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The ecology of optimal aging. Larry W Lawhorne, MD Professor and Chair, Department of Geriatrics Wright State University Boonshoft School of Medicine Dayton, Ohio. AP Story on a dayton TV Website 1/12/2010.

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the ecology of optimal aging

The ecology of optimal aging

Larry W Lawhorne, MD

Professor and Chair, Department of Geriatrics

Wright State University

Boonshoft School of Medicine

Dayton, Ohio

ap story on a dayton tv website 1 12 2010
AP Story on a dayton TV Website 1/12/2010

A famed strongman - once lifted 3,200 pounds and still bending quarters with his fingers at age 104 - died Monday after he was hit by a minivan.

Joe Rollino was struck as he crossed Bay Ridge Parkway in Brooklyn and died a few hours later at the hospital.

“I ain’t a religious person, but Hazel, she comes in and prays for me. I been good to people. I never hurt nobody.”
Because…aging, optimal or otherwise, is a complex ecological phenomenon in which observed variations are driven by any number of ever-changing factors.

From the Greek: οἶκος, "house"; -λογία, "study of."

The scientific study of the relationship of living organisms with each other and their surroundings.

my argument
My Argument
  • The 3 people I just described are examples of optimal aging.
  • Each has experienced a complex ecological phenomenon in which observed variations were driven by a number of ever-changing factors for 90 years.
  • With a thorough history, I can describe a complex ecological phenomenon for each of them in great detail, but where along the way would I have said, “This is optimal aging.”?
no surprise to you
No surprise to you…

Demographic transition

Patterns of high fertility and high mortality rates  Patterns of low fertility and delayed mortality

Epidemiologic transition

Leading causes of death shifting from infectious disease and acute illness  chronic disease and degenerative illness

  • First big wave of Baby Boomers will turn 65 in about 1 year.
  • Number of Americans > 65:

3.1 million in 1900

36 million today

72 million in 2030

  • Number of Americans > 85:

4 million today and 20 million by 2050.

something studs didn t know
Something studs didn’t know

If the pace of increase in life expectancy in developed countries over the past two centuries continues, most babies born since 2000 will celebrate their 100th birthdays.

The Lancet, 3 October 2009

the epidemiologic transition
The epidemiologic transition…

…means that many in this very large cohort of Americans marching toward 100 years of age will have multiple chronic degenerative medical and neuropsychiatric conditions.

ecologically speaking
Ecologically speaking…

One of the relationships between the aging, aged organisms in the population of Homo sapiens currently existing in the habitat known as the United States of America with younger organisms in the same habitat may be unsustainable.

a temptation
A temptation

To define, describe, work toward, commit resources to, etc making optimal aging synonymous with good health so that as we age,

  • We can remain productive in the work force
  • We can live well while we live long
  • We can postpone, dare we say, avoid death
  • We can move to Florida or at least winter there to continue to search for what this man could not find…
nobody gets out of here alive

Nobody gets out of here alive…

No matter how hard we try. And we try hard.

begging the question
Begging the question

Is the reason for this some breakdown in the plot of evolution, which seems to have come to a halt before completing the work of making humans both perfect and immortal?

the book
The book
  • Aimed at Baby Boomers and an attack on self-help health efforts and on the belief that medical technology will save us all.
  • Contends that there are a number of doctors, scientists and others who get rich by selling the promise of a long and healthy life along with very expensive Ponce de Leon concoctions.
the book1
The book
  • Chastises Alzheimer’s researchers for giving us the false hope that cure is just around the corner.
  • Expresses anger with her generation of women by saying that they have ignored the plight of older women…women make up two-thirds of those over 85 and many are lonely and poor.
jacoby and many others

Jacoby (and many others):

Aging is primarily a women’s issue.

contrast with cicero s essay 65 bce
Contrast with Cicero’s Essay (65 BCE)
  • “On Aging” written in the form of a dialogue.
  • Old age brings about a diminution of physical stamina and the likelihood of disease…and of course moving closer to death.
  • But old age is also associated with the opportunity for the “study and practice of decent, enlightened living,” accompanied by a calm that youth, or even middle age, do not allow.
some recent publications
Some recent publications
  • Successful Aging (Rowe and Kahn, 1998)
  • Aging Well (Vaillant, 2002)
  • Aging with Grace (Snowdon, 2001)
successful aging macarthur study
Successful Aging(MacArthur Study)
  • High level of engagement with life.
  • Low risk of disease.
  • High physical and cognitive levels of function.
what of older adults are aging successfully if we use the macarthur criteria
What % of older adults are aging successfully if we use the MacArthur criteria?
  • High level of engagement with life.
  • Low risk of disease.
  • High physical and cognitive levels of function.
select the best answer
Select the best answer…
  • Less than 20%
  • 20 to 33%
  • 33% to 50%
  • Over 50% but less than 75%
  • Over 75%
select the best answer1
Select the best answer…
  • Less than 20%
  • 20 to 33%
  • 33% to 50%
  • Over 50% but less than 75%
  • Over 75%
another definition schmidt 1994
Another Definition(Schmidt 1994)

Successful aging: minimal interruption of usual function although minimal signs and symptoms of chronic disease may be present.

(Using this definition, about 50% of older adults age successfully.)

yet another definition baltes et al 1996
Yet Another Definition(Baltes et al 1996)

Successful aging: Doing the best with what one has.

(Achieving the highest practicable level of physical, mental and psychosocial well being.)

a problem with the term successful
A Problem with the term “Successful”
  • Implication is that there are winners and losers.
  • We don’t write off the “unsuccessful” ones!
  • Alternative terms suggested: healthy aging, aging well, effective aging, productive aging, and optimal aging.
self rated successful aging
Self-Rated Successful Aging
  • Strawbridge et al. The Gerontologist 2002; 42(6):727-733.
  • 867 older adults.
  • 50% self-rated as aging successfully but only 19% met MacArthur study criteria for successful aging.
areas explored in self rating
Best old age one could expect


Life turned out OK

More energy than most

Not depressed

Feel loved

Satisfied with relationships

Happy marriage

Perceived control

Affect balance

Lower cynical distrust

Areas Explored in Self-Rating
aging well
Aging Well

Pulls together data from 3 separate longevity studies (beginning in their teens, following 824 individuals for more than 50 years):

  • Male Harvard graduates
  • Inner-city, disadvantaged males
  • Intellectually gifted women.
aging well1
Aging well

The book beginswith an all-inclusive definition of aging that suggests decay,change, and continued growth. It ends with an admonition thatthe final "task of Integrity is acceptance of one’s oneand only life cycle as something that is to be and that permitsno substitutions."

george vaillant1
"Owning an old brain, you see, is rather like owning an old car.... Careful driving and maintenance are everything." George vaillant
david snowdon ph d
AGING WITH GRACE: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful LivesDavid Snowdon, Ph.D.
the nun study
The nun study
  • The School Sisters of Notre Dame in Mankato, Minnesota
  • 75 to 104 years old and agreed to donate their brain tissue after their deaths
  • High ability in written and oral expression correlated with a low rate of Alzheimer‘s
the nun study1
The nun study

Major factors in avoiding dementia or Alzheimer's:

  • Avid readers
  • Individuals involved in community affairs compared to more reclusive members of the order
  • Heredity, diet, and exercise
the nun study2
The nun study

Suggests that living a fulfilling and worthwhile life and altering our own lifestyles and those of our children so that old age need not be an inevitable slide into ill health and mental confusion, but instead, years of productivity in which intellectual and spiritual vigor and good health are retained.

  • More than “been there, done that”
  • More than “fundamental life pragmatics,” which include a rich factual-knowledge base and the ability to think contextually and relativistically
3 domains of wisdom
3 Domains of wisdom
  • Cognition
  • Personality
  • Interpersonal processes
3 domains of wisdom1
3 Domains of wisdom
  • Cognition
  • Personality
  • Interpersonal processes
cognitive component of wisdom
Cognitive component of wisdom

Insightfulness, which is based on knowledge and the ability to comprehend complex constructs and to use dialectical and relativistic modes of thinking

3 domains of wisdom2
3 Domains of wisdom
  • Cognition
  • Personality
  • Interpersonal processes
personality aspects of wisdom
Personality aspects of wisdom

Comprised of ego processes, including emotional balance, attachment, and integrity, which are all based on self-knowledge

3 domains of wisdom3
3 Domains of wisdom
  • Cognition
  • Personality
  • Interpersonal processes
interpersonal aspects of wisdom
Interpersonal aspects of wisdom

Focus on justice, generosity, and compassion…”character”

vaillant asked for a definition of wisdom
Vaillant asked for a definition of wisdom
  • Empathy, through which one must synthesize both care and justice.
  • Tolerance and a capacity to appreciate paradox and irony even as one learns to manage uncertainty.
  • Self-awareness combined with an absence of self-absorption.
  • The capacity to “hear” what others say.
vaillant asked for a definition of wisdom1
Vaillant asked for a definition of wisdom
  • Perspective, sense of larger context of life, realization that there are two sides to everything, nothing is black or white. Patience. Sense of irony of life.
  • A sense of connectedness of all things.
concluding remarks
Concluding Remarks
  • Maintaining good health is clearly desirable but not the most critical component of optimal aging.
  • Compensating for functional deficits and adapting to disability are key elements in optimal aging.
  • Developing the equanimity to face the adversity of disability in late life and achieving wisdom are the central components of optimal aging.
crossing to safety
Crossing to safety

I could give all to Time except – except

What I myself have held. But why declare

The things forbidden that while the Customs slept

I have crossed to Safety with? For I am There

And what I would not part with I have kept.

Robert Frost