Successful Aging: Optimizing Life in the Second Half

by Sol Stern, M.D. and Richard O’Boyle
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The impact of the physiological changes of aging is determined by the attitude of a person as he/she ages. “Successful aging” is an attitude relatively new to western culture. Taoism and other eastern philosophies, however, have long promoted this concept. Successful aging stems from and results in an enhanced quality of life. People who age successfully are healthy, energetic people leading active, vital lives. By staying healthy, fit, and engaged with life, older people contribute to society and maintain their self-esteem.

From about the age of 30, physical and mental abilities inevitably begin to decline. The good news is that this process can be slowed down. In the book “Successful Aging,” John Rowe, M.D. and Robert Kahn, Ph.D. describe how to make the best of our later years. Their recommendations are based on the MacArthur Foundation Study of Successful Aging. From that study, Rowe and Kahn suggest three actions that positively influence the aging process and enhance quality of life in later years:

  • Avoid Disease and Disability
  • Maintain High Cognitive and Physical Function
  • Stay Involved With Life and Living

Following these tenets from one’s early years would be of value, but the authors emphasize that it is never too late to get started; there are noticeable benefits from physical and mental exercise, social interaction, and cessation of smoking at any time of life.

Avoid Disease and Disability

The risk of disease increases with age. Some conditions can be prevented or, if not, discovery of these conditions at an early stage increases the chance of a cure.

  • Cancer: Prevention and Early Discovery
  • Heart Disease: Reducing the Risk
  • Stroke Prevention
  • Osteoporosis: Prevention and Early Discovery
  • Dementia
  • Vaccination

Cancer: Prevention and Early Discovery

Clinical studies over the years have shown some convincing associations between some lifestyle choices and environmental factors and specific cancers. According to the National Cancer Institute the most consistent finding is the strong association between tobacco use and many different types of cancers. Additional examples of modifiable cancer risk factors include alcohol consumption (associated with increased risk of oral, esophageal, and other cancers), physical inactivity (associated with increased risk of colon, breast, and possibly other cancers), and being overweight (associated with colon, breast, endometrial, and possibly other cancers), according to NCI.

Fruit and vegetable consumption has generally been found in studies to be associated with reduced risk for a number of different cancers, the NCI says. However, it is not currently known which specific components of fruits and vegetables (such as beta carotine) are responsible for the reduced risks. Consumption of red meat and inadequate folic acid intake have also been associated with increased risk of colon cancer.

Ask your physician for more information about suggestions for preventing and detecting cancer.

Heart Disease: Reducing the Risk

Cholesterol: Persons with tendencies to high cholesterol should be monitored. High levels of cholesterol can be reduced by replacing saturated fats with unsaturated fats in the diet. Stopping smoking, exercising, and taking 1 - 2 ounces of alcohol per day are thought to help maintain good cholesterol levels.

Smoking: Stop smoking. There are remarkable benefits at any age. The risk of coronary heart disease falls rapidly regardless of the age when you stop smoking.

Hypertension (high blood pressure): Exercise and diet adjustments with a physician’s guidance, plus medication if required, will bring blood pressure levels down. Exercise early in life delays hypertension. Strict glucose control has been shown to reduce the “small blood vessel” complications of diabetes mellitus and may lessen the risk of heart disease.

Obesity: Being overweight is a risk factor for heart disease. It also tends to increase blood pressure and makes glucose control in diabetes more difficult. Stressful lifestyles worsen coronary heart disease.

Stroke Prevention

A stroke can happen in one of two ways. In the first case - Ischemic Stroke - blood flow to the brain is blocked because of blood clots or cholesterol plaques in blood vessels in the neck. In the second case - Hemorrhagic Stroke - a blood vessel in the brain ruptures and blood passes into the brain tissue. 

The most common cause of these damaging attacks is hypertension or high blood pressure. As with heart disease, a physician can prescribe medication and recommend diet and exercise plans to lower blood pressure and reduce the risk of stroke.

Smoking increases the risk of stroke. When a person stops smoking (regardless of their age) there are measurable reductions in the risk for stroke.

Osteoporosis: Prevention and Early Discovery

Osteoporosis refers to a loss of bone mass per unit volume. This loss of bone density increases susceptibility to bone fractures. The most common fractures are in the hip, spine, wrist, and ankle. The humped-back appearance of some osteoporosis sufferers results from fractures and compression of individual vertebrae. To prevent osteoporosis, stop smoking. It is also important to look at weight-bearing exercises that encourage bones to become stronger, hormone replacement therapy, and calcium in the diet.


It was once thought that dementia, or senility, was an inevitable consequence of old age. Dementia is not normal aging. Some forgetfulness and slowing down of mental processes can be expected with age, but this functional loss does not normally threaten an older person's independence.

Earlier theories that environmental agents including mercury, aluminum, and viruses might hasten the onset of Alzheimer's Disease have not been borne out by research. Post-menopausal hormone replacement is believed by some to prevent or delay Alzheimer's Disease, though this is unconfirmed. Another preventive measure may be nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs such as aspirin and ibuprofen are commonly used for arthritis. There seems to be some evidence that long-term use of these drugs prevents decline of cognitive (understanding, problem-solving) abilities. But once again, more proof is needed.


Flu Vaccine: All elderly persons should receive annual flu vaccinations. If a reaction to the vaccine occurs, it is usually localized to the site of the injection, lasts only for a couple of days, and rarely interferes with normal activities.

Pneumococcal Vaccine: Research from the MacArthur Foundation provides support for giving pneumococcal vaccinations to people over the age of 65 to prevent pneumococcal pneumonia. One vaccination is effective for 6 years. Routine booster doses of this vaccine are not recommended but revaccination may be considered after 6 years for some people.

Maintaining High Cognitive and Physical Function

You’ve probably heard of the physical benefits of exercise – reduced rates of heart disease and diabetes, improvement in blood pressure levels, and protections against osteoporosis, to mention a few. “But what about improving balance and strength to make walking and climbing easier and to help prevent falls? What about finding an outlet for your frustration and anxiety? What about feeling better about yourself and how you look?” asks Constance Serafin, a Registered Nurse and Family Nurse Practitioner at Pace University’s Health Care Unit in New York.

Research from the MacArthur Study of Successful Aging suggests that loss of mental and physical function is an avoidable consequence of aging. Physical exercise promotes vitality, mental sharpness, physical strength, balance, and overall wellness. In their book Rowe and Kahn recommend regular moderate exercise, like gardening or walking, several days a week. Each effort should be enough to burn off 1000 calories. This will maintain your fitness level. Even if you have never exercised, it's never too late to start. You will have more energy, be steadier on your feet and less likely to fall and, best of all - you will extend your useful life.

Aerobic Exercise vs. Weight Training

Walking, calisthenics, jogging, dancing, hiking, swimming - any of the exercises that get your heart and lungs working - are good for flexibility and increase your endurance. Weight training, on the other hand, builds strength. Muscles get bigger and, most important, stronger. This activity is not restricted to young bodybuilders. Even people in their 90s recovering from hip surgery can benefit from supervised weight training. Both kinds of exercise are beneficial and the ideal situation is a balance of both. An activity like gardening with walking, bending, digging, and lifting is a good combination. A slow start is best for the person who has been inactive for a long time.

A program of regular exercise keeps the mind active and helps reduce depression. Some slowdown of mental processing and problems recalling names or numbers are not uncommon. Successful agers keep their minds sharp with reading, word games, mental puzzles, and interesting conversations.


Proper nutrition can be a problem for older people, particularly those living alone. Fortunately, if they have a caregiver, there is someone to provide nutritious and appealing meals.

Older people are prone to dehydration because they have less muscle mass to conserve water and the kidneys are not as efficient at keeping water in the body. This means most older people should take in about one and a half to two liters of fluid each day. (Persons with heart or kidney disease should take the advice of their physician). The fluid can be juice or other beverages as well as water. Bear in mind that caffeine (in coffee and tea, for example) stimulates the kidneys to produce more urine, causing a net loss of fluid from the body.

“Proper nutrition depends on well-balanced meal planning. The wider the variety of foods within the diet the greater the chance that you will take in all the important nutrients necessary for maintaining health and preventing illness,” says Marie Truglio-Londrigan, Ph.D., a certified Geriatric Nurse Practitioner. “Nutrients include some fats, proteins, simple and complex carbohydrates, vitamins, minerals, and water.”

Calories from fat should be no more than 30% daily. Carbohydrates from sugar, potatoes, pasta and bread should be 55 to 60% of the daily calories. Sources of fiber should be included - 20 to 30g of fiber is the ideal. Older people need about 12% of their daily calories to come from protein. This provides the resources needed for wound repair, immune-system vitality, and muscle strength. Proper nutrition gives an older person the fuel they need for their life-extending physical exercise.

Staying Involved with Life and Living

There are two important ways to stay involved in life. First is interaction with people. Second is contributing to life in some meaningful way.

Interaction with others fills two needs for the older person. In times of need, they may be able to seek help with the everyday tasks. But more important, contact with others provides conversation and exchange of friendship. Caring about other people gives everyone a reason for living. Life remains interesting and it has a purpose. Staying involved prevents the isolation that can ruin mental and physical health.

“Humans require positive meaningful interactions with other humans. Lack of stimulation from these types of interactions can lead to depression and cause memory problems,” says Joanne Singleton, Ph.D., Associate Professor at Pace University, Lienhard School of Nursing, and Director of Pace's Institute for Healthy Aging. “Unfortunately not all human interactions are of this nature. In addition to your routine interactions seek out those with whom you can have positive and meaningful interactions.”

Contributing something valuable to life builds self-esteem at any age but this is especially important for older people. Their contribution can be paid or unpaid activity in the community or it can be as simple as baking a special pie or building a birdhouse. The contribution is appreciated and valued by others and in turn the older person values him or herself.

“Aging isn’t ‘all in your head.’ Tools for introspection are important. Some of the most important dimensions of ‘Conscious Aging’ are lifelong learning, late-life creativity, psychological understanding (for example, through dreams), and meditation and spiritual practices,” adds Harry “Rick” Moody, Director of the Institute for Human Values in Aging and Chairman of the Board of Elderhostel.


 - “Successful Aging: The MacArthur Foundation Study” by John W. Rowe, M.D., and Robert L. Kahn, Ph.D. Dell Publishing, New York, 1998
 - National Cancer Institute, Cancer: Prevention, Genetics, Causes
 - “Exercising Care” by Constance M. Serafin, M.Ed., M.S., R.N,C, FNP
 - “Proper Nutrition 40+” by Marie Truglio-Londrigan Ph.D., R.N.,C.S., GNP
 - “Memory Enhancement” by Joanne K. Singleton, PhD, RN, CS, FNP
 - “Tips on… Quitting Smoking” by Richard O’Boyle

Recommended Reading:

- “Successful Aging: The MacArthur Foundation Study,” by John W. Rowe, M.D. and Robert L. Kahn, Ph.D.
- "Fit for Life" by Harvey and Marilyn Diamond
- "In the Ever After: Fairy Tales for the Second Half of Life" by Allen Chinen (hard to find)
- "The Measure of My Days" by Florida Scott-Maxwell
- "Still Here" by Ram Dass
- "Exploring Our Lives: A Writing Handbook for Seniors" by Francis E. Kazemek
- "From Age-ing to Sage-ing: A Profound New Vision of Growing Older" by Zalman Schachter
- "The Five Stages of the Soul: Charting the Spiritual Passages that Shape Our Lives" by Harry (Rick) Moody

- More books on Healthy Aging in our Longevity & Wellness Bookshelf


Available from ElderCare Online™                2002 Prism Innovations, Inc.