By Carla MillsCarla Mills is a licensed and accredited Nurse Practitioner who has been a practicing clinician for more than 20 years. She is the author of A Nurse Practitioner’s Guide to Smart Health Choices, an easy to understand, medical reference guide for patients with no prior medical knowledge. Read her blog at maverickhealth.com.
The following article is adapted from Carla Mills’ blog, which is available at www.maverickhealth.com/blog. Carla has edited the content slightly from the original posting. Although the content is written for patients, it provides useful information for nurse practitioners.
Growing old is not for the faint of heart. And aging does not have to be accompanied by illness or decline, either. That commonly held belief is a myth. In my book, A Nurse Practitioner’s Guide to Smart Health Choices, I write: “Building a healthy life is like climbing a mountain. The challenge is always before you and there is effort involved. There are things you can control and things you can’t. A life that begins with a happy childhood, grows into a vigorous and productive adulthood, and concludes in a peaceful and wise old age is possible.” My belief in that possibility motivated me to write my book, and I hope that same belief will motivate you to make the effort to age to perfection—regardless of your current age.
Gerontologists and psychologists have identified five key requirements for aging to perfection—good health, an active engagement with life, maintaining interpersonal relationships, staying productive, and functional capacity.
Functional Capacities—Physical, Cognitive and Emotional
Functional capacity refers to one’s ability to comprehend an issue or perform a task. Those functional capacities exist in three domains: physical, cognitive, and emotional, ie, the body, mind, and spirit.
We may be living longer, but we are not necessarily living better. Although we aren’t dropping dead at 62 the way people once did, for many of us who haven’t been physically active in years, living longer doesn’t feel like such a blessing. With every passing decade, people tend to become less and less active, just at a time when they really need to become more active.
Findings from a study published in the Archives of Internal Medicine in 2008 suggest that adults of any age who are physically active in their leisure time may actually be biologically younger than “couch potatoes.” Without going into the details of the study, it found that inactive adults were biologically older by 10 years than adults of the same age who participated in regular heavy physical activity for an average of 199 minutes, or about 3.5 hours, per week.1
Being overweight also becomes more of a burden as you age. According to an article in the Journal of the American Medical Association, obese people over the age of 60 are almost three times as likely to have some sort of disability as people of normal weight. Compared with nonobese individuals in this age group, obese people were significantly more likely to suffer from arthritis (P<0.001), asthma (P=0.003), chronic bronchitis (P=0.03), congestive heart failure (P=0.004), and diabetes (P<0.001).2 Carrying around extra weight also takes an added toll on knee and hip joints, increasing arthritis pain and limiting mobility.
Maintaining your physical capacity and mobility so that you can go about your activities of daily living comfortably and avoid falls is the goal. You don’t have to run marathons. Doing exercises such as squats may not seem like much fun now, but if they enable you to get in and out of bed or on and off the toilet without help, being able to do them may just keep you out of a nursing home!Can you do the following easily?
Walk a quarter of a mile without becoming short of breath or having to stop and rest?
Walk up 10 steps without resting, stooping, crouching, or kneeling?
Lift and carry 10 pounds?
Stand up from an armless chair?
If you are struggling with any of these activities, you may want to rethink your relationship with exercise.
There are three types of exercise—and you should be doing some of all of them. Take part in aerobic exercise (eg, walking, biking, swimming, or running) for your heart for at least 30 minutes a day on most days of the week. That’s the minimum—60 minutes a day is better. Strength training two or three times a week to maintain your muscle mass will help your strength and balance. Where strength training is concerned, you want to work muscles to fatigue at each session. Your muscles get stronger during the rest periods in between workouts. You also need some kind of flexibility and balance training (eg, yoga or tai chi). This will also improve your balance and reduce your risk of falls, which are a leading cause of nursing home placements and death in the elderly. Meditative disciplines (eg, yoga or relaxation techniques) can improve your body, mind, and spirit and help you in your quest to age to perfection.
Does having a “senior moment,” such as forgetting a person’s name or where you put your car keys, signal that your brainpower is declining? Are these moments the beginning of a decline into Alzheimer’s disease (AD)? Probably not.
A growing number of studies suggest that an aging brain is simply taking in more data and sifting through a larger volume of information. Think about it this way—a 70-year-old brain has a lot more information and memories to review than a 20-year-old brain when retrieving a thought or memory. It is true that some brains do deteriorate with age. The Alzheimer’s Association reports that AD strikes 13% of Americans aged 65 and older. That is scary! There currently are 5.1 million Americans aged 65 and older suffering from AD, and it is estimated that this number could increase to 7.5 million by 2030 and to 11–16 million by 2050.3 The reason for this increase is that most of us are living longer. But remember that AD is a disease—not a normal part of aging. If you or anyone in your family is concerned about AD, see a health professional. There is testing that can be done and medications that can slow the progress of the disease if it is detected early.
Since we don’t yet know how to prevent or cure AD, the best defense against it is a good offense. Being physically active and fit, staying mentally active and engaged, and nurturing strong interpersonal relationships seem to help ward off all kinds of disease. As humans, we are “use it or lose it” creatures. That’s true for our minds, our bodies, and our spirits.
Growing old gracefully takes courage, resilience, and an unbelievably good sense of humor. There are many factors that play a part in a person’s emotional capacity. Remaining actively engaged with life, maintaining meaningful interpersonal relationships, and staying productive will help keep you healthy. In addition, having a purpose and a rich spiritual life will add to your enjoyment of life and deepen your appreciation of the role others play in it.
A person with high emotional capacity is self-confident, self-aware, and self-disciplined. There are many healthy ways to stretch your emotional capacity. Being open, trusting, and patient are qualities of a person with high emotional capacity. Enjoying time alone, whether in nature or curled up with a good book, gives you the opportunity to rest and to reflect on your own unique journey and path.
Wisdom—the Capacity to Endure
Wisdom is the reward given to the old for maintaining their functional capacities and surviving. The young are blessed with beauty, physical prowess, and seemingly endless restorative powers, but elders—if they are lucky—acquire wisdom. I don’t know about you, but if I am lucky enough to grow old, I hope I get there having acquired a little wisdom along the way. All I know so far is that wisdom has a price. Anything of real value does not come cheaply. Money cannot buy life’s richest gifts—they can only be earned.
Stephen S. Hall wrote a fascinating article titled “The Older-and-Wiser Hypothesis,” which was published in The New York Times Magazine in May of 2007.4 In his article, Hall explains that clinical psychologist Vivian Clayton, PhD, identified three aspects of human activity that are central to wisdom: the acquisition of knowledge (cognition); the analysis of information (reflection); and the filtering of knowledge and information through the emotions (affection).According to Hall’s article, the characteristics of a wise person include:
having a clear-eyed view of human nature and the human predicament
having the ability to step outside oneself and understand another person’s point of view
possessing forgiveness, compassion, and humility
emotional resiliency, ie, being able to handle adversity and bounce back emotionally
an openness to other possibilities
being balanced in heart and mind when reaching a decision
making good decisions
acknowledging uncertainty, at the level of both thought and action
having the ability to cope in the face of adversity and remain calm in the midst of a crisis
possessing a sense of emotional contentment, even in the face of adversity or uncertainty
having a knack for learning from lifetime experiences appreciating one’s historical, cultural, and biological circumstances during the arc of a lifespan
Adversity and loss are human experiences that are inseparable from the development of wisdom. Hall cites psychologist Laura Carstensen, PhD, director of the Stanford Center on Longevity at Stanford University, as saying “There’s a lot of loss associated with aging, and humans are the only species that recognizes that time eventually runs out. That influences the motivation to savor the day-to-day experiences you have, it allows you to be more positive. Appreciating the fragility of life helps you savor it.”