Larry W Lawhorne, MD
Professor and Chair, Department of Geriatrics
Wright State University
Boonshoft School of Medicine
Dayton, Ohio
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.
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Optimal aging is
difficult to define or
even describe.
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“Go get it for him.”
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“I ain’t a religious person, but
Hazel, she comes in and prays
for me. I been good to people.
I never hurt nobody.”
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“I think I’m still a person other
people want to know.”
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Why do these three people,
separated in time and space,
come to mind when I think of
optimal aging?
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Because…aging, optimal or
otherwise, is a complex
ecological phenomenon in
which observed variations are
driven by any number of everchanging factors.
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From the Greek: οἶκος, "house"; -λογία,
"study of."
The scientific study of the relationship
of living organisms with each other and
their surroundings.
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 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.”?
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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
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 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.
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Who wants to live to be 100?
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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
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…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.
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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.
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Year
Workers / Social
Security recipient
1946
1960
1972
2011
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10
8
3.3
2030
1.5
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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…
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No matter how hard we
try. And we try hard.
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?
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Susan Jacoby
Published by Pantheon
 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.
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 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.
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Aging is primarily a
women’s issue.
She makes some good points,
but…
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 “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.
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A trend: Not just good health in old
age, but “positive” adult
development.
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 Successful
Aging (Rowe and Kahn, 1998)
 Aging
Well (Vaillant, 2002)
 Aging
with Grace (Snowdon, 2001)
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 High
level of engagement with life.
 Low risk of disease.
 High physical and cognitive levels of
function.
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 High
level of engagement with life.
 Low risk of disease.
 High physical and cognitive levels of
function.
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 Less
than 20%
 20 to 33%
 33% to 50%
 Over 50% but less than 75%
 Over 75%
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 Less
than 20%
 20 to 33%
 33% to 50%
 Over 50% but less than 75%
 Over 75%
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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.)
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Successful aging: Doing the
best with what one has.
(Achieving the highest
practicable level of
physical, mental and
psychosocial well being.)
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 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.
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 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.
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 Best
old age one
could expect
 Happy
 Life turned out
OK
 More energy than
most
 Not depressed
 Feel
loved
 Satisfied with
relationships
 Happy marriage
 Perceived control
 Affect balance
 Lower cynical
distrust
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Aging Well: Surprising Guideposts to a
Happier Life from the Landmark
Harvard Study of Adult Development
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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.
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The book begins with an all-inclusive
definition of aging that suggests decay,
change, and continued growth. It ends with
an admonition that the final "task of
Integrity is acceptance of one’s one and
only life cycle as something that is to be
and that permits no substitutions."
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"Owning an old brain, you see, is
rather like owning an old car....
Careful driving and maintenance
are everything."
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AGING WITH GRACE: What the Nun Study
Teaches Us About Leading Longer,
Healthier, and More Meaningful Lives
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 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
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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
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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.
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The importance of wisdom
as a marker for optimal
aging.
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Like social security and
Medicare, there is no
guarantee that wisdom will
come at age 65!
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What is wisdom?
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 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
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 Cognition
 Personality
 Interpersonal
processes
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 Cognition
 Personality
 Interpersonal
processes
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Insightfulness, which is based on
knowledge and the ability to
comprehend complex constructs
and to use dialectical and
relativistic modes of thinking
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 Cognition
 Personality
 Interpersonal
processes
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Comprised of ego processes,
including emotional balance,
attachment, and integrity, which
are all based on self-knowledge
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 Cognition
 Personality
 Interpersonal
processes
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Focus on justice, generosity, and
compassion…”character”
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Aging Well: Surprising Guideposts to a
Happier Life from the Landmark
Harvard Study of Adult Development
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 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.
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 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.
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A lifetime achievement award.
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 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.
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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
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Today’s program provides guidance
in helping ourselves and others
achieve equanimity and wisdom…
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