Once in a great while an outstanding health book comes along that should be featured on every radio and television talk show and in every major newspaper. Yet it fails to attract the attention it deserves because it isn't "sexy" enough. It doesn't rashly promise that you can live healthfully to 100 if only you would take this, that or the other pill, potion or dietary supplement.
Successful Aging, by Dr. John W. Rowe and Dr. Robert L. Kahn (Pantheon, 1998, $24.95), is such a book. It summarizes a decade of solid research, not wild speculation or extrapolation, conducted by 16 prestigious scientists among thousands of older Americans and Swedish twins.
The project, sponsored by the MacArthur Foundation, involved men and women age 70 and older living in normal environments outside nursing homes and hospitals. They were repeatedly examined by researchers seeking "the positive side of aging."
The result is a highly readable, myth-shattering treatise directed at people of all ages who are interested in achieving the goal established for humanity by the ancient Greeks _ to die young, as late in life as possible. The work also has important messages for everyone who deals with older people and may underestimate their abilities and compromise their potential for exciting, productive lives after the age of 65.
To help get its message across, the MacArthur Foundation is sending 12,000 copies of the book to community leaders and policy makers throughout the country.
Rowe, 53, who is president of Mount Sinai Hospital and School of Medicine in New York, said that far too many assumptions about the elderly had been based on people who were sick or in institutions. In fact, most older Americans are in reasonably good health, living independently and generally doing well.
His co-author, Kahn, is a professor emeritus of psychology and public health at the University of Michigan in Ann Arbor who, at 80, is the self-described "grand old man" of the MacArthur project and, as a result of the research, has added daily weight training to his bicycling routine.
Debunking the myths
They and their collaborators say that the first step to increasing the chances for a successful old age lies in demolishing widely held myths about older people and their potential for improvement.
MYTH No. 1: To be old is to be sick.
To be sure, nearly half of the people over 75 have arthritis, nearly a third have high blood pressure, heart disease or hearing impairments and 11 percent have diabetes. But rarely do these problems get in the way of a full life. The MacArthur studies and other research have shown that people are far more likely to age well than to become ill and decrepit. Only 5.2 percent of the elderly live in nursing homes, nearly 90 percent of people ages 65 through 74 report no disability whatever and even after the age of 85, 40 percent are fully functional. Furthermore, chronic disease among the elderly has been declining steadily since the late 1960s.
MYTH No. 2: You can't teach an old dog new tricks.
Despite constant references to Alzheimer's disease, "no more than 10 percent of all people 65-100 or more are Alzheimer's patients," the researchers said. And in their study of those 74-81, they said, "half showed no mental decline whatsoever over the next seven years." They found that the aged brain has "a remarkable and enduring capacity to make new connections, absorb new data and thus acquire new skills," including learning how to operate a computer, surf the Internet and communicate by e-mail.
Although short-term memory weakens with age, a few training sessions in memory skills can bolster the memories of the elderly, the researchers said. And while the mental processing of data slows with age, given enough time the elderly can do as well as younger adults.
MYTH 3: The horse is out of the barn.
Too many older people with lifelong unhealthy habits assume that it is too late to change and reap health benefits from, say, quitting smoking, starting exercise, losing weight or eating a more nutritious diet. The findings of the MacArthur studies, among many others, show otherwise. Immediately after quitting smoking, for example, the risk of a heart attack begins to decline and after a decade, so does the risk of lung cancer.
At any age, consuming more calcium and vitamin D can decrease the risk of osteoporosis and debilitating fractures, consuming more of the B vitamins folate and B-6 can decrease the risk of heart disease and taking a vitamin E supplement can protect against both heart disease and Alzheimer's disease.
But perhaps the broadest benefits to both body and mind accrue from becoming physically active, even after eight decades on the couch. The authors cite 91-year-old Edward, who had not exercised at all before signing up for a program at a home for older people when he was 86. Edward reported: "Once I started, I felt stronger, full of action. The weight lifting helps my walking. I feel better, I sleep better, I eat better. It has changed my life."
MYTH No. 4: The secret to successful aging is to choose your parents wisely.
A study of several hundred twins by the MacArthur researchers belies the belief that genes overwhelmingly determine one's health fate. Only about 30 percent of the characteristics of aging are hereditary, and the role genetics play in health, along with physical and mental function, diminishes with age. By age 80, genetics has virtually no influence. Rather, the authors say, "MacArthur research provides very strong scientific evidence that we are, in large part, responsible for our own old age."
MYTH No. 5: The lights may be on, but the voltage is low.
While sexual activity does tend to diminish with age, the MacArthur researchers report: "When it comes to sexual activity, chronological age itself is not the critical factor. There are tremendous individual differences in this intimate aspect of life, determined in part by cultural norms, by health and illness and by the availability of partners."
MYTH No. 6: The elderly do not pull their own weight.
The MacArthur researchers take society to task for not giving older people due credit for unpaid work and for failing to acknowledge that the elderly simply do not have an equal opportunity to obtain paying jobs.
"Millions of older people are ready, willing and able to increase their productivity, paid and voluntary," the researchers said. Even now, in taking care of spouses, siblings and grandchildren, the elderly do the work of 3 million care givers. For growing numbers of older people, retirement is not the end of a productive life but the beginning of a new one.
In many ways, Mary Elizabeth is an average late 20th-century older American. Widowed at 51 with seven children then aged 7 through 21, she began working part time at her alma mater and worked her way up to become the college's alumni director, finally retiring at 78.
Her thin, frail appearance belies her stamina. At 80, she bounced back from a hysterectomy faster than women half her age. At 81, she helped a daughter dig her car out after a blizzard buried it in two feet of snow and ice. No matter what the circumstances, she laughs readily and has a smile and cheerful word for neighbors and passers-by.
Now nearly 83, Mary Elizabeth lives alone in a three-story Brooklyn brownstone. She keeps her house neat and her stoop and sidewalk spotless, goes to lectures with a friend, attends church every Sunday, drives a car, visits a critically ill sister almost daily, entertains visiting children and grandchildren, reads a newspaper every day, gets her exercise by walking and climbing stairs, takes supplements of vitamin E and selenium and fixes nutritious meals for herself.
What is Mary Elizabeth's secret to aging successfully? Drs. Rowe and Kahn would say she is a can-do person with strong self-esteem who remains involved with people and events that support her emotionally, stimulate her mind and exercise her body.
They caution well-meaning friends and relatives against doing too much for older people because taking over tasks that the elderly can do for themselves is belittling. It undermines self-esteem, leads to "learned helplessness" and increases dependence.
When given a highly stressful test involving simulated driving, those with high self-esteem performed better and produced lower levels of stress hormones, Rowe said. "This was a clear-cut demonstration of the mind-body connection," he said.
The researchers found that it was important for older people to remain productive and for younger people to appreciate their contributions. Being productive can mean part-time employment, unpaid work, volunteer activities, taking care of children or the infirm, and all manner of household projects, from knitting and gardening to woodcutting.
Of course, healthy habits play a major role in successful aging. The authors lament that society incorrectly equates "usual" aging with "normal" aging, stating that "people often blame aging for losses that are in fact caused by life style _ overeating and poor nutrition, smoking, excessive use of alcohol, lack of regular exercise and insufficient mental exertion." The researchers found that such factors determine 70 percent of the mental and physical attributes of people 65 to 75 and nearly all the age characteristics of those over 80. Their overriding conclusion: "You are responsible for your own old age."
Exercise is crucial
There has perhaps never been a more ringing endorsement of the benefits to body and mind of regular physical exercise than was derived from the MacArthur studies. "Physical activity is at the crux of successful aging, regardless of other factors," the authors stated emphatically.
The studies found that even among smokers and those with high blood pressure, older people who are physically fit are "at lower risk of death than nonsmokers with normal blood pressures who are couch potatoes."
Exercise can also reduce the risk of diabetes, arthritis, and cancers of the breast, uterus and colon. At any age, it can enhance overall stamina, increase stability and decrease the risk of falls, and counter depression.
"The frailty of old age is largely reversible," the authors wrote, adding that it was never too late to start. The MacArthur studies showed that very old people, even those in their 90s who never exercised before, can become more physically fit and, as a result, function better and live longer and better, even if they have health problems or bad habits.
"Couch potatoes are now being grouped with cigarette smokers as taking their lives into their own hands," the authors wrote. In trying to encourage the sedentary, they noted: "The more frequent the exercise, the greater the benefit, but you don't have to overdo it. Moderate exercise such as bowling, golf, light sports, gardening, walking and the like proved to be nearly as protective as vigorous exercise."
Perhaps least often recognized are the immediate benefits of exercise to emotional well-being and mental sharpness, especially for those who work out with others.
As Rowe said in an interview: "We've learned that isolation is bad. Social interaction and exercise feed on each other. Especially in men, emotional support _ providing you-can-do-it encouragement _ is an important predictor of getting men to exercise and to maintain their physical fitness."