Last week, my wife and I visited Boston where I spoke to members of the IT Department at the Joslin Clinic, a world-renowned Diabetes Clinic since 1898, and the Massachusetts Medical Society, the oldest state medical society in America. Beaumont native, Jeff Reimers, visited us from his studies at Yale University, during which we spent several pleasant hours touring the campus and bookstore at Harvard University. One of the books I purchased is entitled Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development by George E. Vaillant, MD, director of the Harvard Study of Adult Development and professor of psychiatry at Harvard Medical School.
Longitudinal Study
This is a fascinating book because it is founded upon one of the longest "longitudinal studies" every done. "Longitudinal" refers to a study done on the same subjects over a period of time. All of the participants in this study have participated for six to eight decades - that's sixty to eighty years! The original researchers are not alive today and such a study requires not only incredible funding, but the assumption of the study by future generations of researchers, not to speak of extremely cooperative participants.
The summary of this study reads like a best-selling novel, it is so engaging. For SETMA, as we continue the development of our Lifetime Health and Wellness program, built upon the solid foundation of an excellent, multi-specialty, electronically-based, integrated healthcare delivery system, this study adds fuel to the fire of our passion to develop systems and disease-management tools to help Southeast Texans live well all of their lives. Rejecting the superficial approach to simply try to make people "look" better, SETMA has adopted the approach of helping you "be" better, while you make efforts to "look" better.
"Six Variables That Did Not Predict Healthy Aging"
Surprisingly, the Harvard Study found that the following six variables were not associated with healthy aging:
- Ancestral longevity
- Cholesterol
- Stress
- Parental characteristics
- Childhood temperament
- Vital Effect and General Ease in social relationships
"Seven Factors that Did Predict Healthy Aging"
The following factors did contribute to aging well.
- Not being a smoker or stopping young
- Adaptive coping style (mature defenses)
- Absence of alcohol abuse
- Healthy weight
- Stable Marriage
- Some exercise
- Years of education
To be sure that it is not lost on you, look at these two lists again. Do you see what is characteristic of them? Every variable which contributes to "aging well" is "changeable." All of the variables which we have thought were critical to "aging well," most of which are not "changeable" are actually, as demonstrated by this longest of all studies of the aging process, not contributory to longevity and "aging well."
Now, before we "throw the baby out with the bath water," don't think that you don't need to know what your cholesterol, LDL, HDL and sometimes your Lpa values are. You do. But, the lessons of the work which Dr. Vaillant has continued let us know that these variables are not the most important factors in our quest for a long, healthy, happy and productive life.
We can change
In his book, Dr. Vaillant opines, "In a world that seems ruled by genetic predestination, we need hope that we still can change." As to whether change matters, the following observations have been drawn from the Harvard study:
- It is not the bad things that happen to us that doom us; it is the good people who happen to us at any age that facilitate enjoyable old age.
- Healing relationships are facilitated by a capacity for gratitude, for forgiveness, and for taking people inside. (By this metaphor I mean becoming eternally enriched by loving a particular person.)
- A good marriage at age 50 predicted positive aging at 80. But surprisingly, low cholesterol levels at age 50 did not.
- Alcohol abuse unrelated to unhappy childhood consistently predicted unsuccessful aging, as part because alcoholism damaged future social supports.
- Learning to play and create after retirement and learning to gain younger friends as we lose older ones add more to life's enjoyment than retirement income.
- Objective good physical health was less important to successful aging then subjective good health. By this I meant that it is all right to be ill as long as you do not feel sick.
The Last Two Decades of Life - The Challenges
Aging well presents the following challenges to all of us, according to Dr. Vaillant. The following are four critical components of the last two decades of life, whether those are the eighth and ninth, the sixth and seventh, or the seventh and eighth decades of one's life. Those components are:
- "Being ill without felling sick" - this does not so much refer to not being nauseated but to not majoring on illness but on life.
- Regaining a capacity for creativity and play in retirement -- I experienced this recently as I watched my own father in his ninth decade of life, three weeks after a near-death experience with acute illness, get down on the floor with his six-year-old granddaughter laughing and playing games. This ended up with his sitting and braiding her hair. His spontaneous joy and amusement with life is a gift to his family and is a contributor to his "aging well."
- "The acquisition of wisdom" - Perspective on life should be the result of having lived life and that perspective should offer guidance and instruction for those who follow. This is wisdom.
- "The Cultivation of spirituality" - Seeing life beyond the physical, which is one of the elements of "spirituality," promotes healthy aging as it encourages the focusing on how well you live rather than how long you live.
Four Personal Qualities - Leaving the Screen Door Unlatched
In the Harvard study, of those who "aged well," the best exhibited four personal qualities that are subjective but real:
- Future orientation - the ability to anticipate, to plan and to hope
- A capacity for gratitude, and forgiveness, the capacity to see the glass of life as half-full, not half empty. Put differently, Thanksgiving is not "just another day" and paranoia and injustice collecting can destroy old age.
- Being able to imagine the world as it seems to the other person, the capacity to love and to hold the other empathically - but loosely.
- The desire to do things with people, not to do things to people or ruminate that they do things to us.
All of this relates to the desire and ability to "invite people into" our lives, much like one successful participant in the Harvard study who always "left the screen door unlatched" on her front door so as to facilitate the inviting of people into her home and heart.
Positive Aging
Finally, Dr. Vaillant summaries the elements of "aging well" in what he terms a "third pass" at summarizing the lessons of the Harvard Study. He said, "In this book, I have repeatedly highlighted 75- to 80-year old Study members with the following characteristics":
- She cares about others, is open to new ideas, and within the limits of physical health maintains social utility and helps others. Unlike King Lear who demanded that his daughters take care of him, she remembers that biology flows downhill.
- He shows cheerful tolerance of the indignities of old age. He acknowledges and gracefully accepts his dependency needs. When ill, he is a patient for whom a doctor enjoys caring and remembers to be grateful. Whenever possible he turns life's lemons into lemonade.
- She maintains hope in life, insists on sensible (autonomy to do for herself what one is able), and cherishes initiative. She remembers that all life is a journey and that development goes on for all of our lives.
- He retains a sense of humor and a capacity for play. He willingly sacrifices surface happiness for basic joys. As Voltaire suggested, he cultivates his garden.
- She is able to spend time in the past and to take sustenance from past accomplishments. Yet she remains curious and continues to learn from the next generation.
- He tries to maintain contact and intimacy with old friends while breeding Anne Morrow Lindbergh's injunction that "the seeds of love must be eternally resown."
Very often, we focus so much on living long, that we don't give full attention to living as long as we are alive. Those who age well and consequently who often live longer, are those who adapt to each age gracefully, creatively and positively.
As we attempt to preserve our health and our life, we need to focus as much on making a life, all of our life, as we do on trying to extend the length of our lives. Additionally, while everyone wants to "look" as well as they can, our focus really needs to remain on "being" as well as we can. Next week, we'll discuss the tasks of aging and what we can do to make certain that we successfully accomplish the tasks at each stage of our lives.
It is important for it is your life - as well as your living - and it is your health.
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