The ecology of optimal aging

1. The ecology of optimal aging Larry W Lawhorne, MD Professor and Chair, Department of Geriatrics Wright State University Boonshoft School of Medicine Dayton, Ohio

2. AP Story on a dayton TV Website 1/12/2010 A famed strongman - once lifted 3,200 pounds and still bending quarters with his fingers at age 104 - died Monday after he was hit by a minivan. Joe Rollino was struck as he crossed Bay Ridge Parkway in Brooklyn and died a few hours later at the hospital.

3. Optimal aging is difficult to define or even describe.

4. “Go get it for him.”

5. “I ain’t a religious person, but Hazel, she comes in and prays for me. I been good to people. I never hurt nobody.”

6. “I think I’m still a person other people want to know.”

7. Why do these three people, separated in time and space, come to mind when I think of optimal aging?

8. Because…aging, optimal or otherwise, is a complex ecological phenomenon in which observed variations are driven by any number of ever-changing factors.

9. ecology From the Greek: οἶκος, "house"; -λογία, "study of." The scientific study of the relationship of living organisms with each other and their surroundings.

10. My Argument • The 3 people I just described are examples of optimal aging. • Each has experienced a complex ecological phenomenon in which observed variations were driven by a number of ever-changing factors for 90 years. • With a thorough history, I can describe a complex ecological phenomenon for each of them in great detail, but where along the way would I have said, “This is optimal aging.”?

11. Demographic and epidemiologic transitions

12. No surprise to you… Demographic transition Patterns of high fertility and high mortality rates  Patterns of low fertility and delayed mortality Epidemiologic transition Leading causes of death shifting from infectious disease and acute illness  chronic disease and degenerative illness

13. Demographics • First big wave of Baby Boomers will turn 65 in about 1 year. • Number of Americans > 65: 3.1 million in 1900 36 million today 72 million in 2030 • Number of Americans > 85: 4 million today and 20 million by 2050.

14. Who wants to live to be 100? Studs turkel

16. Something studs didn’t know If the pace of increase in life expectancy in developed countries over the past two centuries continues, most babies born since 2000 will celebrate their 100th birthdays. The Lancet, 3 October 2009

17. The epidemiologic transition… …means that many in this very large cohort of Americans marching toward 100 years of age will have multiple chronic degenerative medical and neuropsychiatric conditions.

18. Ecologically speaking… One of the relationships between the aging, aged organisms in the population of Homo sapiens currently existing in the habitat known as the United States of America with younger organisms in the same habitat may be unsustainable.

19. fewer workers for each retiree

20. A temptation To define, describe, work toward, commit resources to, etc making optimal aging synonymous with good health so that as we age, • We can remain productive in the work force • We can live well while we live long • We can postpone, dare we say, avoid death • We can move to Florida or at least winter there to continue to search for what this man could not find…

22. Nobody gets out of here alive… No matter how hard we try. And we try hard.

23. Begging the question Is the reason for this some breakdown in the plot of evolution, which seems to have come to a halt before completing the work of making humans both perfect and immortal?

24. Never say die: the myth and marketing of the new old age Susan Jacoby Published by Pantheon

25. The book • Aimed at Baby Boomers and an attack on self-help health efforts and on the belief that medical technology will save us all. • Contends that there are a number of doctors, scientists and others who get rich by selling the promise of a long and healthy life along with very expensive Ponce de Leon concoctions.

26. The book • Chastises Alzheimer’s researchers for giving us the false hope that cure is just around the corner. • Expresses anger with her generation of women by saying that they have ignored the plight of older women…women make up two-thirds of those over 85 and many are lonely and poor.

28. Jacoby (and many others): Aging is primarily a women’s issue.

29. She makes some good points, but…

30. Contrast with Cicero’s Essay (65 BCE) • “On Aging” written in the form of a dialogue. • Old age brings about a diminution of physical stamina and the likelihood of disease…and of course moving closer to death. • But old age is also associated with the opportunity for the “study and practice of decent, enlightened living,” accompanied by a calm that youth, or even middle age, do not allow.

31. Models of optimal aging

32. A trend: Not just good health in old age, but “positive” adult development. Optimal Aging

33. Psychosocial DevelopmentErikson’s Eight Stages of Development

34. Some recent publications • Successful Aging (Rowe and Kahn, 1998) • Aging Well (Vaillant, 2002) • Aging with Grace (Snowdon, 2001)

35. Successful Aging(MacArthur Study) • High level of engagement with life. • Low risk of disease. • High physical and cognitive levels of function.

36. What % of older adults are aging successfully if we use the MacArthur criteria? • High level of engagement with life. • Low risk of disease. • High physical and cognitive levels of function.

37. Select the best answer… • Less than 20% • 20 to 33% • 33% to 50% • Over 50% but less than 75% • Over 75%

38. Select the best answer… • Less than 20% • 20 to 33% • 33% to 50% • Over 50% but less than 75% • Over 75%

39. Another Definition(Schmidt 1994) Successful aging: minimal interruption of usual function although minimal signs and symptoms of chronic disease may be present. (Using this definition, about 50% of older adults age successfully.)

40. Yet Another Definition(Baltes et al 1996) Successful aging: Doing the best with what one has. (Achieving the highest practicable level of physical, mental and psychosocial well being.)

41. A Problem with the term “Successful” • Implication is that there are winners and losers. • We don’t write off the “unsuccessful” ones! • Alternative terms suggested: healthy aging, aging well, effective aging, productive aging, and optimal aging.

42. Self-Rated Successful Aging • Strawbridge et al. The Gerontologist 2002; 42(6):727-733. • 867 older adults. • 50% self-rated as aging successfully but only 19% met MacArthur study criteria for successful aging.

43. Best old age one could expect Happy Life turned out OK More energy than most Not depressed Feel loved Satisfied with relationships Happy marriage Perceived control Affect balance Lower cynical distrust Areas Explored in Self-Rating

44. Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development George vaillant

45. Aging Well Pulls together data from 3 separate longevity studies (beginning in their teens, following 824 individuals for more than 50 years): • Male Harvard graduates • Inner-city, disadvantaged males • Intellectually gifted women.

46. Aging well The book beginswith an all-inclusive definition of aging that suggests decay,change, and continued growth. It ends with an admonition thatthe final "task of Integrity is acceptance of one’s oneand only life cycle as something that is to be and that permitsno substitutions."

47. "Owning an old brain, you see, is rather like owning an old car.... Careful driving and maintenance are everything." George vaillant

49. AGING WITH GRACE: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives David Snowdon, Ph.D.

50. The nun study • The School Sisters of Notre Dame in Mankato, Minnesota • 75 to 104 years old and agreed to donate their brain tissue after their deaths • High ability in written and oral expression correlated with a low rate of Alzheimer‘s