The Silver Lining in the Graying of The United States:
Healthy Aging Is the New Norm
By Gary J. Kennedy, MD and Laura Gardner, MD; psychiatrictimes.com; October 09, 2013
The forecasted pandemic of disability from the escalating amount of adults living to advanced age has not materialized. Nonetheless, there remains a negative connotation to growing old. Ageist stereotypes remain, conjuring images of frailty and depression, rather than strength and optimism. Elevated public recognition of Alzheimer disease, while required to advance services and development, may also have led to the misapprehension that if one lives long enough, dementia is inescapable. An unfortunate corollary is that vitality in old age is rare and the consequence of genes, chance, or privilege. Cost containment has become a frequent policy solution. In contrast, scientific conclusions from thirty years of exploration indicate that healthy aging, rather than senile infirmity, is the new norm.
Golden years or dependency?
In 1980, James Fries was among the first to counter the thought that more individuals living longer meant pervasive dependency. He found that population survival curves were changing so that a greater number of people were passing away at a very advanced age—in effect compressing morbidity into the conclusion of life. An even larger number of Americans were remaining independent until the last years before demise, creating a proportionately greater compression of disability.
The findings were initially controversial, with the nature of the test and the definition of disability brought into question. Even so, making use of numerous measures of disability connected to death records from the 1991 to 2009 Medicare Current Beneficiary Survey data, Cutler and colleagues found disabled life expectancy had fallen by 0. 9 years and disability-free life expectancy had grown by 1. 6 years. The effect was observed among men and women, whites and non-whites. Curiously, rates of illness continued to be comparatively constant, raising the questions of how we are to define healthful aging and how to explain it.
Obviously, old age is linked with inevitable decline in cardiac output, creatinine clearance, muscle mass, response time, and cognitive speed. Nonetheless, decline that is not the consequence of disease, injuries, or disuse is not substantially disabling and, in some instances, can be mitigated by psychological and bodily exercising and interpersonal activity. How is this preservation of functionality in spite of illness and decline obtained? The answer is in the acknowledgement that growing older is not only a biomedical fact but also a psychosocial construct.
At age 75, Henry Tchaikovsky, the concert pianist, still performs worldwide. People love him and are amazed at the emotive, nuanced quality of his performances. When asked how he does it, he tells us that as he gets older, his system for performing changes. He practices daily to retain the endurance needed for a live concert, but he no longer performs some of his favorites from the repertoire due to the fact they are too physically challenging. However, he understands his audiences well and performs their favorites instead. Slower pieces usually precede those that demand a more rapid meter. The effects give the sense of undiminished artistry, but the effect is achieved by assortment of repertoire and compensation for age-related alterations in reaction time and speed of coordination. This solution allows him to continue being a popular success despite his advancing age.
In 1987, Rowe and Kahn argued that productive aging as opposed with standard aging is not simply freedom from disease but instead a combination of lack of chronic disease, preservation of bodily and cognitive functionality, and engagement in social and productive pursuits. In terms of the sociology of growing older, old age is associated with a shrinking social network as friends and family move away or pass away. But most elderly adults react by investing greater vitality in the members of the network that remain. As a result, very few older adults, even those who live alone, identify themselves as lonesome.
It is satisfaction with one’s social supports, not frequency of contact or network dimension that forecast freedom from depression. And with the increasing quantity of productive older adults making new associates, new companions in old age are more common than ever. In spite of changes in the sexual response routine, older adults with companions are intimate into very late life. Senior Americans are also better informed and more financially secure than preceding generations. Better schooling is linked not only with economic security but also with elevated cognitive reserves, which are believed to forestall the emergence of dementia.
What new information does this specific article present?
The forecast “Senior Tsunami” of disabled elders has been supplanted by data from many years of studies showing both a reduction in the number of disabled years older adults are likely to encounter and an extension of the active, disability-free life span they can anticipate.
What are the ramifications for psychiatric practice?
Psychiatrists will encounter an increasing amount of elderly Americans seeking to make the most of their remaining years. This will change the standard practitioner’s bias from minimizing the risk of an intervention to maximizing prospective benefits. Or stated in another way, start low, go slow, but treat to target.
A similar procedure arises with the psychology of growing older. As a result of either experience or stage of life viewpoint, older individuals are more emotionally resistant and less prone to crippling responses when stressed. Psychological resilience has been characterized as successful adaptation to hardship, “bouncing back” after trauma or impairment. It encompasses personal competences across intellectual, psychological, and interpersonal domains, including expectations, effective coping, interpersonal skills, and self-efficacy.
Resilience is a dynamic trait that may change according to conditions across the life span. It is the opposite of vulnerability. Older adults seem to be more resistant than younger adults, particularly with respect to emotional regulation and problem resolving. In the aftermath of the 9/11 tragedy, the incidence of PTSD was lower in older New Yorkers, which suggests that they possessed greater resilience than their younger counterparts.
As one factor that may underpin resilience, the theory of socioemotional selectivity challenged earlier concepts that presumed the psychological state would follow the same downward trajectory as biological age. This life-span principle of motivation posits that as time horizons get smaller with age, individuals become more and more discerning, investing greater assets in emotionally meaningful goals/activities that then influence cognitive processing. This shift in investment of attentional assets results in comparative inclination for beneficial over unfavorable data, dubbed the “positivity effect.”
As folks age, regulating sentiment becomes more crucial than various other objectives that may have taken priority earlier in life. Life satisfaction and affective well-being appear to stabilize or even increase during growing older, in all likelihood as a result of this elevated emotional steadiness and its effect on resilience. Subsequently, elderly adults tend to recognize their limitations and become more discerning in their pursuits, compensating for weaknesses and optimizing advantages.
Neuropsychological alterations also take place throughout aging, described by the Scaffolding Theory of Aging and Cognition, in which intellectual functions are guarded by both structural and functional brain changes. Processes such as vocabulary that are highly lateralized in youth become redistributed bilaterally. Frontal cerebral areas take on more of the workload. These compensatory modifications serve to maintain functionality by rerouting cognitive operations as overloaded neural circuits begin to fray. This process is assisted by neurogenesis, the migration of neural stem cells into the hippocampus to become functional neurons effectively re-scaffolding the hippocampus as more mature neurons age and die.
Long-term, consolidated memory, both semantic and procedural, is distributed across the cortex, but it is in the hippocampus where learning occurs and new details is prepared for consolidation. The cortex has substantial storage capacity, while the hippocampus, because it is responsible for processing, has restricted volume. It can be overloaded by extreme demands, such as multitasking. And, it can fail to function properly if neurogenesis is degraded by depression or Alzheimer disease. Antidepressants recover hippocampal neurogenesis when it is reduced by a depressive disorder. Physical exercise promotes neurogenesis through the elevated expression of brain-derived neurotrophic factor.
Elderly adults can make up for loss of intellectual speed by improved pattern recognition based on knowledge or practical experience. Recent studies indicate that computer-based routines can repair age-relevant decrements in reaction time and response accuracy. Challenging cerebral activities also help sustain the quality of cognitive processes in late life. This is evidenced by seasoned taxi drivers in London, where the streets are notoriously disarrayed. These taxi drivers have larger than anticipated hippocampal volumes. If the brain is like a computer system in which education and adaptation can upgrade the software program and rerouting the scaffolding of neural circuits maintains the hardware, then the brain is also like a muscle that requires physical exercise to sustain good condition.
Attaining healthy aging
Keeping in mind that the psychosocial constructs are as significant as the biomedical sets the stage for suggestions regarding how to attain healthy aging. To realize a healthy old age, one needs to start young, but middle age and above is not too late. Keep a heart-healthy lifestyle with ideal body weight maintained by diet and daily exercising. Stay socially engaged for the positive reinforcement of satisfying relationships. Stay intellectually stimulated by finding an activity that is both enjoyable and challenging. Activities shared with a group or partner may be more easily maintained than those that are solitary.
Two self-help publications supply guidance without touting financial interests or products. Reaching past what it means to remain physically and psychologically well, Wining Strategies for Successful Aging covers the range of topics from financial security to sexual health to altruism. The SharpBrains Guide to Brain Fitness: How to Optimize Brain Health and Performance at Any Age reviews expert opinion as well as scientific research that indicates mental exercise is as important for the human brain as actual physical exercise is for the heart. The two publications suggest that the training regimen must be individualized and that the social dimension cannot be overlooked.
The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013-2018 is a joint effort by the Alzheimer’s Association and the Centers for Disease Control and Prevention. It advances the healthy aging goal outside of individual accountability to entail health policy. The Healthy Brain Initiative is timely because there is no guarantee that the compression of disability that followed the advent of Medicare and Medicaid will continue. We will need policy that promotes a secure, age-friendly environment and offers easily obtainable opportunities for exercise and social connections for both kids and adults. The intergroup contact theory applied intergenerationally indicates that if the young and old have the opportunity to more openly communicate, they will gain a new appreciation and comprehension of each other’s way of living. The living history and wisdom that older adults possess coupled with the mastery of information technology by young people could be a solid combination to enhance healthy behavior.
Preparing young people for a healthy old age is then an obvious goal to prevent the onset of both disease and disability. First, public policy should support interventions to promote educational attainment and physical activity and to stop cigarette smoking, obesity, and diabetes. Also essential are interventions to reduce unintentional deaths and injuries as a result of lapses in vehicular, firearm, and athletic safety. Second, interventions to stop smoking; slim down; and manage blood pressure, diabetes, and hypercholesterolemia are needed. Third, we should have interventions to reverse what would otherwise be progressive disability and premature mortality. These include joint replacements, heart valve repairs, pacemakers, and implantable defibrillators. Fourth, long-term–care management to preserve the wellbeing of family caregivers of persons with dementia and other prolonged, disabling conditions is essential. Finally, because mental disorders challenge both preventive and restorative interventions, collaborative models of mental health care are integral to healthy aging guidelines.
The healthy aging sensation is legitimate, and the technology conveying it is well organized. However, further compression of disability will likely require public demand for broader health guidelines that incorporate biomedical and psychosocial approaches. This will require the abandonment of ageist perspectives that view old age as both undesirable and unaffordable.