What We Mean By Healthy Aging

by Nina

Melitta teaches "Granny Yoga" to her mother,  aunt, and aunt's friend

For us, the life story of our friend Melitta’s mother Nancy is a perfect example of “healthy aging.” Born in San Francisco on December 12, 1921, Nancy died on August 27, 2015, age 93 (or 93 and a half as she liked to say). She was very active all her life. She played sports in school, and was her high school and college track and field champion in shot put and discus. She loved skiing, sailing, hiking, horseback riding—all things outdoors. She even worked as a wrangler at ranches around California. 

Even in her last years, she walked three miles every morning with her walking buddies Elaine and Ellen, power walking along the beach and greeting the other regular walkers. She did have some back problems with spinal stenosis, so Melitta gave her a yoga mat and some back care yoga poses to do. Nancy did them faithfully every morning, and was so pleased that they really improved her back.

Nancy also loved traveling, and during her lifetime, she traveled around the world, visiting every continent. In 2011, she returned to her favorite country, Turkey, and traveled around Eastern Turkey. In 2012, she did her last safari in Africa, and then gave up long haul travel, though she continued to travel within the US to spend time with family. She volunteered at her church until about age 91, and had an amazing network of friends and family. 

She lived independently in her apartment until her last few days. At age 90, she had made her own decision to stop driving. Although she didn’t have any hired help, her friend Elaine, a true force of nature, looked in on her regularly (and considered it an honor to do that). Elaine also helped her by taking shopping after she stopped driving and would send her husband Lloyd over to help her with tech stuff, such as her computer and printer. 

It was only in the last year of her mom’s life that Melitta noticed her mom was slowing down. She and Melitta did discuss her fear of decline, and Melitta’s fear of her decline. She had some gallbladder issues, and in July 2015 she had a bile duct blockage and had surgery. Then, in August 2015, she had emergency surgery for gallstones, but she also developed sepsis. She was in ICU for four days, and although doctors "threw all the antibiotics" they could at her, her organs were failing, so the family followed her directives and discontinued care. When Melitta first got to the hospital, Nancy was still conscious but unable to speak because she was intubated. In the joking way they had with each other, Melitta said, "it must be bad if I am here." Nancy laughed as best she could. She died two days later, with her children holding her as she moved on. 

In our post What is Healthy Aging, Anyway?, we defined what we mean by "healthy aging," describing its three basic components:

Compressed Morbidity. This is the time out of your life span that you spend in ill health. Nancy had a lifetime of excellent health, with some slowing down and her only serious problems limited to her last year of life. (This is generally the best-case scenario for people who live as long as she did.)

Independence. This means not just being able to live on your own, but being able to continue to do the activities that you love and that give your life meaning. And Nancy was not only able to stay in her home until the end of her life, she was able to keep up her active life almost until the end, including walking on the beach with her friends, traveling, volunteering at her church, and spending time with friends and family.  

Equanimity. This means being able to face difficulty and handle challenges with balance and grace. Although there’s much we don’t know about her life and how she faced earlier challenges, we think it’s worth considering how Nancy dealt with the challenges of being older. It sounds like she faced them head on! She realistically decided to stop overseas travel and driving when the time was right. And she was able to discuss her fears of decline and to confront her death. That allowed her to leave directives for her family and to die on her own terms. Finally, being able to laugh at her daughter’s joke at the very end sounds like she was she was able to stay engaged in life and family for all her days. How beautiful!

Thanks, Melitta, for sharing this story with us.

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Can We Delay Aging?

by Brad Gibson, Ph.D.

The Damsel of the Holy Grail
by Dante Gabriel Rosetti

“No, we cannot “prevent aging”… but what if we could delay it?

Unfortunately, the deterioration that comes with aging is part of a fundamental aspect of the universe, so it cannot be eliminated. Recent research suggests, however, that the rate of deterioration is indeed malleable, at least in many different animal models. So why not in people?” — Dr. Felipe Sierra

Dr. Felipe Sierra's post Can We Delay Aging? on the Next Avenue site is a reasonable and thoughtful response to what is actually a very difficult question. While, some researchers in the aging field have gone so far as to talk about extending one’s life to 200 years or more, or even becoming immortal, Dr. Sierra sidesteps these assertions and instead tackles the more practical, and the less politically charged issue, of targeting an increase in “‘healthspan,” or what is known in the field as “compression of morbidity.”

“Traditionally, research on aging has focused on longevity, but we all recognize that longevity without health is a hollow goal. As the field has matured, we are paying more attention to healthspan — the proportion of lifespan spent in reasonably good health.

Many of the interventions identified in animals lead to improved healthspan. Not only do the animals die later, they die with fewer diseases and debilitating conditions than their control counterparts. This suggests that, at least in mice and other species, it might be possible to attain the Holy Grail of aging research: compression of morbidity.”

This “compression of morbidity” hypothesis, first proposed by James Fries at Stanford Medical School back in 1980, states that the “Extension of adult vigor into a fixed life span compresses the period of senescence near the end of life” (J. F. Fries, The New England Journal of Medicine July 17, 1980). From the NIH and governments budget perspective, this is a laudable goal, as it would potentially lead to less healthcare expenditures in the later years of one’s life, which currently consume over 50% of all medical costs. It would also have the obvious advantages of reducing chronic illness and diseases associated with aging, such as cancer, Alzheimer’s disease, and diabetes.

But can it be achieved? Evidence in model organisms from worms to flies to mice suggest that many of the underlying molecular pathways that appear to have an effect on the lifespan of an organism also tends to improve other phenotypic traits, such as movement, and cognitive and behavioral functions. This is important, as many of the early studies just examined lifespan extension in these model organisms without a close examination of whether there was also an increase in the health or robustness of the organisms. Clearly, the last thing we want to experience for ourselves is an increase of 10-20 years of our lifespan if it was to be lived in a chronic state of debilitation. And while we all know that improved exercise and diet can have significant effect on our health or robustness, the question of whether this will lead simply to an increase in our lifespan but not a compression of morbidity or an increase in our healthspan. 

The jury is still out with respect to unequivocal evidence of the compression of morbidity hypothesis, but several published studies suggest that it may be achievable. Indeed, the term “geroscience” that Dr. Sierra invoked in his essay as a new field of research devoted to answering this question was first coined by scientists at my own institute, the Buck Institute for Research on Aging. It was the title of a successful NIH proposal, “Geroscience” to the NIH to “support interdisciplinary approaches to solving significant and complex biomedical problems, particularly those that have been resistant to traditional approaches.” The essential notion of geroscience was that processes that drive aging and the diseases of aging overlap. And if we are to make any real progress in understanding aging, scientists need to study age-related diseases in the context of aging in a truly interdisciplinary manner. 

This may seem like an obvious statement, but most basic science research into diseases that occur late in life were not, and are still not, conducted with aging as a major variable in the overall experimental design. For example, the vast majority of studies of neurodegenerative diseases, such as Alzheimer’s or Parkinson’s diseases, where mouse models were used, the age of the mice were typically 6 months old, or about late-adolescence in human terms. But this is changing, and there is now an emerging consensus in the scientific community that we need to study these diseases in aging models to gain the insight we will need to find cures. So where are we in this process? Dr. Sierra concludes by saying:

“When will people benefit from this?

It is definitely too early to say, which is why I have refrained from even mentioning the interventions that work in animals. So, despite the thriving industry of “anti-aging” treatments, nothing that we know of today has been shown to prevent or delay the aging process in people. Thus, the current generation may not benefit from this groundbreaking research. But maybe our children and grandchildren will.”

Indeed, there are no anti-aging treatments available today that have proven effects on delaying aging despite some interesting studies in animal models. And I mostly agree with him that progress will be slow and we are unlikely to benefit from this basic research in our own lives. So in the meantime we are left with what we know can affect our general health: diet, exercise, reducing stress, etc. So instead of waiting for the miracle cure or fountain of youth—when and if it ever comes—there are plenty of non-pharmacological ways to improve your health, whether or not that they will delay the rate of your aging.

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What is Healthy Aging, Anyway?

by Nina

Dahlia by Melina Meza

It has only struck me recently that while we’ve written about what aging is and the many ways yoga can help foster healthy aging, we’ve never really addressed what “healthy aging” is. So I thought I’d take a moment to give an overview of the thoughts that Baxter and I currently have on this topic. At this point—we’re still just discussing these ideas—we consider healthy aging to have three important aspects:

• Compressed Morbidity
• Independence
• Equanimity

And the reason why we’re such proponents of yoga for healthy aging is that we believe yoga can help with all three of these aspects of healthy aging. For now, I’ll just give you a brief overview of how.

Compressed Morbidity. Last week I wrote a post Longevity vs. Morbidity comparing the difference between longevity and morbidity. The medical term “morbidity” refers to the period of time you spend in ill health before you die. Obviously we all would like—both for ourselves and for our loved ones—to keep this period of ill health as short (that is, compressed) as possible. A well-rounded yoga practice, especially one that includes stress management, can help by preventing some of the diseases, such as heart disease, high blood pressure, and diabetes that plague people during their older years.

Independence. Another goal I think we all share for ourselves and our loved ones is that we can continue to live independently and care for ourselves as long as possible. From our point of view living independently includes both the basic daily self care activities, such as dressing, going to the toilet, getting up and down from a chair, doing light housework, and so on as well as the ability to continue to do the activities we love (which I wrote about in my post Being Able to Do What You Love) for as long as possible. A regular asana practice—even one that is modified over time—will help keep us able bodied, rather than sliding into the stiffness and weakness that results from a sedentary lifestyle.

Equanimity. For me, maintaining emotional stability as we age is the most important aspect of healthy aging. For even if we can “compress” morbidity, we will certainly have to go through poor health at some point. And even if we can prolong our independence into old age, we may eventually have to face the loss of that, however briefly. In addition, even if we are ourselves blessed with long and healthy lives, we’ll all have to deal with losing people we love. So being able to handle the challenges ahead with balance and grace is crucial. But I also believe that this is where yoga has its greatest strength. Stress management practices help reduce stress, anxiety and depression. And meditation and yoga philosophy can help us keep grounded and strong. At least that is my fervent hope.

Baxter and I will be writing more on these topics in the weeks to come, but we’d also love to hear your thoughts, ideas and personal stories.

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