What is Healthy Aging?

by Nina

Despite the horrifying vision of “exergames,” Brad’s post on Tuesday ("Successful Aging and the Thinking-Moving-Feeling Triad") got me interested in Dr. Dilip Jeste’s work. After all we’re all blogging away here about “healthy aging” without ever having really defined what it is. And that’s exactly what Dr. Jeste, Estelle and Edgar Levi Chair in Aging and Director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego, is currently trying to do. In an interview on Medscape (here), he said the following: 

“Successful aging has not been consistently defined; that is one reason why this area is ideal for research. There have been some studies funded by the MacArthur Foundation beginning in the mid-1980s going on through the mid-1990s. But the [scientific] literature is limited, and there is no consensus on what is successful aging. Our research goals include developing a definition as well as criteria for successful aging.”

Jeste and his colleagues observed that while the components of successful aging typically include: longevity, life satisfaction, absence of physical disease, freedom from disability, mastery/growth, active engagement with life, high/independent living, and positive adaptation, sometimes only physical functioning and disability are considered. But most importantly, very few scientists include “self rating” in their assessments (that is, to put it bluntly, they don’t bother asking the subjects how they feel about their own experience of aging). So they decided to do a study in which “participants’ subjective ratings of successful aging were contrasted with sets of researcher-defined criteria, and correlates of subjectively rated successful aging were examined.” (See "Correlates of self-rated successful aging among community-dwelling older adults".)

One result of this study was this: “Nearly all the study participants rated themselves as aging successfully, but far fewer met researcher-defined criteria for absence of illness and physical disability.” (Note that only participants with higher levels of cognitive functioning were studied.)

Dr. Jeste concluded, as he said in the Medscape interview, “It is also important to say what is not an essential part of successful aging—absence of either physical diseases or physical disability is not necessarily a part of successful aging. I want to stress that people who have physical illnesses or physical disabilities can be aging successfully.” Instead he lists the components for successful aging as:

• Higher level of cognitive functioning
• Adaptation to changes associated with aging
• Socialization—that is, some kind of social activity and/or social contacts
• Life satisfaction

And in the very same interview, he gives two examples of people he considers to have aged successfully, and they are: Franklin Roosevelt and Frank White, a well-known Los Angeles yoga teacher. Hmmm. It appears we're not on different wavelengths after all. You may want to watch this video of Dr. Dilip, in which he speaks about wisdom and successful aging. Around the 12-minute mark, you can hear him speak about the Bhagavad Gita.

For some time now, I’ve been going around saying that yoga provides two out of the three of the requirements for healthy aging: exercise and stress reduction (the third is a healthy diet). As of today, I’m going to add a new one: wisdom.

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Successful Aging and the Thinking-Moving-Feeling Triad

by Brad

Early this month I attended a symposium sponsored by the Longevity Consortium at the Buck Institute for Research on Aging on “Environmental, Developmental, and Genetic Factors in Aging and Longevity.” There were lots of interesting presentations, especially on the search for genetic determinants for longevity, or what we call genome wide association studies (GWAS). It turns out that almost nothing survives rigorous statistical scrutiny at this level, suggesting that the genetic factors for long life are very complex and highly dependent on a host of environmental factors.

However, there was one talk on a very different subject that was of particular interest. Dr. Dilip Jeste from UCSD gave a lecture on the meaning of successful aging, and why almost no one asks patients directly to assess their views of their own aging experience.  Almost all definitions of successful aging (and again, many prefer the term “healthy aging”, although they are often used interchangeably) are based largely on the absence of age-associated physical disabilities, such as cardiovascular disease, diabetes, neurodegenerative disease, etc. Dr. Jeste made a compelling case that self-assessment of one’s physical and psychological well-being at advanced age is critical for a better determination of what constitutes “successful aging.” Interesting concept, and one that may be more in sync with the yogic idea of the mind-body connection and mindfulness.

Larch Tree in Autumn by Philip Amdal

Intrigued by this, I went on to look at some of Dr. Jeste’s publications on these topics, and came across a very recent editorial published last year in BMJ titled, “Promoting successful aging through integrated care” (see here). I was struck the following statement:

“Another way of dealing with physical and mental health comorbidity may be through use of interventions that simultaneously increase physical activity, cognitive stimulation, and positive affect, thereby affecting all three components of the thinking-moving-feeling triad implicated in poor health related quality of life.”

As I read this I thought this is a pretty good definition of yoga, a “thinking-moving-feeling triad.” Maybe not an especially elegant summation, but pretty succinct. But what followed next took me back a bit:

An example of such an approach is the use of “exergames”—entertaining video exercise games. If such approaches were specifically adapted to the needs of older people, they could conceivably affect obesity, diabetes, heart disease, and depression simultaneously.”

Exergames? Not exactly sure what the meaning of this is (I confess to a horrible vision of a group of seniors playing bingo while clapping their hands to a Lady Gaga video), but if that's the best example they can come up with then something is wrong. Is yoga still met with such suspicion in the medical and academic community that such an obvious and natural connection is not made here? Is it going to take another generation for the current (and aging) yoga practitioners to retire before this can go more mainstream?

As I wrote in my last blog entry, one of the main reason I started practicing yoga at the age of 50 was that I was looking for a more age-appropriate exercise routine that would provide me with more flexibility, balance and core strength without exposing me to injuries. Sounds to me like yoga would be a much better fit here addressing all three of these goals (“thinking-moving-feeling triad”) in a much more integrated and natural fashion….

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Clarification: Aging, Yoga and Science

by Brad

Winter Trees by Brad Gibson

Today’s post is largely in response to the question: How would one go about investigating the effects of yoga on aging scientifically? Before tackling this question—which I will get to in the next week or two—I will first attempt to define or at least discuss a few key terms and assumptions. The reasons for this will hopefully become clear.

In the broadest the terms, “aging” applies to how systems or entities change with time. To inanimate objects, such as your new car or jacket, this begins right after it’s manufactured or, more relevantly, after you bought it. This process of aging can be rapid or slow (weeks, months, or years), and depends a lot on what the object is and what it was designed for. In biological systems (including us), we typically think of aging as starting after development, or post-puberty in our case. We also tend to associate aging with a decline and/or loss of functions, both physical and mental. However, aging can include more positive properties or phenotypes, such as increased knowledge and skill sets, and it isn’t all that hard to name a few that fit into this category. But in most biological scientific studies of aging, we refer to aging mostly in the former sense, i.e., an accumulation of mostly pathological properties, such memory loss, frailty, neurodegenerative diseases, bone loss, muscle loss, and so on. Surprisingly there are quite a few competing theories of basic aging, such as error accumulation, telomere shortening, antagonistic pleiotrophy, free-radical theory, and entropy, just to name a few. What all (or most) of these theories seek to address is the underlying molecular and physiological event that drives these largely negative processes. 

The term “successful aging” is more recent, having come into wide use in the last few decades. If you want to read more about this concept, I found the first chapter in the book Successful Aging: Perspectives from the Behavioral Sciences by Paul and Margaret Baltes quite useful (for information see Cambridge ebooks). 

Even last week as I read the science section of the New York Times (see NY Times), I came across a short review of a just-published study on “Alcohol Consumption at Midlife and Successful Ageing in Women: A Prospective Cohort Analysis in the Nurses Health Study” (see PLOS). In this prospective correlative study, researchers at Harvard demonstrated that a modest increase in successful aging for women who consumed small, but regular amount of alcohol at mid-life. (Maybe a glass of wine after yoga class isn’t such a bad idea after all?). Here they defined "successful aging" in a more precise manner: "as being free of 11 major chronic diseases and having no major cognitive impairment, physical impairment, or mental health limitations." Of course, this more operational definition to successful aging made it easier to make clear and objective distinctions among the woman in this group, typical of population based epidemiological studies. 

When we chose the term ‘healthy aging’ for this blog, the purpose was to provide information not on just how practicing yoga might help to avoid or reduce your chances of acquiring one or more of these age-related losses, but also to better manage and minimize their impact when they occur. Indeed, this is the position most of us are in, whether is through the vagaries of our genetic background, chance, past behavior, or whatever. (This reminds me of the joke: Q: What’s the best thing you can do to insure a long life? A: Choose your parents well.) So as I go back and reconsider the original question on how science can study the relationship of yoga and aging, I will reframe this question a bit: How can science study the effects of yoga on our overall physical and mental health as we age? I’ll tackle this question next time…. But as a preview, there are few good places to start, including the 2009 pilot study in Lancet on comprehensive lifestyle changes and telomere length (a biomarker of aging and cellular senescence) and several recently funded NIH studies examining yoga’s effects on depression, fatigue, and menopause. 

And please leave any questions for the Friday Q&A in the comments.

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