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) ©2005 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
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