Successful Aging: Alive and Well in San Diego!
When we think about treating the rapidly growing population of seniors, the first thing that may come to mind is an increase in disease and disability — a tidal wave of dementia, hip fractures, and walkers. But at the UC San Diego’s Stein Institute for Research on Aging, we focus on what goes right in the aging process — the science of successful aging. We believe that how and why people age without significant impairments is as important as how and why they become ill.
We all know that physical health and some cognitive abilities decline with age, but studies have shown that mental health and psychosocial functioning tend to improve. This “paradox of aging” is clearly evident in some of our recent studies in which we have surveyed a total of more than 3,000 seniors between the ages of 60 and 102 years from local retirement communities and those who have participated in other UC San Diego studies. When asked to rate themselves on a scale from 1 (not successful) to 10 (extremely successful) in terms of aging, most gave themselves a score of 7 or higher, even though they had some serious health problems.
This tells us that many San Diegans believe that they are aging quite well; they tend to place more importance on cognitive, emotional, and psychosocial qualities, such as having a positive attitude or being socially engaged, than on the physical aspects of aging. Their perception of aging is “golden,” not “gray.”
Successful aging research substantiates this. For example, a study on the power of positive thinking, or “dispositional optimism,” found that men who exhibited a high level of optimism had a reduced risk of cardiovascular death compared to those with a negative attitude. A positive self-perception of aging has been reported to be associated with a nearly eight-year survival advantage.
Likewise, numerous studies have shown that social support and interactions, as well as satisfaction and engagement in life, are associated with protection against hypertension, other cardiovascular diseases, and depression; higher baseline cognitive performance; delayed onset of dementia; and lower mortality rates. Additional bio-psycho-social factors that enhance successful aging include caloric restriction, physical exercise, nontoxic environments (e.g., nonsmoking), cognitive stimulation, adaptability, a sense of humor, purpose and self-control in life, self-esteem, and reduction of stress.
You might think that genetics supersedes many of these factors, but a study of more than 2,700 twin pairs found that genes only have a modest (22 percent) role in age-related functional impairments — our behavior and the environment in which we choose to live take the lead (78 percent).
Studies have shown that senescent mice living in a stimulating environment have better brain function and structure. Brain research, using magnetic resonance imaging, shows that their brains compensate for any neurodegeneration; neuroplasticity allows their brains to form new neurons and synapses, even in old age. These findings apply to humans as well, indicating that our behavior and environment may impact the function and structure of our brain; successful aging will increasingly depend on our brain health.
With this evidence-based knowledge, we as physicians have the perfect opportunity to enhance the quality of life of our patients as they enter their golden years by providing them with strategies to improve their behavior and psychosocial support, and thus, improve their brain function and structure.
These strategies should focus on prevention and intervention, and can be traditional or nontraditional. For example, time spent on Sudoku, crossword puzzles, and reading each day could help our senior patients keep their minds sharp. Square dancing, gardening, and playing Wii, an interactive video game, could help them stay physically active. Through patient education materials and credible websites, we can teach them about proper nutrition and “super foods,” such as blueberries, beans, and walnuts.
Additionally, we need to set an example for successful aging, as many of us have joined or will be joining our senior patients in this journey into successful aging! We need to reinforce to our patients that successful aging isn’t just something that happens on their 65th birthday — it’s a lifelong process. The things that happened to you as an infant, a child, a teenager, and a young adult, as well as the things that you do now, are predicting your health going forward. This not only applies to your health but also to your socioeconomic status and quality of life.
Having a loving and caring family is also an essential component of successful aging. Many of our geriatric patients have children and grandchildren who come to their appointments. This is the perfect time to discuss issues like planning for retirement, long-term care, and developing a hobby or interest outside of work. Through a shared decision-making process, we can ensure that they not only understand how to treat their disease or disability, but also participate in successful aging. No matter what age they are, it’s never too late to start!