Transcript Successful Aging

What is successful ageing
and who should define it?
Bowling A & Dieppe P.
BMJ 2005;331:1548–51
Prof Y Barak, MD, MHA
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Decline and fall? Goya’s Les Vieilles “Time of the Old Women”
Prof Y Barak, MD, MHA
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The Controversy
 A forward looking policy for older age
would be a programme to promote
successful ageing from middle age
onwards, rather than simply aiming to
support elderly people with chronic
conditions.
 But what is successful ageing? And who
should define it?
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Method
 Included in analysis
were 170 papers
presenting reviews or
overviews of the topic,
data from cross
sectional and
longitudinal surveys,
and qualitative studies.
 Also included were lay
definitions elicited from
our own recent survey
of successful ageing.
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Lay views
There are a few investigations into older
people’s views of what is successful
ageing.
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UK Survey
 A national, random population survey of
perceptions of successful ageing among 854
people aged 50 or more, living at home in
Britain.
 Part of an Office for National Statistics
omnibus survey.
 Of these people, 75% (631) rated themselves
as ageing successfully “Very well” or “Well”
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Lay Definitions
 The most commonly mentioned
definition of successful ageing, in
response to open ended questioning,
was having good health and functioning.
 These were rarely mentioned in
isolation, and most people mentioned
more than one definition
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Additional lay definitions
Accomplishments
Enjoyment of diet
Financial security
Neighbourhood
Physical appearance
Productivity and contribution to life
Sense of humour
Sense of purpose
Spirituality
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Policy implications:
lay opinions
 With greater recognition that older people are
not a homogeneous group, health
professionals need more balanced,
interdisciplinary perspectives of older age.
 Clinicians need to be aware of their patients’
values and expectations of ageing in order to
enhance mutual understanding of their health
goals and priorities, and to consider
interventions that will optimize their chances
of “ageing successfully” in their terms.
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Successful Aging
Vaillant & Mukamal, Am J Psychiatry,
June 2001.
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Epidemiology
 In 1990 there were 4
million Americans
age 85 and older
 In 2040 there will be
X10 that many
 The increase is
mainly due to more
people living to age
65
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Conceptualizing Aging
 Aging can be seen from 3 dimensions
 Decline
 Change
 Development
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Decline
 By age 70 we
identify only 50% of
the smells
 Night vision
declines…by age 80
few can drive at
night
 By age 90 50% can
not use public
transportation
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Change
 Hair, waistline,
skin…change
 Making love shifts from
3/week to 2/month
 Our ability to love and
be loved does not
diminish
 Our capacity for joy is
undiminished
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Development
 At 70 we are more
 Patient
 Accepting of affect in
ourselves
 Likely to tolerate
paradox
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The Berlin Aging Study
Baltes & Mayer, 1999.
The MacArthur Study of Aging
Rowe & Kahn, 1999.
 The 2 most important
predictors of successful
aging were:


High level of education
Extended family network
“Our greater longevity is
resulting in LESS, not
more, years of
disability.”
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A Prospective Study of Successful Aging:
The Study of Adult Development
Vaillant & Mukamal, 2001
 Until now we have NOT known how to predict
successful aging
 All large-scale prospective studies were
flowed by “selective mortality” : by beginning
in late life these studies failed to include
those who died before age 60 or 70
 The Study of Adult Development (SAD)
provides a way around some of these
difficulties
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The Study of Adult Development
Background
 The SAD was initiated in
Harvard
 Two socially diverse cohorts
of adolescents (college vs.
core-city) were followed until
they became greatgrandfathers
 Birth cohort was limited to
the period 1918-1932
 Gender (male), Nationality
(USA) and Skin Color (white)
were held constant
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The Study of Adult Development
Definitions & Domains
 Six domains of function were
chosen to classify old-age
along a continuum from
”happy-well” to “sad-sick”
 Individuals who did well in all
6 areas until age 80 were
classified as “happy-well”
 Those who were both
psycho-socially unhappy and
physically disabled were
“sad-sick”
 Those who fell in between
were classified as
intermediate
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The Study of Adult Development
Outcome Domains
 Physician assessed
 Objective mental health
objective physical health and
absence of irreversible
physical disability
 Subjective physical health
(instrumental tasks of daily
living)
 Length of active life (No. of
years before age 80 without
objective/subjective physical
disability)
(evidence of
competence in 4
domains: work,
relationship, play and
NO psychiatric
care/medication)
 Subjective life
satisfaction
 Social support
(objective evidence of
friends)
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The Study of Adult Development
Subjects
 College cohort:

268 subjects
 Harvard sophomores
 Selected for physical and
mental health
 Core-city cohort:

456 subjects
 Nondelinquent
 Mean IQ 95
 Mean education 10 years
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The Study of Adult Development
Independent Predictor Variables
 Smoking (pack years)
 Maturity of defenses (at age
 Alcohol




abuse/dependence
(DSM-III)
BMI (at age 50)
Years of education
(core-city only)
Regular exercise (500
kCal/week)
Stable marriage






47; DSM-IV Defensive
Functioning Scale)
Depression (before age 50)
Parental social class
Warmth of childhood
Ancestral longevity (mean
mother’s and father’s age at
death)
Stable childhood
temperament (parental
report)
Objective disability (at age
50)
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The Study of Adult Development
Results (1)
Quality of Aging
 College (237)
 Core-city (332)

Happy-well=26%(62){>80}
 Intermediate=32%(75){77.6}
 Sad-sick=17%(40){71.4}
 Prematurely
dead=25%(60){62.3}
 Note: ( )=N, { }=age at
death/disability

Happy-well=29%(95){>70}
 Intermediate=34%(114){65.6}
 Sad-sick=14%(48){62.3}
 Prematurely
dead=23%(75){55.0}
 Note: ( )=N, { }=age at
death/disability
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The Study of Adult Development
Results (2)
Rates of permanent Disability or Death after age 50
College
 Disability and
Core-city
CoreCollege
%
death for the 2
groups increased
over time
 The slopes in the
graph are similar
 College-men
reached every
stage 10 years
LATER than the
core-city cohort
AGE
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The Study of Adult Development
Results (3)
Correlation of Predictor variables (before age 50) with 5 aging Outcomes
 Controllable variables:


Smoking
Alcohol
Exercise
BMI
Stable marriage

Maturity of defenses



 Uncontrollable variables:






Depression
Parental social class
Warmth of childhood
Ancestral longevity
Childhood temperament
Objective disability at age 50
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The Study of Adult Development
Results (4)
Correlation of Predictor variables (before age 50) with 5 aging Outcomes
For both college and corecity men absence of
alcohol and cigarette
abuse (less than 30
pack-years) before age
50 were the most
IMPORTANT protective
factors for successful
aging
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The Study of Adult Development
Results (5)
Correlation of Predictor variables (before age 50) with 5 aging Outcomes
 Exercise and education are
indirect measures of selfcare and perseverance
 Both appeared to be
important predictors of
multiple domains of
successful aging
 Preseverance (tested by the
5 mts treadmill test) at age
19 predicts 61% happy-well
vs. 13% of the sad-sick
(NOT explained by physical
fitness) p=0.005
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The Study of Adult Development
Results (6)
Multivariate model
 Each of the 6 factors over which an individual has some control
predicted successful aging when other factors were statistically
controlled
 The importance of alcohol abuse (core-city) and smoking
(college) were masked by colinearity
 Uncontrollable factors
 NOT significant:
 Parental social class
 Unhappy childhood
 Ancestral longevity

Significant:

Depressive disorder before 50
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The Study of Adult Development
MESSAGE
 The 7 protective factors that
distinguish happy-well from
sad-sick are under some
personal control
 We have considerable
control over our weight,
exercise, education, smoking
& alcohol abuse
 Hard work/therapy can
modify our coping styles &
relationship with spouse.
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The Future
Successful oldage may lie
not so much
in our stars
and genes as
in ourselves
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Joseph S. Alpert, MD
“12 Guides to Health,
Happiness, and Longevity”
The American Journal of Medicine, Vol 121, No 7, July
2008
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Guide #1:
Try to be born into a family with a
history of longevity.
There is no replacement for good genes.
This is the single factor that one cannot
influence with a change in
lifestyle or attitude.
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Guide #2:
Never smoke!
If you are unlucky enough to
be a current smoker, quit the moment you
finish hearing this
lecture.
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Guide #6:
Don’t get fat.
It is okay to be a few kilograms
(and only a few) over your ideal weight.
If you are 5 kilograms or more over your
ideal body weight, start
a program of dieting and exercise.
Consult
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Guide #9:
Cultivate family and friends.
Enjoy conversation,
dining, and recreation with people whom
you like (for example, your spouse).
Spend as little time as possible with
folks you don’t like or who make you
uncomfortable.
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Guide #11:
Be informed,
but try not to be overwhelmed
by current events as portrayed by the
popular media.
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Thank you for your attention !!!
Prof Y Barak, MD, MHA
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