What is Optimal Aging? Models of Optimal Aging Wisdom and Optimal Aging Religiosity, Spirituality, and Optimal Aging Ars Moriendi ----- The Art of Dying Optimal Aging Optimal aging is a relatively new concept. It is more than just good health; it must include notions of adult development as well. The term optimal aging allows for the recognition that there may be different ways of aging well, that people start with different configurations of vulnerabilities and resources that affect how they age. Models of Optimal Aging Rowe and Kahn’s Model of Successful Aging Vaillant’s Model of Aging Well Rowe and Kahn’s Model of Successful Aging Rowe and Kahn’s Model has three components: 1. Avoidance of disease (no genetic disease) 2. Maintenance of high cognitive and physical function 3. An active engagement with life Rowe and Kahn’s Model 1. Avoiding disease and decelerating the aging process Three critical elements in the prevention of chronic illnesses in late life: 1) Avoidance of toxins (smoking, excessive alcohol consumption, substance abuse and UV radiation) 2) Good nutrition (carbohydrates, fat and protein, vitamins, caloric restriction?) 3) Exercise (moderate and different exercise?) Rowe and Kahn’s Model (cont) 2. Maintenance of high cognitive and physical function Good diet, exercise and avoiding toxins Good exercise programs can improve cardiopulmonary and musculoskeletal function even in old-old and very frail elders. Exercises should not only include physical activity but cognitive activity as well (playing cards, crossword puzzles) Card number game: Using +, -, x, and ÷ to get 24 with these four cards. Card number game: Using +, -, x, and ÷ to get 24 with these four cards. Rowe and Kahn’s Model (cont) 3. An active engagement with life – as a high level of social support and productive work (Rowe and Kahn, 1998) Social support and good mental and physical health. Caregiving from family and friends can help to mitigate disability and allow elders to remain in the community. Older adults also engage in organized volunteer work. How could the volunteer work help themselves? Vaillant’s Model of Aging Well Vaillant’s Model includes six criteria: Three physical health criteria: 1. No physical disability at age 75 (physician-rated) 2. Good subjective physical health (no problem with IADL) 3. Length of undisabled life Three social engagement and productive work criteria: 1. Good mental health (interviewed-rated: career, …) 2. Objective social support (marriage, children, …) 3. Self-rated life satisfaction in 8 domains (marriage, income-producing work, …..page 310) Vaillant’s Model of Aging Well (cont) 3. Self-rated life satisfaction in 8 domains: 1) marriage 2) income-producing work 3) children 4) friendship and social contact 5) hobbies 6) community service activities 7) religion 8) recreation/sports All these six criteria derived from three longitudinal studies (Vaillant, 2002) on page 310. Vaillant’s Model of Aging Well (cont) Four coping strategies: 1. Altruism - is selfless concern for the welfare of others. It is a traditional virtue in many cultures, and a core aspect of various religious traditions, 2. Humor – the ability not to take oneself too seriously. 3. Sublimation – artistic creation to resolve conflict and spinning straw into gold. 4. Suppression – a stiff upper lip, patience, seeing the bright side. http://www.applehollow.com/rumple.html Wisdom and Optimal Aging Wisdom – a deep understanding and realizing of people, things, events or situations, resulting in the ability to choose or act to consistently produce the optimum results with a minimum of time and energy. Wisdom is a multidimensional construct including 3 domains: 1. Cognition – perspicacity or insightfulness. 2. Personality – ego process (emotional balance, detachment, and integrity). 3. Interpersonal process – justice, generosity, and compassion. Wisdom and Optimal Aging (cont) Relationship of these 3 domains in wisdom: They are not separate but rather support and inform each other in the wise person, such as the ability to be calm and detached can facilitate both perspicacity and moral behavior. Wisdom may be contextual (depending on the domain of knowledge) and culturally specific. Wisdom has an action component which should be focused on long-term goals rather than immediate gain or gratification. Wisdom and Optimal Aging (cont) Vaillant (2002) summarized the definitions of wisdom from his Harvard survey study: 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 or selfabsorption The capacity to “hear” others say Perspective, sense of the larger context of life, realization of two sides to everything, nothing is black or white. Patience, Sense of the irony of life. A sense of the connectedness of all things. Wisdom and Optimal Aging (cont) How does wisdom affect optimal aging? Wisdom is opposite of narcissism (self-absorption and attachment to desire). The losses and problems in late life results in increase in narcissism, but wisdom is a recipe for despair and social isolation (page 315). Snowdon (2001) provided a humbling example from his Nun study on page 316. What did you learn from this story? Religiousness, Spirituality, and Optimal Aging Koening et al. (1997) found that religious attendance was negatively related to depression; however, listening to or watching religious radio or television programs was positively related to depression, while private prayer and Bible reading were apparently unrelated. Religiosity and mental health: Hood et al. (1996) stated that “… faith buttresses people’s sense of control and self-esteem, offers meanings that oppose anxiety, provides hope, sanctions socially facilitating behavior, enhances personal well-being, and promotes social integration. Religiousness, Spirituality, and Optimal Aging (cont) Religiosity and physical health (a complex relationship): Religious service attendance is often correlated with good health to participate in social activity in late life. Many religions have restrictions that can promote good health behavior, such as banning smoking, alcohol and eating meat. Participation in organized religion also provides a course of social support. Religiousness, Spirituality, and Optimal Aging (cont) Stronger religious belief was a predictor of positive affect among caregivers under chronic stress (Rabbins et al., 1997). However, religiosity may not be an absolute requirement for optimal aging. Do you agree with this statement? If wisdom is a sine qua non for successful aging, one must ask whether religiosity is necessary for the development of wisdom. The answer is on page 318. Ars Moriendi ----- The Art of Dying Ars moriendi ("The Art of Dying") is the name of two related Latin texts dating from about 1415 and 1450 which offer advice on the protocols and procedures of a good death, explaining how to "die well" according to Christian precepts of the late Middle Ages. “How we die” is the final chapter of the life. In the late life, death is much more likely to be a slow and gradual process so that older people in their very late life can prepare financially, emotionally and spiritually (ex after hospice training on page 319). The Art of Dying (cont) Hospice and palliative care have had a positive impact on the way in which people die. Most people prefer to die at home (King et al., 2000). Why? Death may be welcome in very late life. People who have outlived spouses, friends, and even children may feel that it is “their time to go”. Most cultures have some concept of what constitutes a good death (examples of Irish culture and Buddhist monks on page 320). The Art of Dying (cont) Witnessing the death of others can be deeply spiritual experience. Elders who believe in an afterlife often speak of rejoining their loved ones, which helps to mitigate their fear of death. Even those without such beliefs, may feel that they are old enough, that they have done what they wanted to do, and therefore, accepted their imminent deaths. Wisdom helps us face death. What did you learn from this chapter?