Emphasizing that lifestyle choices are more important than heredity, they spell out the choices the elderly can make to enhance each component. While focusing on what to do, they also make clear what not do to (e.g., they warn against such popular anti-aging remedies as DHEA and human growth hormone). They then turn to society's role in promoting successful aging. Finding that the elderly are one of the country's great underutilized productive resources, they propose that improving the mix of education, work and leisure throughout life would keep workers in the labor force longer, and they call on the government to make the necessary regulatory changes.
Successful Aging: How Lifestyle Changes-More than Genes-Determine Health and Vitality as You Ageby John Wallis Rowe M.D., John Wallis Rowe, Robert L. Kahn
* About Large Print
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Here at last is a compelling and inspiring presentation of what determines how well we agethe results of the MacArthur Foundation Study of Aging in America, which show how to maintain/b>
See the difference, read Successful Aging in Large Print
* About Large Print
All Random House Large Print editions are published in a 16-point typeface
Here at last is a compelling and inspiring presentation of what determines how well we agethe results of the MacArthur Foundation Study of Aging in America, which show how to maintain optimum physical and mental strength throughout later life.
Research into aging has been revolutionized in the past ten years largely due to the MacArthur Study, which under the leadership of Drs. John W. Rowe and Robert L. Kahn created a network of leading research scientists from key fields to determine what aging actually involves. Rejecting the established approach of studying aging in terms of anticipated decline, these scientists set out to identify the factors that were enabling vast numbers of people to preserve and even enhance their mental and physical vitality in later life.
Successful Aging brings together the remarkable results of the study for the first time. They explode the myths about aging that have long shaped individual and institutional attitudes toward growing older, including the biggest myth of all: "The key to aging well is choosing your parents wisely." In fact, they discovered that lifestyle choicesmore than genesdetermine how well we age. Drs. Rowe and Kahn outline those vital choices, including changes in diet, types of exercise, mental stimulation, self-efficacy, and dynamic connections. These choices can make a difference no matter how late in life they are made. In addition, Drs. Rowe and Kahn include the latest research-based strategies to delay orprevent the common diseases of old age.
Society can also influence how we age. Drs. Rowe and Kahn detail innovative programs and policies that are enabling older men and women to stay healthy and to continue to contribute to their societies.
For all of us, the rewards of successful aging are great; this eye-opening work shows how they can be attained and enjoyed.
Read an Excerpt
From Chapter One
BREAKING DOWN THE MYTHS OF AGING
The topic of aging is durably encapsulated in a layer of myths in our society. And, like most myths, the ones about aging include a confusing blend of truth and fancy. We have compressed six of the most familiar of the aging myths into single-sentence assertions--frequently heard, usually with some link to reality, but always (thankfully) in significant conflict with recent scientific data.
myth #1: To be old is to be sick.
myth #2: You can't teach an old dog new tricks.
myth #3: The horse is out of the barn.
myth #4: The secret to successful aging is to choose your parents wisely.
myth #5: The lights may be on, but the voltage is low.
myth #6: The elderly don't pull their own weight.
Contrasting these myths with scientific fact leads to the conclusion that our society is in persistent denial of some important truths about aging. Our perceptions about the elderly fail to keep pace with the dramatic changes in their actual status. We view the aged as sick, demented, frail, weak, disabled, powerless, sexless, passive, alone, unhappy, and unable to learn--in short, a rapidly growing mass of irreversibly ill, irretrievable older Americans. To sum up, the elderly are depicted as a figurative ball and chain holding back an otherwise spry collective society. While this image is far from true, evidence that the bias persists is everywhere around us. Media attention to the elderly continues to be focused on their frailty, occasionally interspersed, in recent years, by equally unrealistic presentations of improbably youthful elders. Gerontologists, an importantgroup of scholars which has become prominent during the last few decades, have been as much a part of the problem as the solution. Their literature has been preoccupied with concerns about frailty, nursing home admissions, and the social and health care needs of multiply impaired elders.
That we as a society are obsessed with the negative rather than the positive aspect of aging is not a new observation. Robert Butler, a pioneering gerontologist and geriatrician who was founding director of the National Institute on Aging and established the United States's first formal Department of Geriatric Medicine at Mount Sinai Medical Center in New York, coined the term "ageism" in his Pulitzer Prize-winning book Growing Old in America--Why Survive? in 1975. Butler saw ageism as similar to racism and sexism--a negative view of a group, and a view divorced from reality. More recently Betty Friedan, a leading architect of the women's movement, wrote about the mystique that surrounds aging in America, and our obsession with "the problem of aging." The persistence of the negative, mythic view of older persons as an unproductive burden has been underlined in recent congressional debates as to whether America can "afford the elderly." Ken Dychtwald, founder and CEO of Age Wave, Inc., has consistently sounded the call for a realistic view of aging and of older persons, exhorting American corporations to become more responsive to elders' needs.
. . .
Most of us resist replacing myth-based beliefs with science-based conclusions. It involves letting go of something previously ingrained in order to make way for the newly demonstrated facts. Learning something new requires "unlearning" something old and perhaps deeply rooted. Acknowledging the truth about aging in America is critical, however, if we are to move ahead toward successful aging as individuals and as a society. In order to make use of the new scientific knowledge and experience its benefits in our daily lives, we must first "unlearn" the myths of aging. Here we present each myth with a glimpse of the scientific evidence that corrects or contradicts it. In the following chapters of this book, we will explore that evidence in greater detail and discover its implications for how long, and how well, we live.
"TO BE OLD IS TO BE SICK"
Ironically, myth #1 could be the title of many a gerontological text. Happily, though, the MacArthur Study and other important research has proved the statement false. Still, a central question regarding the status of the elderly is, "Just who is this new breed of seniors?" Are we facing an increased number of very sick old people, or is the new elder population healthier and more robust?
The first clue comes in the prevalence of diseases. Throughout the century there has been a shift in the patterns of sickness in the aging population. In the past, acute, infectious illness dominated. Today, chronic illnesses are far more prevalent. The most common ailments in today's elderly include the following: arthritis (which affects nearly half of all old people), hypertension and heart disease (which affect nearly a third), diabetes (11 percent), and disorders which influence communication such as hearing impairment (32 percent), cataracts (17 percent), and other forms of visual impairments including macular degeneration (9 percent). When you compare sixty-five- to seventy-four-year-old individuals in 1960 with those similarly aged in 1990, you find a dramatic reduction in the prevalence of three important precursors to chronic disease: high blood pressure, high cholesterol levels, and smoking. We also know that between 1982 and 1989, there were significant reductions in the prevalence of arthritis, arteriosclerosis (hardening of the arteries), dementia, hypertension, stroke and emphysema (chronic lung disease), as well as a dramatic decrease in the average number of diseases an older person has. And dental health has improved as well. The proportion of older individuals with dental disease so severe as to result in their having no teeth has dropped from 55 percent in 1957 to 34 percent in 1980, and is currently approaching 20 percent.
But what really matters is not the number or type of diseases one has, but how those problems impact on one's ability to function. For instance, if you are told that a white male is age seventy-five, your ability to predict his functional status is limited. Even if you are given details of his medical history, and learn he has a history of hypertension, diabetes, and has had a heart attack in the past, you still couldn't say whether he is sitting on the Supreme Court of the United States or in a nursing home!
There are two key ways to determine people's ability to remain independent. One is to assess their ability to manage their personal care. The personal care activities include basic functions, such as dressing, bathing, toileting, feeding oneself, transferring from bed to chair, and walking. The second category of activities is known as nonpersonal care. These are tasks such as preparing meals, shopping, paying bills, using the telephone, cleaning the house, writing, and reading. A person is disabled or dependent when he or she cannot perform some of these usual activities without assistance. When you look at sixty-five-year-old American men, who have a total life expectancy of fifteen more years, the picture is a surprisingly positive one: twelve years are likely to be spent fully independent. By age eighty-five, the picture is more bleak: nearly half of the future years are spent inactive or dependent.
Life expectancy for women is substantially greater than that for men. At age sixty-five, women have almost nineteen years to live--four more than men of the same age. And for women, almost fourteen of those will be active, and five years dependent.
It is important to recognize that this dependency is not purely a function of physical impairments but represents, particularly in advanced age, a mixture of physical and cognitive impairment. Even at age eighty-five, women have a life expectancy advantage of nearly one and a half years over men and are likely to spend about half of the rest of their lives independent.
There are two general schools of thought regarding the implications of increased life expectancy on the overall health status of the aging population. One holds that the same advances in medical technology will produce not only longer life, but also less disease and disability in old age. This optimistic theory predicts a reduction in the incidence of nonfatal disorders such as arthritis, dementia, hearing impairment, diabetes, hypertension, and the like. It is known as the "compression of morbidity" theory--in a nutshell, it envisions prolonged active life and delayed disability for older people. A contrasting theory maintains just the opposite: that our population will become both older and sicker.
The optimistic theory may be likened to the tale of the "one-horse shay" by Oliver Wendell Holmes. Some sixty-five to seventy years ago, when one of us (RLK) was reluctantly attending the Fairbanks Elementary School in Detroit, students were required to memorize poetry. One of Robert's favorites was a long set of verses by Oliver Wendell Holmes entitled "The Deacon's Masterpiece or The Wonderful One-Horse Shay." (A shay was a two-wheeled buggy, usually fitted with a folding top. The word itself, shay, is a New England adaptation from the French chaise.)
The relevance of all this to gerontology becomes clear early in the poem. The deacon was exasperated with the tendency of horse-drawn carriages to wear out irregularly; one part or another would fail when the rest of the vehicle was still in prime condition. He promised to build a shay in which every part was equally strong and durable, so that it would not be subject to the usual breakdowns of one or another part. And he was marvelously successful. The shay showed no sign of aging whatsoever until the first day of its 101st year, when it suddenly, instantly, and mysteriously turned to dust. The poem concludes with a line that stays in memory after all the intervening years. It is the poet's challenge to those who find the story difficult to believe. Since every part of the shay was equally durable, collapse of all had to come at the same moment: "End of the wonderful one-hoss shay; logic is logic; that's all I say."
The second, more negative theory--in which older people become sicker and more dependent with increasing age--is losing favor. MacArthur Studies and other research show us that older people are much more likely to age well than to become decrepit and dependent. The fact is, relatively few elderly people live in nursing homes. Only 5.2 percent of older people reside in such institutions, a figure which declined significantly from the 6.3 percent found in a 1982 survey. Furthermore, most older Americans are free of disabilities. Of those aged sixty-five to seventy-four in 1994, a full 89 percent report no disability whatsoever. While the proportion of elderly who are fully functioning and robust declines with advancing age, between the age of seventy-five to eighty-four, 73 percent still report no disability, and even after age eighty-five, 40 percent of the population is fully functional.
Between 1982 and 1994, the proportion of the population over age sixty-five that reported any disability fell from 24.9 percent to 21.3 percent, a meaningful reduction. And another statistic really sends the message home: in the United States today there are 1.4 million fewer disabled older people than there would be had the status of the elderly not improved since 1982. Furthermore, many studies show that the reduction in disability among older people appears to be accelerating. This is true at all ages, even among those over age ninety-five.
And so, the optimistic vision of aging seems to hold true--and the fact that the elderly population is relatively healthy and independent bears on the future of social policies for older people. It has important implications for issues as broad as establishing the proper eligibility age for Social Security benefits, and projecting the likely future expenses of federal health care programs including Medicare and Medicaid. Furthermore, beyond social policy implications, the greater our understanding of disability trends, the greater, in turn, will be our insights into the degree of biological change in our aging population. Disability in older people results from three key factors: 1) the impact of disease, or more commonly, many diseases at once; 2) lifestyle factors, such as exercise and diet, which directly influence physical fitness and risk of disease; and 3) the biological changes that occur with advancing age--formally known as senescence. It is not clear whether the reduction in the incidence of many chronic diseases--and the reduction in many risk factors for those diseases--is connected to a more general slowdown in the rate of physical aging. There is increasing evidence that the rate of physical aging is not, as we once believed, determined by genes alone. Lifestyle factors--which can be changed--have powerful influence as well. We will discuss this in much greater detail later in the book, but it's a very empowering notion to keep in mind. We can, and should, take some responsibility for the way in which we grow older.
So far, we have been focusing on objective information about older people's ability to function. But another important issue is how older people perceive their own health status. Again, we are optimistic. Research finds that older people have a quite positive view of their own health. In one major study, older people were asked to rate their health as excellent, very good, good, fair, or poor. In 1994, 39 percent of individuals over the age of sixty-five viewed their health as very good or excellent, while only 29 percent considered their health to be fair or poor. Even among those over age eighty-five, 31 percent considered themselves to be in very good or excellent health, while 36 percent viewed themselves as in poor health. Men and women were equally positive, but there were some racial differences--for instance, older African Americans were more likely than Caucasians to rate their health as poor. In general, however, a growing body of evidence shows that older people perceive themselves as healthy, even in the face of real physical problems. Why the occasional dissonance between objective measures of health and people's perceptions of it? It may reflect a remarkably successful adaptation to disability. Despite society's view of older persons as frail and in poor health, older people simply don't share that view, even when they have objective evidence of disability.
In sum, decades of research clearly debunk the myth that to be old in America is to be sick and frail. Older Americans are generally healthy. Even in advanced old age, an overwhelming majority of the elderly population have little functional disability, and the proportion that is disabled is being whittled away over time. We are delighted to observe increasing momentum toward the emergence of a physically and cognitively fit, nondisabled, active elderly population. The combination of longer life and less illness is adding life to years as well as years to life.
At the same time, as a result of the MacArthur Foundation Studies of Aging in America and other research, we now can identify the lifestyle and personality factors that boost the chance of aging successfully. This book discusses strategies to reduce one's risk of disease and disability, and to maintain physical and mental function. Our main message is that we can have a dramatic impact on our own success or failure in aging. Far more than is usually assumed, successful aging is in our own hands. What we can do for ourselves, however, depends partly on the opportunities and constraints that are presented to us as we age--in short, on the attitudes and expectations of others toward older people, and on policies of the larger society of which we are a part.
Meet the Author
John W. Rowe, M.D., is president of the Mount Sinai School of Medicine and Mount Sinai Hospital in New York City. Dr. Rowe has chaired the MacArthur Foundation Research Network on Successful Aging since its inception. He lives in New York City.
Robert L. Kahn, Ph.D., is professor emeritus of psychology and public health at the University of Michigan. A member of the MacArthur Foundation Research Network on Successful Aging, and lives in Ann Arbor, Michigan.
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