by John W. Rowe, M.D. and Robert L. Kahn, PhD, “Successful Aging: The MacArthur Foundation Study,” Random House, 1998.

The Demographics

Life expectancy, the average number of years people life, has increased by 27 years from the Bronze Age to 1900 and has increased at least that much since 1900.

According the the U.S. Census Bureau, life expectancy today is:

• 79.5 for white women
• 73.7 for black women
• 73.1 for white men
• 64.6 for black men

It is currently estimated that of all the human beings who have ever lived to be 65 years or older, half are currently alive.

Life expectancy at age 65 for the average American in now 17 years.

There have been two major phases in the improvement of life expectancy during the last 200 years:

• The reduction of infant mortality and childhood deaths in the 19^th and early 20^th centuries because of better prenatal care, clean water, increase in the food supply, and the control of infectious diseases.
• The decline of the death rate of middle-aged and older people because the take better care of themselves, as well as advancements in science and medicine.

Centurions, people age 100 or older, were rare in 1900, swelled to 32,000 in the U.S. by 1982, increased to 50,454 in 2000, and it’s projected to be over 600,000 by the middle of the 21^st century.

215 people reach age 100 everyday in the U.S.

Four out of five centurions are women.

Aging is a women’s issue in many ways – among those 85 or older, there are five women for every two men.

What is Successful Aging?

Successful aging is not the same as attaining wealth or power.

The components of successful aging include:

• Good health, low risk of disease and disability.
• High mental and physical functioning.
• Active engagement with life, an active life.

All three components are important, but one doesn’t have to have all three to be successful in at least a limited fashion. For example, President Franklin Roosevelt led the U.S. out of the economic depression and through the greatest of wars, despite the crippling effects of polio. Physicist Stephen Hawking, considered by many to be great in his field, is free to explore the universe despite being bound by a wheelchair with Lou Gehrig’s disease.

The Aging Myths –
Examining Successful Aging by debunking myths about growing older.

Ageism is like any other bias - grouping people together into one “box” fails to acknowledge that there are many differences among people, regardless of their race, sex, religion, and even age.

Factors which perpetuate the myths of aging - that older people are:

• sick, frail, irreversibly ill, disabled, weak, demented, alone, unhappy, passive
• unable to learn
• unable to recover lost functioning
• doomed to their genetic makeup
• inadequate mental, physical, and sexual ability, sexless
• unproductive, a burden, holds back society, needy

Myth #1 – “To be old is to be sick.”

There has been a dramatic reduction in the three major precursors to chronic disease - high blood pressure, high cholesterol, and smoking.

There has been a significant reduction in arthritis, arteriosclerosis, dementia, hypertension, stroke, emphysema, and there is better dental care today.

Not only can chronic disease be controlled, but what really matters is not the number of chronic diseases one has, but one’s ability to function with chronic disease.

• There are two ways to determine people’s ability to remain independent:
• one’s ability to manage one’s own personal care, and
• the number of activities of daily living one can perform without difficulty. (ADL limitations are difficulty with eating, bathing, grooming, dressing, transfer from bed or chair, and incontinence.)

Today, only 5 percent of all older people live in a nursing home. Not only is this percentage down from a high of 6.3 percent in 1982, it also means that 95% of older people are living independently in the community.

Ten percent of people over age 65 have Alzheimer disease, but 90 percent do not.

Disability in older people results from:

• the impact of disease or diseases,
• lifestyle choices - i.e., diet, exercise, smoking, and
• biological changes of advancing age.

If we control the factors which affect the aging process (and the health risk factors), we can better control our health “destiny”.

Many diseases can be avoided, or delayed, by diet and lifestyle - diseases such as high blood pressure, abdominal fat (excessive weight), blood sugar, decreases in lung, kidney, and immune function, and bone density.

Mental ability and social relationships were also critical factors in determining older people’s physical status. The link between mind and body is a powerful one.

Myth #2 – “You can’t teach an old dog new tricks.”

Older people can and do learn new things.

Three features that predict strong mental function are:

• regular physical activity,
• strong social support, and
• belief in one’s ability to handle what life has to offer.

All three of the three features that predict strong mental function can be initiated or increased even in later life.

Older people have successfully learned to use new technologies, such as food processors, microwave ovens, ATM machines, VCRs, and even computers.

What becomes difficult to learn in advanced age are the kinds of learning which require speed, physical coordination, and muscular strength.

Short-term memory is, in general, weaker for older people, but memory training and practice can help to improve short-term memory in older people.

The keys to learning are:

• work at your own pace,
• practice new skills, and
• avoid the embarrassment of not being able to keep up (or learn as fast) by working privately or with peers.

The capacity to learn is lifelong - create conditions under which learning can be nurtured and achieved.

In the absence of disease, older people can increase their mental abilities.

But, even moderate declines in some areas of memory functioning does not necessarily interfere with one’s ability to function independently.

There are four important known facts about social relations:

• isolation is a powerful risk factor for poor health.
• social support - such as emotional, physical, and personal contact - has direct positive effects on health.
• social support can buffer or reduce some health-related effects of aging.
• the effectiveness of social support depends on the situation, the person, and his or her needs. Unwanted or unneeded support can do more harm than good.

There are two kinds of social support - emotional and hands on care - emotional social support involves believing that one is cared for, trusts in others, being held in esteem by others, and a member of a network of mutual friends.

Social support helps protect one against the stresses of life.

Those with strong social support require less pain medication after surgery.

There are many ways to give and get social support - such as by telephone, personal visits, and participating in church activities, clubs, etc.

Myth #3 – “The horse is out of the barn.”

Not only can older people recover lost function, but in some cases it can actually be increased beyond the prior level.

It is never too late to stop smoking, eat right, and exercise and receive the health benefits of an improved lifestyle.

Physical activity is the crux of successful aging. Physical activity includes aerobic activity such as walking, dancing, and gardening and more strenuous activity like weight training (or weight lifting).

Diet and exercise helps reduce weight, the chances for heart disease and colon and rectal cancer, reduces the effects of diabetes, arthritis, and osteoporosis, and helps to increase strength and balance which helps to reduces falls.

Fitness cuts our risk of dying. Older women who exercise are 20 percent less likely to die than those who were sedentary.

The risk of heart disease falls as soon as one stops smoking. After five years of cessation, an ex-smoker is not much more likely to have heart disease as a non-smoker.

Smoking cessation results in reduced chances of heart disease, increased lung capacity, and a decrease blood pressure.

Active mental stimulation and keeping up with social relationships with friends and family also helps to promote physical ability.

Older people can sustain, perhaps even increase their mental functioning by reading, through word games and mental exercises, and by engaging in stimulating conversation.

Estrogen for women is known to boost mental functioning. However, most pills and potions are not recommended, may only “slow down the aging clock a little bit” or may have only temporary results. Examples are: DHEA, Melatonin, Human Growth Harmon (hGH), Testosterone, Anti-aging skin treatments (Retin A), and AHA Acid.

Myth #4 – “The secret to successful aging is to choose your parents wisely.”

Physical aging is not determined by genetics alone!

Genetics – although important in families pre-disposed to such diseases as Huntington’s disease, cancer, and high blood pressure – may not play as large a role in successful aging as previously expressed.

A national study, called the MacArthur twins studies, leaves substantial room for factors “other” than genetics in determining life expectancy.

Genetics plays less of a factor in mental and physical functioning than environment and lifestyle.

As we grow older, genetics becomes less important and environment and lifestyle becomes more important.

Genetics does play a part in good health, but it doesn’t mean we can’t use lifestyle changes to control the effects of genetics.

Myth #5 – “The lights may be on, but the voltage is low.”

Are some cognitive losses an inevitable part of aging? Perhaps yes and perhaps no – some mental processes do slow down with age but many do not!

These mental functions do slow down with age:

• the speed of processing information.
• recall of memory on demand of such things as names, numbers, or locations.
• older people do not learn well when there are given complicated instructions or there are distractions. They learn better when they can learn at their own pace, on their own in private, and by learning one project at a time.

There are some aging factors over which we have no control like genetics. Some aging factors are a result of early childhood experience and reduced opportunity which we can no longer control. But, some factors can be undertaken at any age, such as physical exercises which enhances nerve growth and memory function, maintaining a positive (can do) attitude, and using one’s mental abilities continuously to solve problems.

People often blame aging for functional losses that actually are caused by lifestyle, such as over eating, lack of exercise, smoking, excessive alcohol, poor nutrition, or insufficient mental challenges and exertion.

There are some reassuring messages from research, such as:

• the fears about functional loss are exaggerated (the reason for many of the myths of aging).
• much functional loss can be prevented and even regained through diet and exercise, mental training, and social supports.

Sigmund Freud wrote the following to his daughter which captures the precious qualities of active life in later years:

“You have, my poor child, seen death break into the family for the first time . . . and perhaps shuddered at the idea that for none of us can life be made any safer. This is something that all we old people know, which is why life for us has such a special value. We refuse to allow the inevitable end to interfere with our happy activities . . .”

“Happy activities” are essential to successful aging.

And, successful aging is “aging well.”

The decline in sexual activity in men is more related to a decrease in testosterone than age.

Chronic diseases and medications are frequent impediments to sexual function especially for women.

For women, however, regularity of sexual activity depends primarily on the availability of an appropriate partner.

Myth #6 – “The elderly don’t pull their own weight.”

Is a man who gets paid to write commercials for cigarettes more productive to society than a grandparent raising a grandchild an older volunteer who delivers meals to shut-ins, or an elderly spouse caring for his or her ill, frail partner?

Two-thirds of older people work for pay - or volunteer in churches, hospitals, and other organizations.

Independence is the goal in aging well, which depends on good mental and physical health.

We should strive for longer, healthier, more productive lives, not just added years.

An active engagement with life
“Only connect . . .”

Active engagement with life is achieved by close personal relationships with family and friends, and with continued involvement in productive activities.

Many seniors report that friendship is a key factor in keeping them active and emotionally secure, even in advanced old age.

As a rule, people whose connections with others – family, spouse, and members of a organization – are relatively strong tend to live longer.

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