Albert Einstein, Eubie Blake, Georgia O'Keeffe, Brooke Astor, Bob Hope. It is common to hear that people such as these, who live vital lives into their eighties and nineties, somehow have beat overwhelming odds to achieve a fulfilling old age. The bleak assumption about old age is that it dooms us to being lonely, sick and unproductive. In an effort to develop an empirically based "new gerontology" that moves from such outdated myths about aging to reflect the realities of successful aging today, the MacArthur Foundation Study of Aging in America conducted a wide range of research projects led by an array of scholars. The results of the study, presented in Successful Aging by physician John Rowe of Mount Sinai Hospital in New York and psychologist Robert Kahn of the University of Michigan, show that far from being doomed to inevitable decline, the vast majority of older people maintain their health, enjoy good quality of life and contribute substantially to society well into old age.
By examining how older members of our society actually live and looking at what we can learn from people who age successfully, the research study shifted the focus away from the deficits experienced in aging to the factors that permit individuals to function effectively, both physically and mentally, well into old age. The findings debunk many common myths about aging.
MYTH: Illness, declining mental capacity and disengagement from life are inevitable. The research found that a high percentage of aging respondents were mentally and physically healthy and actively engaged in life. Only 21 percent had any significant disability, only 10 percent showed significant signs of dementia and only 5 percent lived in institutional settings. In contrast, 39 percent view their health as very good or excellent.
MYTH: Genes determine our experience of aging. The MacArthur study reveals that lifestyle choices, not genetics, most powerfully determine how people age. Diet, exercise, mental stimulation, a sense of self-efficacy and connection to others emerged as key factors in maintaining high function and being content in life. In a study of twins designed to identify the specific effects of heredity and environment, only 30 percent of the quality of life was determined by genes lifestyle and environment were the major determinants of how the elderly aged physically. The research shows that even the likelihood of developing genetic-related diseases, such as cancer and heart disease, is powerfully affected by lifestyle and environment. In addition, lifestyle far outweighs genetics in determining whether the elderly maintain high physical and mental function and active engagement in life, two key characteristics of successful aging.
The study also looked at the impact of specific lifestyle choices on the experience of aging. Inactivity, for example, emerged as more harmful than the combination of smoking and exercising regularly. Beginning regimens of good diet, exercise and health-related behaviors, such as stopping smoking and losing weight, at any age appears to improve the quality of life and experience of aging.
Social supports connections to family and friends not only have positive effects on health, but also buffer the effects of aging when illness does strike. Instrumental support (having meals prepared or the house cleaned) was not as important as emotional support in maintaining physical functioning, however.
Interesting trends also emerged in looking at the relative quality of life among the elderly. Those with incomes over $10,000, those who were more physically fit (as measured by lung capacity) and those who participated in moderate or strenuous physical activity generally reported better quality of life than others. Those with high mental functioning were more likely to retain physical functioning as well. A sense of self-efficacy also proved vital to successful aging.
MYTH: The elderly are not productive. The MacArthur study shows that this myth derives in part from where we look. Our studies of productivity typically only consider employment, ignoring the variety of other contributions made by the elderly. As Rowe and Kahn point out, a service carried out by an employee in a hospital is not typically considered productive activity when done in one's home for other family members. The MacArthur research redefines productive behavior as any activity, paid or unpaid, that generates goods or services of economic value. Using this broader notion, the study found that most older people continue to do substantial productive work throughout their lives. More than 40 percent of the elderly report at least 1,500 hours of productive activity a year. Only 2 percent report not engaging in any productive activity. Providing informal help to friends and relatives reaches its peak among individuals aged 55 to 64, and even individuals aged 75 and over often still provide the same level of help to others as people half their age.
The MacArthur study challenges our myths and assumptions about aging. As therapists, we need to recognize the contributions made by our elderly clients and pay attention to the kinds of productive activity in which older people engage. We can educate our clients young and old about the realities of the "new gerontology" and successful aging. Without glossing over the difficulties older people face, therapists can help elderly clients identify their strengths, realize the extent of their contributions (which often go unrecognized) and develop ways to maximize their chances of aging successfully. Therapy approaches aimed at improving self-efficacy and social connection appear to fit particularly well with promoting successful aging. Finally, we should remember that psychotherapy offers a potentially life-enhancing contact for older adults.
The MacArthur study shows us that being old does not necessarily mean fading away. Far from demonstrating that older people can only benefit from medication to ameliorate their symptoms, the study underscores the fact that most of society's elders are not drains on their communities, but active contributors to the well-being of others.
This blog is excerpted from "Aging: Fact and Fiction," by Jay Lebow. The full version is available in the July/August 1998 issue
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