Growing old with purpose

For Active Aging
Published: 4/22/2019 1:35:45 PM

In 1959, when I was seven years old, the prevailing attitude toward aging was summed up in a quote attributed to French-born entertainer Maurice Chevalier. When asked how it felt to be 71, Chevalier reportedly replied, “Wonderful, when you consider the alternative.”

At that time, “successful aging” was not written about much. Chevalier’s oft-repeated quip reflects that the bar had historically been set pretty low: Back then, aging well meant just staying alive.

This attitude shouldn’t surprise us. According to the National Center for Health Statistics, the life expectancy for males born in 1888, Chevalier’s birth year, was 40 years. It was indeed atypical for him to thrive at the age of 71, and continue acting another 10 years.

Happily, it is no longer unusual to be long-lived and active. By 2011, life expectancy had nearly doubled to 76.6 years for white males, though significant differences between genders and among racial and socioeconomic groups were now clearly recognized.

In 2011, life expectancy for black males was only 72.2 years. Both white and non-white females generally live four to six years longer than their male counterparts. These two trends – a remarkable increase in life expectancy and a growing understanding of health inequities among demographic groups – characterize our last century. This has influenced our expectations of old age.

My own career decisions were influenced by these trends. I chose the field of Geriatric Medicine, which means I specialized in the care of older adults, chronic illness, and end-of-life decision-making, and I worked in several underserved areas.

My training taught me to set a higher bar for successful aging. Our goal was not just postponing death, but preserving independent functioning and reducing the burdens of aging. In the ideal case of successful aging, I was taught, an older adult would live a long disability-free life, followed by a rapid demise. The medical term for this idea is “compression of morbidity” – pushing frailty and dependence out to the briefest possible phase just before death.

This theoretic goal has obvious appeal, but that ideal world is not reality for most aging adults. Moreover, as a definition of aging well, this medicalized view is also a limited one. It fails to recognize that old age is often deeply meaningful despite significant losses, illness and disability.

Navigating through these hardships is common; according to the Centers for Disease Control, 77 percent of American adults over 65 have two or more chronic health conditions, including arthritis, heart disease, stroke, cancers, diabetes and substance use disorders. These ailments take a huge toll on our well-being, energy, and pocketbooks, yet I have often heard frail individuals also describe deep happiness, even bliss.

In fact, scientific studies summarized by the Brookings Institute in 2014 show that adults worldwide report increasing levels of happiness with each year of age, with the lowest levels of happiness occurring at ages 40 to 60. Psychologist Mary Pipher, in her recent book Women Rowing North, describes many examples of resilience and acquired wisdom among aging women, often after repairing fractured relationships, intentionally reframing attitudes, caring for loved ones at times of illness, or accepting themselves and others in new and deeper ways.

She quotes her wise grandmother as saying “I get what I want, but I know what to want.”

As we all know, not everyone is so fortunate. Loneliness and suffering are too frequent, though not always permanent. Is there a prescription for aging well? Wise health choices do not invariably result in a happy old age, but good health sure makes old age easier. Doctors influence this less than you might think.

The Center for Disease Control reports that a person’s well-being is influenced more by their socioeconomic circumstances and by their everyday lifestyle decisions than by the medical care they receive. As a society we must redouble efforts to reduce social inequities which impact health negatively. Poverty, intolerance, poor education and nutrition, isolation and loneliness all pose enormous barriers to healthy aging. We need to devote more energy to understanding why men fare worse than women in so many health measures, particularly longevity.

Healthful individual choices take many forms. Planning for inevitable losses of friends and family by actively broadening social connections is highly advisable. This could mean joining a faith community, sharing your living space with others, or making a timely move to a more communal living situation.

Daily walking usually helps the joint stiffness and pain that my 84-year-old friend Don gleefully refers to as “early-onset rigor mortis.” Exercise is a central tenet of today’s healthy aging, as are choosing a plant-rich diet and avoiding tobacco and excessive alcohol.

Mindful meditative practices are useful skills which help with stress and anxiety. Remaining mentally active – for example through conversation, hobbies, music, Bridge, part-time work, or life-long learning – encourages a satisfying old age and slows cognitive decline.

None of these things is for everyone, just as successful aging means different things to each of us.

Ultimately, I hope more people will consciously prepare for their own longevity, and in turn come as close as possible to their own personal definition of “aging well.”

(Dr. Lyn Lindpainter is medical director of Eldercare Services at Concord Hospital.)

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