AGELESS: A Prescription for Successful Aging

AGELESS: A Prescription for Successful Aging
0261463-00001-00 Ed. 05/2014 Exp. 11/08/2015
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AGELESS:
A Prescription For Successful Aging
BOB POKORSKI, MD
Vice President & Medical Director, Individual Life Insurance
The traditional view is that most people are able to
maintain good health until old age, which is
currently defined as beginning at age 65, at which
time they experience a series of medical problems
that lead to progressive disability late in life. New
medical research is challenging this belief by
highlighting the remarkable variability in health at
older ages. While serious illness is more frequent
at older ages, a surprisingly large proportion of
people reach advanced age with few or no
medical problems or disabilities.
Figure 1 shows the likelihood of serious illness in
older Americans.1 Half (50%) of 65- to 69-yearolds have not been diagnosed with any of the top
five chronic diseases. Serious conditions are more
common at ages 75 to 79, but many people remain
in excellent health even at the oldest ages. At ages 85
and older, about one-in-three (32%) people still have
not been diagnosed with any of the top five chronic
diseases.
FIGURE 1
PROPORTION OF OLDER PEOPLE WHO HAVE
NOT BEEN DIAGNOSED WITH ANY OF THE
TOP FIVE CHRONIC DISEASES
50%
Age
65-69
75-79
85+
60%
40%
20%
0%
65-69
38%
32%
75-79
32%
85+
FIGURE 2
PROPORTION OF OLDER PEOPLE WHO HAVE NO
FUNCTIONAL LIMITATIONS OR WHO HAVE
SUCCESSFULLY ADAPTED TO A DISABILITY
80%
67%
Age
65-69
75-79
85-89
90+
60%
40%
20%
57%
Proportion
67%
57% 32%
32%
19%
19%
0%
65-69
75-79
85-89
90+
AGE
Successful adaptation means independent living via
assistive devices such as canes, walkers, wheelchairs,
scooters, grab bars, bath or shower seats, and raised
toilet seats.
Proportion
38%
50%
A national survey of Medicare beneficiaries also found
remarkable variation in health at older ages (Figure 2).2
At ages 65 to 69, two-in-three (67%) people had no
functional limitations or had successfully adapted to
a disability. Functional limitations were more common
with advancing age, but many people were able to
avoid disability or adapt regardless of their age. About
one-in-three (32%) 85- to 89-year-olds and one-in-five
(19%) people ages 90 and older had no functional
limitations or had successfully adapted to a disability.
AGE
Chronic diseases include heart disease, cancer,
stroke, lung disease, and diabetes.
Lowsky DJ, et al. Heterogeneity in healthy aging. J Gerontol A Biol Sci Med Sci. November 17, 2013. doi:10.1093/gerona/glt162.
Freedman VA, et al. Behavioral adaptation and late-life disability. American Journal of Public Health 2014;104:e88-e94.
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How are some individuals able to reach old
age without experiencing a serious illness or
significant disability?
There is no single answer.
Health and wellness reflect numerous influences over a lifetime, including genetic predispositions,
environmental factors, socioeconomic conditions, education, medical care, lifestyle factors such as
diet, exercise, and smoking, and an element of luck. But it’s clear we don’t need to rely on futuristic
visions of medical care based on nanotechnology, genetic manipulation, immune system boosters,
and miracle drugs. We can benefit from existing strategies that are helping people live longer and
healthier lives. This approach is called AgeLess, a prescription for successful aging based on positive
steps we can take today to increase our chances for a longer and healthier life.
START HERE J
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You’re only as old as you feel.
− Anonymous
ATTITUDE
One of the most commonly cited definitions
of successful aging was proposed in 1997 as
the “avoidance of disease and disability, the
maintenance of high physical and cognitive function,
and sustained engagement in social and productive
activities.”3 While this is an appealing notion — that
we can avoid all illnesses by concerted attention to
diet, exercise, and other lifestyle factors — the reality
is much different. Most of us eventually experience
health problems and physical limitations despite our
best efforts.
So what is the key to successful aging? It’s all about
attitude: being optimistic, living life to the fullest,
developing one’s full potential, and meeting older age
head on — on your terms. It also means accepting
whatever comes later in life.
ADAPTING TO THE REALITIES OF AGING
Adapting to the realities of aging was the subject of
a study that explored how people deal with disability
late in life. Researchers interviewed a multicultural
group (average age, 78 years) consisting of
“56 African American, White, Cantonese-speaking
Chinese, and Spanish-speaking Latino disabled
elders who participated in On Lok Lifeways, a
program of all-inclusive care for the elderly” in San
Francisco, California.4 They found that many people
were aging well even though they didn’t meet the
conventional definition of successful aging.
How did they do it? By using two different strategies:
(1) acknowledging the new reality, or (2) rejecting the
new reality.
ACKNOWLEDGING THE NEW REALITY
»» Acknowledging and adapting to aging. Aging
is unavoidable and disability at older age is a
natural part of life.
»» Accepting help. There are things we can’t do for
ourselves at older age. We need to ask others for
help.
»» Shifting priorities. The focus is shifted away from
disability, something that is “unsuccessful,” to
other aspects of aging, such as financial success
and providing a better life for one’s children.
DENYING THE NEW REALITY
»» Backgrounding aging and disability. These
individuals age successfully by minimizing their
disability, i.e., by putting it in the background so
they don’t think about it.
»» The unreconciled self. Not everyone in the study
aged successfully. Some people couldn’t adapt
or reconcile themselves to the limitations of age.
Rowe JW, et al. Successful aging. Gerontologist 1997;37:433-40.
Romo RD, et al. Perceptions of successful aging among diverse elders with late-life disability. The Gerontologist 2013;53:939-49.
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A POSITIVE ATTITUDE MAY REDUCE FUTURE DISABILITY
A positive attitude helps us adapt to the realities of aging
today, but it can also reduce our chances of being disabled in
the future. Researchers in England followed more than 3,000
men and women age 60 and older to determine if enjoyment
of life predicted a lower risk of functional impairment.5
Enjoyment of life was rated as High, Medium, and Low
according to the answers to these four questions:
• I enjoy the things that I do.
• I enjoy being in the company of others.
• On balance, I look back on my life with a sense of happiness.
• I feel full of energy these days.
Over the next eight years, impairment of two or more activities
of daily living occurred in only one-in-twenty-five (4%) people
who scored High on the four questions, compared to one-ineight (12%) who scored Medium, and one-in-six (17%) with
a Low score (Figure 3).
FIGURE 3
PROPORTION OF PEOPLE WHO DEVELOPED AN
IMPAIRMENT OF TWO OR MORE ACTIVITIES OF
DAILY LIVING
20%
Activities of daily living
High
15%
12%
Medium
10%
Low
4%
17%
Proportion
4%
12%
17%
5%
0%
High
Medium
Walking speed was also faster in people
who scored High on the questionnaire.
Some results in the study were based on
economic factors, baseline health status,
and lifestyle. But half of the differences
were unexplained by traditional risk factors
and the authors suggested that a positive
outlook was a significant contributor to a
healthier and more active life.
THE POWER OF POSITIVE THINKING
If attitude is such an important contributor
to successful aging, is there anything
we can do to boost our outlook on life?
Emerging evidence suggests there might
be. It’s done by harnessing the power of
positive thinking.
Subjective age refers to how young
or old we feel compared to our actual
(chronological) age. The image we have of
ourselves, as being relatively young or old
compared to our peers, can sometimes
rival or even outperform chronological
age as a predictor of mental and physical
health.6 A small French study was able to
experimentally induce a younger subjective
age in older people (average age, 74).6
Subjects in the study were tested for
handgrip strength, a widely used surrogate
measurement of mortality, disability,
and other health-related complications.
Half the participants were given positive
feedback by telling them they were
stronger than 80% of people their age.
Low
ENJOYMENT OF LIFE SCORE
Activities of daily living included bathing, dressing,
eating, toileting, transferring, and walking.
Steptoe A, et al. Enjoyment of life and declining physical function at older ages. Canadian Medical Association Journal
2014. DOI:10.1503/cmaj.131155.
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Stephan Y, et al. Feeling younger, being stronger: An experimental study of subjective age and physical functioning
among older adults. Journals of Gerontology, Series B. 2013;68:1-7.
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The other half received no feedback. Handgrip strength was then retested in both groups. Participants
who were told they were stronger than most people their age showed a significant increase in grip
strength, whereas no changes were seen in the other group. In other words, people who believed they
were younger often had the potential to act younger.
The power of positive thinking as a way to enhance successful aging was further strengthened by
a Yale study funded by the National Institutes of Health.7 Subjects with an average age of 79 were
asked a series of questions to determine if they had a positive or negative stereotype of older people.
Responses ranged from most negative (decrepit) to most positive (spry). Over the next ten years, some
people experienced at least one month of disability, defined as needing help with bathing, dressing,
transferring, or walking. The question asked by researchers was, “Does age stereotype affect the
likelihood of recovery from serious disability?” The answer was an unequivocal “Yes!” Older subjects
with positive age stereotypes were 44% more likely to fully recover compared to those with negative age
stereotypes. The likely explanation is that people who believe they can recover from illness and disability
devote more time and effort to rehabilitation programs and other healthy behaviors that speed recovery.
What can I do?
»» Learn from the best. Talk with friends and relatives
who have aged successfully. How did they do it?
What is their philosophy of life?
»» Redefine success. A recent study reported that the
top four ways we define our own success were
(1) “good health,” (2) “finding time for the
important things in life,” (3) “having a good
marriage or relationship,” and (4) “knowing
how to spend money well.”8 “Having a lot of
money” didn’t even make the top ten.
»» Reduce stress. Chronic stress can overwhelm
our ability to care for ourselves and our family.
Reduce stress with healthy eating, regular exercise,
adequate sleep, avoiding alcohol and drugs, and
getting professional help if you’re not improving.
»» Look inside yourself. Meditation can help realign
one’s perspective on the changing realities of
life. Books, online tutorials, and community
college courses teach beginners how to focus on
the present and achieve a sense of tranquility
regardless of life’s circumstances.
Levy BR, et al. Association between positive age stereotypes and recovery from disability in older persons.
JAMA 2012;308:1972-3.
8
The LifeTwist Study. An independent report commissioned by American Express. The Futures Company.
May 13, 2013, p.6.
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The greatest wealth is health.
− Virgil
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GOOD MEDICAL
CARE
In an ideal world, the main purpose of health care would be to prevent illness, literally, care that
keeps us healthy. But the bulk of health care today — medications, surgery, tests, and visits to
health care providers — is to fix problems that have already developed.
Heart disease and cancer are responsible for almost half (49%) of deaths at ages 65 and older,
and two-in-three deaths (67%) are due to just five conditions: heart disease, cancer, chronic lower
respiratory disease, cerebrovascular disease, and Alzheimer’s disease (Figure 4).10 Imagine the
peace of mind you’d have if there was one guideline that could help prevent or delay all of these
conditions. “Health care” would be mainly routine checkups to be sure everything was still going
well.
Such a guideline exists: Life’s Simple 7™.11 Developed by the American Heart Association, Life’s
Simple 7™ was created to define ideal cardiovascular health and thereby reduce the likelihood of
cardiovascular diseases and stroke. Only later was it discovered that these same recommendations
can help prevent or delay cancer, chronic lower respiratory diseases, and Alzheimer’s disease.
FIGURE 4
PROPORTION OF DEATHS DUE TO THE TOP FIVE CAUSES OF DEATH AT
AGES 65 AND OLDER IN THE UNITED STATES
30%
27%
Causes of death
22%
Heart disease
Cancer
Chronic lower respiratory
diseases
Cerebrovascular diseases
7%
Alzheimer’s
25%
20%
15%
10%
Proportion
27%
22%
7%
6%
5%
6%
5%
Cerebrovascular
diseases
Alzheimer’s
disease
5%
0%
Cancer
Chronic lower
respiratory diseases
Virgil. Quote Garden. http://www.quotegarden.com/health.html (Accessed February 10, 2014).
Heron M. Deaths: Leading causes for 2010. National vital statistics reports. Vol.62, No.6, Table 1. National Center for
Health Statistics. December 20, 2013.
11 The Simple 7. American Heart Association. http://mylifecheck.heart.org/Multitab.aspx?NavID=12&CultureCode=en-US
(Accessed February 10, 2014).
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Heart disease
The components of Life’s Simple 7™ include:12
11.
Get active. At least 150 minutes of
moderate physical activity each week.
22.
Control cholesterol. Keep your
cholesterol below 200 mg/dL.
33.
Eat better. More fruits and vegetables,
unrefined fiber-rich whole-grain foods,
and fish, and less saturated and trans
fats, cholesterol, and added sugars.
4. Manage blood pressure. Keep your
blood pressure in the normal range,
which means less than 120 mm Hg
systolic and less than 80 mm Hg
diastolic, or less than 120/80.
4
55.
Lose weight. If you are overweight
or obese, losing as few as five or
ten pounds can help reduce blood
pressure, cholesterol, and blood sugar.
66.
Reduce blood sugar. A fasting blood
sugar of 100 mg/dL or higher could
indicate diabetes or pre-diabetes.
Controlling blood sugar decreases the
risk of heart disease and stroke.
7. Stop smoking. If you smoke, quitting
is the best thing you can do for your
health.
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HEART DISEASE AND STROKE
A large study of the U.S. population confirmed the value of
Life’s Simple 7™. Researchers compared outcomes in people
according to how many of the seven favorable risk factors in
the guideline were present. Survival rates during the 15-year
study were 51% higher in people with six or seven favorable
factors compared to those with zero or one favorable risk
factor. Attaining four favorable factors increased survival by
37%, and having even two favorable risk factors increased
survival by 19%.12
CANCER
Life’s Simple 7™ can also reduce the likelihood of developing
cancer. Research supported by the National Heart, Lung, and
Blood Institute found that people with six or seven favorable
risk factors lowered their risk of cancer by 51% compared
to those with zero factors. Four favorable factors reduced
cancer risk by 33%, and having even two favorable risk factors
reduced risk by 21%.13 Four risk factors were responsible for
most of the reduction in cancer rates: not smoking, physical
activity, ideal body weight, and a healthy diet. Of these, “not
smoking” was the most important, but people who satisfied
five or six of the remaining goals still experienced a 25% lower
risk of cancer.13
ALZHEIMER’S DISEASE
Many factors that increase the risk of cardiovascular disease
are also associated with a higher likelihood of Alzheimer’s
disease, including lack of physical activity, unhealthy diet,
obesity, diabetes, high cholesterol, hypertension, and
smoking.14 The National Institute on Aging suggests that
controlling such risk factors can help reduce the risk of
Alzheimer’s disease as well as cognitive decline.15
Yang Q, et al. Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults.
JAMA 2012;307:1273-83.
13 Rasmussen-Torvik LJ, et al. Ideal cardiovascular health is inversely associated with incident cancer. Circulation 2013;127:1270-5.
14 2013 Alzheimer’s Disease Facts and Figures. Alzheimer’s Association 2013, p.12.
15 Alzheimer’s Disease Fact Sheet. http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet (Accessed
February 10, 2014).
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CHRONIC LOWER RESPIRATORY DISEASES
Most chronic lower respiratory diseases are caused
by chronic obstructive pulmonary disease (COPD),
“a group of conditions that cause airflow blockage
and breathing-related problems.16 COPD includes
emphysema, chronic bronchitis, and in some cases
asthma.” Since smoking is the main cause of COPD,
the value of Life’s Simple 7™ lies mainly with the
recommendation to stop smoking.17
And mortality rates for stroke, the third leading
cause of death, have been declining since 1960.18
Yet more needs to be done. Greater emphasis on the
components of Life’s Simple 7™ might prevent or
further delay the onset of these conditions. Figure 5
shows the proportion of American adults with favorable risk factors. Only about one-in-four (26%) of us
have three favorable risk factors, one-in-five (22%)
have four, and one-in-six (17%) have six.12 Even
small changes — adding more fruits and vegetables
to our diet, a walk after dinner, and losing as few as
five or ten pounds — might make a difference.
PROGRESS, BUT WE NEED TO DO MORE
Mortality rates for heart disease, the leading cause
of death, have declined since 1980. Death rates for
cancer, the second leading cause of death, have
shown a gradual downward trend since 1993.
FIGURE 5
PROPORTION OF AMERICAN ADULTS WITH FAVORABLE CARDIOVASCULAR RISK FACTORS
30%
25%
20%
15%
10%
5%
0%
1%
0
Number of favorable risk factors
26%
0
22%
1
2
18%
3
4
5
7%
6
7
1
2
3
4
Proportion
1%
7%
18%
17%
26%
22%
17%
8%
8%
1%
5
Favorable risk factors
include not smoking;
being physically
active; having normal
blood pressure, blood
glucose, and total
cholesterol levels;
normal weight; and
eating a healthy diet.
1%
6
7
NUMBER OF FAVORABLE RISK FACTORS
What can I do?
Government websites address the
many aspects of good medical care.19,20
General recommendations include:
»» Regular medical examinations.
»» Screening tests to detect cancer, high blood pressure,
high cholesterol, diabetes, and hepatitis.
»» Vaccines recommended by your health care provider.
»» Control of cardiovascular risk factors.
Chronic Obstructive Pulmonary Disease (COPD). Centers for Disease Control. http://www.cdc.gov/copd/ (Accessed February 10,
2014).
17 Smoking. American Lung Association. http://www.lung.org/stop-smoking/about-smoking/health-effects/smoking.html (Accessed
February 10, 2014).
18 Murphy SL, et al. Deaths: Final data for 2010. National vital statistics reports; Vol. 61, No.4. National Center for Health Statistics.
2013, p.8,10.
19 Healthfinder.gov. http://www.healthfinder.gov/ (Accessed February 10, 2014) (Accessed February 10, 2014).
20 HealthyPeople.gov. http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx (Accessed February 10, 2014).
(Accessed February 10, 2014).
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Physical fitness is not only one of
the most important keys to a healthy
body, it is the basis of dynamic and
creative intellectual activity.
− John F. Kennedy
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EXERCISE
Cardiorespiratory fitness — the ability of the heart, lungs, and muscles to supply oxygen during
sustained physical activity — may be the strongest predictor for cardiovascular disease and total
mortality.22 And the good news is you don’t need to be an Olympic athlete to reap the benefits
of exercise. A large study sponsored by National Institutes of Health found that leisure time
physical activity added years to life expectancy after age 40 (Figure 6).23 A physical activity level
approximately comparable to brisk waking for up to 75 minutes per week was associated with a
gain of almost two (1.8) years in life expectancy, compared to people with no leisure time physical
activity. Life expectancy increased even more with higher levels of activity, with a gain of four-anda-half years in people who walked briskly for 450 minutes (7.5 hours) or more each week.
FIGURE 6
YEARS OF LIFE GAINED AFTER AGE 40 ACCORDING TO MINUTES OF
LEISURE
TIME PHYSICAL
ACTIVITY
Minutes
of brisk walking
each week Years of Life Gained
5
4
3
0
1-74
75-149
150-299
300-449
450+
2.5
0
1.8
2.5
3.4
3.4
4.2
4.5
4.2
4.5
1.8
2
1
0
1-74
75-149
150-299
300-449
450+
MINUTES OF BRISK WALKING EACH WEEK
John F. Kennedy, The Soft American, Sports Illustrated, Dec. 26, 1960.
Kaminsky LA, et al. The importance of cardiorespiratory fitness in the United States. A policy statement from the American
Heart Association. Circulation 2013;127:652-62.
23 Moore SC, et al. Leisure time physical activity of moderate to vigorous intensity and mortality. PLOS Medicine. November 2012,
Vol.9, No.11, e1001335.
21 22 11
Increased life expectancy and cardiorespiratory
fitness aren’t the only benefits of regular exercise.
According to the U.S. Department of Health and
Human Services, there is strong evidence that
adults and older adults who exercise regularly have
a lower risk of coronary heart disease, stroke, high
blood pressure, high cholesterol, type 2 diabetes,
metabolic syndrome, breast and colon cancer,
falls, and depression. And exercise often helps
even if you’ve already developed health problems,
such as arthritis, heart disease, diabetes, balance
problems, or difficulty walking.24
Finally, a regular exercise program may also
improve cognitive function, help prevent
Alzheimer’s disease, and benefit people with
early dementia.25 It does this in a number
of ways.26 First, it lowers cardiovascular risk
factors associated with a higher risk of cognitive
impairment, including high blood pressure and
high cholesterol, metabolic syndrome, diabetes,
and inflammation. Second, exercise increases
nerve growth factors (neurotrophins) that
regulate brain cells and stimulate formation of
new blood vessels within the brain. A Canadian
study suggested that people ages 65 or older
who exercised 30 minutes a day for five days per
week would be almost 40% less likely to develop
Alzheimer’s disease compared to those who were
inactive. For the province of Ontario, this would
mean that more than one-in-seven cases of
Alzheimer’s disease might be prevented if everyone
who is currently inactive were to exercise at the
recommended level.27
Endurance exercises, also called aerobic
activities, are exercises that increase your
breathing and heart rate. They include brisk
walking, jogging, hiking, climbing stairs,
swimming, biking, tennis, basketball, aerobic
exercise classes, jumping rope, golf (without
a cart), dancing, and yard work (mowing,
raking, digging). The American Heart
Association recommends “at least 30 minutes
of moderate-intensity aerobic activity at least
five days per week for a total of 150 minutes,
or at least 25 minutes of vigorous aerobic
activity at least three days per week for a total
of 75 minutes; or a combination of the two.”29
Physical activity guidelines for Americans. U.S. Department of Health & Human Services.
http://www.health.gov/paguidelines/guidelines/chapter2.aspx (Accessed February 10, 2014).
25 Nagamatsu LS, et al. Physical activity improves verbal and spatial memory in older adults with probable mild cognitive
impairment. Journal of Aging Research. Volume 2013, Article ID 861893.
26 Kirk-Sanchez NJ, et al. Physical exercise and cognitive performance in the elderly. Clinical Interventions in Aging 2014:9:51-62.
27 The role of physical activity in the prevention and management of Alzheimer’s disease − Implications for Ontario. Ontario Brain
Institute. March 8, 2013.
28 Go4Life. National Institute on Aging. http://go4life.nia.nih.gov/4-types-of-exercise (Accessed February 10, 2014).
29 American Heart Association Recommendations for Physical Activity in Adults. http://www.heart.org/HEARTORG/GettingHealthy/
PhysicalActivity/StartWalking/American-Heart-Association-Guidelines_UCM_307976_Article.jsp (Accessed February 10, 2014).
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TYPES OF EXERCISE
Exercises fall into four categories: endurance,
strength, balance, and flexibility.28 Some
activities fit into several categories. For
example, many strength exercises also build
endurance, and vice versa.
New research suggests that many of the
benefits of fitness are possible with shorter
exercise durations. One approach uses a sevenminute period of high-intensity circuit training
that combines aerobic and resistance training.
People can choose from a dozen exercises
that can be performed at home, including
jumping jacks, push-ups, sit-ups, lunges, and
squats.30 Even shorter periods of exercise may
be beneficial. A study from Norway focused
on ways to improve fitness for inactive middleaged men who were overweight but otherwise
healthy. Vigorous running on a treadmill for just
four minutes three times a week for ten weeks
significantly improved their fitness and reduced
blood pressure and blood glucose levels.31
Strength exercises, also called resistance
training, increase muscle strength. They also
reduce muscle loss that occurs with aging and
during a weight-loss program. Examples include
weight lifting, using an elastic resistance band,
heavy gardening, and calisthenics such as
push-ups, pull-ups, and sit-ups. The American
Heart Association recommends moderate- to
high-intensity strength training at least two or
more days per week.29
Balance exercises help prevent falls. They
include exercises with a balance ball or balance
disc, standing on one foot, heel-to-toe walking,
Tai Chi, and many exercises that increase lower
body strength.
Flexibility exercises become more important
at older ages because our muscles, tendons,
and ligaments lose some of their elasticity as we
age. Useful exercises include stretching, yoga,
and Pilates.
You’re never too old
to start, and always
too young to stop.
Two recent reports from the British Journal of
Sports Medicine highlight the value of exercise
at older ages, even when we start later in life.
But the findings come with a caveat: some of
the benefits fade over time if we stop exercising.
The first study included almost 3,500 healthy
men and women, whose average age was
64 years, who participated in the English
Longitudinal Study of Ageing.32 Exercise levels
at the beginning of the study were categorized
as “inactive (no moderate or vigorous activity
on a weekly basis),” “moderate activity at least
once a week,” and “vigorous activity at least
once a week.” Healthy aging was defined as
survival for the duration of the study without
developing depression, physical or cognitive
impairment, or a serious chronic illness, such
as cardiovascular disease, cancer, diabetes,
chronic lung disease, Parkinson’s disease, or
Alzheimer’s disease. The association between
physical activity and healthy aging was reported
over eight years of follow-up.
Klika B, et al. High-intensity circuit training using body weight: Maximum results with minimal investment. Health & Fitness
Journal 2013;17:8-13.
31 Tjønna AE, et al. Low- and high-volume of intensive endurance training significantly improves maximal oxygen uptake after 10weeks of training in healthy men. PLOS ONE. May 2013, Vol.8, No.5. e65382.
32 Hamer M, et al. Taking up physical activity in later life and healthy ageing: The English Longitudinal Study of Ageing. Br J Sports
Med 2014;48:239-243.
30 13
»» Sustained exercisers. Men and
women who exercised during the
entire period were almost eight
times as likely to be healthy agers
as those who were inactive.
»» Late to the game. Those who
began an exercise program
during the study were three times
as likely to be healthy agers as
those who were inactive.
»» Faders. Some people stopped
exercising during the study. They
still reaped some health benefits,
but less than sustained exercisers
or participants who started an
exercise program after the study
began.
The second study investigated the likelihood of healthy aging in
more than 12,000 Australian men age 65 to 83 who exercised for
150 minutes or more per week, compared to those who exercised
less often.33 Healthy aging was defined as being alive after 10 to 13
years of follow-up and having no significant functional impairment,
cognitive problems, or depression.
»» Sustained exercisers. Men who exercised for at least 150
minutes per week throughout the entire study were 60% more
likely to experience healthy aging than those who exercised less
often.
»» Late to the game. Those who exercised less than 150 minutes
per week at the beginning of the study gained significant health
benefits if they became more active during the study.
»» Faders. Some participants who had exercised for at least 150
minutes per week became less active during the study. Some of
health benefits were lost compared to those who exercised more
often.
What can I do?
»» Find the motivation that works for you. Some people exercise because
of the long-term benefits, such as lower blood pressure and cholesterol,
reduced risk of health problems, and weight loss. For others, it’s both
social and emotional; exercise makes them feel more productive and
engaged, less stressed, and happier because of time spent exercising
with friends and being more active with grandchildren.
»» Make the time. Rather than “Will I exercise today,” the question is “What
type of exercise will I do today?”
»» Some exercise is much better than none. The greatest improvement in
health and well-being occurs in people who transition from no exercise to
small amounts of exercise done on a regular basis.
»» Walking is a good way to start. It’s free, easy, fun, and an excellent
exercise. After dinner, take a 10-minute stroll with the family. Gradually
increase the length of your walks and add other forms of exercise.
»» Include all four categories of exercise without overemphasizing any of the
components, especially in late middle- and older age when balance and
flexibility become even more important.
Almeida, et al. 150 minutes of vigorous physical activity per week predicts survival and successful ageing. Br J Sports
Med 2014;48:220-5.
33 14
You live and learn.
Or you don’t live long.
−Robert A. Heinlein
34
LIFELONG
LEARNING
FORMAL EDUCATION
Formal education is determined by educational attainment. Figure 7 shows life expectancy (average
remaining years of life) for Americans who are age 25.35 Life expectancy is significantly higher in people
with more education. At age 25, women with less than a high school degree have a life expectancy of 50
years, compared to 62 years for women with a college or graduate degree. The difference is even greater
for men. Life expectancy at age 25 is 44 years for men with less than a high school degree, compared to
57 and 60 years, respectively, for men with a college or graduate degree.
FIGURE 7
LIFE EXPECTANCY AT AGE 25, BY EDUCATIONAL ATTAINMENT
62 | 57
70
Life expectancy at age 25 (years)
60
50
40
30
56 | 51
Education Level
62 | 60
58 | 52
Less than high school graduate
22%
High school graduate
Some college
Life Expectancy
Women
50
56
58
Men
44
51
52
College graduate
Graduate degree
62
62
57
60
50 | 44
Women
Men
20
10
0
Less than high
school graduate
High school
graduate
Some college
College graduate
Graduate degree
Robert A. Heinlein & D. F. Vassallo, The Notebooks of Lazarus Long (1978).
Hummer A, et al. The effect of educational attainment on adult mortality in the United States. Population Reference Bureau.
Population Bulletin 68, no.1 (2013), p.8.
34 35 15
Educational attainment also affects the likelihood of disability later in life (Figure 8). For people ages 65 and
older, almost four in ten (38%) with less than a high school diploma have a functional limitation, compared to
only two in ten (20%) of those with a college degree.36
FIGURE 8
FUNCTIONAL LIMITATIONS IN PEOPLE AGE 65 AND OLDER WHO ARE
LIVING IN THE COMMUNITY, BY EDUCATIONAL ATTAINMENT
38%
Difficulty performing 1 or more IADLs
Difficulty performing 1 or 2 ADLs
50
| 44
10%
Difficulty performing 3 or more ADLs
24%
22%Less than a high
20%
school diploma
Difficulty performing 1 or more
6% IADLs
Difficulty performing
1 or 2 ADLs
18%
Difficulty performing 3 or more ADLs
14%
Total
10
5%18
10
12%38
High school
diploma
17%
6
14
5 4%
24
5%
11%
10%
10%
Less than a high
school diploma
5%
4%
4%
3%
High school
diploma
Some college
College degree
Postcollege
LIFELONG LEARNING
Lifelong learning means continuous learning
throughout life, mainly outside the classroom. It
includes learning by thinking and doing, acquiring
new knowledge and skills, and cultivating a mind
that is flexible, creative, and adaptable to different
ideas, people, and cultures.
Two novel concepts — cognitive reserve and
neuroplasticity — highlight the value of lifelong
learning. Cognitive reserve is excess brain capacity
that confers protection against age-related decline in
brain function.37 Neuroplasticity refers to the ability
living (IADLs) include preparing
meals, shopping, using the
telephone, managing money, and
taking medications.
of the brain to change — physically, functionally,
and chemically — in response to new information,
stimulation, or damage.38 Many people can increase
their cognitive reserve, with the accompanying
changes in brain structure and function, but it takes
work. In much the same way that muscles need
regular exercise to keep them flexible and strong,
we need to exercise our brain as well, especially at
older ages.
Hagen S, et al. Rising demand for long-term services and supports for elderly people. Congressional Budget Office.
June 26, 2013, p.13.
37 Park DC, et al. The aging mind: Neuroplasticity in response to cognitive training. Dialogues Clin Neurosci
2013;15:109-19.
38 Mora F. Successful brain aging: Plasticity, environmental enrichment, and lifestyle. Dialogues Clin Neurosci
2013;15:45-52.
36 16
Some
College
Postcollege
college
degree
Activities of daily living (ADLs)
5 include bathing,
5 dressing, eating,
4
12walking, transferring
11
10 or
out of bed
4 a chair, and using
4 the toilet.3
22Instrumental20
17
activities of daily
What can I do?
Maintain the skills you’ve already acquired.
»» For some people this might mean working later in life, either for
a salary or as a volunteer. A large study from France reported
a lower rate of dementia in people who retired at older ages,
probably because of mental activity and socialization during
work.39
»» Challenge your brain with new tasks, especially those requiring
concentration.
This might include reading, learning a new language, taking
courses at the community college, playing a musical instrument,
cooking, travel, using the opposite hand to tap on the touch
screen of your phone or tablet, and new hobbies such as painting
or woodworking.
Computerized “brain games” are receiving a great deal of
attention as a way to increase cognitive reserve and produce
favorable changes in neuroplasticity. One study supported by the
National Institutes of Health reported that middle-aged and older
adults were able to slow age-related cognitive decline by playing
a commercially available video game.40 Another study from the
University of California used a custom-designed video game to
analyze the effect of multitasking training on people age 60 to
85.41 The challenge was to use a hand-held controller to race a
car on a video screen while identifying or ignoring road signs that
appeared during the game. As expected, improvements in game
performance were observed during the study, but older adults
also performed better at memory and attention tests outside
the game. Researchers documented changes in brain waves
indicating subtle improvements in brain structure and function in
response to training sessions. AARP also provides links to online
games as a way to strengthen memory and enhance problemsolving and language skills.42
»» Exercise your memory. Memorize the names of U.S. Presidents,
the 50 states and their capitals, countries of the world, baseball
statistics, telephone numbers of friends and family, or the
scientific names of plants and flowers in your garden.
Dufouil C, et al. Older age at retirement is associated with decreased risk of dementia. Alzheimer’s & Dementia. Vol.9,
Issue 4, Supplement, p.342-3, July 2013.
40 Wolinsky FD, et al. A randomized controlled trial of cognitive training using a visual speed of processing intervention in
middle aged and older adults. PLOS ONE. May 2013, Vol.8, Issue 5, p.1-11.
41 Anguera JA, et al. Video game training enhances cognitive control in older adults. Nature 2013;501:97-101.
42 Brain Games. AARP. http://www.aarp.org/health/brain-health/brain_games/ (Accessed February 10, 2014).
39 17
Eat your vegetables.
They’re good for you.
− Moms everywhere
EAT
HEALTHIER
This dietary advice, given to us decades ago by our mother, captures the essence of healthy eating: eat what
has always been recognized as food, rather than what comes in boxes, cans, packages, tubes, and ready-to-eat
meals.
The recommendations in the table, which summarize the fundamentals of healthy eating, were largely adapted
from the most recent Dietary Guidelines for Americans.43 The emphasis is on variety (different foods with
different nutrients), balance (don’t eat too much of any single food), and moderation (be mindful of calories and
portion size). Note that healthy eating is not a diet and weight loss is not the primary intent. Rather, the goal is to
eat healthier, starting today, by gradually changing our dietary habits. For those interested in weight loss, there’s
no shortage of options. A list of diets — 670 of them — can be found online.44
GENERAL RECOMMENDATIONS FOR A HEALTHIER DIET
EAT MORE
Fruits and vegetables. Choose from a rainbow of
colors: red, orange, yellow, green, blue, purple,
white, black, and pink.
Cholesterol. Eggs and beef are the major sources
of cholesterol in the American diet.
Monounsaturated (canola, olive, safflower) and
polyunsaturated (soybean, corn, cottonseed) oil.
Trans fats. Found mainly in fried food, frozen
desserts, baking mixes, shortening, and stick
margarine.
Dairy. Reduced fat milk, yogurt, and ice cream;
low-fat cheeses (cottage, ricotta, part-skim mozzarella, string cheese, goat cheese).
Saturated fats. Whole milk, pizza, full-fat cheese,
cakes, cookies, pies, pastries, donuts, ice cream,
sausage, hot dogs, bacon, and ribs.
Fish. At least twice a week.
Foods with added sugar and salt.
Beans and peas. Natural sources of fiber and
protein. Kidney beans, lentils, chickpeas, pinto
beans.
Processed foods. Foods packaged in boxes, cans
or bags. They often contain preservatives and
artificial flavorings.
Unsalted nuts. A great snack, but watch the
portions. Nuts are high in calories.
Fast food.
Whole grains. Whole-wheat bread, whole-grain
cereals and crackers, oatmeal, and brown rice.
Refined grains. White bread, white flour, white
rice, pasta, tortillas, cereals, cakes, cookies, pies,
pastries, and donuts.
Dietary Guidelines for Americans, 2010. 7th Edition. U.S. Department of Agriculture and U.S. Department of Health and
Human Services. December 2010. (Dietary Guidelines for Americans is reviewed, updated if necessary, and published
every 5 years).
44 Everydiet. http://www.everydiet.org/diet (Accessed February 10, 2014).
43 18
EAT LESS
The U.S. Department of Agriculture recently reported good news about the eating habits and diet quality of
working-age adults.45 Between 2005 and 2010, average daily caloric intake decreased by 118 calories, the
share of calories from fast food declined, and more meals were eaten at home. Intake of cholesterol and
saturated also decreased. The improvements were due to increased consumer preferences for nutritious
foods, greater use of nutrition information during food shopping, and to a lesser degree, the recession of
2007 to 2009, which reduced the money available for meals away from home.
What can I do?
»» No foods are “off limits.” There’s no need to give up the meals we
love. Everyone enjoys certain foods that are not the most nutritious
choices. It’s okay to eat them, but less often, and in smaller amounts.
»» Smaller portions. Use smaller plates to trick your brain. Fill half the
plate with vegetables and salads.
»» Don’t skip meals. If you do, you might be ravenous when lunch or
dinner arrives and then overeat at the next meal. Plan on four to six
meals a day: breakfast, lunch, dinner, and healthy snacks between
meals and after dinner if you like.
»» Focus on nutrition, not calories.
»» Eat slowly. It will be easier to recognize when you’ve had enough to
eat.
»» Don’t multitask. This is your time to eat. Don’t text, check emails, or
watch TV while eating.
»» Be easy on yourself. Eating habits are not acquired overnight and
relapses into old patterns are inevitable.
»» Get professional advice from a health care professional if you have
health problems or special dietary needs.
Todd JE. Changes in eating patterns and diet quality among working-age adults, 2005-10. ERR-161. U.S. Department of
Agriculture, Economic Research Service, January 2014.
45 19
Early to bed and early to rise
makes a man healthy,
wealthy, and wise.
− Benjamin Franklin
46
SLEEP
Sleep, like good nutrition and regular physical exercise,
is critically important to overall health and well-being.47
It plays a role in metabolic and emotional regulation,
performance, memory consolidation, and learning.48
New research also suggests sleep may help remove
waste products that accumulate in the brain while we’re
awake.49
The Centers for Disease Control recommends
the following steps to improve sleep hygiene:52
»» Go to bed at the same time each night,
and rise at the same time each morning.
Adults need seven to eight hours of sleep per night,
yet more than one-in-three (35%) of us sleep less than
seven hours most nights. Sleep-deprived adults are
more likely to have daytime sleepiness, which can lead
to poorer job performance, workplace injuries, and
impaired driving. Insufficient sleep and poor quality
of sleep are also associated with obesity, diabetes,
hypertension, heart disease, stroke, depression, a
weaker immune system, and problems with memory,
learning, and concentration.48
»» Sleep in a quiet, dark, and relaxing
environment, which is neither too hot nor
too cold.
Medical studies have identified an association between
poor sleep and cognitive impairment in older adults,
especially in people with Alzheimer’s disease.50,51 For
example, many people with early Alzheimer’s disease
sleep poorly or for short durations. It’s not known if poor
sleep is a risk factor for Alzheimer’s disease or simply a
consequence of the disease. But these studies confirm
what has long been known: sleep is not a luxury; it’s a
necessity for good health, even at older ages.
»» Avoid large meals before bedtime.
»» Make your bed comfortable and use it only
for sleeping and not for other activities,
such as reading, watching TV, or listening
to music.
»» Remove all TVs, computers, and other
“gadgets” from the bedroom.
Other tips for a good night’s sleep are to
finish eating at least two to three hours before
bedtime, avoiding caffeine and alcohol close
to bedtime, regular exercise, and stopping
smoking.53
Benjamin Franklin. The Quotations Page. http://www.quotationspage.com/quote/34564.html (Accessed February 10, 2014).
Sleep Health. http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=38 (Accessed February 10,
2014).
48 Perry GS, et al. Raising awareness of sleep as a healthy behavior. Preventing Chronic Disease. Centers for Disease Control.
Vol.10, August 8, 2013.
49 Xie L, et al. Sleep drives metabolite clearance from the adult brain. Science. October 18, 2013.Vol.342, p.373-7.
50 Spira AP, et al. Self-reported sleep and ß-amyloid deposition in community-dwelling older adults. JAMA Neurol 2013;70:153743.
51 Ju YS, et al. Sleep quality and preclinical Alzheimer disease. JAMA Neurol 2013;70:587-93.
52 Sleep and Sleep Disorders. Centers for Disease Control. http://www.cdc.gov/features/sleep/ (Accessed February 10, 2014).
53 National Sleep Foundation. http://www.sleepfoundation.org/article/how-sleep-works/how-much-sleep-do-we-really-need
(Accessed February 10, 2013).
46 47 20
What can I do?
Man is by nature a social animal.
−Aristotle
54
SOCIALIZATION
Social relationships are a fundamental part of health and wellness. We spend our lives interacting with friends
and family, neighbors, coworkers, and strangers, sharing their joys and sorrows, learning from each other,
helping them and being helped. So it’s no surprise that social isolation and loneliness are often associated with
poor health and higher mortality.
SOCIAL ISOLATION
Social isolation means a smaller social network.
It’s more common at older ages because
of reduced economic resources, health
problems that limit mobility, and the death of
family members, friends, and neighbors who
represented the majority of our social contacts.
Social isolation has been associated with a
higher risk of cardiovascular disease, cognitive
deterioration, and mortality.
A recent study of older men and women in
England shed additional light on the relationship
between social isolation and mortality.55 Social
isolation was based on being “unmarried or not
cohabiting; having less than monthly contact
(including face-to-face, telephone, or written/
email contact) with children, other family
members, and friends; and no participation in
organizations such as social clubs or residents
groups, religious groups, or committees.” Over
the next seven years, mortality was 26% higher
in the most socially isolated people. Why would
social isolation increase the risk of death?
People with limited social contact may have
an unhealthy diet, be less active, smoke more,
not follow medical recommendations, and lack
access to help from others if they become sick
or disabled.
Aristotle. Goodreads. http://www.goodreads.com/quotes/183896-man-is-by-nature-a-social-animal-an-individual-who
(Accessed February 10, 2014).
55 Steptoe A, et al. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the
National Academy of Sciences 2013;110: 5797–5801.
54 21
LONELINESS
Loneliness is a feeling of isolation, not belonging, or
lacking companionship.56 It’s different from being alone.
For example, we might feel lonely when surrounded by
family and coworkers, and not at all lonely even though
we live alone. The difference is that loneliness reflects
dissatisfaction with the relationships we have and those
we’d like to have.55
Researchers have reported a higher risk of health
problems and early mortality in people who feel lonely.
One of the largest studies was done at the University
of California, San Francisco.56 Subjects in the study,
whose average age was 71 years, were asked if they
(1) “feel left out,” (2) “feel isolated,” or (3) “lack
companionship.” They were classified as “lonely” if
they responded “some of the time” or “often” to any of
the three questions. Outcomes were assessed six years
later, and the results were striking. Lonely people were
more likely to experience functional decline, including
decreased mobility and greater difficulties with upper
extremity tasks, climbing stairs, and the activities of
daily living. Death rates were also 45% higher in people
who were lonely compared to those who were not lonely.
Explanations for poorer outcomes in lonely people
include inadequate nutrition, medication noncompliance,
decreased mobility, and the stress and poorer quality of
life that often occur in people who lack social support.57
What can I do?
»» Volunteer. There’s no better way to make
friends, build your social network, and
help others in the community.
»» Rekindle a passion. Join a walking or
gardening club, learn ballroom dancing,
build furniture, or write your memoir.
»» Adopt a pet … especially a dog. Taking
Fido for two walks a day is a great way to
get exercise, have a break from your daily
routine, and meet new people.
»» Go online. The possibilities are endless:
games, including games that improve
memory, chat rooms, and education.
»» Take a class. Learn a new language,
pursue your life-long dream of being a
painter, creative writer, or chef, or join
others in a line dancing or exercise class.
»» Sail away. Many tour companies
specialize in international travel and
cruises geared specifically for older adults.
FINAL THOUGHTS
We all arrive at today with the opportunity to make tomorrow better. AgeLess, a prescription for successful
aging, can help. For some people, it might be a concerted effort to improve our attitude, receive good medical
care, start an exercise program, or learn something new. Others might decide to eat healthier, make time for a
good night’s sleep, or build a broader social network. There’s no guarantee these steps will add years to our life.
But they’ll probably add life to our years, and help us enjoy a happier and more fulfilling retirement.
Perissinotto CM, et al. Loneliness in older persons: A predictor of functional decline and death. Arch Intern Med
2012;172:1078-83.
57 Bucholz EM, et al. Loneliness and living alone. Arch Intern Med 2012;172:1084-5.
56 22
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[The opinions reflected are those of the author and are not necessarily those of Merrill Lynch and Merrill Lynch expresses no
opinion with regard to them.]
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0261463-00001-00 Ed. 05/2014 Exp. 11/08/2015