Successful Aging: A Paradigm Shift

Successful Aging: A Paradigm Shift

 Michael Garko, Ph.D.

Nationally Syndicated Host & Producer – Let’s Talk Nutrition

 

Suggested Citation: Garko, M. G. (2016, November).  Successful aging: A paradigm shift. Health and Wellness Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.

 

Introduction

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 far more hopeful and compatible with the successful aging model.

The March, 2017, edition of Health and Wellness Monthly is to discuss 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 disease operating across the lifecycle. Age, aging and successful aging are discussed. There is also a discussion contrasting the aging gracefully and successful aging models, with the former being part of the long standing paradigm of aging featuring genetics and the latter being part of a paradigm shift emphasizing the importance of diet and lifestyle, among other differences between the two. A brief discussion on the compression of morbidity hypothesis is also presented.

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 classifying normal aging as a disease (see Nieuwenhuis-Mark, 2011).

In contrast, an optimistic narrative of aging sees it as a gradual and dynamic process beginning at birth and 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 live can 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.

 

What is Age?

Age can be conceptualized in at least two ways: Chronological age and biological/functional age. Chronological age is simply the passage of time. It measures how much time has lapsed since birth. Time is incapable of producing biological effects. Chronologically speaking, average life expectancy in the U.S. is 77.9 (78) years for the 2005 cohort.

 

Biological age is determined by physiological rather than chronological factors

Indicative of changes in physical structure, performance of motor skills and sensory awareness. Biological age often occurs at a different rate than chronological age and occurs at a different rate in different people. For example, it is possible for a person to be 60 years of age chronologically but 45 years of age biologically or vice versa.

 

What Is Aging?

It is not being argued that aging is a damage-free process divorced from death.

On the contrary, aging can be viewed as “the accumulation of random damage in the building blocks of life – especially to DNA, certain proteins, carbohydrates and lipids – that begins early in life and eventually exceeds the bodies’ self-repair capabilities” (Olshansky, Hayflick & Carnes, 2002).

 

Point for Discussion: This is not the only formal definition of aging. This particular definition was selected because it is often cited in the literature and can serve as a starting point for other definitions that the class may have in mind and would like to share in the discussion.

 

As you know, most patients/clients probably do not think about aging in such a formal way. Rather, they construe it in ways that they experience as they move through the lifecycle. Here is a partial list of aging features, which seems to represent how some often think of aging:

 

  • Things we want to remain supple become hard (e.g., arteries)
  • Things we want to remain firm become soft (e.g., muscles)
  • Things we want to keep we lose (e.g., hair, hearing, eyesight)
  • Things we want to lose we keep (e.g., weight)
  • Things we want to remain smooth wrinkle (e.g., skin)
  • Things we want to go up go down (e.g., energy levels, libido)
  • Things we want to go down go up (e.g., inflammation, blood pressure, cholesterol, homocysteine)
  • Things we want to stay moist go dry (e.g., skin, mucous membranes)
  • Things we want to stay thick get thinner (e.g., bones, skin, hair, nails)

 

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).

 

 

 

Graceful Aging Model vs. Successful Aging Model

One often hears someone commenting on how gracefully another is aging. I often wondered what that really meant. The more I thought about it, the more the idea of aging gracefully appeared limiting and uninspiring and saw the successful aging model as more empowering. I view the graceful aging model as part of the paradigm of aging. While it is not blatantly pessimistic, it is disempowering.

Below is a contrast of the two models, at least as I see it.

 

Graceful Aging Model

  • Promotes a bystander/onlooker approach to aging by placing too much emphasis on genetic endowment and not enough focus on environmental factors such as diet, nutrition and lifestyle
  • Lulls a person into believing that his/her genes will carry the day
  • Considers aging gracefully and not being sick during old age as a matter of genetic good luck
  • Aging confined to the later stages of the lifecycle
  • Implies that a person is not as youthful looking as he/she once was

 

Successful Aging Model

  • Promotes an active participant approach to aging
  • Aging viewed as a life-long process
  • Encourages and empowers the individual to take charge of his/her health
  • Makes personal responsibility essential for health
  • Aging not conceived of as disease but as modifiable risk factor for disease
  • Diet and lifestyle recognized as accounting for most of variance of and instruments for successful aging

 

Point for Discussion: What are some other ways in which the two models differ? On the other hand, you may believe that there really is no difference and that it is a false contrast.

 

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.

 

Point for Discussion: Is it realistic to believe that morbidity (i.e., the condition of being afflicted with disability or infirmity from disease) can be compressed? If so, what are some of the ways by which morbidity can be compressed?

 

Conclusion

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 lifestyle and nutritional principles, including dietary supplementation, which possess the potential to de-accelerate aging, delay disease and defer death to a later time in the life cycle.

 

References

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.

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.

 

Suggested Citation: Garko, M. G. (2016, November).  Successful aging: A paradigm shift. Health and Wellness Monthly. Retrieved (insert month, day, year), from www.letstalknutrition.com.