Annals of Long Term Care

The first of a two-part article from the author on optimal aging.

In 1997, the oldest person to have ever lived died at age 122 years and 164 days.¹ Jeanne Louise Calment lived in France, took up fencing at age 85, and still rode a bicycle at 100. She was from a family of long-lived persons: her father died at age 93, her mother at 86, and her brother at age 97. She did quit smoking when she was 117, reportedly because she was nearly blind and felt embarrassed asking for a light. In 1965, when she was 90 and had no living heirs (she had outlived her daughter and grandson), she entered into a legal agreement to sell her condominium apartment to lawyer Francois Raffray, who was then age 47. He agreed to pay a monthly sum, similar to a “reverse mortgage,” until she died, so that he would obtain the apartment. Unfortunately for him, she survived him, and his widow had to continue the payments. In many ways, one can view the life of Jeanne Calment as an example of “optimal aging.”

The concept of healthy aging is attractive for many reasons. Virtually all people hold the vision of an active and independent older person in high esteem. With the growing number of baby boomers nearing age 65, a surge in publications and marketing strategies are capitalizing on healthy aging. GeezerJock magazine² caters to master athletes. Exercise clubs are forming specifically for people over age 50. Health maintenance organizations advertise to the Medicare population using pictures of active older adults, in part to increase the number of enrollees with lower risk. Retirement communities market their facilities with emphasis on wellness programs, access to alternative medicine, and state-of-the art exercise facilities. Healthy aging is big business.

We are witnessing a remarkable transformation. Only 40 years ago, the baby boomers listened to songs talking of there being no useful life after age 30. Aging was seen in uniformly negative terms, a time for disengagement, and becoming “senile” was an expected part of a long life. Major psychological theories saw the primary developmental task of old age as readying oneself for decline and death.³ As the baby boomers have aged, the notion of inevitable decline, helplessness, and dependency is being discarded.

What is Healthy Aging?
But what exactly is healthy aging, and how should it be defined? Many terms have been suggested. Perhaps the most common has been successful aging, as suggested by Rowe and Kahn.⁴ Others include aging well, effective aging,⁵ robust aging, positive aging, elite aging, and even anti-aging. Using Rowe’s definition, successful aging contains three essential components: absence of disease and disability; high cognitive and physical functioning; and active engagement with life. Usual aging, on the other hand, describes the common mode of aging in which there are significant physiological losses along with substantial loss of reserve capacity. Some have felt uncomfortable with these definitions. Many persons over age 65 have a chronic disease; the majority of those over 85 have one or more chronic diseases and have functional deficits. Are we to label the vast majority of those over age 85 “unsuccessful?” The opposite of success is failure. Is frailty (however one may define it) the ultimate failure? Furthermore, the world loves the story of those who have overcome cancer or serious heart conditions to return to meaningful life activities. Are not such persons successful? Finally, most such definitions are locked into a world-view that is primarily biomedical, focusing on health or disease.