Prof. Dr. Dr. h.c. Andreas Kruse
Institute of Gerontology, Heidelberg University
Interview of January 13, 2014 with Birgit Kramer and Katrin Boch
What does age or aging mean to you? When is one old or “on the shelf”?
The term aging describes a continuous change of our organism over the entire course of life. An introduced term of the biomorphe by Max Bürger seems appropriate: continuous functional (in parts also structural) changes of our organism and our psyche: this seems to describe the aging process ideally. To me the term age is first of all a societal: At a certain age we belong to the group of the “elderly”, however there seem to be changes in understanding and use of this term: Also on the societal level we observe a variety of definitions – the transition into the after work phase alone is not sufficient anymore for the social definition of “old”. For me the term “age” is in addition subjective: When does an individual feel “old”? With a view on subjective age, large inter- and intraindividual differences can be observed. In particular the latter is interesting to me: With a view on what symptoms of the organism and personality make an individuals feel “old” or not old? Are there phases in which one feels older or younger?
How do you define frailty?
In my understanding, frailty constitutes of three attributes: First a distinct higher vulnerability of diseases, second a significant decrease of physical reserves as well as the ability for compensation and restitution and third a considerable increase of functional losses.
Are there objective attributes on which one can determine when a human being is considered frail?
The three mentioned attributes seem to be the key. Mainly gaining importance are functional losses, the significantly reduced restitution- and compensation ability as well as a considerably rising fatigue, are important indicators.
Can the German term “Gebrechlichkeit” be synonymously used for the English term “frailty”?, which describes a geriatric syndrome?
In my eyes, the English term “frailty” concentrates mainly on functional losses. In my definition, which corresponds with numerous articles from geriatrics and gerontology, more attributes are added. Especially important to me are the decreased restitution- and compensation reserves.
How do frailty and vulnerability differ?
In my understanding, vulnerability is an important symptom of human existence – not only at an older age but in all life phases. At an oldest age, vulnerability increases recognizable: A higher susceptibility to diseases and larger functional losses are considerable characteristics of a higher physical vulnerability, capacity loss of the working memory and concentration- and loss of the ability to adapt are characteristics of higher cognitive vulnerability. And in the old and oldest - leaving psychological diseases aside - the probability of temporarily occurring psychological exhaustion is noticeably higher - attributes of psychological vulnerability. It is important to recognize, that despite this vulnerability, there are still noticeable psychological resources and potentials of development, that human beings can develop further within this vulnerability and even use it as an impulse for further psychological development. Karl Jaspers, the great philosopher and psychiatrist from Heidelberg and later Basel, developed the philosophy of borderline situations and establishes here an important anthropological context, that helps us to better understand and classify development processes in borderline situations.
How can people learn to endure that their body is getting more and more frail?
One, it is of importance that the individual discovers and develops reference points in his life to avoid self centering and a too intense preoccupation with oneself. When the individual experiences itself in regards to other people and realizes that it can do something for other people - it is needed by others - the danger of self centering is noticeably less and therefore the danger to be overwhelmed by diseases and disease symptoms is also lower/less. I am learning through our own empirical research on the old and oldest, how important the subjectively lived and practiced concern for others is for a subjectively consistent meaningful life – that it helps to mentally overcome or get over diseases and functional losses, which Hans Georg Gadamer describes in his work on pain. But also the mental and spiritual concentration of the individual and the ability within this concentration on itself to find new psychological strength is important. And finally enjoyment of the world – of other human beings, of nature and culture: these also create the reference points that are important, so the individual does not get lost in contemplation. In this context I would like to mention explicitly the significant meaning of a mature spirituality for this mental and spiritual concentration.
Where are the potentials of development in frailty for a human being?
In a very concentrated lifestyle: with concentrated I mean the mindfulness with oneself and the relationship with people that are mentally and spiritually appealing to oneself and with whom one can share thoughts, experiences and deliberations in an open and emotional way.
And where are limits to development?
Mainly in chronic pain, in mobility barriers that complicate access to public buildings and the contact to other people. And mainly with the experience that the own habit of worrying about others - being driven by the question: What can I do for other people? – cannot be upheld, to be cut off from other people. This shows: We have to pay much more attention to medication and non medication pain therapy; furthermore the task of independent, mobile and participation friendly designs of our socio-spatial environment. Think about the residential design. And finally it is of importance to attain a much more differentiated image of aging, also with the view to old and oldest age: With this I mean a differentiated perception of and reaction to a single person, whom we cannot reduce to a physical dimension but apprehend the person in his or her emotional, mental, spiritual and social dimensions. What psychological potential is noticeable in old and oldest people that we do not recognize and address because we concentrate on the physical.
Is a frail human being already in the process of dying?
No, I wouldn’t say that – at least not from a physiological perspective. And even psychologically we cannot say: With frailty, the process of dying begins. A process of dying is the timely proximity to death and we notice within this timely proximity, significant changes in physical parameters (further losses of restitution and the ability of compensation and some parameters of cognitive capability (also defined as terminal decline). People more and more seclude themselves, although open up from time to time, but those moments become shorter and weaken. The withdrawal increases and gains more and more importance. Nevertheless: We should prepare ourselves early enough for our transience and finiteness, make this an important matter in our existence, bring together and integrate the order of life and the order of death - without falling into resignation and depression. In one of Michelangelos 48 sonette, he describes this approach with the term “stirb an”.
Andreas Kruse was born in 1955 and studied psychology, philosophy and musik at the universities of Aachen and Bonn as well as the conservatory in Köln. Since 1997, Andreas Kruse is Director at the Institute of Gerontology of the Heidelberg University. Next to his professional interests, he takes great delight in music, literature and theology. Andreas Kruse is married and has 2 children and two grandchildren.
