Growing Older Successfully
By Carla Garnett
Photos by Bill Branson
On the Front Page...
While it may be true that "the old gray mare ain't what she used to be," it is becoming increasingly clear to researchers that she needn't be put out to pasture because of it. According to panelists at a recent seminar on Successful Aging, staying healthy, fit and active are the keys not only to living well into one's old age, but also living into one's old age well.
"Recent evidence in aging is beginning to generate a lot of exciting suggestions that we may be able to change the nature of old age in fundamental ways," began Dr. Laura Carstensen of Stanford University, whose topic was "New Thoughts on Old Minds." "We are clearly seeing evidence that behavioral, medical and social practices influence aging outcomes, so the cumulative effects of how people live their lives have very important influences later in life."
She described imminent changes in the world's vital statistics. In the U.S. which reflects trends around the world the proportion of older adults went from roughly 4 percent in 1900 to 13 percent today, and will increase to more than 20 percent by 2030. By 2020, one in 6 people will be over age 65. Women account for the majority of older people now, and although the gap between the sexes is narrowing slightly, elderly women will continue to outnumber elderly men.
"It's not just about old people anymore," Carstensen pointed out. "When over 20 percent of a given society is over age 65, it matters to all of us old and young alike." Everything will change, including families, health care, education, public policy and financial markets, she continued. The nature of work, and people's expectations of work, will change.
"Mostly when we hear this," she said, "it's framed as a crisis on the horizon. I want to argue that there is nothing inherently wrong with an older population. We need to stop asking, 'How do we cope with aging?' and ask, 'How do we ensure that the maximum number of individuals reach old age in optimum physical and mental health?' That is the challenge of the 21st century."
Carstensen also presented the bad and good news about cognitive changes that come with age: Studies show that as people age, working memory and perceptual speed decline, and processing of new information is slower. Older people have poorer comprehension of text and experience word-finding difficulty, that "tip of the tongue phenomenon. This is not dementia, by the way," she explained. "We are talking about normal, cognitive aging."
On the positive side, areas of preserved functioning or growth include memory for emotional information ("Older people actually outperform younger people in recognition of slides promising an emotional reward"); stories told by elderly people are more interesting and coherent; access to acquired knowledge is maintained ("You can retrieve things you know as well when you're older as you did when you were young"); solving problems related to everyday life, or "what some people call wisdom" remains intact; and mental health ("some say old people are actually happier than young people") may even improve.
The neurological model of the aged brain has also been altered in recent years, Carstensen said, as some scientists now suggest that cognitive decline is due more to biochemical changes in intact neural circuitry than progressive cell death. The new model is better also because instead of relying mainly on how an average person ages and performs on mental tests, it considers individual differences among older people.
What accounts for individual differences? Carstensen gave several examples: "Well-educated people do better," she said. "If you're married, you do better. Being free of important physical illnesses, getting proper amounts of exercise and nutrition also count a lot.
"Interestingly, in the United States, being white is related to better performance cognitively later in life," she noted, citing an outline of a theory by former NIH associate director for behavioral and social science research Dr. Norman Anderson about possible links related to chronic racism, hypertension, health and long life. "Recent data are beginning to change the question from 'what's wrong with these individuals?' to 'how is the environment failing these individuals?'" Carstensen said.
The fourth and final 2001 seminar in the series sponsored by the NIH Office of Research on Women's Health was opened by Dr. Vivian Pinn, NIH associate director for research on women's health. "Successful aging is a very important topic," she said, "and we have adopted it as one of our priorities for the coming year in terms of stimulating new and expanded research."
Dr. Nanette Santoro of Albert Einstein College of Medicine, who discussed the endocrinology of aging, recommended that gerontology researchers now move beyond merely studying changes to a woman's reproductive system.
"We've got to get off the ovary and estrogen as being the whole reason for aging in women," she said. "There has been intense focus on those issues, yet menopause and aging must be disentangled as two different processes. Over time, we've begun thinking of estrogen as the WD-40 for aging endocrine systems, but if you haven't taken care of the rest of the machinery, throwing a little estrogen on it isn't going to do much. However, if you're finely tuning an already well-kept, or reasonably well-kept machine, [estrogen therapy] may have some benefit."
She said scientists should begin to incorporate a more holistic view of the body particularly a woman's body as it ages. "I think it's really important and significant that we have aging models of endocrine function," Santoro said, "but they need to be interpreted within the whole person. We need to get out of the situation where we confine our endocrine observations to one system. It's usually good science to isolate the system, but I think we've gone as far as we can with that approach and need to start integrating them again. Healthy aging changes are just beginning to be investigated. We're starting to have a database of changes that may form the basis of therapy, but obviously the eventual goal is to identify issues early. All of us want to live to be 103, like Jiminy Cricket, but we want those to be a good 103 years."
Nutrition and fitness specialist Dr. Pamela Peeke of the University of Maryland School of Medicine offered practical advice on "Power Aging: Eating and Moving for Optimal Aging."
Citing studies on people who lived past 80, she listed several common aspects of their lives: Most have never been obese, alcohol consumption among them is not common, smoking is almost non-existent, and they are "stress resilient, physically active consistently and psychologically stimulated," she noted. "It's simple. If you want to live well, you move!"
Peeke said that as people reach middle age, some weight gain "filling in" particularly between the belly button and the pubis is normal. "The fat that accumulates above the abdominal muscle wall does not impact significantly on mortality and morbidity," she explained, revealing the humorous titles she has given those added inches: "the menopot," for women; "the manopot," for men.
"It's the fat deep inside the belly that is most dangerous," she continued, soberly. "That's associated with diabetes, stroke, high blood pressure, heart disease as well as a variety of cancers. It's no longer how much you weigh, it's also where you weigh it. If you're filling in deep inside your belly, that's a problem."
Peeke said reasons people should "keep moving" as they age include improvements in cognitive function, mood and sense of well being as well as in daily functioning, strength, flexibility and endurance.
"All of our studies many sponsored by the National Institute on Aging and other gerontology centers found clearly that all the way through their eighties and into their nineties, people who have been normally sedentary and have lost a tremendous amount of muscle mass can recoup that very nicely and increase power and strength as well," she said. "Sedentary people between the ages of 20 and 70 can lose upwards of 40 percent of their muscle mass and 30 percent of strength. That's why it's so easy to gain weight. They lose that muscle mass that allows them to burn calories efficiently."
She encouraged a regimen that includes walking 30 to 45 minutes a day, lifting weights for 30 minutes 2 or 3 times per week and stretching 3 times daily.
In order to "eat for optimal aging," Peeke suggested increasing fruits and vegetables, adding fish (which contains heart-protecting Omega-3 fatty acids) as a source of protein, drinking green tea for the polyphenols and other chemicals that have been shown to reduce risk for some cancers, and using monounsaturated oils such as olive oil. Decreasing red meat servings by once per week, she counseled, could reduce the incidence of colon cancer nationwide by 11 percent.
Concluding tips on diet, Peeke quipped, "If you haven't found the fiber message by now, then you are just simply not regular." She also urged the audience to decrease consumption of refined sugar, processed foods, saturated fats, hydrogenated fats and cholesterol. In addition to following general recommendations on vitamins, she suggested, people can help their bodies age better by considering such dietary supplements as lycopene, folate, vitamin E, selenium and a multivitamin.
The seminar also heard from two firsthand experts on aging well. University of Wisconsin professor Dr. Gloria Sarto, who discussed "Aging with Attitude," said that beyond an absence of illness, the mind plays an important part in a person's ability to age well. She listed several key attitude factors: having self-esteem, exerting control or autonomy, developing quality relationships with other people and "seeing life as meaningful."
In addition to her professional duties, Sarto coaches volleyball and soccer, and on occasion shoots hoops. "One does not grow older without a certain amount of resilience," she said. "Find something positive in the face of adversity. See an ordeal as an opportunity to learn."
Offering "Thoughts on Successful Aging," former NIH deputy director Dr. Thomas Malone, who is 75 and for whom NIH's Bldg. 31 fitness center is named, called himself a "living witness for successful aging." Athletically inclined from a young age, he has continued to swim, jog and teach his beloved judo. He said the most stimulating and valuable thing he and his wife had done was to rear his grandchildren after their mother was paralyzed in an automobile accident. The routine of going through the education process all over again, reviewing homework material that includes "the new math" and translating it for these young people has helped him maintain cognitive function, said Malone, who took up flying lessons at age 50 and recently began learning to play the violin. "It's entirely satisfying to do this at an advanced age," he said. "I also think young. I don't for a moment feel or act like I'm in my upper seventies."
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