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“Do not go gentle into that good night.” —Dylan Thomas |
Use It or Lose It |
Although not all of us will be blessed with the opportunity to experience the perspective of old age, certainly all of us have an interest in knowing what research in cognitive science has discovered about the effect of aging on mental structure and ability. This chapter focuses on findings that can help us to age with maximum effectiveness and to better understand those who are preceding us into the Golden Years.
First, one note. Much of what we know about adult development is coming out of the Baltimore Longitudinal Study of Aging, in which 2,400 volunteers of all ages travel annually (at their own expense) to Johns Hopkins Bayview Medical Center for three days of examination. Begun in 1958, it is the longest-running study of its kind. In the first 20 years, only white men were studied, with women and African Americans added to the study in 1978. African Americans are still underrepresented at 13 percent (compared with the target of 20 percent). The study continues to recruit volunteers in specific age, race, and sex categories. If you are interested in joining, call 800-225-2572. Among their findings: personality doesn’t change essentially from age 30 on, vocabulary continues to grow into later life, problem-solving and reasoning skills continue into old age, and people age at different rates.
Parallel to the Baltimore study (which emphasizes personality), the Seattle Longitudinal Study emphasizes mental ability over the life span. The director is Warner Schaie (a professor at Pennsylvania State University). Here are some of their major findings (Schaie, 1996, pp. 12–15):
1. “There is no uniform pattern of age-related changes across all intellectual abilities.” Different abilities decline at different times for different sexes for different reasons.
2. The primary factors that prevent decline in mental ability are
(a) absence of cardiovascular and other chronic diseases;
(b) a favorable environment mediated by high socioeconomic status;
(c) involvement in a complex and intellectually stimulating environment;
(d) flexible personality style at midlife;
(e) maintenance of high levels of perceptual processing speed.
3. “Observed decline in many community-dwelling older people might well be a function of disuse and is clearly reversible for many. Indeed, cognitive training resulted in approximately two-thirds of the experimental subjects showing significant improvement, and about 40 percent of those who had declined significantly over 14 years were returned to their predecline level.”
Another adult development study just beginning to bear fruit is the Nun Study, which was initiated by graduate student David Snowdon in 1986. His study, housed at the Sanders-Brown Center on Aging at the University of Kentucky, involved nuns from School Sisters convents in Mankato, Minnesota, and six other cities, beginning with 3,926 Notre Dame sisters born between 1886 and 1916, most of whom had joined the order in their 20s. Results from this study are of particular interest because of the nuns’ similar lifestyles. Autopsies are beginning to reveal new knowledge, particularly about Alzheimer’s disease.
One promising line of research was reported by Marsel Mesulam, then of Harvard Medical School, now a psychiatry professor at Northwestern University. While at Harvard, Mesulam and other researchers identified a chemical, acetylcholinesterase, that is present at higher levels in people over 90 who have better mental abilities. The Harvard researchers have isolated a kind of cell in the brain that makes this chemical; it is hoped that, in time, drugs will be able to regulate acetylcholinesterase. In addition, researchers at Scripps Research Institute, La Jolla, California, have identified (in Science, March 2000) 61 genes that appear to control the speed of aging. These genes appear to slow down over time, leading to fragile bones, stiff joints, gum disease, and other maladies. Researchers are looking for drugs that target these genes and prevent their slowdown. In effect, they are working on “perpetual youth” drugs.
On another front, Barbara Sherwin, researcher at McGill University in Montreal, has reported (in New Scientist, July 31, 1999) that estrogen levels have a direct effect on women’s memory. Sherwin studied 100 women who experienced sharp drops in estrogen level after their ovaries and uterus had been surgically removed. Half received HRT (hormone replacement therapy) and half received a placebo. The results: women with restored estrogen levels performed on memory tests as well as their presurgery performance, while the placebo women performed significantly lower than presurgical levels.
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TOPIC 6.1 |
We are born with roughly 23 billion neurons. By making new synapses (establishing connections between neurons), the brain increases its mass threefold until the early 20s. Conventional wisdom has held that we lose some 100,000 neurons daily. This is not the case; individual rates of brain cell loss vary widely. Proportionately more are lost in the frontal and temporal cortex, especially the motor cortex, which contains the long axons from the spine necessary for balance (see appendix A). Alcohol consumption increases the daily destruction proportional to the quantity consumed (around 60,000 neurons per day for a heavy drinker or alcoholic). Sickness, medication, and untold other assailants can also increase the rate of neuronal loss. The average person loses about 10 percent of his brain weight in a lifetime. This loss in brain weight used to be interpreted as the result of deceased neurons, but today it is interpreted as the result of shrunken neurons. Men lose more mass than women, and men lose more in the left hemisphere, which controls language, than in the right, which controls visual-spatial skills. Females experience about a two-ounce drop in brain mass around menopause, whereas males experience their accelerated loss beginning somewhere around age 60.
Experts caution that we should take extra care of our brains, for, unlike other organs and body systems, neurons have not been thought to divide and duplicate or replace themselves. However, in October 1998, Fred Gage, a professor at the Salk Institute for Biological Studies in La Jolla, California, along with Swedish researchers, reported the first observed regenerated brain cells in humans. Marian Diamond, a professor of integrative biology with the University of California, Berkeley, has found a higher proportion of glial cells (structural cells, also called “helper” cells, which provide nutrition for other neurons), in enriched-environment rats, and also in the preserved brain of our most famous physicist. Albert Einstein’s brain, protected and maintained by Princeton University scientists in 1955 when he died at age 75, shows a clearly higher ratio of glial cells to normal neurons when compared with the brains of 11 men of average intelligence. In the meantime, why not play it safe and encourage everyone to keep body and mind active? Certainly this is a modest proposal.
As a general rule, aging itself does not have a large impact on deterioration of brain function. Mary N. Haan, director of the University of California, Davis, Center for Aging and Health, reported (in Journal of the American Medical Association, July 7, 1999) that a 10-year longitudinal study of more than 5,000 community-dwelling senior citizens revealed no significant cognitive decline for 70 percent of the group. Seniors with the ApoE4 gene (associated with Alzheimer’s) and either atherosclerosis or diabetes were eight times more likely than others to show significant cognitive decline. In a large-scale French study of elder citizens (reported in Neurology, December 1999), persons of retirement age were found to be twice as likely to suffer a decrease in mental ability if they had untreated high blood pressure. In fact, the study suggested that antihypertensive medications have a beneficial effect on mental ability during the aging process. Although debate continues to rage on this issue, following are thirteen of what are accepted to be the most significant assailants on neurons:
• Medication
• Chronic disease (especially heart disease)
• Extended grief over personal loss
• Alcohol
• Absence of a stimulating partner
• Unfavorable living environment
• Inflexible personality style
• Sedentary lifestyle
• High blood pressure, especially in middle age
• Lack of stimulation
• Low educational level and lack of curiosity or desire to learn
• Malnutrition
• Depression
The lesson of all this is: Use it or lose it! As neurologist David Krech says, “They who live by their wit die with their wit.” Dean Keith Simonton, who teaches psychology at the University of California, Davis, has studied the creative careers of composers, writers, and artists. He found that their creativity does not diminish with age, but the kind of creative energy sometimes changes. Igor Stravinsky, for example, switched in later life from a more traditional tonality to the “12-tone row,” or writing music “in series.” Thomas Edison, Johann Wolfgang von Goethe, Victor Hugo, Claude Monet, and Titian did some of their best work in their 70s and 80s. George Bernard Shaw, Pablo Picasso, Arthur Rubinstein, Albert Schweitzer, and Pablo Casals were still productive in their 90s. Also:
• David Ray of Franklin, Tennessee, learned to read at 99.
• Armand Hammer actively headed Occidental Petroleum at 91.
• At 92, Paul Spangler completed his 14th marathon.
• At 91, Hulda Crooks climbed Mount Whitney (the highest mountain in the continental United States).
• George Burns performed in Proctor’s Theater, Schenectady, New York, first at age 31 and again 63 years later at age 94.
• Kathrine Everett was still practicing law in North Carolina at age 96.
• The classical pianist Mieczyslaw Horszowski recorded a new album at the age of 99.
• Martha Graham still choreographed in her 90s.
• Photographer Imogen Cunningham worked in her 90s.
• Grandma Moses retired from crocheting around age 70 (because of arthritis) and started a new career in painting.
• Pulitzer Prize–winning novelist Herman Wouk completed The Lawgiver (2012) at 97 and is at work on the next novel in his corpus, which includes The Caine Mutiny (1951), Marjorie Morningstar (1955), and War and Remembrance (1978).
At age 76, my mother-in-law moved to North Carolina from Alabama. A longtime church organist, she found a new service niche. She was in high demand for after-dinner music and music therapy classes at her retirement home, and she played frequently in the musical interlude just before her church’s Sunday-morning service. Seven years later and 83, she moved to a nursing home, where she still tried on her better days to entertain her friends and fellow residents on an electronic keyboard and was known to experiment with some unfamiliar rhythms and timbres provided by Sony. She was well respected for her talent.
The more we use our brains as we age, the higher our performance level stays and the higher is our ratio of synapses to neurons—that is, our brains stay denser the more we use them. Nerve growth factor (NGF) is one of many trophic, or nutritional, agents that stimulate and support growth of the myelin sheath—the coating of the neural fiber—and of new synapses. NGF is released as a result of neural transmission itself. Exercise also produces extra NGF (see topic 10.2). In other words, by using our nervous system, we grow it.
Applications
Make it a personal goal to continually learn something new. Once you’ve mastered it to the point where it is routine, it’s time to learn something new. Linus Pauling, winner of two Nobel prizes (chemistry in 1954, peace in 1962) was asked, “What does one do after one wins the Nobel prize?” Pauling quipped, “One changes fields!” Never stop learning. Never stop setting goals.
Disuse breeds disuse. Use what you know and have. Fight idleness and boredom with all your energy. If you can’t think of anything to do, remember that there are plenty of organizations looking for volunteers. You can be helpful either from the confines of your own home (by telephoning, addressing, sewing, mending), in an an office park, or at the hospital.
Establish and maintain a balanced diet. (See chapter 14.)
Exercise caution when changing physical positions after age 50. Be especially careful when using ladders or stools to gain height; most people’s sense of balance just isn’t what it used to be. Leave the shower, tub, and car with a little more caution. And be sure to exercise regularly.
Assume that you will retain your full mental powers forever. Just because we slow down doesn’t mean we have to stop! We will always have a contribution to make!
Dr. Thomas Perls has a Web-based longevity assessment that relates specific behaviors, practices, etc., to your life expectancy. More at www.livingto100.com/.
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TOPIC 6.2 |
There are two clear trends associated with the aging of the brain:
1. Between ages 20 and 60, reaction time doubles—we slow down.
2. The ratio of synapses to neurons increases for people who continue using their brains and decreases for those who stop (see figure 6.1). Learning means new synapses, and new synapses mean higher density, which counterbalances the normal brain weight loss. Accordingly, performance continues to improve with age among those who use their brains, while it declines among those whose brains retire when they retire from their jobs.
Figure 6.1. The Effect of Inactivity and Disuse on the Brain
Quartz and Sejnowski (2002) report that “nuns [in the Nun Study] who are more educated and perform stimulating work, such as teaching, tend to age more successfully than those who have less education and perform mundane tasks. They also live an average of four years longer” (p. 241). Further (p. 243):
The dendrites of those who lived in a complex environment—had a college degree, a stimulating job, and were mentally active throughout their life—were a full 40 percent more complex than those of high school dropouts. They were also more complex than those of university graduates who had not been mentally active after college. . . . It turns out that it is never too late to engage the brain in a stimulating environment. Sherry Willis and Warner Schaie demonstrated in the Seattle Longitudinal Study that reengagement in later life can boost mental performance even in people whose mental performance has already significantly declined. They studied a group of two hundred people over the age of sixty-five, half of whom had significantly declined in mental performance over the previous fourteen years. Through training, most improved significantly. Among those who had declined, a full 40 percent were able to regain their performance levels of fourteen years earlier. Seven years later, they were still significantly ahead of those with similar levels seven years earlier.
A pattern of avoiding new situations and new learning as we age takes its toll. Schaie has found that middle-aged folks who are set in their ways exhibit far greater decreases in mental performance in their gray years than aging seniors who continue to experiment, to learn, to explore, to take on new challenges. Schaie encourages seniors to seek therapeutic assistance if needed to achieve greater mental flexibility.
Renee Solomon and Monte Peterson, two experts in social interventions for older adults, suggest that “flexibility and adaptability are critical personality dimensions of successful aging. . . . Older persons who lack optimism, humor, and relatedness find it difficult to be flexible and adaptable and may well be a risk for emotional collapse.”
In a Harvard Medical School study of over 1,000 physicians, Dean Whitla and Sandra Weintraub found that the 10 physicians over age 65 with the highest scores on a standard cognitive skills test were still actively working as physicians, whereas the 10 physicians with the lowest performance scores were no longer working. The working and nonworking physicians showed similar patterns of medication and illness, so the difference in performance cannot be attributed to those factors. In other words, their physical health and mental health scores were independent. I know that “Use it or lose it” sounds like an oversimplification, but . . .
Many reports show mental abilities declining in old age, but these reports typically fail to control for degree of brain use. Apparently the nonusers are bringing down the scores of the users! Researcher C. Edward Coffey, Henry Ford Health System, Detroit, has documented that well-educated seniors (age 65–90), in spite of significant brain shrinkage (as measured by MRI), continue to perform well with no signs of memory or reasoning loss. Less educated seniors, however, do show memory and reasoning decline. Referencing the Seattle Longitudinal Study, Warner Schaie, Director of the Pennsylvania State University Gerontology Center, finds that measurable loss in mental performance (for example, loss in spatial reasoning) can be reversed with training, except for performance loss caused by brain damage from drug use, disease, or trauma. Timothy Salthouse of the University of Virginia’s Cognitive Aging Laboratory clarifies (2010) many of these cognitive aging issues by pointing out that, first, crystal intelligence (the knowledge we possess) does not decrease in the way that fluid intelligence (our ability to analyze and solve problems) does, and, second, that research on aging and cognitive ability normally fails to take context into account. He points out that performing on an IQ test at age 70 is one matter, while performing as a problem solver at one’s office in an area that has consumed one’s life for 50 years is an entirely other matter. Furthermore, he points out that, across all studies, aging itself accounts for only 20 percent of the decline in mental ability, while such factors as those listed as “assailants on neurons” in topic 6.1 have a dramatic impact on mental performance and explain most of the differences in individual performance over time. Finally, Salthouse points out that most research on aging and mental ability is cross-sectional, not longitudinal, and that means that it does not consider how specific individuals perform over time.
In a project funded by the University of California, Los Angeles Task Force on Psychoneuroimmunology, George Solomon and John Morley found that age does not uniformly affect the immune system (Cousins, 1989). Older healthy people show immune levels of white blood cells, lymphocytes, granulocytes, and so on that are somewhat higher than those of comparable younger people. In addition, older adults with “hardy” attitudes (those who maintain their commitment, positive emotion, self-control, and exercise) show an even higher level of immune cells as well as endorphins.
Salthouse also finds that seniors typically show heightened powers of creative innovation as a result of five benefits of aging. First, aging brings increased capacity for empathy, and seeing others’ points of view is critical for effective innovative ideas. You can’t successfully innovate by seeing things only from your own point of view—a bias common to the younger, less experienced mind. Second, age brings wide experience and its associated capacity to see the big picture, while youth tends to reveal its limited perspective. Third, older people are better able to foresee problems based on past experience with similar situations. Fourth, the critical thinking ability of seniors continues to grow, as the cumulative wisdom of the years provides a more patient and suspicious outlook. Seniors are less prone to self-interest motives that cloud critical thinking ability—they have less at stake career-wise. Fifth, seniors tend to live more in the present than the future. This enhances creative innovation by focusing on how to make current circumstances more pleasant for all. The one constraint of aging with respect to innovative thinking is the persistence of past successes: seniors can have a tendency to think within the box of their past experience, while younger people have no past experience to speak of, and hence not much of a box—except for their often narrower, more self-serving outlook.
Applications
Plan for retirement. Don’t become a television addict without hobbies or interests.
Beware, as you age, of depending on speedy performance in order to feel good about yourself. If you feel that you are overextending yourself, begin to move toward activities that are compatible with slower reaction times. You might move from driving cars and riding motorcycles to walking, riding bicycles or tricycles, and taking buses. Move from power tools to hand tools, from debate to dialogue, from reading stories to storytelling. Card and board games that tolerate varying speeds of individual play are often successful as intergenerational activities. Take greater pride in the quality of your accomplishments rather than your speed.
As you age, maintain high expectations for yourself, keep developing your sense of humor, take control of stress, and continue to exercise and eat right.
In the face of disease, “accept the diagnosis but defy the verdict,” as Norman Cousins says (Cousins, 1989). Examples of recovery from “terminal” illnesses are numerous and increasing. The limits of the mind’s ability to positively influence health are unknown.
Lawrence Katz, Duke University neurobiologist, and coauthor Manning Rubin (1999) propose a series of exercises they dub “neurobics.” Each of the exercises below is designed to form new associations among previously unassociated parts of the brain, thereby bringing new resources to one’s consciousness. A kind of mental jogging, these neurobic exercises result in the formation of new synapses and the rejuvenation of already established synapses. The result: countering the tendency toward decline in memory and general ability that some experience during aging.
1. Make different smells available from morning to morning.
2. Occasionally use your unaccustomed hand to brush your teeth.
3. Switch what you normally wear (pins, wristwatch, pocket contents, hair part, etc.) on the left side to the right side, and vice versa.
4. Take a different route to a frequently destination, such as work.
5. Try picking out the right coins (and other objects) without looking.
6. Turn things literally upside down, such as a picture in your office.
7. Chat with people whom you (and others) tend to overlook (e.g., store clerks).
8. If you’re not an artist, try painting or drawing a picture. If you are an artist, try doing it with your feet.
9. Try searching for foods in the wild.
10. If you exercise indoors, try switching occasionally to outdoors, and vice versa.
11. Master some new piece of technology from time to time. This could range from something as simple as a new wine bottle opener to a digital camera.
12. Try eating and preparing ethnic foods you’ve never experienced.
13. Acquire a new hobby.
If you are a senior, offer your services to family, professional, civic, and other entities in need of creative thinking about how better to accomplish their mission. If you work with one of these entities, seek seniors to broaden your perspective when strategizing and envisioning how to better accomplish your mission.
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TOPIC 6.3 |
The principles elaborated later (in chapter 33) concerning the effect of control on stress apply equally to seniors. Specifically, Judith Rodin of Yale University (Keeton, 1992) has demonstrated that nursing home residents age 65 to 90 who are allowed to take a direct planning and decision-making role in their programming (1) live longer, (2) are sick less, (3) are happier, (4) are more alert, and (5) have less of the stress hormone cortisol.
Psychology professors Christopher Peterson of the University of Michigan and Martin Seligman of the University of Pennsylvania (see topic 34.5) found that baseball players who were more optimistic at age 25 lived significantly longer. Depression is thought to be common among the elderly and may well be the cause of many of their medical problems. In 1999, 10 medical centers around the country began a long-term control study on 200 patients each, using the antidepressant Celexa (citalopram) and a placebo.
Now, there is control, and then there is control. Having some control over one’s destiny is one thing, but being a control freak is another. Michael Babyak, an assistant clinical professor of medical psychology at Duke University, in a 22-year longitudinal study of 750 white, middle-class men, found that men who always need to be in control (monopolizing conversations, frequently interrupting, having a compulsive need to be number one, etc.) tend to die younger than men whose social behavior is calmer and more accepting of the ascendancy of others. Robert Sapolsky (1997, pp. 161–173) describes two different male primate behaviors in the gray years. Some tend to leave the tribe in which they had held a fixed place in the hierarchy and join new groups, alone and friendless, but not picked on anymore, just ignored. Others stay with their tribe, having something the deserters don’t—friends (to be specific, female friends). These latter males at an early age tend to avoid the hierarchy battles and establish relationships (not necessarily sexual) with females. As a result, these friendly males do not suffer the scornful picking that the first group does.
Quartz & Sejnowski (2002) suggest that “the parent that cares for the offspring typically lives longer than the mate, regardless of gender” (p. 179). This is based on the work of John Allman at Caltech on both animals and humans. He mentions that epidemiologists Lisa Berkman and S. Leonard Syme, in a nine-year study of 7,000 adults in California, found that people with fewer social ties were up to three times as likely to die of all causes than people with more contacts (p. 180).
In another vein, William Strawbridge of the California Public Health Foundation, in a study of 5,000 people over 28 years old, found that people who attended religious services had a 36 percent lower death rate. Harold Koenig, family physician with Duke University Medical Center, followed 4,000 senior citizens in the Durham, North Carolina, area for six years and found that those who reported little or no religious meditation (e.g., Bible reading, prayer) ran a 50 percent greater risk of dying than those who reported at least two episodes of religious meditation monthly (Journal of Gerontology, July 2000). However, reporting in the June 1997 American Journal of Public Health, Strawbridge qualified his findings, cautioning that the lower rate could be related to improved health practices, higher social contacts, and more stable marriages, each of which is associated with, but not limited to, religious participation.
This and similar findings relate to a recent term, “social capital,” which is the capability of an individual’s social contacts to assist in realizing common goals. Other examples of social capital include participation in volunteer organizations and trust in civic government, both of which are associated with lower mortality rates.
Applications
If you are responsible for the care of older adults, do everything you can to include them in planning, decision making, and problem solving. Share responsibility and control with them. If you are on the staff of a community for older adults, establish committees, consult with the residents, and empower them by responding to their ideas, requests, and needs.
If you are an older adult, whether you are living alone or in a community, stay involved in planning your life; if you live in a community for older adults, establish committees, create suggestion boxes, ask those charged with your care to consider your ideas, and pool your resources for trips and other big-ticket items, such as lawyers, entertainment, transportation, or equipment.
Establish friendships early on, regardless of sex; nurture them; enter old age with a support system.
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TOPIC 6.4 |
Current research reveals that people naturally gain weight as they age. The new weight charts, such as the one devised by Reubin Andres, clinical director at the National Institute on Aging, allow for considerably more weight than the traditional charts developed by Metropolitan Life Insurance Company. For decades, the informed wisdom (e.g., Raloff, 1991) has been that severely restricted food consumption was associated with living longer. A much-awaited longitudinal study led by Rafael de Cabo of the National Institute on Aging found, however, that severe diet restriction did not lead to greater longevity. This study began in 1987 and followed normally fed monkeys and sparsely fed monkeys, with both groups showing equal longevity.
Restak (1997) cautions about generalizing animal research results to humans. He does, however, find promise in a line of research by Denham Harman of the University of Nebraska Medical School. Harman worked with free radicals, molecules containing one unpaired electron. Such molecules are unstable, grabbing at available electrons like starving creatures and indiscriminately foraging. In this situation, a negative outcome would be that free radicals could consume available electrons in the mitochondria of the cell nuclei and destroy DNA, with the effect of accelerated aging. On the other hand, a positive outcome could be that free radicals are bound by the available electrons in antioxidants such as vitamin C and beta-carotene. Restak warns that people should not rely on pills as a source of antioxidants, preferring that they consume them in their natural form by eating fresh fruits and vegetables.
Rosebud Roberts led a Mayo Clinic team that studied the impact of diet on risk for Alzheimer’s disease. Their study of 1,200 seniors concluded that the dietary needs of seniors shifts from carbohydrates to fats, with proteins remaining the same. Seniors eating heavily from carbs showed greater risk for Alzheimer’s, while those minimizing carbs and leaning more on fats—both the healthy oils from nuts and seeds as well as other sources—showed substantially lower risk for Alzheimer’s. Apparently the sugars are the culprit, so high-glycemic carbs like candies and other sweets are worst. The summary of this study that I read did not mention the role of fats in metabolizing into acetylcholine, a chemical necessary for maintaining the suppleness of neural membranes. This clearly grows in importance as we age. Low fat means brittle membranes and risk for tangles and plaques.
Applications
As you reach seniority, maintain protein consumption, back off of carbohydrates—especially high-glycemic ones—and increase fats, especially healthy ones. If you love ice cream and want to find a lower-calorie version, prefer low-sugar or no-sugar to low-fat or nonfat versions. Better yet, get a Donvier unit and make your own ice cream with whole milk and nonsugar sweetener—that’s what Jane and I do! Prefer vegetables to fruits, and prefer dark fruits (blueberries, blackberries) to light ones (grapes)—as a general rule, the dark fruits have substantially more antioxidants.
To keep free radicals from chomping down on you, provide antioxidants to keep them at bay. Feed them, or they’ll feed on you. Sample recommendation for one day’s worth of feeding free radicals: 6 ounces of cranberry juice, 2 cups of broccoli, 2 cups of strawberries, 2 cups of orange juice, or a kiwi fruit.
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TOPIC 6.5 |
According to research reported in Folkins and Sime (1981), exercise programs can at least arrest and often reverse many of the degenerative physical effects of aging in older patients. One explanation of this phenomenon is that exercise promotes increased absorption of oxygen. William Greenough, a neuroscientist at the University of Illinois, identified an increase in capillaries around neurons in the brain as a result of aerobic exercise. Carl Cotman, a neurology professor at the Institute for Brain, Aging and Dementia at the University of California, Irvine, found that aerobic exercise produces an increase in neurotrophins. Neurotrophins are nerve growth agents—“fertilizer” for nerve cells.
Arthur Kramer, a psychology professor with the University of Illinois’ Beckman Institute, established that aerobic exercise (a 45-minute water aerobics class, three times a week for 10 weeks) in 63- to 82-year-olds results in improved, faster reaction times. He avers that declines in reaction time are generally more attributable to declines in fitness than to aging. Aerobic exercise is best. In a study conducted by researchers at the Salt Lake City Veterans Administration Hospital, three out-of-shape groups were followed: one was put on a walking regimen, another lifted weights, and the third carried on business as usual with no exercise of any kind. The walkers showed much higher scores on eight tests of mental ability, the weight lifters showed a little improvement, and the others showed no improvement. Researchers at the University of Illinois (at Urbana-Champaign) worked with 124 sedentary seniors (age 60–75), comparing aerobic and anaerobic exercise programs for their effect on mental processes, including planning, scheduling, inhibition, and working memory. The walkers showed significant improvement in all categories (BrainWork, August 2004). They cited Harry Truman (88) and John Glenn (83 in 2004) as power walkers. Anaerobic exercise (stretching, weightlifting, etc.) was not accompanied by the same improvements.
Applications
Keep walking, briskly. Or, swimming—lap it up!
Inquire about organized and medically supervised exercise programs for seniors and join up. Senior centers have taken the lead in this area.
Don’t stop exercising because you think you’re too old. There’s an aerobic exercise that’s safe and beneficial for you.
Ensure that you and all your family members get aerobic exercise for 30 to 45 minutes at least five days per week.
Research conducted by Albert Einstein College of Medicine revealed that dancing has a dramatic preventive effect on Alzheimer’s disease. Frequent dancing was associated with a 76 percent reduction in risk of exhibiting Alzheimer’s in a 21-year longitudinal study of seniors aged 75 and older. “Dance, did you say dance?” quoth Zorba the Greek. (Hmm, I wonder if dancing is the key to the longevity associated with the so-called Mediterranean diet?)
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TOPIC 6.6 |
In a study reported in Merzbacher (1979), individuals with cardiovascular disease and an average age of 60 were placed on the Pritikin diet, which includes more complex carbohydrates and fewer proteins and fats, and were assigned six to ten miles per day of jogging or walking. After completing this 26-day program, subjects scored higher on intelligence tests and had measurably improved their circulatory systems.
Application
Don’t just exercise; eat right.
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TOPIC 6.7 |
The quality of our night vision decreases with age. At 63, I am aware of poorer perception when driving at night. It is getting harder to see the curbs of the road onto which I want to turn when lighting is suboptimal. Also, men tend to have better day vision (note that more women wear sun-protective glasses), and women tend to have better night vision (Moir and Jessel, 1991).
Manley West, a University of West Indies pharmacology professor, researched the rumor that marijuana improved night vision. He found that a nonpsychoactive ingredient in marijuana, canasil, caused a significant improvement in night vision. At the time of this writing, canasil, which is the same ingredient in marijuana that relieves glaucoma, is not yet available in the United States.
Applications
As you age, take extra precautions when you drive at night, especially if you are a man. Allow extra distance between you and vehicles in front of you, drive more slowly, and take more breaks. Let a younger person or a woman drive when possible. Don’t let your male ego interfere with safe driving options.
All other things being equal (driving skill, physical condition, road familiarity, and so on), a woman will be a safer driver at night because of generally superior night vision. During the day, men will tend to be safer because they are less subject to fatigue from the sun. Women will generally desire or require more breaks to avoid eye fatigue during the day, with men requiring more during the night.
Understand that these differences exist, and don’t assume that people who are different from you are weak, malingering, or inferior.
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TOPIC 6.8 |
Although the memory processes slow down as we age, the accuracy of our memories improves. When he administered recall-and-recognition tests to youths and seniors in church fellowship halls, Paul Foos, of the psychology department at the University of North Carolina at Charlotte, found that the seniors, with an average age of 65, consistently beat the youths. As we age, the number of items we can associate to a particular memory chunk dramatically increases. So although we may take longer, we are more likely to remember things accurately. In fact, there is some evidence that the rich associative network of seniors is one factor in the slowdown of their memory processes.
My 82-year-old brother-in-law and I were riding through eastern North Carolina in 1993 to a family reunion. Making small talk, I referred to a basketball player from our hometown of Kinston who had recently signed to play basketball at the University of North Carolina; I called him Shackleford. My brother-in-law commented that I didn’t have the name right. I agreed. We both started searching our minds for the correct name. He won the race. I asked him how he’d remembered. He said that he got an image in his mind of a furniture store in Goldsboro (on his route for many trips from Chapel Hill to Kinston) called Stackhouse Furniture, flipped from that image to one of a retired professor friend in California named Stackhouse, and came up with “Stackhouse,” the right name. (Alas! How memory is fickle. After reading this passage, my brother-in-law corrected me: his friend Stackhouse was not a professor, but a businessman, and the Goldsboro store was not a furniture store, but a lumber business!) My effort to describe this process is captured in Kim Allman’s illustration in figure 6.2. Apparently, my brother-in-law’s network of isolated memories connected in something like the following manner to give him the right answer (try following along in the figure):
1. He heard “Shackleford,” a relatively new auditory memory gained around age 70, based on a well-known Kinston athlete who attended North Carolina State University, not the University of North Carolina at Chapel Hill.
2. He associated the name Shackleford to basketball and Kinston.
3. He unconsciously and instantaneously relived his frequent trips from Chapel Hill to Kinston to visit his parents and his in-laws.
4. A prominent building halfway between the two towns, Stackhouse Furniture (correction: Lumberyard), popped up ever so briefly into his consciousness.
5. This submerged memory of the furniture (lumber) store, firmly entrenched from about the age of 17, connected to another strong memory of his long-standing friendship, from about the age of 48 on, with a California professor (correction: businessman) named Stackhouse.
6. By the time he envisioned his California friend, he became conscious that the name “Stackhouse” was the one he was looking for.
Figure 6.2. My Brother-in-Law’s Memory Process
I hope that at age 82 my memory processes will be as abundant and effective as my brother-in-law’s.
In a recent line of research using PET scans to compare the brain activity of youths vs. seniors, Daniel Schacter, a psychologist at Harvard University, has found equal levels of hippocampal activity when both youths and seniors are engaged in the process of remembering something easily. However, when they are “searching” for a memory, the youths show greater activity in the frontal area. Apparently, in a significant number of seniors, the “search engine” becomes sluggish, while the memories lie in wait for a rise to consciousness.
Working with a large sample of older Swedish people, David Bunce, psychologist at the University of London, and others found (Neuropsychology, Vol. 18, No. 2) three factors associated with poor memory performance in seniors:
• possessing the gene for Alzheimer’s (ApoE4)
• low levels of vitamin B-12 and folate
• absence of cues or hints to assist in recall
When any one of these three factors was missing, memory performance in seniors improved markedly.
Seniors commonly experience trouble with short-term memory, especially in remembering words, phrases, facts, and movements that are new to them. Recent research has linked this phenomenon to disrupted sleep, whereas it had formerly been attributed to nervous system decline. As other research has demonstrated, disrupted sleep minimizes REM sleep, the phase in which we dream—the so-called deep sleep phase. And REM sleep is essential in establishing new memories! The lesson is clear: improve your sleep and you’ll improve your short-term memory. Subsequent experiments have confirmed this relationship. In one experiment, poor sleepers wore helmets that emitted electrical patterns that mimicked REM sleep. Those benefitting from this device and its accompanying good night’s sleep showed remarkable improvement in short-term memory. See the brief review of sleep-friendly practices in application 7.
Applications
Slow is okay. You’ll get there.
Don’t push seniors to remember more quickly; the frustration of being pushed will interfere with the effort to remember. Give people the time they need.
Try the “I knew it all the time” test. Harvard University psychiatry and neurology professor Marilyn Albert suggests that when your memory fails you and you subsequently recall, or are reminded of, what you tried to remember originally, you should have the feeling: “Yes—I knew that all along.” A more appropriate time to worry about your memory is when you recall or are reminded of a memory and it does not feel familiar to you.
When finding a familiar word or term inaccessible to your memory, try silently saying the alphabet, once through, twice through, etc. What happens is that you say the vowel or consonant that matches the first letter of your familiar word. Soon your memory bank will allow the word to surface. In fact, while saying the alphabet, you’ll have the sensation of “Okay, I think it is either a ‘k’ or an ‘r.’” And in a matter of seconds, “kangaroo” will come to mind. Or something like that. This is a form of “priming the pump.”
Check your levels of vitamin B-12 and folic acid. If they are low, determine an appropriate dietary or supplementary source.
Provide cues for yourself or for your elder friends when struggling to remember a name or other term. Have them try the alphabet technique (application 4 above), encourage them to recall the place or time in which the memory was formed, and so forth.
For strengthening short-term memory, review chapter 16 on “A Good Night’s Sleep.” Make a commitment to improving your sleep. Here is a brief summary of sleep-inducing behaviors:
• Exercise
• Proper diet (and not eating too late!)
• Regularity of sleep onset time
• Minimizing alcohol consumption (or rehydrating with water when you have more than one serving)
• Avoiding caffeine for at least seven hours before sleep onset
• Take melatonin (see topic 16.10) or get it naturally from dairy products a couple of hours before desired sleep onset
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TOPIC 6.9 |
It is accepted that aging is not kind to driving performance. Here are some facts (Source: AAA Foundation for Traffic Safety):
• Drivers over 65 are twice as likely to die in an accident as drivers 45–64.
• Drivers who are 85 are four times as likely to die in an accident as drivers 45–64.
• One reason for the higher mortality rates is that older drivers are more frail and more likely to die from the same accident as a younger driver.
• The primary cause of accidents for drivers 65 and older is a lapse in perception (such as failing to see a sign or traffic light).
• Fifty-nine percent of drivers 75 and older in accidents report such a lapse. Incidentally, this is the same percentage as that for 15-year-old drivers!
• Sixty-seven percent of drivers 85 and older in accidents report such a lapse.
• Drivers 65 and older are 25 percent more likely to have an accident of any kind than a middle-aged driver.
• Older drivers are more likely to have accidents while attempting a left turn, a maneuver that often requires quick judgment of the speed and distance of oncoming traffic.
Applications
As you age, use caution when making a left turn. Don’t take a chance on the accuracy of your perception as to the speed and distance of oncoming traffic. Wait for oncoming traffic to pass before you turn. Wait until there’s no doubt as to your safety in turning.
Where possible, figure out routes that do not involve making left turns in heavy traffic. Find a way to limit entry into heavy traffic to right turns only.
Anticipate where signs should be! Be paranoid about the location of stop signs.
As you age, don’t let your ego (see description of the “low A” personality in topic 30.2) lead you into high-risk driving behaviors. Act your age, and learn to exercise appropriate caution. Let others drive when possible. Let your ego learn to be fed by achievements other than driving.
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TOPIC 6.10 |
Based on a study of 918 men between the ages of 45 and 59, research epidemiologists George Davey Smith of the University of Bristol and Stephen Frankel of Queen’s University, Belfast, Northern Ireland, reported in the December 1997 British Medical Journal that there appears to be a rather strong relationship between rate of sexual orgasm and length of life. The men were followed up 10 years later and analyzed on the basis of three groups: those who had two or more orgasms per week, fewer than one per month, or a number between these two extremes. The death rate for the least sexually active men was twice as high as that for the most active, whereas the death rate for the intermediate group was 1.6 times that of the most active group. Although some have criticized the methodology of the study, following its implications could not be harmful in and of itself, certainly! On the other hand, we need to be alert for studies that confirm or challenge these findings, as well as for studies that include women.
Application
Rest assured that frequent orgasms do not appear to affect mortality adversely. However, if you have less frequent sexual activity and wish to hedge your bets longevity-wise, don’t go looking for more mates or browbeat your partner into reluctantly increasing his or her frequency: simply take things in hand.
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TOPIC 6.11 |
The senior adult’s sleep episodes (which can include more than one sleep cycle) are 20 percent shorter than those of younger people (6 vs. 7½ hours), and the total time awake during the night between initially going to sleep and getting up for good in the morning progresses gradually from around 1 percent in infancy to around 6 percent in seniors.
Applications
Although some shortening of sleep requirements and some increase in sleep-time wakefulness are normal in senior adults, drastic changes are not. Look for pharmaceuticals, diet, illness, or lack of exercise as probable culprits.
Understand that you probably will not sleep as long and as continuously at age 75 as you did at 25. Build a nap into your schedule, and simply get up and do something constructive if you cannot sleep.
It’s okay to “wake up” throughout the night. Don’t worry about it. Everyone wakes up between cycles; as we age, we just tend to be more aware of it. See more about sleep cycles at topic 16.1.
A Final Word on Aging Gracefully
In his book Older and Wiser (1997, pp. 228–244), Richard Restak lists “30 steps you can take to enhance your brain in the mature years.” I have reviewed his list, added to and subtracted from it, combined items, and modified them. Here’s my revision of Restak’s list:
1. Stop smoking.
2. Do weight-bearing exercises daily.
3. Don’t rely on any particular food, drug, or chemical to promote longevity.
4. Maintain normal levels of blood pressure, blood sugar, and cholesterol.
5. Avoid a sedentary lifestyle; don’t stop being active just because you are slower.
6. Prefer standing exercises to sitting exercises.
7. Walk at least four hours a week.
8. Practice balancing daily when standing for long stretches (for example, while in a line, or singing a hymn, or standing at a party) by standing on one leg for as long as possible, then the other, and so on, alternating, just barely lifting the other foot off the floor. Try to do it without people noticing what you’re up to.
9. Reduce stress, or change (reframe) your attitude toward stressors.
10. Indulge your curiosity to the max.
11. Enjoy your coffee and other caffeine-drink energizers (but don’t exceed the proper dosage—see topic 12.3).
12. Nap.
13. Don’t fret about the possibility of memory loss; work on developing and improving your memory with books and gadgets (such as palm-held computers).
14. Don’t worry about becoming senile.
15. Keep working—gainfully or not—at something you enjoy for as long as possible.
“To add life to years, not just years to life.”
—Motto of the Gerontological Society of America
16. Minimize spare time.
17. Avoid excessive use of alcohol.
18. Keep challenging your mental abilities, from doing crossword puzzles to learning new skills and knowledge.
19. Keep a diary in some form that you enjoy. For example, work on your autobiography as a legacy for your children, relatives, or associates. Leave a copy to your library—they like to keep these as a form of local history.
20. Avoid social isolation. Engage in many diverse kinds of activities with other people: if you get “retired” from your church choir, start a choir for seniors; if you live alone, get a pet.
21. Remain active on the Internet. Use it as a support group, information source, and means of communication with family and friends. Start and maintain a family web page. My oldest sister acquired her first computer at age 88. She had never learned to type except by “hunt and peck,” but we exchanged e-mails to our mutual satisfaction until her death at age 94.
22. Continue to stimulate your five senses with art, food, people, and nature in its abundance.
23. Accept the fact that your ability to concentrate will shorten (to about 15 minutes), and take 3- to 5-minute breaks between 15-minute concentration periods.
24. Enjoy games as a way to nurture your ability to concentrate.
25. Accept being a slower organism and avoid activities that rely on speed of response: replace speed with wisdom.
26. Maintain—even increase—your sense of humor.
27. Maintain your friendships and develop new ones.
28. Prefer a diet with a moderate caloric intake, with a predominance of fresh fruits and vegetables.
29. Women after menopause should consult with their physician regarding the risks and advantages of taking estrogen supplements.
30. Take melatonin as a sleep aid (see particularly topic 16.10).
31. Follow the research on dehydroepiandrosterone (DHEA), and begin taking it when the studies consistently point to its safety and effectiveness in promoting physical and mental vitality; if you’re already in your 70s, you might consider taking it now. Ask your physician. As of this writing (2013), WebMD (www.webmd.com) discourages the use of DHEA supplements both for inadequate proof of their benefits and some indication of their risks and side effects.
If you consider 31 steps too intimidating, try these guidelines from the California Human Population Laboratory’s study conducted in the 1970s (Hobson, 1994, p. 188). People who followed six out of these seven recommendations lived longer and in better health: (1) Sleep. (2) Exercise. (3) Eat breakfast. (4) Don’t snack. (5) Watch your weight. (6) Do not smoke. (7) Use alcohol moderately.
Perhaps you are content with the way things are. If so, you might, just to amuse yourself, try taking the online life expectancy quiz at www.livingto100.com. This quiz is maintained by the Paul Beeson website, www.beeson.org, center of activity for the Beeson scholars, who are devoted to research for the purpose of improving quality of life, especially as it relates to aging.
SUGGESTED RESOURCES
Fossel, M. (1996). Reversing Human Aging. New York: Morrow.
Friedan, B. (1993). The Fountain of Age. New York: Simon & Schuster.
Keeton, K. (1992). Longevity: The Science of Staying Young. New York: Viking Penguin.
Medina, J. J. (1996). The Clock of Ages. Cambridge: Cambridge University Press.
Restak, R. M. (1997). Older and Wiser. New York: Simon & Schuster.
Ricklefs, R. E., and C. E. Finch (1995). Aging: A Natural History. New York: Scientific American Library.
Schaie, K. W. (1994, April). “The Course of Adult Intellectual Development.” American Psychologist, 49(4), 304–313.
Schaie, K. W. (1996). Intellectual Development in Adulthood: The Seattle Longitudinal Study. New York: Cambridge University Press.
Schaie, K. W., and S. L. Willis (1996). Adult Development and Aging (4th ed.). New York: Addison-Wesley.