Friday, May 31, 2013

Successful aging protects health and wealth


May 31, 2013, 7:01 a.m. EDT

‘Successful aging’ protects health and wealth

Strategies to reduce the impact of late-in-life illnesses

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Gerontologists, researchers who focus on life’s later phases, increasingly like to talk about “successful aging.” A skeptic could be forgiven for reacting negatively to that terminology and thinking, “I work hard all my life and now you tell me I have to excel at growing old?”
But the question of successful aging holds real implications for people’s health and wealth. Those who can avoid or postpone admission to a nursing home will enjoy a better quality of life. They’ll also run less risk of outliving their nest eggs, since Medicare doesn’t pay for long-term care. Dementia—perhaps the most feared condition of older age—costs the country $157 billion to $215 billion annually, more than cancer or the country’s leading killer, heart disease, according to a recent study by the Rand Corp.
Most of us aspire to independence in our golden years, but how much control do we really have over how we age? Put another way, how much responsibility do we have to make sure we do it right? Plenty, according to experts.
Successful aging traces its roots back to the concept of “morbidity compression.” Introduced more than 30 years ago by Dr. James Fries, a professor at Stanford University School of Medicine, the hypothesis states that if a person develops his first chronic illness at a later age, then his period of infirmity will be squeezed into a shorter period closer to death (assuming that his longevity doesn’t increase by long enough to erase the advantage). The results, ideally, would include less time spent suffering, and less money spent treating one’s medical problems.
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As intuitive as it sounds, “it’s simplistic to say it’s easy,” said Dr. Fries, now an emeritus professor of medicine at Stanford. (For one, Fries noted, the country’s obesity epidemic will challenge our ability to accomplish this goal.) But while genetics do play a role, studies show that common-sense moves like exercising and eating well really can help us stay healthier for longer. And the earlier we start, the better. “The seeds of successful aging are planted in middle adulthood,” said David M. Almeida, professor of human development at the Center for Healthy Aging at Penn State University.
Almeida’s research has focused on how people’s responses to daily stressors—like a fight with a spouse or an unexpected traffic jam—affect their long-term health. One study studied the stress responses of subjects ages 30 to 60, who reported no chronic conditions at the start, over a 10-year period. Those who experienced a more negative reaction to stress were more than twice as likely to develop a chronic condition such as heart disease, high blood pressure, or arthritis. The study controlled for socio-economic status, education, income, and parental status but not genetics. People can’t change their genes or the temperament they’re born with, but those who tend to internalize stress can recognize that and use physical exercise and social support to help cope, Almeida said.
Losing weight—or better yet, not gaining excess weight in the first place—can help people ward off a host of maladies from heart disease to diabetes. The latter, a potentially devastating condition in itself, can double one’s chances of developing Alzheimer’s, said Dr. Gary Small, director of the UCLA Longevity Center and author of the book “The Alzheimer’s Prevention Program.” The book outlines steps people can take, from exercise to nutrition to memory training, to help keep the dreaded disease at bay.
There’s no cure for Alzheimer’s, and there’s no easy test that shows a person’s likelihood for developing the disease. Yet brain scans can reveal early signs of Alzheimer’s long before symptoms appear. The goal, Dr. Small said, is to delay the onset of Alzheimer’s dementia--the stage when the disease impairs people’s daily functioning—for as long as possible. If someone’s healthy habits can buy her a few more symptom-free years, she might die of another, less debilitating cause before developing dementia, the thinking goes.
To be sure, we can only control so much. Genetics account for roughly one-third to one-half of our longevity, experts say. Most people have a variety of so-called health profiles in their family—the grandma who lived to be 100 and the uncle who died of a heart attack at half that age. The question then becomes, “Whose genes do I have?” said Dr. Albert Wu, a professor at the Bloomberg School of Public Health at Johns Hopkins University and the director of the Center for Health Services and Outcomes Research there.
The actress Angelina Jolie made headlines earlier this month when she reveled she had undergone a preventative double mastectomy after learning she carried a gene mutation that was very likely to lead to breast cancer. Few diseases have such clear markers, Wu said, and until science develops most people won’t have the benefit of such reliable information when they look toward their futures.

Clarity for caregivers

Many boomers worry about becoming a burden to their families in old age. While most of us can’t control whether we’ll ultimately need help toward the end of life, we can ensure that we communicate our wishes before that stage arrives, said Stephen S. Hanson, associate professor of philosophy and a faculty member of the department of family and geriatric medicine at the University of Louisville. This in turn can lessen the burden on caregivers.
Hanson, who has worked as a hospital ethics consultant, has seen family members struggle with the type of medical interventions to recommend for terminally ill loved ones who have never communicated their wishes. “We don’t want to talk about death and severe illness,” he said. There are tools to help facilitate such conversations, Hanson said, such as the Go Wish cards developed by the Coda Alliance, a nonprofit organization in California. Each card is printed with a wish, such as to be free of pain, and patients’ ranking of their priorities can help family members learn what is most important to them.
Some argue that as a society, we focus too much on physical health in our definition of successful aging. We lionize the person living alone at 95, and while that’s certainly laudatory, we could also celebrate those who remain connected to their communities despite their infirmities, or those who have saved enough to afford whatever care is needed. “Dependency doesn’t necessarily mean lack of success,” said Russell Woodruff, assistant professor of philosophy at St. Bonaventure University in St. Bonaventure, N.Y. who teaches a course on the philosophy of aging.
Bottom line? When it comes to healthy aging, let’s control what we can and try not to worry too much about the rest. “Once you get to a certain point,” Almeida said, “biology just takes over.”
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