How We Age Realizing the Potential for Wisdom, Creativity and Growth

1. How We Age Realizing the Potential for Wisdom, Creativity and Growth MARC E. AGRONIN, MD Medical Director for Mental Health and Clinical Research, Miami Jewish Health Systems, Miami, FL Affiliate Associate Professor of Psychiatry and Neurology. University of Miami Miller School of Medicine, Miami, FL

2. SOLVING FOR X % of Total World Population 2 billion people over 65 years old! Age < 5 years 15% 10% 5% Age > 65 years 1950 2017 2050 “Why Population Aging Matters: A Global Perspective.” National Institute on Aging, NIH, US HHS and Department of State, Publication No. 07-6134, March 2007.

3. Old Age in Antiquity . . . • Old age was rare • Old age conferred honor as one was seen as a repository of knowledge and traditions • But under stressful living conditions, old age was also seen as a burden

4. One of the most enlightened perspectives on aging appeared in Cicero’s work “De Senectute,” translated as “On Old Age” “the reasons why old age is regarded as unhappy are four: one, it withdraws us from active employments; another, it impairs physical vigor; the third, it deprives us of nearly all sensual pleasures; and four, it is the verge of death.”

5. Cicero (106 – 43 BC) sought to counter these beliefs by asserting that old age should be guided by rational reflection and not hedonism. “The arms best adapted to old age,” he wrote, “are the attainment and practice of the virtues; if cultivated at every period of life these produce wonderful fruits when you reach old age.” The Roman physician Galen (131 – 201 AD) provided the first theory of aging: “Old age is an unavoidable and incurable condition, intrinsic to the body. This is why we grow old. For that which all men commonly call old age is the dry and cold constitution.”

6. Why Do We Age? • Programmed Aging: built-in genetic mechanisms promote aging • Wear and Tear: accumulating DNA, cellular and tissue damage • Disease effects: leads to irreparable damage RADIATION CROSS-LINKING

7. Can We Live Forever? British researcher Aubrey DeGrey believes that we can “solve” the mystery of aging by re-engineering cellular aging – thus extending the lifespan indefinitely.

8. THE AGING BRAIN

9. What Neuroscience Has Discovered • The brain is continually resculpting itself in response to experience and learning. • New brain cells do form throughout life. • The brain’s emotional circuitry becomes more balanced with age. SOURCE: Cohen GD. The Mature Mind. New York: Basic Books 2005, p. 4

10. There are certain factors that we acquire and develop not in spite of age, but because of it . . . • Resilience • Wisdom • Creativity • Emotional maturity • Tolerance • Purpose • Integrity • Hope

11. Resilience • The ability to adapt to adversity • The ability to continue with normal functioning after stress • Resilience can increase with age O’Hara et al. Stress, Resilience, and the Aging Brain. In Depp and Jeste (Eds), Successful Cognitive and Emotional Aging. APA Press, 2009 (pp. 173-196)

12. Resilience in Late Life • Resilience may increase in late life, as shown in Hurricane Katrina victims and in rates of PTSD after crimes and accidents • Factors that improve resilience: higher emotional well-being, optimism, social engagement, fewer cognitive complaints • Genetic factors: APOE-4 and short allele of serotonin transporter gene associated with increased vulnerability to stress O’Hara et al. Stress, Resilience, and the Aging Brain. In CA Depp and DV Jeste (Eds), Successful Cognitive and Emotional Aging. Washington DC: APA Press, 2009 (pp. 173-196)

13. Developmental Intelligence The maturing of cognition, emotional intelligence, judgment, social skills, life experience and consciousness and their integration and synergy. “The degree to which an individual has manifested his or her unique neurological, emotional, intellectual and psychological capacities.” SOURCE: Cohen GD. The Mature Mind. New York: Basic Books 2005, p. 35

14. Postformal Thinking Piaget’s model of cognitive development stopped at young adulthood with “formal operations” Many cognitive scientists have proposed the development of postformal thinking: • Ability to understand and compare competing sets of relationships or systems • Thinking is more relative and less universal • Appreciation of the tension between one’s own perspective and that of other people or systems • Thinking may be less logical, more pragmatic

15. The Six Traits of Wisdom • Empathy • Compassion • Altruism • Self-understanding • Emotional stability • Pro-social attitudes In our adult lives we can take advantage of this developmental impetus to energize our creativity and jump-start our efforts to explore new ideas or make desired change SOURCE: Cohen GD.In: Principles and Practice of Geriatric Psychiatry, 2ndAgronin & Maletta (Eds.), Philadelphia, PA: LWW, 2011, pp 15- 30

16. Gerotranscendence • Defined as a final stage of maturation and wisdom • It is a shift in perspective, a redefinition of the self • Less materialistic and superficial, but deeper and more spiritual connection to the past • Time is seen as a moment instead of a horizon • One is better able to understand and cope with the approaching end of life SOURCE: Tornstam L: Gerotranscendence: A Developmental Theory of Positive Aging. NY: Springer Publishing Company, Inc., 2005

17. Key Predictors of Successful Aging Harvard’s Study of Adult Development • Good relationships are more influential than events • Key strengths: forgiveness, gratitude, lovingkindness • A good marriage at 50 predicts positive aging at 80 • Healthy defenses: humor, altruism, sublimation, and suppression • Alcohol abuse is predictive of unsuccessful aging • Friendship, play, and creativity more important than income • Subjective health is a better predictor than objective health Vaillant GE: Adaptation to Life (1977) ;Aging Well (2002). Boston: Little, Brown & Co.

18. Gene Cohen on Creativity and Growth: “The secret of living with one’s entire being is the creative spirit that dwells in each of us. It can occur at any age and under any circumstances, but the richness of experience that age provides us magnifies the possibilities tremendously.” SOURCE: Cohen GD. The Creative Age: Awakening the Human Potential in the Second Half of Life. HarperCollins Publishers, 2000.

19. Creativity is Not Just for Artists Cohen emphasizes the role of creativity playing a dynamic role in: • Relationships: “new starts, new directions, and mid-course corrections.” • Responding to adversity: “problems become a catalyst for developing the potential.” • Intergenerational and community interactions: “an opportunity to do something for the common good.” SOURCE: Cohen GD. The Creative Age: Awakening the Human Potential in the Second Half of Life. HarperCollins Publishers, 2000.

20. Cohen’s Human Potential Phases • There is continual potential for inner development in late life • Physical and psychological changes do not automatically produce growth in late life, but contain elements to be tapped into • These potential phases depend upon both individual efforts and the help of others

21. Cohen’s Human Potential Phases

22. The Social Portfolio • Based on the reality of active, if selective engagementin late life • Focuses on an active review of one’s life-long personal assets • Emphasizes the role of diversificationto enable a resilientportfolio • Emphasizes the need for “insurance” in the face of disability or loss SOURCE: Cohen GD. The Mature Mind. New York: Basic Books 2005

23. WHAT WE MAY LOSE Memory speed and acuity Motor speed and agility Lifelong relationships Physical appearance Social and financial status WHAT WE MAY GAIN Knowledge Wisdom Positive Emotions Creativity Integrity Transcendence Age That Adds As It Takes Away

24. But these are things we can do something about! A Perspective on Age Age is not always the problem, even in the last few years of life. Rather, it is the loss of dignity, meaningful relationships, vital activity, and hope that can tip the balance.