Suggested Citation: Garko, M. G. (2018, April). Successful aging: A paradigm shift. Health and Wellness Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.
Aging – Part II: Successful Aging – A Paradigm Shift
Michael Garko, Ph.D.
Syndicated Host & Producer – Let’s Talk Nutrition
In his essay On Old Age, Cicero, the ancient Roman philosopher and rhetorician, commented on why he believed people thought of old as being an unhappy experience. He said:
The fact is that when I come to think it over, I find that there are four reasons for old age being thought unhappy: First, that it withdraws us from active employments; second, that it enfeebles the body; third, that it deprives us of nearly all physical pleasures; fourth, that it is the next step to death (Cicero & Powell, 1988).
Although written over two thousands year ago, Cicero seemed to capture how more than a few think and feel about old age and by implication the process of aging. Such a view implies that aging is an unmodifiable, pathogenic process, culminating in death. However, there is another narrative of aging which is more hopeful and compatible with the model of successful aging.
The June, 2018, edition of Health and Wellness Monthly discusses the concept of successful aging within the context of two competing narratives regarding aging, one in which aging is viewed as an inherent disease process taking hold in the latter stages of the lifecycle and another which views aging as a modifiable risk factor for age-related diseases operating across the lifecycle. Age, aging and successful aging are discussed.
Pessimistic vs. Optimistic Narrative of Aging
A pessimistic narrative of aging is one that sees senescence and aging as inextricably linked and laments aging and old age. Aging is regarded as a pathogenic process characterized by dread, depression and dysfunction, culminating in death. From this perspective, aging is viewed as a process occurring in the later stages of life and preceding the end of life characterized by either a precipitous or slow tortuous decline into frailty, senility and mortality. As Nieuwenhuis-Mark (2011) has observed and criticized, there is even a widespread call for calling or classifying aging as a disease (e.g., see Bulterijs et al., 2015; Gems, 2011, 2015; Longevity Reporter, 2016; Lustgarten, 2016; Nieuwenhuis-Mark, 2011; Zhavoronkov & Bhullar, 2015).
In contrast, a more optimistic narrative of aging sees it as a dynamic process extending over the life span and not confined to a fixed or designated period in the life cycle (Moody, 2010). From this perspective, aging is not inherently a pathogenic, debilitating disease process but more as a modifiable risk factor for disease. As it turns out, people can live and often do for long stretches of time without disease. While disease can take hold at any time during life cycle, it is not necessarily confined to old age.
Aging as a modifiable risk factor for disease. Recently, James Kirkland, M.D., Ph.D., director of the Mayo Clinic Robert and Arlene Kogod Center on Aging commented that “[a]ging is the largest risk factor for most chronic diseases, including stroke, heart disease, cancer, dementias, osteoporosis, arthritis, diabetes, metabolic syndrome, blindness and frailty” (Forliti, 2016). While he may recognize it as a risk factor for disease, Dr. Kirkland is of the view that “[r]ecent research suggests that aging may actually be a modifiable risk factor” (Forliti, 2016). Hence, on the one hand, aging may be the accumulation of random damage in the building blocks of life. But on the other hand, that damage and aging itself is modifiable.
It should be mentioned that Dr. Kirkland is one of more than 100 investigators from across the U.S. and Europe who are members of the Geroscience Network, which he formed and which is seeking to accelerate the pace of discovery in developing interventions to delay, prevent or treat chronic diseases as a group, instead of one at a time (Forliti, 2016).
What is Successful Aging?
Successful aging seems like an oxymoron, whereby aging can convey loss, decline, weakness and death and success can be defined in terms of gains, victory, strength and achievement. One notion as to what “success” means relative to successful aging is found in Rowe and Kahn’s (1997) definition of successful aging:
Successful aging is “the ability to maintain three key behaviors or characteristics: Low risk of disease and disease-related disability; high mental and physical function; and active engagement in life” (Rowe & Kahn, 1997, p. 38).
It is important to note that while it has made a meaningful contribution to the literature on successful aging, Rowe and Kahn’s definition is not without critics. In fact, there is considerable controversy that swirls around the theory and practice of successful aging.
As with the other terms and concepts presented, Rowe and Kahn’s definition of successful aging is not the only one. For example, Vaillant & Mukamal (2001) contend that successful aging is best viewed from three dimensions, that is, decline, change, and development. They concede that the term “aging” can suggest decline, which is not successful. As they point out:
After age 20 our senses slowly fail us. By age 70 we can identify only 50% of the smells that we could recognize at 40. Our vision in dim light declines steadily, until by age 80, few of us can drive at night; by age 90, 50% of us can no longer use public transportation (Vaillant & Mukamal, 2001, p. 839).
However, Vaillant & Mukamal (2001) also contend that the term “aging” can convey change. They describe it this way:
Analogous to the transformation of trees from spring to winter, our hair changes from chestnut to white, our waistline becomes portly, our eyes acquire crow’s feet, and our frequency of making love shifts from three times a week to twice a month. But equally important, our ability to love and be loved does not diminish with age. At the beach we pick up grandkids instead of sweethearts, but our capacity for joy is undiminished (Vaillant & Mukamal, 2001, pp. 839-840).
Finally, from a successful aging perspective, Vaillant & Mukamal (2001) assert that the term “aging” represent development and maturation. They offer the following to explain what they mean:
Analogous to a grand cru wine evolving from bitterness to perfection, at 70 we are often more patient, more tolerant, and more accepting of affect in ourselves and others. We are more likely to tolerate paradox, to appreciate relativity, and to understand that every present has both a past and a future. Adults, like toddlers, can lose millions of neurons even as their cognitive skills evolve, and the midline laminar bundle linking the limbic brain to the frontal lobes evolves until age 50. Finally, like age itself, experience can only increase with time (Vaillant & Mukamal, 2001, p. 840).
Compression of morbidity hypothesis. A concept that turns-up in the conversation on successful aging is the compression of morbidity hypothesis proposed by James Fries (1980). Moderating age-related suffering is central to the hypothesis. Specifically, Fries (1980) hypothesized that if the start of chronic disease can be delayed, then the period of infirmity from the onset of chronic disease to death can be shortened (Fries, 1980). From a successful aging perspective, the goal would be to shorten the period of long-term disability and suffering so that a person can live disease- and illness-free for as long as possible.
The concept of aging successfully represents a paradigm shift in the narrative on aging. It is a shift from pessimism to optimism. It is a shift from viewing aging as a pathogenic process confined to old age to one of viewing it as a lifelong dynamic process beginning at birth and extending over the lifespan. It is a shift from aging as a disease process to aging as a modifiable risk factor for disease. It is a shift from relinquishing personal responsibility for one’s health to taking responsibility for it. It is also a shift from recognizing genetics as the driving force in aging to emphasizing diet and lifestyle as factors moderating aging as a risk factor for disease, among other shifts in emphasis mentioned above.
Good News and Bad News
Notwithstanding the theoretical, technological and therapeutic advancements in aging, the truth is that the biology of aging remains one of the more unsolved mysteries of science. Death is still a biological inevitability. The life span is finite. There are no groups of people who live beyond the expected maximum life span of about 120 years. Back in 2002, of the planet’s six billion people, no more than 25 were more than 110 years old (National Institute of Health, 2002). Finally, scientists have not discovered how to short-circuit the physiological limits of aging and make achieving maximum life expectancy as common place as reaching average life expectancy (Moody, 2010). That is the bad news.
The good news is that there is now an extensive body of scientific evidence to suggest that manipulations of genetic and environmental factors can alter life expectancy and maximum life span and it is possible to postpone or even reverse the process of biological aging. Furthermore, there is compelling evidence to suggest that most of the chronic diseases of aging are not necessarily pre-programmed genetically and are more a function of environmental factors such as lifestyle. As the saying goes, genetics loads the gun and lifestyle pulls the trigger.
As a practical matter, immortality and eternal youth are not likely to be realized any time soon. However, people can live to average life expectancy and beyond with quality of life and minimum morbidity or otherwise achieve successful aging if they have a basic understanding of what age and aging are, know what constitutes successful aging and practice proven dietary, nutritional and lifestyle principles, which possess the potential to de-accelerate aging, delay disease and defer death to a later time in the life cycle.
Bulterijs S et al. (2015). It is time to recognize biological aging as a disease. Front Genet 6, 205.
Cicero, M.T. & Powell, J. G. F. (1988). Cato maior de senectute. Cambridge [Cambridgeshire]: Cambridge University Press.
Forliti, M. (2016, August). Mayo clinic, collaborators working to advance aging research. Retrieved from http://newsnetwork.mayoclinic.org/discussion/mayo-clinic-collaborators-working-to-advance-aging-research/.
Fries, J.F. (1980). Aging, natural death, and the compression of morbidity” New England Journal of Medicine, 303 (3): 130–135.
Gems D (2011). Tragedy and delight: the ethics of decelerated ageing. Phil Trans R Soc B, 366, 108-112.
Longevity Reporter, 2016. Aging is a disease and it is time to recognize it as such. Retrieved from http://longevityreporter.org/blog/2016/12/5/biological-aging-is-a-disease-and-it-is-time-to-recognize-it-as-such
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Moody, H. (2010). Aging: concepts and controversies. Pine Forge Press. Los Angeles, CA.
Nieuwenhuis-Mark, R.E. (2011). Healthy aging as disease? Frontiers in Aging Neuroscience, 3 (3), 1.
Vaillant & Mukamal (2001). Successful aging. American Journal of Psychiatry, 158, 839-847.
Zhavoronkov A, Bhullar B (2015). Classifying aging as a disease in the context of ICD-11. Front Genet, 6: 326.
Suggested Citation: Garko, M. G. (2018, June). Successful aging: A paradigm shift. Health and Wellness Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.