Volume 28, Issue 3 , Pages 323-324, April 2005
Feeling fine at a hundred and three:
Secrets of successful aging1
Article Outline
In his “book for the obsolete children,” Dr. Seuss describes the green pastured mountains of Fotta-fa-Zee where everybody feels fine at the age of a hundred and three.1 Their secrets?
’cause the air that they breathe
is potassium-free
and because they chew nuts
from the Tutt-a-Tutt Tree.
Unfortunately, most of us would not be able to avail ourselves of either the potassium-free air or nuts from the Tutt-a-Tutt tree. However, two articles in this issue discuss more feasible behavioral modifications that are associated with successful (or healthy) aging.
Peel et al.2 summarize findings from a review of the literature on behavioral determinants of healthy aging. The authors report an association of healthy aging with not smoking, being physically active, maintaining optimal body weight, and having moderate alcohol consumption. They suggest that interventions targeting smoking, alcohol abuse, and poor exercise and nutrition might be adapted for use with older adults, as lifestyle modification may offer health benefits into older age. Reinforcing the point that it is never too late to change is the finding regarding smoking. Whereas current nonsmoking had the largest effect size of all the variables examined for an association with healthy aging, people who had quit smoking for some time were also more likely to be aging well compared to those who had continued to smoke into old age.
Hillsdon et al.3 present results of a 9-year follow-up of 6398 relatively healthy, mostly working, middle-aged men and women. The principal finding from the study was that the level of physical activity at baseline predicted higher physical function at follow-up even after controlling for the presence of chronic illnesses and baseline physical function. The authors conclude that participation in physical activity during mid-life may be important for maintaining high physical function in later life. Thus, it is not too early to start preparing for healthy aging. Another noteworthy point coming out of this study is the relative independence of long-standing illness and successful aging. Physical inactivity in the absence of chronic illness could lead to later loss of function. On the other hand, loss of physical function could be delayed or possibly even avoided by being physically active. This result calls into question the validity of the criteria for successful aging that require an absence of physical disease or disability as discussed below.4
In describing the world’s changing demographics during the past century and the next one, the most commonly used expression is “graying of the world.” A frequently implied connotation is that as the population ages, it will lose vitality and energy, and be devoid of color and sparkle. Yet, a number of studies of successful aging, illustrated by the two articles in this issue, have challenged this notion. Nonetheless, the negative stereotyping of old age continues even among scientists, in large part because of the persistent focus of medical research on disease and disability.
There are difficulties in studying successful aging. For example, there is no agreement on the nomenclature, let alone the definition and criteria for this entity. The terminology used includes not only successful or healthy aging but also productive aging, effective aging, aging well, robust aging, and positive aging. However, none of these terms is entirely satisfactory because they all suggest that people who do not meet the specified criteria are those who have somehow failed. An issue more important than mere nomenclature is who should define successful aging—should that be the individual herself/himself or the researcher? Probably the most cited criteria for successful aging are those by Rowe and Kahn.4 In their landmark article, these authors described three essential components of successful aging: absence of chronic disease and disability, high cognitive and physical functioning, and active engagement with life. The McArthur Network of Successful Aging conducted a series of studies using an operationalized definition of these criteria. A number of important findings have emerged from these investigations, including the long-term benefits of psychosocial support and perceptions of personal control. Nonetheless, the Rowe and Kahn criteria have come under criticism for excluding physically disabled individuals, and for implying that most successful agers are those who have necessarily been successful throughout their entire life.5 Phelan and Larson6 have stressed the subjective nature of successful aging. These authors have rightly pointed out that there is a critical need for considering elderly individuals’ perspectives about themselves.
Better, more consistent, and translatable phenotypic characterization as well as greater understanding of biopsychosocial determinants will help clarify the concept of successful aging, and will hopefully lead to prevention and treatment studies for enhancing healthy aging. We can consider our work successful when the term “graying of the world” is replaced in the common lexicon by “the world becoming more golden.”
This work was supported, in part, by the National Institute of Mental Health (grant MH66248), and by the Department of Veterans Affairs.
References
- Dr. Seuss. You are only old once! A book for obsolete children . New York: Random House Publishing Group; 1986;
- . Behavioral determinants of healthy aging . Am J Prev Med . 2005;28:298
- Prospective study of physical activity and physical function in early old age . Am J Prev Med . 2005;28:245
- . Human aging (usual and successful) . Science . 1987;237:143–149
- . Successful aging (from cell to self) . Philos Trans R Soc Lond B Biol Sci . 2004;359:1413–1426
- . “Successful aging”—where next? . J Am Geriatr Soc . 2002;50:1306–1308
PII: S0749-3797(04)00369-1
doi:10.1016/j.amepre.2004.12.015
© 2005 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Volume 28, Issue 3 , Pages 323-324, April 2005
