It's Not Age

Older people do not always take action to remedy conditions they assume are natural ramifications of aging. Recognizing that physical and mental deterioration are not necessarily part and parcel of growing old could help more seniors increase their health spans.

Around age 50, the unwelcome stereotypes of aging start to shuffle into our lives. Menus in dimly lit restaurants become unreadable; car keys disappear. At 60, we nod off in front of the television and then lie awake all night. By 70, the number of pills swallowed daily starts to catch up to the number of candles on the birthday cake. But we take it all in stride because slowing down and growing infirm are the inevitable consequences of aging.

A lot of people share this view. "As many as 60% of older adults still attribute health conditions and disability to normal aging itself," says geriatrician Catherine Sarkisian of the University of California, Los Angeles, School of Medicine. "Older people expect to become depressed. They expect sleep problems. They expect pain, less ability to have sex, and less energy."

But aches and pains, insomnia, and senior moments are not necessarily a natural byproduct of aging. "These may become more common with age, but they re not necessarily caused by age," says Sarkisian. And harboring such low expectations for the Golden Years, she fears, might prevent seniors from achieving "successful aging," a term that encompasses more than surviving into the triple digits. When Eric Larson and his colleagues at the Center for Health Studies in Seattle, Washington, asked people to define successful aging, longevity did not even make the final list. Respondents instead said they hoped to avoid chronic, disabling diseases, keep from becoming a burden to others, and continue to undertake meaningful activities, Larson says.

Researchers do not deny the physical realities of aging. Nearly 80% of people over 65 have at least one chronic health condition, and more than 20% live with disability. But many older people can avoid much of the "usual" disease and decrepitude, researchers say, if they minimize their disease risk factors, exercise their brains and bodies, and stay actively engaged in life. People have more control over their fate than they tend to realize, says Sarkisian. For example, forgetfulness is a common complaint among seniors. But preliminary results from a national memory training study suggest that simple memory exercises--forming word associations for new information, for example--sharpen wits, says psychology professor Peter Lichtenberg, director of the Institute of Gerontology at Wayne State University in Detroit, Michigan.

Other so-called side effects of aging, however, might be signs of more serious health conditions. "All too often individuals regard aging as the basis for the symptoms they have that are really due to disease, disuse, poor nutrition, or depression," says Robert Butler, president and CEO of the Longevity Center and professor of geriatrics at Mount Sinai School of Medicine in New York City. "Sleeplessness is one of the examples." The sleep difficulties suffered by about one-third of all older Americans are not a natural part of aging, he says, although illnesses and lifestyle changes associated with aging can make the problem worse. Decreased physical activity, less exposure to the sun, and the death of a spouse can all contribute to poor sleep.

If left untreated, "sleeplessness sets up a vicious cycle," according to Getting Your Zzzzzzzs: How Sleep Affects Health and Aging, a report recently published by the International Longevity Center-USA and the AARP Foundation. "Older people have problems that disturb their sleep, which often affects their other body systems, causing more problems that disturb sleep even more." Loss of sleep can lead to memory problems, depression, and greater risk of falling. Although sleeplessness "is difficult to treat," says Butler, "it does pay to do something about it."

Unfortunately, physicians and the health care systems they work for might also accept age-associated medical problems instead of treating or preventing them. Take falls, for example. "Despite ample evidence that falls confer increased risk for an assortment of substantial adverse outcomes--including admission to nursing homes, higher health care utilization, and mortality--and that good evidence from clinical trials shows falls can be prevented, we still don t have a mechanism to incorporate fall prevention in our usual medical practice," says geriatrician and epidemiologist Thomas Gill of the Yale University School of Medicine. "There is no mechanism to bill Medicare for any services for fall prevention."

If preventing falls could be prescribed in pill form, says Gill, "it would have been approved years ago." Ultimately, such knee-jerk reliance on medication might be one of the problems when it comes to treating many of the mild maladies associated with aging, particularly insomnia. "A lot of us feel very strongly that instead of pills being the first line of defense, we should be trying behavioral interventions, such as education and treatment strategies to teach people how to manage sleep better," says psychiatrist Timothy H. Monk, director of the human chronobiology research program at the University of Pittsburgh Medical Center in Pennsylvania. Monk is testing how two behavioral therapies might improve sleep and other aspects of life for recently widowed seniors by helping them to reestablish the health-promoting routines they followed with their spouses, such as regular mealtimes, daily walks, or volunteer activities.

Much of the deterioration associated with "normal aging" is really a function of sedentary living, says exercise physiologist Miriam Morey of the Duke University Center for the Study of Aging and Human Development. Although a certain amount of functional decline comes with age--no matter how fit or healthy we are--Morey says that "being physically active preserves physical function," particularly in cardiovascular fitness. "Even people in their 90s can experience benefits by going from sedentary to active," she says.

As for the seniors, simply having a "can do" attitude can go a long way, says social and behavioral epidemiologist Eleanor Simonsick, senior scientist at the National Institute on Aging and associate professor of geriatric medicine and gerontology at Johns Hopkins University School of Medicine. In a study of 900 moderately to severely disabled women over 65, she found that individuals with strong "control beliefs"--those who strongly agreed with statements such as, "I can do anything I set my mind to"--were more than twice as likely to walk every day compared to women who accepted their functional incapacities. "We need a pill for tenacity," Simonsick concludes. Barring that, we can all make an effort to reject the hackneyed inevitabilities depicted on those bad over-the-hill greeting cards and set a higher bar for aging well that clinicians and policymakers would do well to support.

Carol Cruzan Morton, a science writer based in Belmont, Massachusetts, more clearly sees the rewards of exercising after she found a $20 bill on a deserted sidewalk during her early-morning walk last week.