Resilient AgingGregg Warshaw, MD
University of Cincinnati
OAGE ConferenceDayton, OhioMarch 28, 2014
Myth #1
To Be Old is to Be Sick
Self-rated Health
ADL/ IADL Limitations
National Health Interview Survey, 1999 data. CDC. NCHS.
> age 65 65-74 years > age 750
10
20 ADL Limitation
IADL Limitation
Per
cen
tag
eP
erce
nta
ge
Myth # 2
You Can’t Teach an Old Dog New Tricks
Myth # 3
The Horse is Out of the Barn
Myth # 4
The Secret to Successful Aging is to Choose Your
Parents Wisely
Myth # 5
The Lights May Be On but the Voltage is Low
Myth # 6
The Elderly Don’t Pull Their Own Weight
What is Aging?
Aging
Is not a diseaseOccurs at different rates•among individuals•within individuals
Does not generally cause decline in function or significant symptoms
Usual Aging
Functioning wellAT RISK for disease and disability
MOST older adults
Usual Aging: RISKS
Decline in reserves in organ systems
Decline in immune/recuperative power
Successful Aging. . .
If we can figure out how to get the Baby Boomers to arrive at old age in better shape:•Society’s health care costs will be reduced
•Life-long personal resources will be saved
•Families will be less burdened
Rowe & Kahn (1987)’s definition:
•Few or no age-related declines
•Implies that it is possible to reach advanced age relatively free of age-associated disease and functionally intact
•Paradigm shift, but number of persons experiencing this type of “successful” aging is minority
Successful Aging vs. Resilient Aging
Alternate definitions•“Minimal interruption of usual function”•“Doing the best with what one has”
Shifts the focus from minority to majority•Major differentiator: extent to which a person can have a chronic disease or functional disability and still be considered to be aging successfully
Schmidt (1994); Baltes & Carstensen (1996).
Resilient Aging
Avoid or manage chronic illness and disability
Engage independently or with support in most normal activities of daily living
Maintain cognitive functionAble to cope with physical, social, and emotional changes
Sense of control of life
Determinants of Successful Aging
Biologic Aging
Disease
Health Behaviors
Social Supports
Normal Physiologic Effects of Aging
Copyright © 2010 Pearson Education, Inc.
Determinants of Successful Aging
Biologic Aging
Disease
Health Behaviors
Social Supports
Determinants of Successful Aging
Biologic Aging
Disease
Health Behaviors
Social Supports
Lifestyle Choices
DietExerciseSmokingDrinking
Rather than seeking permission to exercise, you should have to get
permission to be sedentary.
Maria Fiatarone, M.D.
Source Undetermined
Source Undetermined
Benefits of Exercise
Weight loss•Decrease central adiposity•Increase lean body mass
Blood pressure decline Aerobic capacity increase Insulin sensitivity increase Increase bone mass Increase muscle strength Increase perceived well being
Determinants of Successful Aging
Biologic Aging
Disease
Health Behaviors
Social Supports
Social Factors
MarriageFamilyFriendsReligiosity WorkVolunteering
Resiliency Independently functioning
In good health at least to the age of ninety.
Few centenarians are obese
Substantial smoking history is rare
Source: Perls T., Silver M., Lauerman J, 1998
Centenarian Characteristics
Regular exercise Healthy diet Avoid tobacco Alcohol in moderation Correct use of medications Screen for disease and treat early
Education about caring for illnesses
Strengthen social network
Health Promotion Needs to be a Major Focus
for Geriatrics/Gerontology Professionals
Prevention of premature death Delay of the onset of chronic diseases Postponement of disability related to chronic diseases
Higher quality of life Greater participation in the life of the family and community
Reduction in medical care costs, especially hospitalization and nursing home costs
Reasons for Geriatrics/Gerontology Professionals to
Focus on Health Promotion/Disease Prevention
Longevity is a splendid trend in the United States
Successful, resilient aging is complex Exercise, Exercise, Exercise Achievements of centenarians demonstrate that physiologic aging can allow for late life independence, productivity, and pleasure
To Summarize…
“Age is not a particularly interesting subject. Anyone can get old.
All you have to do is live long enough.”
—Groucho Marx (1890-1977)
