How Shall We Age?

Smyer, M. (2016). Is There a Secret to Aging Well? Solutions 7(1): 55–61. thesolutionsjournal.com/2016/1/how-shall-we-age

Feature

Is There a Secret to Aging Well?

by Michael A. Smyer

In Brief

Sari Dennise

An elderly man in Zozocolco de Hidalgo, Mexico. Today’s older adults, pioneers of the longevity bonus, hold the secrets to aging well.

As the Baby Boomers reach and move beyond traditional retirement ages, they are increasingly concerned about issues of aging. The demographics are compelling. By 2050, the older portion of the population will increase from 7 to 16 percent of the world’s population, with the developed world leading the way with even higher percentages.

Today’s older adults are pioneers of a landscape historically unprecedented.

With possibly thirty years of a “longevity bonus,” many older adults are asking how best to use their years. While there are many social policy and political issues involved in managing an aging society, there are also many things that individuals can do throughout their lives to prepare for aging.

Lifestyle choices reflecting aging accelerators or decelerators will impact the pace and outcomes of aging processes.

This essay draws lessons from several books in the fields of gerontology (the study of the normal processes of aging) and geriatrics (the study of diseases that often accompany aging) to answer a simple question: How shall we age?

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s the Baby Boomers reach and move beyond traditional retirement ages, they are increasingly concerned about issues of aging. Although there are major social policy and political issues involved in an aging society,1,2 this essay focuses on individuals and what they can do to prepare for aging. Focusing on the individual runs the risk of overlooking the direct and indirect impacts of the ecology of aging—the interactive social, political, and cultural contexts of older adults’ lives. However, the broader social policy dimensions of an aging society are beyond the scope of this article.

Boomers are increasingly asking the questions posed more than three decades ago by French philosopher Michel Philibert: “Of aging, what can we know? About aging, what may we hope? With aging, what must we do?”3 But before we turn to the concerns of Boomers and those who are worried about them (i.e. Gen Xers and Millenials), there is a logically prior issue to sort out: How old is old?

How Old is Old? Age, like beauty, is in the eye of the beholder according to recent research by the Pew Research center.

When asked “at what age does the average person become old?,” the answer depended upon the age of the respondent: those 18–29 said age 60; those 30–49, 69; those 50–64, 72; and those 65 and above said 74. A majority of the sample agreed that you are old somewhere between 65 and 75.

From a policy perspective, old also depends on the eye of the beholder. In the United States, the Age Discrimination in Employment Act (ADEA) defines the protected class of “older workers” as starting at age 40. Medicare eligibility is 65 and Social Security eligibility is currently 66 and a half, edging up toward 70. Many of the resources reviewed here, however, cover the age of 65 and older.

Older Adults: A Growing Resource?

Apart from the Baby Boomers, policy makers and family members are paying more attention to aging issues because they have to. The demographics are compelling. Under modest assumptions, the world’s population is estimated to grow by 50 percent in the first half of this century from 6 billion people in 2000 to 9 billion in 2050.

During this time, the older portion of the population will increase from

Key Concepts • The “longevity bonus” is the years of life expectancy after age 65 that have been added during the last century.

• Older adults achieve optimal aging when they test the limits of physical and mental abilities for their age range.

• Stereotype threat is being at risk of confirming, as a self-characteristic, a negative stereotype about your own group (e.g. about older adults).

• Aging accelerators and aging decelerators are lifestyle choices that affect the pace and outcomes of aging processes.

• Present bias is the tendency to overvalue immediate rewards at the expense of our long-term intentions.

7 percent to 16 percent of the world’s population, with the developed world leading the way with even higher percentages.

Older adults are increasingly viewed as a resource, with time and talent available for investing in their communities. According to the Administration on Aging, those reaching age 65 in 2013 had an average life expectancy of an additional 19.3 years (20.5 years for females and 17.9 years for males). Public and private sector programs are increasingly reaching out to older adults to engage them in

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service and entrepreneurship. From Senior Corps Foster Grandparents and the Senior Companion programs to AARP’s Experience Corps to Encore. org’s efforts, many are encouraging today’s older adults to make the most of their “longevity bonus” through some kind of continuing productive engagement in their families and communities.

Lessons from the Field: Gerontology, Geriatrics, and Beyond For more than 60 years, scientists from a variety of fields have tried to understand the processes of normal aging; the field of gerontology. At the same time, specialists in medicine and allied health fields (nursing, social work, and psychology) have focused on understanding effective assessment, diagnosis, and treatment of diseases that often accompany aging; the field of geriatrics. A recent special issue of Science focused on the cellular mechanisms underlying mammalian aging. Biologist Matt Kaeberlein highlighted the emerging field of geroscience: basic research on the biology of aging, an important subfield of gerontology.4 One summary of the field of gerontology in the United States over the last 60 years or more is that it progressed across the normal distribution of functioning: early studies focused on older adults in institutional settings, conflating disease with the processes of aging.

These were followed by longitudinal studies (following people over time) of community-dwelling elderly, notably in Baltimore, Kansas City, Durham, and Los Angeles. Eventually, attention turned to “optimal” aging, or “testing the limits” of physical and mental capacity, focusing on older adults who are outstanding in their abilities. Fortunately, several books have drawn from both gerontology and geriatrics to distill lessons on the processes of aging.

Martin

Older women socialize outside of a café in San Damiano d’Asti, Italy.

Advice for and from Pioneers of the Longevity Bonus As Dame Penelope Lively put it: “Our experience is one unknown to most of humanity over time. We are the pioneers.” Today’s older adults are pioneers and explorers of a historically unprecedented landscape. With possibly 30 years of a “longevity bonus,” many older adults are asking how best to use these years.

Cornell University sociologist Karl Pillemer has focused on getting advice directly from the pioneers in 30 Lessons for Living: Tried and True Advice from the Wisest Americans.5 Using both surveys and individual interviews, Pillemer has distilled advice from today’s older adults into a very readable book. One question, of course, is how their advice lines up with lessons drawn from the fields of gerontology and geriatrics.

Like Pillemer, Dan Buettner used a select group of older adults as key informants for his book The Blue Zones: 9 Lessons for Living Longer.6 Buettner’s target was a little different: he sought out “blue zones,” areas of the world with an unusually high rate of centenarians. He visited centenarians in five locations (Sardinia, Okinawa, California, Costa Rica, and Greece). In the end, Buettner boiled down their experiences and advice into nine rules for longevity. He complemented these with interviews with prominent geriatricians and gerontologists to confirm and provide context for the experience of the individual sites.

Laura Carstensen, Director of Stanford’s Center on Longevity, has compiled her advice in A Long, Bright Future: An Action Plan for a Lifetime

of Happiness, Health, and Financial Security.7 Drawing from both geriatrics and gerontology, Carstensen advises that we should be preparing ourselves to live to be 100, getting ready to take full advantage of the longevity bonus.

Carstensen’s book is among the most recent in a series of books that have translated findings from the fields of gerontology and geriatrics into lessons for living. One of the most influential was Successful Aging

by Jack Rowe, a geriatrician, and Robert Kahn, a psychologist. 8 Their work epitomized focusing on optimal aging, or older adults at the peak of their powers. Building upon an earlier article and adding information from a MacArthur Foundation-sponsored study of the determinants of successful aging,9 Rowe and Kahn’s work

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Garry Knight

An elderly couple strolls down East Street in Brighton, England.

influenced generations of research and practice. A recent review of the research and practice spurred by Rowe and Kahn’s work suggested that their view was both influential but limited because of its lack of attention to cultural contexts, its marginalization of older adults who are not “successful” and its relative emphasis on individuals, without taking into account their social surroundings.10 Another contribution to the translational literature is George Valliant’s Aging Well: Surprising Guideposts to a Happier Life. Valliant, a psychiatrist by training, led a longitudinal study of Harvard men that began when they were in college and followed them into late life. Vaillant’s research team combined expertise from geriatrics and gerontology as they followed their informants for several decades.11

The Power of Stereotypes of Aging In the 1990s, Carstensen’s colleague in psychology at Stanford, Claude Steele, explored the impact of stereotype threat on children. Gerontologists have extended this work to older adults and their functioning.12 The title of a recent Wall Street Journal article summarized the importance of how we frame and anticipate our own aging: “To Age Well: Change How You Feel About Aging.”

Anne Tergesen’s article documents the impact of stereotypes on the physical and mental well-being of older adults.13 Even when you don’t agree with them, stereotypes can have a pernicious effect. That is why societal attitudes, especially myths, are powerful and worth attending to.

For example, Yale psychologist Becca Levy and her colleagues have

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focused on the impact of negative stereotypes of aging on cardiovascular health and brain structures in a series of studies.14,15 Levy and her colleagues drew on data from the Baltimore Longitudinal Study that followed individuals over decades of their lives. They found that negative views of aging were associated with higher rates of cardiovascular incidents, even decades after the initial view was taken.

Similarly, negative stereotypes of aging were associated with brain changes often associated with Alzheimer’s disease (reduced hippocampal volume and neurofibrillary plaques and tangles)—25 years after the stereotypes were assessed. Becca Levy suggests a two-step mechanism for the impact of stereotypes: stereotypes contribute to stress and chronic stress contributes to pathological changes in the brain.

Five Myths of Aging Carstensen frames her book around five powerful myths of aging, providing data to dispel each. When combined with the observations of Pillemer’s informants, lessons from Bueetner’s blue zones, and Vaillant’s longitudinal studies, a consistent picture emerges.

So what are these five myths?

70, four of these elements reduce mortality by 60 percent: exercise; not smoking; moderate alcohol consumption; and a Mediterranean diet (fruits, vegetables, and healthy fats like olive oil) to maintain weight.

Pillemer’s pioneers summarized it well: “Act now like you’ll need your body for 100 years.”

Work hard, retire harder. In visiting cen-

Older people are miserable. As

Carstensen points out, a repeated finding is that happiness peaks later in life (in the 70s). For example, a recent Pew Research Center found that 81 percent of Americans 65 and older reported being very happy or pretty happy.

What do Pillemer’s pioneers say? Their consensus: “Being old is much better than you think.”

tenarians, Buettner did not find a bright line between work and retirement, nor did Carstensen. Most older adults don’t go from full-time work to full-time retirement abruptly (except in the case of physical disability). Most engage in what economists call “bridge jobs”—either a reduction in duties or responsibilities or a shift in activities. They continue to work for a variety of reasons: health

Older adults are increasingly viewed as a resource, with time and talent available for investing in their communities.

DNA is destiny. You may think that

the secret to longevity is to pick your grandparents well. As Dan Buettner points out, however, only about 25 percent of longevity is determined by our genes. Our own behaviors and lifestyle choices determine the other 75 percent. George Vaillant’s advice is helpful here. He suggests seven rules: don’t smoke, don’t abuse alcohol, exercise regularly, maintain your weight, have a stable marriage, get an education, and control your stress. Vaillant’s advice focuses on aging accelerators (smoking, alcohol abuse, stress) and aging decelerators (exercise, social support, education, stress management). (The only one of these that Buettner didn’t highlight was education—but then he wasn’t following Harvard alums!)

Carstensen points out that, after age

adults are providing a variety of support for their family members. In part, this is a result of the changing family dynamics of an aging society: parents and children will now spend 50 years together, and the majority of the parent/child bond will happen with both sides in adulthood.

Grandchildren can expect to know their grandparents for 20 or more years. For most of those years, the grandparents will be providing support to the family, not the other way around. Pillemer’s pioneers understand these dynamics and advise us to “take a life-long view of parenting.”

The second variation of this myth is that older adults are too productive: when will they ever leave the work force? Boston College economist Joe Quinn calls this the “still” age of work: Are you still working? The fear behind this myth is that older adults won’t leave room for successive generations.

(This is closely tied to the notion that there is a hard line between work and retirement for older adults.)

We age alone. There is a stereotype

benefits (in the U.S.), income, and/or social connectedness. Economist Alicia Munnell warns that many older adults may have to work longer because they have not been able to save for their “longevity bonus.”16 Pillemer’s pioneers give advice to those at the outsets of their careers or looking for bridge jobs: Pick something that makes you want to “tap dance to work,” and “choose a job for its intrinsic rewards.”

Older people are a drain on our resources. This myth has two

variations. In the scarcity myth, older adults are taking up scarce resources. Again, the Pew Research Center data refutes the myth. Most middle-aged adults are more likely to be providing assistance to young adult children than they are to older parents. It is more likely that older

of the abandoned older person at the end of life; however, the reality is very different. Psychologists Toni Antonucci and Robert Kahn suggest that we develop “convoys of support” across the lifespan, developing friendship and kinship networks that will support us on our journey in late life.

These social ties are important for our mental and physical health as we age; in fact, they can be age accelerators or age modulators. Carstensen points out that having fewer than three people we feel emotionally close to is a risk factor for psychological and physical problems. In fact, feeling socially isolated is as great a risk factor for poor health and death in late life as cigarette smoking. Carstensen notes that there is a natural “pruning” of our social ties as we age, a process she has labeled “socioemotional selectivity.”

In part, we become more aware of time—shifting to a metric of time

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left to live, savoring our time and our connections. Buettner’s blue zone residents know the value of being surrounded by the “right tribe”—those who share your values and outlook on life. Pillemer’s pioneers sum it up well: “friendship is as important as love” in later life.

What Could Go Wrong?

Carstensen warns of several pitfalls, highlighting three in particular: lacking a vision of how to use the longevity bonus, spending money like there’s no tomorrow, and failing to address health threats.

Dan Buettner’s Blue Zone centenarians have a good sense of the “big picture” and their role in it. Whether through a faith community or close neighbors, these older adults know how to stay engaged, even as their abilities change over time. Psychologists Paul and Margret Baltes called this “selective optimization with compensation”—consciously or unconsciously setting priorities and accommodating the gains and losses of aging. For example, a great gardener may tend beautiful flower beds throughout her yard until her late 70s. When arthritis limits her, she may turn to growing orchids in window boxes. When she moves into a nursing home (in her early 90s), she tends a houseplant on her bedside table. Her self-definition as a gardener is important to her and she maintains it despite her frailty in advanced old age.

Carstensen warns of the financial perils of spending like there’s no tomorrow. She joins economists (e.g.

Alicia Munnell) and others in urging us to plan our finances as if they have to last to 100. Here the work of Harvard psychologist Dan Gilbert is helpful. He points out that seeing across time is similar to seeing across space: we are good at things close by but have difficulty in far-off vision.

There is a present-time bias that requires that we develop disciplines to “force” ourselves to set aside funds.

American Advisors Group

A crucial component of aging well is planning personal finances in anticipation of living to 100 years old.

(The field of behavioral economics has many suggestions on this front.17) Maintaining health in later life takes work. Most older adults have one or more chronic diseases that require managing. In the 2014 Current Population Survey, roughly 10 percent of “leading edge” Baby Boomers described their health as “fair” or “poor.” At the same time, almost one in five reported having a work-limiting health difficulty.

In addition, there are three specific elements that today’s older adults and those in the future will have to contend with: the obesity epidemic, contagious diseases, and climaterelated health challenges. Projections are that by 2030, 86 percent of American adults and 30 percent of children and teenagers will be overweight. Carstensen points out that

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America passed a milestone in 2000, with more Americans overweight than underweight. This obesity epidemic may shorten lifespans and add chronic disease burden to later years. At the same time, contagious diseases pose a real threat to older adults with compromised immune systems. Finally, as the Center for Disease Control, the Intergovernmental Panel on Climate Change, and the Australian Academy of Sciences have noted, older adults are vulnerable to the effects of severe weather events (droughts, heat waves, etc.). However, recent data from the Yale Project on Climate Change Communication indicate that most people—even those who are most concerned about climate change—are unaware of the health risks that climate change presents, especially for older adults.18

References 1. Hudson, R.B. (ed). The New Politics of Old Age Policy (Johns Hopkins University Press, Baltimore, 2014).

2. Fond, M., A. Haydon, N. Kendall-Taylor, and E. Lindland. Gauging aging: mapping the gaps between expert and public understandings of aging in America. FrameWorks Institute [online] (2015) http://www.frameworksinstitute.org/assets/files/ aging_mtg.pdf.

3. Philibert, M. in Dimensions of Aging: Readings (eds Hendricks, J. and C.D. Hendricks) 379–394 (Winthrop Publishers, Cambridge, 1979).

4. Kaeberlein, M., P.S. Rabinovitch, and G.M.Martin.

Healthy aging: the ultimate preventative medicine.

Science 350(6265), 1191–1193 (2015).

5. Pillemer, K. 30 Lessons for Living: Tried and True Advice from the Wisest Americans (Penguin Group, New York, 2011).

6. Buettner, D. The Blue Zones: 9 Lessons for Living Longer (National Geographic, Washington DC, 2008, 2012).

7. Carstensen, L. A Long, Bright Future: An Action Plan for a Lifetime of Happiness, Health, and Financial Security (Broadway Books, New York, 2009).

8. Rowe, J. and R. Kahn. Successful Aging (Pantheon Books, New York, 1998).

9. Rowe, J. and R. Kahn. Science 237(4811), 143-149 (1987).

10. Pruchno, R. Successful aging: Contentious past,

Andrew Aliferis

An elderly woman sells oranges at a farmers’ market in Kalamata, Greece. A Mediterranean diet high in fruits, vegetables, and healthy fats helps to reduce mortality.

productive future. The Gerontologist, Special Issue: Successful Aging, 55(1), 1-4 (2015).

11. Valiant, G. Aging Well: Surprising Guideposts to a Happier Life (Hachette Books Group, New York, 2002).

Encore Adulthood?

For many of us, the years between 65 and 80 are similar to our 20s. We are faced with similar issues: How can we support ourselves? Where shall we live? Where will our family and friends be? In a forthcoming book, sociologist Phyllis Moen has labeled this period “Encore Adulthood.”19 A friend of mine, Fr. Michael Himes, suggests that students who are facing their 20s need to answer three questions: What gives me deep pleasure? What am I good at? And finally, who cares? The first question focuses on what really engages you, what leads you to lose track of time. The second question focuses on being realistic about what you have to offer. The third question brings in the ecology of aging: what are the structures available for being engaged and engaging?

Each of us has to answer these questions as we face the transitions of aging. What do I want to prioritize (selectively optimize in Paul and Margret Baltes’ phrase) and how do I assure that I continue to be engaged? For some, the challenge is simpler: how can I afford to live out my years? As an aging world, we all have a stake in answering these questions.

12. Westerhof, G.J. et al. The influence of subjective aging on health and longevity: a meta-analysis of longitudinal data. Psychology and Aging 29(4), 793–802 (2014).

13. Tergesen, A. To age well: change how you feel about aging. Wall Street Journal (October 19, 2015).

14. Levy, B.R. et al. Age stereotypes held earlier in life predict cardiovascular events in later life.

Psychological Science 20, 296–298 (2009).

15. Levy, B.R. et al. A culture-brain link: negative age stereotypes predict Alzheimer’s disease biomarkers.

Psychology and Aging, 31(1), 82-8. (2016).

16. Ellis, C.D., A.H. Munnell, and A.D. Eschtruth.

Falling Short: The Coming Retirement Crisis and What To Do About It (Oxford University Press, New York,

Our Pioneers Have the Last Word

2014).

17. Thaler, R.H. and C.R. Sunstein. Nudge (Penguin

Karl Pillemer focuses on the take away messages, what he calls the refrigerator magnet messages, gleaned from the wisest Americans.

One key lesson from them: “Time is of the essence.” Live as though life is short, because it is—even if you live to 100.

Books, New York, 2009).

18. Yale Project on Climate Change Communication.

Global Warming’s Six Americas, October 2014 (2015) http://environment.yale.edu/climatecommunication/article/global-warmings-sixamericas-perceptions-of-the-health-risks/.

19. Moen, P. Encore Adulthood: Boomers on The Edge of Risk, Renewal, and Purpose (Oxford University Press, New York, In Press).

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