Jessica Strong

“You see the hood's been good to me, ever since I was a lowercase g. But now I’m a Big G.”

• Montell Jordan

In his monster 1995 hit ‘This Is How We Do It’, Montell Jordan makes the distinction between a “lowercase g” and a “Big G”. In his case, he’s making reference to being a young child, understanding and evincing the gangsta part before he grew to adulthood and achieved proper, professional gangsta status by releasing a staggeringly popular debut single.

Like Montell Jordan, it was music that led Dr. Jessica Strong to her eventual career path, one where she too makes a distinction between lowercase gs and Big Gs. ‘Big Gs’ are the expert specialties, Geriatrics, Gerontology, Geropsychologists like Dr. Strong. ‘Lowercase g’ refers to the little competencies everyone needs to have. Social workers, family doctors, personal support workers at retirement residences, caregivers, or retail workers. Anyone who deals with an older population in their day-to-day lives. Says Dr. Strong,

“I have a lot of students who aren’t necessarily interested in Geropsychology (big G), but we work on developing this ‘lowercase g’ workforce, which is not working with older adults exclusively. They may be a generalist psychologist, but one who has the competency to work with older adults. They understand the cohort issues and generational differences, and know how to modify an intervention or screen for mild cognitive impairment.

I tell all our clinical students ‘you want to work in paediatrics, great! How many grandparents are raising children these days? For your paediatric client, if you’re noticing something off with their grandparent, you’re going to want to figure out whether this is anxiety and stress because they’re raising a nine-year-old, or could this be a mild cognitive impairment? And how am I going to figure that out in a way that serves the interests of my paediatric patient?’”

Dr. Strong is an assistant professor in the department of psychology at UPEI, and a registered clinical psychologist who specializes in Geropsychology. Geropsychology is a subsection of gerontology – the broad study of aging, lifespan, development and identity in late life. It’s a discipline that focuses on relationships, mental health, cognition and more generally the psychology of aging.

It was music that led her toward this career path, as she started playing piano at the age of 9 and soon picked up more instruments, playing alto sax in the high school marching band. It was in high school that she started thinking about music therapy as a career. But music therapy is a pretty specialized occupation, and Jessica is someone who likes to keep as many options open as possible.

In her final year of high school, right around the time we were all learning that “southcentral does it like nobody does”, she shadowed the music therapy program at her local university. She quickly realized that there was a way to get into this while keeping more doors open, and she ended up doing two simultaneous undergraduate degrees – one in music performance, and one in psychology. The idea was that from there she could get a Master’s in music therapy if she chose that path.

But psychology research really spoke to Jessica, who started to become far more interested in the mechanisms of why music makes a difference for people, rather than just using it as a tool. She had done a little bit of work with older adults at an occupational therapy lab at Washington University in St. Louis. Then she moved to Germany, where she worked at a mental health institute for older adults, the Central Institute for Mental Health in Mannheim. She had become a lowercase g.

Soon, she realized that what she really wanted to do was work with older adults. She had never heard the term “Geropsychology” before, but she lucked into a program at the University of Louisville in Kentucky, and was accepted into their Clinical Psychology program, working under the mentorship and supervision of two Geropsychologists. She earned her Ph.D., became a Big G, and says she has never looked back.

“One of the most rewarding things about working with older adults is that they are some of the more complex human beings in the world. They’re such a heterogeneous population because they have all of the demographic differences that any of the rest of us have – gender and race and so on – but they also have all their lived experiences and the changes that have come with those. Physiological aging, emotional aging, cognitive aging. It’s really intellectually stimulating and exciting for me because they’re so much more complex than any of the other groups I’ve worked with who haven’t done as many things.”

Soon, Dr. Strong was working in Boston at a rehab facility in the Veteran’s Health Administration. She studied how integrating music into a mental health group could destigmatize talking about mental health for older male veterans. They got some great feedback, the veterans felt like this group was different from others they’d been in before, and that the use of music made it easier for them to talk about things that both as men and as veterans they’d been conditioned to avoid. Music gave them a way to feel it without necessarily having to find the words.

One of the sessions Dr. Strong did with this group used “a bit of a music therapy technique”. They would start the group session by reading the lyrics to a song aloud, like a poem. They’d talk about the imagery, and what they thought the artist was trying to convey. Then they would listen to the song to see if it felt different than just reading through it. Did the addition of music take away from the message, or did it add something? The veterans in the group, men whose gender and military service compounded a reticence to speak vulnerably, went to deep places dissecting the music.

Dr. Strong says ‘What A Wonderful World’ was a group favourite. Given the age of the participants (some Vietnam veterans, others Korean War veterans, and some survivors of World War II) it makes sense that a song from the 60s resonated as much as it did. Music is often associated with memory and nostalgia, most particularly the music we heard around major life events in our adolescence and in early adulthood. Like a wedding song, a graduation song, or one you heard while you were heading off to war.

When similar sessions are held forty years from now, there’s a good chance a psychologist like Dr. Strong will be integrating much different music into this kind of group therapy. They will discuss what Mr. Jordan is trying to convey when he suggests we “flip the track, bring the old school back”. Dementia support groups that connect people through sing-a-long music will sound like one of those Pitch Perfect mashups. “I reach for my 40 and I turn it up / designated driver take the keys to my truck”.

Music not only triggers memories, it shapes our brains as we age. Dr. Strong is specifically interested in the brains of musicians, and the effect a lifetime of playing music has on the aging process. She talks about something called Cognitive Reserve. This is the idea that everything we do in our lives builds up a reserve in our brains. Dr. Strong describes it like a battery you can charge. Having a formal education, speaking a second or third language, having strong social connections, these are factors that charge our battery and make us more resilient against cognitive impairment later in life.

“If someone has a really high cognitive reserve, a scan of their brain might look awful, with disease, or vascular damage. But they might still function okay because they’ve built up this reserve over time that allows their brain to circumnavigate those damaged pathways. Someone with a lower cognitive reserve might have a brain that looks relatively okay on a brain scan, but they might be showing signs of mild or moderate dementia in their functioning.”

According to Dr. Strong’s studies, and similar studies by her peers, musicians tend to do better in some things as they get older, like in executive functioning and language, but not in all areas. One of the areas where they don’t tend to do better than non-musicians is in memory. Some have suggested that the tests for memory are flawed, and this may be the reason we don’t see a correlation between that and musicianship. When Dr. Strong takes a sabbatical next year, this is one of the things she’s hoping to learn from a longitudinal data set she has collected. But she has learned a lot already from her research up to this point.

“I’ve compared people who retired from playing versus those who continued to play. That was an interesting study, where I found that people who stopped playing lost the benefit they had in some of the more fluid abilities like executive functioning, but maintained the benefits they got in crystallized abilities, things like language. People who continued to play continue to have both benefits.”

There are many challenges to working with older populations, in particular defining what those populations are. The general (Dr. Strong says arbitrary) line at which Geropsychologists and Gerontologists start looking at people as “older” is the age of 65. But they’re also working with people who are much older than that.

“What gets complicated about using 65 as the arbitrary cutoff is that you’re still including people who are 80, 90, even over 100. There are people over 100 participating in research, and you get into this really interesting scientific conundrum of having people who span 30 or 40 years in a scientific sample. Which is absurd – never would we put 10-year-olds and 50-year-olds in the same sample, and this is somewhat of the same construct.

So this is a problem when we work with older adults, and a lot of Gerontology and Geropsychology splits those groups up into the ‘young old’ (65-74), ‘old old’ (75-84) and ‘oldest old’ (85 and up), trying to get a little more nuanced perspective. These people grew up in completely different ways and in completely different cohorts. And a 65-year-old shouldn’t and wouldn’t be expected to be in the same life place as a 95-year-old.

It's a lot easier to get access to research participants who are in that young-old group, so they tend to be overrepresented in research. It’s a lot harder to get a representative sample for the older groups.“

Another challenge is ageism. This is something that matters a great deal to Dr. Strong, and she gets impassioned when she talks about the ways we neglect our older population. Age is a diversity factor that is often overlooked, and Geropsychologists are constantly reminding their organizations, and anyone who will listen, that age must be thought of and included as a diversity factor. Not valuing older adults, the negative attitudes we have about getting old, looking old, and acting old, create real-world harms. Dr. Strong says these are some of the reasons we have a lack of action in overhauling Canada’s long-term care system.

“We know what works in long-term care, it’s just a matter of putting it in place. It wasn’t necessarily intended to be this medical-type institutional facility. People don’t want move there because it signals the beginning of the end, and they think that because of how those facilities work. They’re understaffed, underprioritized. Some of the most amazing models of long-term and dementia care are in Scandinavia. There are enclosed ‘dementia villages’ where people live in their apartments, but they can go shopping and go wander in the park. The person cutting the grass is a trained dementia nurse, as is the barista at the coffee shop. But many of us don’t see older adults, and particularly older adults with dementia, as important enough to care.”

We’re all going to get older. As Dr. Strong tells her students, “if you’re not aging you’re dead – we are privileged to grow older”. So why are there difficulties in recruiting young people, and students in particular, to work with older populations? Ageism, like negative attitudes or death anxiety, are big factors. So is exposure. Young people who have grown up around older adults, or who have teachers or parents who work with older populations, tend to be a lot more receptive.

“I attribute a lot of my interest in aging to my great-aunt Lila. My mom was her primary caregiver when I was growing up, so she spent a lot of time at our house and I spent a lot of time with her. I found her to be fascinating. She wore a wig and I saw her without a wig which was fascinating when I was nine. She told me stories about having a pet rat when she was my age and it was amazing to think about her having ever been my age. I had good relationships with my grandmothers and I had older adults in my life a lot when I was growing up.”

Geropsychology, as a relatively new field, is an exciting one. There is an enormous breadth of research that has yet to be done, and there are countless opportunities to work with people whose life experiences, wisdom, and stories are both fascinating and instructional. They represent a living history of a time the rest of us did not experience, and have lived lives we can’t imagine. Dr. Strong says it’s impossible to overestimate how rewarding this work can be.

“This is a group that has been marginalized, that doesn’t have much of a voice, and when you take the time to interact with them they are so grateful. They have so much wisdom and so many experiences that I can’t help but learn from them. They’ve lived in times and done things that will never be available to me.

The community of Geropsychology and gerontology is such a welcoming one, because we want people to work with older adults. And because the people who end up in that field are warm and welcoming by nature. It’s just a wonderful professional home.”

We need the Big G experts to learn more about aging and about creating a welcoming, flourishing, and healthy society for people as they get older. We also need everyone else to develop lowercase g competencies, so we too can be part of the solution. As each of us gets older, we will want the world around us to change so that we can continue to build community and live meaningful, impactful lives for as long as we are around. This is how we do it.

Research papers:

Cognitive reserve

Mental health and music group development and evaluation (with manual published in the appendices)

Two articles on cognition in older adult musicians

• https://www.sciencedirect.com/science/article/abs/pii/S0278262622000410
• https://journals.sagepub.com/doi/abs/10.1177/0305735618785020

And one recent on attitudes towards older adults