Normal and Optimal Aging: In the 3rd Age of Life

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Normal and Optimal Aging In the 3rd Age of
Life
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What is the Third Age of Life?
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Third Age of Life

• Term coined by writer Simone de Beauvoir
• Refers to stage of life beyond youth (1st age)
  and mid-life (2nd age), where the challenges
  building a career and family are largely
  finished, but short of old-old age (4th age)
• Also called the young-old years
• 3rd Age begins in the 55 to 70 age range, and
  usually ends between 75 and 85

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Normal and Optimal Aging Why is this an
important topic?
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DEMOGRAPHIC
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Growing Numbers of Older People

• Increasing life expectancy, 77 now about 80
  for women 75 for men
• In year 2000, 1 in 7 Americans was
• 65
• By 2025, 1 in 4 will be 65
• 85 (gt3 million) is fastest growing segment of
  U.S. population

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Growing Older Population Not Unique to U.S.
Estimated Percent of 65 by 2025 in Other
Countries

• Korea, Singapore, Malaysia 400
• China 300
• Japan 200
• India ?

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Average Life Expectancy at Birth Ancient to
Modern Times
Hayflick, 1994
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Life Expectancy in the USA 1900-2000 At Birth
and at Age 65
Hayflick, 1994
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ECONOMIC
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Country Needs Productive 3rd Agers

• Due to baby-bust generation, born 1965-1977,
  Fewer young people are entering workforce
• Full Time Employment
• 1980 3 million
• 1990 1.3 million
• Aging average US worker Median Age
• 1980 34.3
• 1988 35.9
• 2000 39.3

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Fewer 30-50 Year Olds

• Impact of low birthrate will result in fewer
  30-50 year olds in workforce
• Gap will widen
• 1996 30-50 year olds were 31 of workforce
• 2006 28.8 of workforce, or 880,000 fewer
• By year 2010, there will be 10 fewer 30-50s
  than in 2000
• Will be 2025 before population of 30-50s is the
  same as 2000

Powell, 2003
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Other Reasons for Post-Retirement Work

• Barriers of mandatory retirement have been
  eliminated
• Miscalculation of financial needs
• Need to engage in productive activity
• Having a job provides a role (What do you do?)
  in society
• Need for social belonging

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LEGISLATIVE
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Anti-Discrimination Laws

• 1986 Congress passes Age Discrimination in
  Employment Act (Public Law 99-592)
• Eliminated mandatory retirement beginning
  January 1, 1994
• Initial exceptions
• Airline pilots
• Law enforcement officers
• College professors

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Declining Disability
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Declining Disability

• Since 1982 the average age of first disability,
  infirmity, or chronic illness has declined
  about 2 per year for those 65
• Patterns are similar for mild and moderate
  disability
• About 1.5 million adults 65 today have avoided
  medical conditions that would have disabled them
  25 years ago

Fries, 2003
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Declining Disability Among Those 65
Manton Gu, 2001
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Declining Disability and theRectangular Model
of Optimal Aging

• Onset of initial disability for 65s postponed
  7-12 years for those who were non-smokers, lean
  and fit
• Those practicing healthy lifestyles have 25 of
  the disability of those with most risk factors
• Advances in medical technology another reason
• These findings provide support for the
  Rectangular Model of optimal aging

Fries, 2003
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Optimal Aging Rectangular Model
Rabbitt, 1990
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More Realistic Rectangular Model of Optimal
Aging Intellectual Ability
Territory to be gained
Powell, 1994
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Evidence for the Rectangular Model of Optimal
Aging Living Younger Longer

• Physical vigor of 3rd Agers has improved
• One measure Improvement in best 10K times for
  ages 40 75 in past decade

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Improvement in Best Times for Running 10K in Past
Decade

• 40 75
• Women 1.0 8.6
• Men 3.4 10.6

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Normal and Optimal Aging What is the
Difference?
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What Is Normal Aging? Provisional Definition

• Normal aging is continuing to function at a level
  characteristic of our age group as influenced
  by relevant demographic factors
• No physical debilitating disease/limitations
• Key physical cognitive indicators are no lower
  than bottom 10 of age group
• Irregular, non-symptomatic, medical checkups and
  appraisal of psychosocial adjustment

PSYC S-1293, 2004
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What Is Normal Aging? Provisional Definition
(Contd)

• Normal aging is also not doing things that we
  know are associated with optimal aging
• Letting nature take its course, letting things
  slide
• For instance, living with hypertension obesity,
  inactivity, being inattentive to potential
  psychosocial problems
• Not doing things that make a difference in
  healthe.g., diet, glasses, hearing aids,
  taking meds regular checkups/medical care

PSYC S-1293, 2004
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Chronological vs. Functional Age

• Chronological age Calendar years
• Functional age Objective physical and mental
  state, and/or performance capabilities

Hayflick, 1994
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What Is Optimal Aging?

• Optimal aging is continuing to function at the
  highest possible level in the context of the
  inevitable limitations that growing older
  places upon us
• It is being aware, as opposed to being unaware,
  of the beneficial effects of certain physical,
  cognitive, and psychosocial activities on our
  body and mind

PSYC S-1293, 2004
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What Is Optimal Aging? (Cont)

• Optimal aging is also doing, as opposed to not
  doing, things that are known to maintain and
  enhance of the quality of life
• It is being proactive about medical checkups
  screenings when not symptomatic, and regularly
  appraising cognitive and psychosocial status,
  making adjustments as needed
• Optimal aging is getting the best out of what is
  possible for as long as possible

PSYC S-1293, 2004
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What Is the Evidence That Optimal Agers Exist?

• Exemplars Grandma Moses, James Mitchener,
  Barbara Cartland, Lionel Hampton
• Our own relatives, friends, neighbors
• Research Data from studies of younger and older
  subjects

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Research Example Identifying Optimal Agers on a
Test of Mental Ability

• Once developed a test of mental ability to be
  used with doctors
• Tested 1,000 MDs and nearly 600 normals
• Ages 25 to 92
• Noticed that some doctors 65 had test scores
  similar to middle aged MDs
• What proportion might that be?

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Average WAIS Full Scale IQ Scores for Age Groups
25-34 to 75
Kaufman, 1990
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of MD Optimal Cognitive AgersTest Scores
Equal to/Higher Than Top 93 of Doctors 45-54
Powell,1994
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Optimal Aging How Much Is Hereditary?

• Estimates vary about s of nature/nurture
• Swedish study of 80 year old identical twins
  found 60 hereditary influence on general
  intelligence
• Minnesota twins studies report 30-50 genetic
  component on IQ and systolic BP
• A reasonable estimate is about 50 nature and
  50 nurture
• Evidence from three studies

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OctoTwin Study Contribution of Genetic and
Environmental Factors to Cognitive Ability in 80
Year Old Twins

• Collaborators at Penn State, a UK research centre
  the Karolinska Institute examined 110
  identical (monozygotic) and 130 fraternal
  (dizygotic) same sex twins 80
• Ss drawn from Swedish Twin Registry
• Could assess relative influence of nature/nurture
  because lived most of life separated from each
  other

Petrill et al., 1998
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OctoTwin Study Genetic Contribution to
Intellectual Abilities- 3 Study Comparison
Petrill et al., 1998
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Potential for Acting Upon Oneself to Maintain
Optimal Health

• Each patient carries his own doctor inside him.
  They come to us not knowing that truth. We are
  the best when give the doctor who resides within
  each patient a chance to go to work.
• Attributed to Albert Schweitzer by Norman
  Cousins, Anatomy of an Illness, 1979, p.69.

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Elements of a Working Definition of Healthor
HRQOL

• Hard to beat this definition
• A state of physical, mental and social well
  being and not merely the absence of disease.
  (WHO, 1948)
• Assessment of HRQOL includes physical,
  cognitive, social and psychological states
• Focus on functional healthhealth is as health
  does

Rivera, 2003
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Four Aspects of Optimal Aging

• Aspect 1 Optimal Physical Aging
• Aspect 2 Optimal Cognitive Aging
• Aspect 3 Optimal Social Aging
• Aspect 4 Optimal Psychological Aging

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Aspect 1 Optimal Physical Aging
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Causes of Death Among People 65
Hayflick, 1994
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Gain in Life Expectancy If Certain Diseases Were
Eliminated
Hayflick, 1994
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Factors Influencing Physical HealthEspecially
Cardiovascular Vigor

• Exercise
• Weight
• Blood pressure
• Social networks
• Immune system
• Substance abuse/dependency

PSYC S-1293, 2004
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Exercise and Longevity

• Studies find people who exercise live longer
• Harvard grads getting 2000 calories or more per
  week of exercise had lower death rates than
  sedentary classmates
• Exercisers lifespan increases 2.15 years
• Conclusion from this and other research is
  that exercising will increase longevity

Hayflick, 1994
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Effect of Age, Gender, and Fitness on
Cardiovascular Response to Exercise
Uncontrolled for Weight/Fat Free Mass
Ogawa et al., 1992
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Weight Longevity

• Ideal weight Subject of considerable debate
• Met Life Insurance Company tables, created in
  1960, served as basis until recently
• Recent studies in past decade contradict Met
  Life ideal weight tables
• Bottom line People living longest are those
  moderately overweight by Met Life tables

Hayflick, 1994
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Blood Pressure and Health

• Not news that hypertension is associated with
  physical problems, including CVD and stroke
• Threshold for DX of hypertension is lower than
  earlier thoughtnow 140/90 as opposed to 160/90
• Also serious cognitive effects

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Lifestyle Modification andBlood Pressure Control
PREMIER Research Group, 2003
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Social Relationships and Age-Adjusted Mortality
For Females Males Four Prospective Studies
House et al., 1988
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Psychoneuroimmunolgy

• Used to be believed immune system functioned
  independently of psychosocial factors
• Recent research found immune system can be
  enhanced by psychosocial factors
• Examples are exercise, social networks, stress
  levels, coping styles, mood states

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Alcohol Abuse After 60

• Not long ago it was widely accepted that few
  adults become alcoholics after 55
• In fact new data show late life onset alcoholism
  accounts for 1/3 alcoholics who are 60
• Doctors/nurses spend lt time with older patients
• And older patients dont volunteer information

Blow, 1998
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Small Differences Can Make Big Differences in the
Quality of Aging

• Not adding a pound a year in weight after
  graduation
• Getting a little more regular, moderate
  exercise
• Cutting out/moderating some things that we know
  are bad for us
• Paying attention to physical state, having
  regular medical checkups

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Aspect 2 Optimal Cognitive Aging
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Optimal Cognitive Aging Topics

• Aptitudes spared and impaired with age
• What raises of the probability of OCA?
• What helps body also helps mind

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Cognitive Skills Spared With Age

• Attention
• Calculation
• Vocabulary
• Information

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Cognitive Skills Impaired With Age

• Spatial
• Reasoning
• Speed (complex task response time)
• Working memory
• Dual task (dichotic) attention

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What Helps/Hurts Body Also Helps/Hurts Mind

• Exercise best example
• Social networks
• Stress reduction

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Aerobic Fitness Cognition in Older Ss SLC
Prospective Study

• Compared the effects of aerobic training with
  strength/flexibility workouts or no- exercise
  among 3 groups of Ss 60 years old
• Exercise Ss met for 3 one hour sessions per week
  for 4 months for fast walking/slow jogging
• Pre/post cognitive tests measured reaction time,
  attention, mental control, reasoning, memory

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Aerobic Fitness Cognition in Older Ss SLC
Prospective Study
Dustman, et al, 1983
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Comparing the Impact of Social Networks on Health
and Cognition
Powell, 2002
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Duration of Combat Exposure and Neuronal Count
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Aspect 3 Optimal Social Aging
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Optimal Social Aging Topics

• SES and health
• Social networks and health
• Possible gender differences
• Social networks and immune system
• Pets and health
• Better to give than receive

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Socioeconomic Class and Health

• Well established that higher SES people live
  healthier lives than those in lower SES
• What are some of the mechanisms which cause this
  to be so?
• ?

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Social Networks Convoy Model
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2
3
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Antonucci, 1985
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Social Relationships and Health

• Scientists long noted association between social
  relationships (soc rels) and health
• of people in social networks associated with
  better health
• All cause morbidity/mortality more among
  socially isolated
• Ditto for accidents and mental disorders
• Suicide more frequent among isolated

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Social Support and Surviving Serious Diseases

• Recently data show that recovery from serious
  illness also correlated with social supports
• Research by Lisa Berkman at Yale followed 194 Ss
  with myocardial infarction(MI) and monitored
  social support
• Found strong relationship between survival and
  social support

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Social Support and Mortality In Six Months
Following MI
Age 65-74 Age 75
Berkman, 1995
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Are There Gender Differences in the Number of
People Necessary to Maintain Health?

• Social network size morbidity/mortality
• Social network size and recovery from heart
  attacks

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Social Support and Mortality Following MI by
Gender
Berkman, 1995
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Social Support and Health Giving May Be More
Important Than Receiving
Brown, et al., 2003
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Aspect 4 Optimal Psychological Aging
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Optimal Psychological Aging Topics

• What is normal psychological adjustment?
• Stress management
• Anxiety depression and aging
• Are most older people happy or sad?

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Characteristics Associated with Normal
Psychological Adjustment

• Ability to obtain a balance of satisfaction from
  Work, Love, and Play in 3rd Age of life
• In the context of high level techniques for
  coping with stress

Powell, 1983
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Nature of Stress

• Any event that taxes our physical or
  psychological or physical state sufficiently to
  cause unpleasant physical or emotional
  responses
• Can be positive or negative events

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Stress Measuring Severity

• l Amount
• l Duration

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Stress and Immunity to Colds
Cohen, et al, 1996
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Two Week Sick Call Rate and Number of Missions
Flown by 8th Air Force Bomber Crews in June 1944
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The Value of Forgiveness

• 72 intro psych Ss asked to imagine harboring
  grudges or forgiving an offense
• Psychophysical measuresEMG, skin conductance,
  heart rate, blood pressure
• Found grudges associated with higher readings on
  all psychophysical measures
• Forgiving thoughts prompted greater sense of
  control and lower physiological stress
  responses

Witvliet, et al., 2001
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Aging and Depression

• Theory that aging is associated with greater risk
  of depression widely held
• Evidence doesnt support this theory
• l From scores on depression tests
• l From clinical ratings of depression

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Age Differences in Depression and Anxiety
Gatz and Singer, 1992

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Are Most People Happy, Sad, or In Between?
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Are Most People Happy? An International Survey
Average Subjective Well-Being on 0 to 10 Scale
Diener and Diener, 1996
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Activities that Influence Body/Mind

• Immune system
• Control
• Social networks
• Stress
• Exercise
• Blood pressure

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Optimal Aging The Bottom Line

• Not helpless
• We have within us the capability to create a
  large portion of the world we grow into in the
  3rd 4th seasons of life
• We can start by acting upon what is known about
  optimal aging
• But we need to begin early