Helping Us To Do It Gracefully
by Eddie Goldberg
June 2010
"Our mission is simple, yet profound - to prevent debilitating frailty and disability in old age"
At some point in most people’s lives, we all contemplate our own mortality. Our species has done so since before we moved out of the caves. It is one of our greatest mysteries to ponder.
Dr. Steven Kritchevsky doesn’t spend his time on death so much as he deals with the process of it, and events leading toward it. Dr. Kritchevsky is the director of the J. Paul Sticht Center on Aging and Rehabilitation in Winston-Salem.
The Sticht Center is a geriatric clinical and research facility that combines the resources of the Department of Psychiatry, Rehabilitation Medicine, Gerontology and Geriatric Medicine Internal Medicine. It is the first facility in the world to incorporate geriatric acute care, transitional care, psychiatry, rehabilitation, and clinical research under one roof.
It’s no secret that as we age, we are generally subject to the greatest amount of physical malfunction of our lives. The ultimate goal for Dr. Kritchevsky is simply to end all that suffering. It might sound a bit ambitious, but realize too, that it’s a process. We are way further along now than we were 20 years ago. Who knows where we might be 20, 50, or even a 100 years from now.
Death is a certainty, but what doesn’t have to happen, and what the doctors at the Sticht Center are all about, is making it so that becoming infirm is not such a certainty. "If we graph a person’s health as they age, it declines steadily until death. What we’re about is squaring this graph," Kritchevsky said.
Dr. Kritchevsky got undergraduate degree in, of all things, geography, from the University of Chicago. He did his senior paper on medical geography. Medical geography, sometimes called health geography, studies the impact of climate and location on an individual's health as well as the distribution of health services. Medical geography is an important field because it can improve the health of people worldwide based on the various geographic factors influencing them.
He said he was simply fascinated with the subject. He eventually got his Ph D in Epidemiology, the branch of medicine that deals with the study of the causes, distribution, and control of disease in populations.
The reasoning behind Kritchevsky’s decision is simply because he believes each individual would prefer, and has a right to live as they choose for as long as they wish. His role at the center provides the opportunity to affect that premise.
There have been multiple experiments over the years to try and best determine the aging process and how we can best avoid some of the more obvious pitfalls.
A 50-year-old woman’s chance of reaching 90 has gone from three to 28 percent during the past 100 years. This fact alone signifies an urgent need to address the health problems in a steadily increasing population over age 65 as well as those in the 80 plus category.
Kritchevsky alludes to Dr. James Fries, who published a seminal paper about the challenges and the opportunities of aging: "Aging, natural death, and the compression of morbidity. ("New England Journal of Medicine, July 17, 1980.)
In Dr. Fries words, the compression of morbidity, "…means that a national policy and scientific goal is to delay the onset of chronic illness, that kind of illness that causes most of the misery in life, to as late in life as possible. Squeezing that misery in between its onset, which is ever later, and the age of death when of course it mercifully ends.
"Successful aging is not a destination. It is a journey. The roots of late-life disability are planted in middle age," says Dr. Kritchevsky.
The focus is to take what has been learned during the past 20 years to the next level — the patients’ bedsides. In addition, as these discoveries are taken to the patients who will benefit from them, additional observations from nurses, therapists, social workers, and physicians are turned back into the research laboratory to develop new ideas for the next 20 years’ worth of work.
"Think of it as a three-dimensional challenge," said Kritchevsky. "Our work runs deep, wide, and long. ‘Deep’ in terms of our growing understanding of the physiological and physical mechanisms of aging; ‘wide’ in the respect that we know more now about, say, how an aging heart affects aging muscles, how an aging kidney can affect an aging brain, and so on; and ‘long’ in terms of the time and resources required to make the necessary breakthroughs."
Dr. Fries promoted the concept that medical science was capable of compressing chronic disease into an increasingly smaller period at the end of life. Dr. Kritchevsky, within his role of director, carries on that work.
This story is slightly different from most profiles we do. I generally try to talk about the people side of the people rather than the work, but it would be impossible to separate the good doctor from the Sticht Center. For the record, he’s been married for 23 years, has two sons, both of them brilliant and with wonderful futures ahead of them. He really like Thai food, and if there is only one personal fact about Dr. Kritchevsky that I couldn’t pass on, it would be his view on retirement.
His grandfather worked until he was 93 and his dad worked till he was 86. Kritchevsky admitted that his role might diminish as he gets past a certain age, but so long as he has something to contribute, he will always follow his fathers rule, "you always need a reason to put on your pants in the morning."
So as health care evolves and traditional treatments are being replaced with new therapies derived from more research studies than we can count, you can thank people like Steven Kritchevsky and all the others who collaborate. We might all be growing old, but their work will let us do it gracefully.