Don't forget spiritual health as well.  We do not suggest that exercise is
the key to all things good, happily ever after, etc.  But it is our
contribution, as exercise specialists, to everyone's search for birds
chirping, sunny days, green grass, happy smiles, and contentment.  To gain
such peace within will require multiple components, exercise is just one.

Carol Oglesby      

-----Original Message-----
From: UTC Staff E-Mail List [mailto:[log in to unmask]] On Behalf Of
Amye R. Warren
Sent: Thursday, September 29, 2005 5:00 PM
To: [log in to unmask]
Subject: [UTCSTAFF] it's not all about physical exercise...

Although I don't dispute the benefits of physical exercise, there is a great
deal of research documenting the value of mental activity for increasing
longevity, quality of life, and maintaining, perhaps even improving,
cognitive ability in later life.  As Rebecca Cook pointed out, sometimes I
think we focus on physical health and ignore mental health, and on
lengthening life rather than improving quality of life.

For those of you who are interested, the following was recently posted on
Medscape Psychiatry.

Secrets of Successful Aging: An Expert Interview With Dilip Jeste, MD


Medscape Psychiatry & Mental Health. 2005;8(2) C2005 Medscape Posted
09/22/2005 Editor's Note:
Successful aging lacks a clear definition. Elizabeth Saenger, PhD, Medscape
Psychiatry & Mental Health Program Director, speaks with Dilip Jeste, MD,
Director of the Institute for Research on Aging, University of California,
San Diego, about the impact of the mind and the body on aging. How do they
influence and predict success?
Medscape: How do you define successful aging?
Dr. Jeste: Successful aging has not been consistently defined; that is one
reason why this area is ideal for research. There have been some studies
funded by the MacArthur Foundation beginning in the mid-1980s going on
through the mid-1990s. But the [scientific] literature is limited, and there
is no consensus on what is successful aging. Our research goals include
developing a definition as well as criteria for successful aging.
At this stage, we think that there are several elements or domains that are
important constituents of successful aging:
a.. Higher level of cognitive functioning;

b.. Adaptation to changes associated with aging;

c.. Socialization -- that is, some kind of social activity and/or social
contacts; and

d.. Life satisfaction.

It is also important to say what is not an essential part of successful
aging -- absence of either physical diseases or physical disability is not
necessarily a part of successful aging. I want to stress that people who
have physical illnesses or physical disabilities can be aging successfully. 
However, severe dementia or severe mental illness cannot be a part of
successful aging. Optimal functioning of the brain and mind are primary
components of successful aging.
Medscape: Can you tell us a little bit more about those different
components? What has your research uncovered about cognitive functioning,
adaptation to change, and so on?
Dr. Jeste: About 1 year ago, when I took on my current position at the
Institute, we started to consider what defines successful aging by first
reviewing the existing literature. But, as I already mentioned, the
literature is limited. There are several reasons for the lack of literature
on successful aging:
a.. The definition has been inconsistent.

b.. It is not clearly diagnosable.

c.. It is somewhat esoteric. In other words, it's easier to do research on,
say, cancer or diabetes, even schizophrenia or depression. It is much harder
to do research on something like successful aging.

d.. There is a stigma about aging -- a kind of cultural belief that
successful aging is a misnomer or even an oxymoron.



Aging is associated with loss of abilities, illnesses, dementia, and 
depression. Many believe that life just goes downhill in old age. Given 
that kind of pessimistic, almost nihilistic, attitude towards aging, people 
have not focused on aging successfully. At the same time, the population is 
growing older, and increasing numbers of people are living healthy, 
functional lives well into old age.
After completing our literature review, we started to look at people from 
San Diego County living in retirement communities as well as those 
attending an extension course at University of California, San Diego (UCSD) 
called Institute, available for retired or semiretired people to take 
classes or seminars. The third and largest cohort from whom we are 
collecting data is the Women's Health Initiative (WHI). As you and many 
readers may know, WHI is a very large National Institutes of Health 
(NIH)-sponsored study that has been going on for the last 12 to 13 years or 
longer. It involves roughly 150,000 women in the United States. For our 
purposes, we evaluated the contingent of women from San Diego County; there 
are about 6000.
We have been conducting surveys in each of these 3 groups of subjects, most 
of whom are over the age of 60. After gathering background, demographic 
information, and a medical history, we ask them whether they think they're 
aging successfully, and we have them rate themselves on a 1 to 10 scale. We 
also ask about physical illnesses, disabilities, health behaviors (smoking, 
drinking, etc.), physical activities such as exercise, mental activities 
like participation in classes, and use of computers. Then, we ask a series 
of questions about their resilience -- how they adapt to the changes of 
aging -- and whether they feel that they have control over their lives. 
Finally, using rating scales, we ask them to rank factors like their level 
of function and quality of life.
We have found that a surprisingly large proportion of older adults surveyed 
report that they are aging successfully; our results also suggest that this 
perspective, this self-perception, is not related to type of physical 
illness or degree of disability. People can have diabetes, hypertension, 
arthritis, even cancer, heart disease, or stroke and still age 
successfully. The key seems to be for one's brain and mind to function at 
optimal levels.
Medscape: Can you speak more about resilience?
Dr. Jeste: To measure resilience, we use the Connor-Davidson Scale[1] which 
is designed to find out how people adapt to stress and to change. To some 
extent, changes are inevitable with aging -- loss of mobility from 
arthritis, for example, or problems with vision or hearing, financial 
stress from retirement, and loss of friends, family members, or even one's 
spouse.
In many cultures, there is a stigma associated with aging -- a sense of 
lack of value or lack of self-esteem, often related to the way the society 
views aging. In addition, healthcare costs go up. These particular stresses 
are, for the most part, universal; the question is how do people adapt to 
these stresses? That's where people differ. One person may be totally 
overwhelmed with a physical illness or loss of a near and dear one, while 
someone else is stressed out for a short time, but then recovers from the 
situation and adapts to the change in a positive way.
Medscape: What makes some people react in one way rather than another?
Dr. Jeste: That's a billion-dollar question! It seems that both genes and 
environment play an important role. Genes play an important role not only 
for longevity, but also for how well people live. There are genes that 
predispose to diseases and genes that predispose to healthy living, as well 
as genes for personality, coping strategies, and resilience.
At the same time, I think we are not necessarily slaves to our genes. Many 
people say that to live a long and healthy life, choose your parents 
wisely. That's not exactly true. Studies have shown that less than 50% of 
longevity is accounted for by genetic factors. Plus, environment and 
behavior have a significant impact on the expression of genes. For example, 
2 people may have similar genes, but one develops lung cancer because he 
smoked, while the other one does not.
Another interesting concept emerging from the literature is neuroplasticity 
of aging. There are some studies showing that the brain can continue to 
grow or develop even in old age. In other words, neuronal regeneration can 
occur, under certain circumstances, as we age. It has been shown in 
animals, for example, that a stimulating environment facilitates 
regeneration of neurons in our brains. Just that suggests that [a 
stimulating environment] might facilitate neuroplasticity of aging and, 
thereby, successful aging.
Medscape: Can you give a few examples of people who have aged successfully?
Dr. Jeste: Franklin Roosevelt was a great example of somebody with a 
physical disability -- in a wheelchair most of his life -- who was 
amazingly successful. Another example is the story of an 83-year-old man 
named Frank White, published in The Los Angeles Times earlier this year.[2] 
Until the age of 68, he was aging unsuccessfully. He had severe diabetes, 
hypertension, and arthritis. He was an alcohol abuser and a dependent 
person. It looked like his life was going downhill. At 68, he had a turning 
point and decided to change his lifestyle. He stopped drinking, and took to 
yoga. (This is not an ad for yoga, but yoga can be more than physical 
exercise.) Frank became so good at yoga that now he has become one of the 
most acclaimed yoga teachers in Hollywood, which is a feat, given the 
numbers of yoga teachers in Hollywood. He still has diabetes and 
hypertension, but they are under much better control. He is a prime example 
of how you can take control of your life and change it.
I don't mean to be simplistic, however. Not everybody can make such 
changes. Many people have serious physical illnesses over which they have 
no control and, in spite of the best treatment available, cannot do much. 
Again, I don't want these points to sound naive. The main message is that 
there are things within one's control, and certain changes can impact one's 
physical health, even though they don't determine one's physical health.
Medscape: Along these lines, can you talk about physical exercise and its 
impact on mood and successful aging? For instance, isn't there research 
suggesting walking on a regular basis instead of going to therapy or in 
addition to going to therapy is a great mood enhancer?
Dr. Jeste: There have been some great studies in mice and in dogs showing 
that exercise not only improves physical function but also brain function. 
In other words, it is not merely improvement in mood -- I mean, it's hard 
to assess a mood in mice, right? But their neuronal function improves.
There have been several well-controlled studies in people as well that show 
that physical exercise not only improves mood, but also improves cognitive 
function. There are studies showing that exercising during your 50s is 
associated with better functioning when in your 60s. Exercise need not be 
strenuous exercise; you don't have to climb mountains or anything like 
that. Just improving your level of physical activity on a consistent basis 
has a positive impact.
Medscape: Would you say, then, that physical activity is essential for 
successful aging.
Dr. Jeste: Physical activity is one key element for successful aging, but 
mental activity is essential as well. You must keep your mind active by 
reading, writing, attending classes, etc. Aging is often associated with 
retirement, but that should not mean retirement from learning new things. 
There is a certain myth that you can't teach an old dog new tricks. In 
fact, that's totally wrong. Even Freud said something along these lines 
that was wrong. He said that people over the age of 50 don't have the 
capacity to learn new things, suggesting that doing any kind of 
reconstructive therapy in old people is a waste of time. Of course, he was 
talking about classic psychoanalysis, which may be different, but old 
people can learn new things. Not only that, people who try to learn new 
things, actively engaging their minds in the process, are much more likely 
to age successfully than those who do not.
Medscape: Is there anything you would like to add?
Dr. Jeste: Well, in my opinion, successful aging should be considered a 
neuropsychiatric entity and, as such, of particular interest to mental 
health clinicians. To date, we have not been involved enough; I think that 
should change.
Also, the typical attitude toward aging is quite negative. When we read in 
the papers about the population growing older, there is a sense of gloom 
and doom about how much we are going to spend on healthcare and Social 
Security. As a culture, we need to look at the positive sides of aging; 
aging can be associated with continued productivity, learning of new 
things, and better contributions to the society. There are things that old 
people can do through their wisdom and experience that would not be 
possible for those who are younger.
Medscape: Thank you very much for sharing your insights and for ending on 
such an optimistic, positive note.
References
1.. Connor KM, Davidson JR. Development of a new resilience scale: the 
Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:76-82.
2.. Stein J. At 83, this yogi is bending the rules; Frank White likes to 
mix things up. And his classes are packed. Los Angeles Times. May 10, 2004.



Dilip Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences, 
University of California, San Diego; Director, Sam and Rose Stein Institute 
for Research on Aging (SIRA) at the University of California, San Diego

Disclosure: Elizabeth Saenger, PhD, has disclosed no relevant financial 
relationships.
Disclosure: Dilip Jeste, MD, has disclosed that he has served as an advisor 
or consultant to Janssen, Otsuka, Solvay-Wyeth, and Eli Lilly. Dr. Jeste 
has also disclosed that he has received grants for educational activities 
from Janssen.
NOTE: To view the article with Web enhancements, go to:
http://www.medscape.com/viewarticle/511194