Richard Besdine, M.D., below, studies successful aging. Director of the Center for Gerontology and Health Care Research, Besdine knows what it takes to increase the "span of vitality" in older people, as he explained recently to the George Street Journal's Scott J. Turner.
Are there "hows" and "whys" behind the increasing number of people living a century or more?
People are living healthier lives, and many of the public health-related problems that used to kill people are now under control. Lifestyle changes, public-health improvements and improved health care have all come together to extend longevity.
What specific factors help people live longer and healthier?
If there is one thing, it’s exercise. Less heart disease, reduced rate of cancer, better cognitive function, lower rates of depression and decreased risk of falls — name something good, and exercise is associated with it.
Are there other lifestyle factors?
Anything you smoke will disable you and make you miserable for a substantial part of your life before you die. You are also what you eat. Eating a bad diet, high in fat and simple sugars, can lead to diabetes, coronary heart disease and other health problems.
What about public health?
For one thing, the immunizations we get as kids for mumps, measles, German measles, chicken pox, tetanus and polio make a significant difference. If you can keep children from dying and adolescents from suffering accidental deaths, then a significant life expectancy has always been a pretty good bet. But many people don’t seem to know that it is also important for older adults to get their vaccinations, particularly against influenza and pneumonia.
How does health care make a difference?
One major contributor to longevity is health insurance for the poor. Medicaid and Medicare have improved well being for older Americans. Increased screening for elevated blood pressure - and treating it when it is detected — has been important. So have improved screening and prevention programs for cancer, osteoporosis and other conditions, including depression.
Have medications made a difference?
Prescription drugs are one of the cheapest and most effective ways to treat illnesses in older persons. However, as people age, the number of diseases they confront goes up, as does the number of drugs they take. Prescription drug safety is also important as you age because there can be unintended drug interactions, or even overdoses, due to the altered physiology of aging.
What about the company you keep?
Rich social networks are important. The more people you talk with in a week for 15 minutes or more, the lower the risk of losing function, being admitted to a nursing home or hospital, or even dying. We screen for stress in CEOs but not in 80-year-olds who are watching their spouses and friends die and who are losing their incomes and homes. Old age is stressful, although coping with stress actually improves with age. And, while there is less depression among healthy older persons, improved screening would help those who are dealing with chronic diseases and other conditions. Nursing home residents, for example, have high rates of untreated depression.
Don’t you also talk about the benefits of improved safety?
Rates of serious injury have gone down among older persons. The highest fatality rates per miles driven belong to older drivers, so attention to them has made very good sense both in driver-training programs and in having road tests for those older than 75. It is important to identify older drivers who have physical or mental impairments that make crashes more likely.
What is your prescription for successful aging?
My mnemonic is "BESDINE’s BOOMERS." B for Blood pressure; E for Exercise; S for Smoking cessation; D for Driving safety; I for Immunizations; N for Nutrition; E for a safe home Environment; and S is for Screening for cancer. The B is for sensible use of Booze; O for good Oral health; O is for Osteoporosis screening and prevention; M is for Mobility, particularly prevention of falls; E is for Emotional health; R for Rx- therapeutic drug safety; and S is for Social networks.