient power dynamic in a way.

Really framing it as the patient is the boss and the physician is really there to serve the patient, and it's the patient laying down the law, laying down the rules, and I just remember him telling me that story and watching him chuckle as he told the story. He thought it was funny and amusing, and he also had another patient he talked about where I still remember him chuckling that she took a third of an aspirin every other day for 50 years, completely not evidence-based, not part of any protocol, not part of anything, but that's just what she did for decades, and that's just what she did, and he just rolled with it. It was just really charming to hear the way that that doctor-patient relationship unfolded, and the funny stories, and just really wonderful.

Anna Chodos: Yes, those are such good stories, such good moments. I have 1,000 examples running through my mind. Actually, I do a lot of dementia care, and a good chunk of people I usually hear the estimate like 50% won't have insight that they have dementia, that they're having cognitive changes, and a good number of caregivers or families will come in, and they'll be like, "You need to tell her she has this going on, and you know that's not something I can achieve." I explain there isn't a world where we are going to be able to convince her she has dementia.

However, can we still address our list of things that would make her life better, that would help her right now manage the symptoms, manage the implications? Absolutely. I think there's a way in which geriatrics just gets crazy practical. You mentioned function, and we love to say we're all about the F word: function. What is the interaction between your physical and cognitive abilities right now, and your environment, and how can we get those to match better?

Emily Silverman: Tell us about storytelling. Everything we've been talking about up until now is so rich with characters and stories, and I know storytelling has been a passion of yours for a long time. You actually inspired me to begin storytelling at UCSF. You yourself had your own storytelling programming going on. Tell us about how that got involved with your creative life and your professional life.

Anna Chodos: It was probably Louise Aronson, and she was really passionate about -- and she was faculty here. She since retired from UCSF to go do more work elsewhere as academic physicians or want to do. She was always very clear, and I think we all learn this. If you're going to try to reach people with the things you care about, the weight of that is not the biggest number of statistics or the most rigorous data. That's important, but what people, of course, remember and resonate with are these stories. Really, the end of one. How do these things impact that end of one? At the time when I was doing the storytelling, it was really to interest students primarily in primary care, because what was so apparent to me was the stories we tell, the stories that really excite us, are the Grey's Anatomy ones, are the ICU ones, are the ER ones, and I was working with all these amazing people in primary care who were so passionate about it, and I wanted them to hear the stories and the amazingness of primary care.

What was really funny is I would invite all these primary care gurus and mega stars, at least, in our local world, and often the stories were about like, "Oh, I did residency during the AIDS crisis, so I'm going to tell stories about being in the hospital with AIDS patients and the incredible care and love I saw strangers provide each other, or the family repairs that were happening or weren't happening." I realized like, ah, there's a drama problem. There is an inevitability to the drama of these stories, and people want to tell them.

The same thing with geriatrics. I'm trying to figure out, and totally ready to take notes here. How do we tell the stories that really compel people, show people the challenges that we can totally overcome if we were doing things differently, the way people live their lives when they're older adults? I did another project, 80 over 80, which the goal there was to take the fact that our city is aging, and what does that mean? What does that look like? Who are these folks?

At the end of the day, these are just neighbors and coworkers, and people who were meeting in coffee shops because they're still working as a barista, whatever. Then there's just this incredible diversity-one in San Francisco, but also in older people in general. That was really, really fun. Myself and a bunch of volunteers went out to just hear people's stories, and it was just little vignettes about their lives.

I was very insistent that we profiled just regular people, as much as somebody who's running marathons barefoot, which we had that guy, he's amazing, and people who have run the local NAACP chapter for years, and people who have served in public office or been baseball stars, and just this woman living in permanent supportive housing who worked for 40 years in one of the hotels downtown. That was really, really fun. Completely selfishly, the best part was meeting all those people, and now having some friends in their 80s and 90s,

but how do we really get stuff like that out there?

It's probably something I could really learn a lot from you, and there is a way in which the stigmas of aging, the-- I don't know how else to say it, like the ick factor that's just out there and just baseline and basal for our society. It's really feels very challenging to crack open or to erode. My colleagues who are activists and really perhaps more eloquent about this than myself just call it ageism. We just have so much fricking ageism, and this is often hand in hand with ableism, but I think it's a real challenge.

If it's way better to see somebody's story about how great this concealer works than it is to see a story about an older person running a drive for clothing in their neighborhood. That's just reality. It's something I'm interested in changing, if that's even on the table.

Emily Silverman: I think there could be so much more public storytelling with protagonists and characters that are older. I remember many years ago there was this great film called Nebraska.

Anna Chodos: Oh, yes. She's still working. She's in her mid-60s.

Emily Silverman: Who?

Anna Chodos: The main character, June Squibb, I think, is her name.

Emily Silverman: Yes, the actress.

Anna Chodos: Yes, she's epic. Yes, icon.

Emily Silverman: It's a story about a father and son, I believe, and the father is suffering from early moderate dementia, and he gets notified through a scam, probably, that he won the lottery, and he decides he's going to drive across the country to claim his lottery winnings. Obviously, this is a scam, but his son decides to humor him, and they go on this road trip to go collect his lottery winnings, and it's filmed in black and white, and it's really beautiful. These characters are super three-dimensional, and they steal the show.

The older characters steal the show, and that was a long time ago. I just think there's a lot of opportunities to highlight older characters in storytelling in the culture.

Anna Chodos: Right, and in an authentic way, where they're coming across as real people as opposed to some stereotype of an older person, which I think was a good feature of Nebraska.

Emily Silverman: Yes, and I think there is the ick factor and the smelly old person ageism trope, but there's also an inverse trope, which is like the wise old person who, and I

think I think you said this to me once when you were like, "I don't love old people because they're wise. A lot of old people are assholes and are not wise at all." I don't know, do you find that? Do you find that there's this noble, like the old wise elder stereotype that similarly doesn't quite ring true?

Anna Chodos: Yes, I see enough people that I can certainly appreciate that people are just people and the age is irrelevant. I think it is okay and appropriate to give a lot of older people credit for definitely being wise and having a ton of experience, and this is where, in the non-artistic space -- not movies or fictional depictions of older people or something like that, but more in the political realm or the pedestrian realm -- I think you see a lot of that wisdom being discarded or not appreciated.

This is the whole thing where, like, as people get older and they hang on to jobs or they continue to work in high-power jobs, it's seen as a problem. The whole gerontocracy argument in our national politics and stuff like that. That's a bad thing. I guess in either direction, if we're going like, this person is older and has significant disability and therefore can't contribute, versus or only the oldest people have wisdom. Either way, these stereotypes are stereotypes, and like the more specific we can be about what the issues are, I think the more we can take them head on.

You're getting into one of the core words that I think about a lot, which is dignity, and that's one of the ones I'm trying to reflect on for this words on aging project. I think a lot of times we see "the indignities" of aging. Maybe having trouble with self-care or needing some support from somebody else to get through a day, and of course we are all interdependent. I want to shout out to the fact that there's no way around that at any stage of life, but older adults will need more hands-on caregiving at some point in their life, so that's a reality for most people.

Sometimes I think a lot of what we refer to as the indignities of aging, which is like this person who isn't well cared for, doesn't smell well, is not completely cognitively there, or something like that. That kind of typical stereotype. That's like, well, what are we doing wrong with caring for that person? The indignity of age is what we're doing to that person. How we're not allowing them to get the care they need. The other side, older adults are wise sages. I guess at the end of the day, culturally, I don't see it respected that often.

I think it is there, and in some cultures, it is more normative to really believe that, but not in American culture. I think we could pretty handily say that's not the case for the good old US of A. This is a core thing that I do love about spending so much time with older adults and seeing what they're dealing with and how they're managing it and how I can help. A lot of folks at 80 years, at 90 years, have been through some things, and it's pretty-- Again, it's this reassuring feeling. It's this inherent lesson that human beings go through a lot, and there's a lot we can't predict, and there's a lot we cannot control.

I'm seeing a bunch of people who have come through 10 of those things, and just watching the resiliency, I think it's such an underappreciated and underadvertised cool freaking thing about aging is like we should all have more faith in our own resilience because I see just again our population, a lot of people are only here because they were dealing with significant violence or significant danger in their home country and they've gone through that. They're here now, and that is something I really, really appreciate. I wish resilience was a more elevated word associated with aging or being older.

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Emily Silverman: You just mentioned the word dignity as being part of your Words on Aging project. Tell us about your Words on Aging project. What is that project? How did you get the idea to start it? What are some of the words that you're looking at?

Anna Chodos: You, your audience, anybody, please come help me. I definitely want to have these thoughts and these musings in conversation. I guess lots and lots of words. The the thing I was thinking about was really, again, just the way certain words loom large. I wish I had a quick example of the words that loom large in infectious diseases or pediatrics, but some of the words I thought to bring to this conversation is the word burden, the word old, and the word dignity. There's a lot of other words on the list, things like autonomy, safety.

There's also phrases, so things like-- Oh my gosh, it even honestly gives me heartburn to say this, but "We're going to put her in a home." That phrase comes up. Put somebody in a home, and what I was trying to think of is, okay, what are some of the reflections we can all have together on why this word is so prominent, and then is there something we could do to either elevate that word more, reduce our use of that word, reframe how we're using that word? I think of nothing else. We know language cannot be effectively policed. Not the point here.

The point is more it tells us something about the way we think about aging. It tells us something about opportunities we have to do better. Yes, we could start with burden if you wish.

Emily Silverman: Yes, let's start with burden. You hear that one a lot. People saying, "I don't want to be a burden to my family. I feel like a burden." That could be physical, emotional burden, but it could also be financial burden. Do you want to just open up that word for us and tell us how you think about it?

Anna Chodos: Definitely. Again, my analysis has not been perfected, so I fully bring this to the table as a conversation because you're such a great conversationalist. To the extent that, again, your audience has any interest in joining the conversation, I would love to chat more. Exactly right. You brought up the phrases you hear all the time, like "I don't want to be a burden." This is something that comes up in my own family. My parents saying, "Because we don't want to be a burden."

A little reframe on that, as I'm continuing to talk, is just to think about how do you feel when somebody says that to you. Somebody you love, somebody who's really important to you, looks at you and says, "I don't want to be a burden to you." We all have an immediate reaction to that. Is it like relief, and you plan your next vacation to Saint Kitts or whatever? No. Is it like, "What?" I get so horrified when they say that, and I just wonder if I'm like the only one or something. Anyway, I don't think so. The other one I would bring in is caregiver burden.

The concept of burden when you're working with caregivers is so oppressive, frankly. It's always there. We bring it up, and we have a dementia care navigation program, which is this thing called Guide. A CMS Innovations Program, and we have to do assessments of caregivers, which is an amazing feature. We're getting paid to directly assess and help a caregiver. Wow, mind blown. Okay, awesome. However, we have to do an assessment of caregiver burden, and it's the Zarit Caregiver Burden Inventory or something like that is the standard instrument.

It's 22 questions, and it says burden survey or whatever right at the top. Obviously, we can cut that off, but physically scissor or crop the page. I'm handing a piece of paper to somebody that says, "Tell me how burdened you are in caring for," and it is completely not to minimize the fact that this role is often a huge source of stress, strain, overwhelm. Whoa, but the word itself, burden, is so deterministic. There's not one question out there that's positive. I don't also give them a questionnaire that's like, "Okay, how is providing all this wonderful care for this person fulfilled you or made you closer to your family?"

Maybe you're like, okay, well that's hokey stuff, and we don't need to know that. It's like it is important because we don't support caregivers enough, and it's good data and information to know where to start with some interventions, blah blah blah, all that, but it's heavy, and that's obviously the implication of burden. Even just that framework itself, I really struggle with.

Emily Silverman: If you think about little kids, they're a ton of work. You're wiping poop, you're changing diapers, you're feeding, clothing, not sleeping, and I just can't

imagine going to the pediatrician's office and being handed a form that says, "Let's talk about the burden of caregiving for your children."

Anna Chodos: Yes, it's just not the same form, and the analogy is really good because obviously, ton of overlap, both the physical, emotional, financial toll it takes on the parents, and you get so much societal and cultural affirmation for performing these functions. Whereas caregiving is like hidden; it's shameful, it ruins your life, it's stressful, and so it makes us so less inclusive of caregivers and what they're going through. I think the framework of burden just adds additional burdens because we're not able to support them properly.

It ends up being constantly relegated to the most marginalized populations in our society, typically women, typically women of color. It's not to say actually a lot, a lot, a lot of men, a lot of men are caregivers for older adults with care needs and with dementia, in both those roles. I guess my point is just we miss the opportunities for growing really good, really skilled jobs. A lot of people do caregiving. It's a unintentional or untrained role for them, and so actually the elements of caregiving that we really need to assess are emotional strain, if that's present, and role preparedness.

The key thing that really reduces stress and strain in the role is if you're prepared, and that would be true for any job. One of the first things I do often, like talking to a caregiver, is just acknowledging like, "Wow, this is a lot of work, and you're doing an incredible job. Look how well she's doing. There's no way she would be doing that well if you weren't

doing such a good job." Maybe sometimes it can be a little bit like A for effort kind of platitudes, but the recognition of the caregiving role, the recognition of a job well done, and

then also just opening up for a little bit of conversation or recognition of how has this come into your life?

How is it a positive thing? Because a lot of people will tell you, "You have no idea what my mom did for me when I was growing up, and what she did for our family, and this is something that actually does bring me a lot of joy." It's really, really hard at times, but I really hold on to-- It's so important to me that she be treated well. You see a really nice and positive side of personal growth and development, and how important it is for us to be carers as much as cared for.

For the other example, I don't want to be a burden. When people say that, what I really hear is we don't have a way to face the normal aspects of aging in a way that's really permissible or normalized, like somehow, just all this normal stuff of being like, "Well, I might need somebody to help me manage my finances," or, "We may have to figure out a different living situation. I may need somebody's help. Maybe I have to move in." All these things. Everything is seen as a burden.

I try to imagine a family where your older loved one is having health crises and financial crises, and you're not involved. I'm trying to think of how you would be sleeping at night. I think most people don't want to be that unburdened by an older person going through standard things that happen in aging. It just also, to me, creates this foreboding aspect about aging, like what if I have these needs? How am I "not going to be a burden?"

Most people, they're not going to have enough financial resources to do it on their own or to hire caregiving, which in San Francisco is 50 bucks an hour. We need each other, and framing the normal issues that come up with aging as all burdensome is not a good way to start that conversation.

Emily Silverman: I'm remembering that controversial essay or article that was published several years ago by ethicist Ezekiel Emanuel. You probably know the one I'm about to say, where -- I'm paraphrasing -- but I think the thesis statement of his essay was like, "I want to die at 75." The implication being that anything beyond that is a burden, or maybe isn't worth living. Living as an older person isn't worth it. That was several years ago, and I actually had a little flashback to that the other day.

I was listening to the Conan O'Brien podcast, which is one of my favorite podcasts. He's just one of the greatest podcast hosts in the world, and is hilarious. He interviews celebrities, but he also interviews random people in the world. It's called Conan O'Brien Needs a Fan, where they'll just have a random guy from Belgium or a random person in Arkansas just talking about-- Usually they have some kind of funny job, like they run a DVD store, something like that, and he had on this guy I can't remember now what his job was, or why they had him on.

He had something funny about him, but he was going on and on about how in love with his wife he is, and how they love theater and they love improv, and his wife is really into the moon, and she has these moon worship clubs, and they sounded like spiritual people, and then at some point, he's like, "Oh, yeah, and my wife and I, we share a lot of the same values, and one of the values is we both don't want to live much longer than 75." This guy was young, and Conan, he's not 75, but he's not 35.

Anna Chodos: Right, right, right. That's not a million years away.

Emily Silverman: Yes, and you could kind of hear. He was like, "Really?" You could hear in Conan's voice just a little bit of astonishment, and Conan was like, "Look, I got to tell you, I just got back from an event with Mick Jagger, and he's in his 80s, and he's living his best life right now," and so anyway, that little exchange reminded me a lot of Ezekiel Emanuel's piece, and I'm wondering how you feel like those sentiments fit with this whole burden conversation.

Anna Chodos: Yes, okay. At this point, I know of the essay, and I read it a million years ago, and obviously, blood boiling, steam coming out of my ears instantly. For lots of reasons. On the face of it, things like obviously devaluing older people in general, making a ton of assumptions about what 75 looks like and 75 and above. I don't remember what his arguments were, so I feel bad about that. At the end of the day, look. Everybody values what they value. I don't want to go on some big diatribe about how you can live such a good life and older.

If you're like, "The only thing that matters to me is being insanely youthful-looking and hot in that way, and there's no way I'm going to achieve that over a certain age. When that

happens, I need to go." If that's your values, what could I possibly say? I think what's so clearly problematic and ageist about that, along with, I think, sometimes the way the word old gets used, which was another trigger word, is really just the fact that that is so not specific.

It's ageist because it's just saying, "At this age, obviously all these things are happening, and that's not worth living." It just doesn't track with most people's experience. I think his argument, if I remember correctly, and maybe I don't, was really about cognitive function. He was like, "Cognitive function really falls off, and for me, life of the mind, having a tip-top brain is all that matters." If I were his clinician, of course I would support him and validate his personal values and what matters to him. I would, of course, point out, well, if there's particular things you're scared of, I think we can talk a lot about how we can live life differently. I think he also recanted or wrote a follow-up that was like, "Okay, never mind."

Emily Silverman: On the eve of his 75th birthday.

Anna Chodos: Yes, exactly. I just dreamt that, and this is actually, I think, a little parallel to arguments against some of the medical aid-and-dying stuff, which has to do with-- Guys, what we're not dealing with is how poorly people with severe disabilities or severe pain or severe symptoms are getting treated. The next step is not let's just-

Emily Silverman: Lights out.

Anna Chodos: -allow that-- Exactly. Yes, let's just push all those folks off a cliff and move on. I think that's where my hackles get up really, really bad. When I think of the word old, the examples that also come to mind are like I'm too old for this or that-- There's a lot of articles again on old people are ruining this or that or like--

Emily Silverman: I think I literally saw a headline this morning that said, like, it was like old people are ruining. Wait, hold on.

Anna Chodos: It's almost incessant, and the whole thing with, Oh boy, I shouldn't talk about this. I was going to say this was also our current presence. Last most recent and current presence is too old for office. That gets at the crux of the issue. It's like, "What are you talking about? What is the specific skill, ability, whatever that you need in

that person?" Because there are other nations that have 96-year-olds that are like, they're able to manage the job. Let me put it that way.

Emily Silverman: Yes, sorry, I don't usually do this, but it's just so on the nose. I have to say that at 7:15 this morning, an email hits my inbox. "Why Old People Are Ruining America."

Anna Chodos: Wow. Well.

Emily Silverman: Samuel Moyn, Kent Professor of Law and History at Yale. He's having a conversation with Yascha Mounk on his podcast.

Anna Chodos: Okay. Well, I'll definitely listen to that and probably need a glass of wine afterwards.

Emily Silverman: It opens, "Why are old people the problem?" Anyway, it's just amazing how just today--

Anna Chodos: I will love to hear how they frame that.

Emily Silverman: Well, anyway, we've been talking for a long time, and we should probably wrap up, as much as I would love to continue this for many more hours because you're just so much fun to talk to. What do you want to leave the audience with? Maybe you can tell us a bit about any additional information about the words project or ways to get involved, ways to get in touch, or just any final messages.

Anna Chodos: Amazing. I think I'll start with just a reflection because the word I love the most is, of course, dignity. I think we talked about how it has a darker side, which is sometimes people just see aging and they think of "indignities of aging." I think dignity really is about this inherent value, this inherent worth of older people. That's "what matters" to our profession.

It's what matters to me, and at the end of the day, it's just this full personhood, I think, and no matter what is going on and that includes cognitive disabilities, like seeing that person as a full person and how we can step up to the task of creating a society that really understands and values the full personhood of older adults. I hope through some of these reflections and stories, always super important, always super important, is to just illustrate some of this, and it's messy stuff for sure, but hopefully this is a privilege we're all going to have of getting older, and how is that going to look?

Imagining that differently, I think we don't spend a lot of time daydreaming about what it's going to be like to be truly, truly in our older years, like 80s, 90s, hundreds, and what do we want that to look like, and where is that gap? Words on aging, I think, hopefully, will be part of that work in that project. Right now it's at Instagram and TikTok. It's just @WordsOnAging as one phrase, and then also a Substack where just a little more sort of essay-type writing on these reflections.

I think those are good places to find me and connect with me. I really look forward to it; I hope. You have such amazing guests, and they've all done such amazing things. I'm really honestly here to be inspired and to have this wonderful moment to have this conversation. Thank you so much.