Successful Aging: Optimizing Life in the Second Half

by Sol Stern, MD (11/5/11)


The impact of the physiological changes of senescence is determined by the attitude of a person as he/she ages, "successful aging" is an attitude relatively new to western culture. Taoism and other eastern philosophies, however, have long promoted this concept. Successful aging stems from and results in an enhanced quality of life. People who age successfully are healthy, energetic people leading active, vital lives. By staying healthy, fit and engaged with life, older people contribute to society and maintain their self-esteem.

From about the age of 30, physical and mental abilities inevitably begin to decline. The good news is that this process can be slowed down. In the book Successful Aging, John Rowe and Robert Kahn describe how to make the best of our later years. Their recommendations are based on the MacArthur Foundation Study of Successful Aging. From that study, Row and Kahn suggest three actions that positively influence the aging process and enhance quality of life in later years:

  • Avoid Disease and Disability
  • Maintain High Cognitive and Physical Function
  • Stay Involved With Life and Living

Following these tenets from one's early years would be of value, but the authors emphasize that it is never too late to get started; there are noticeable benefits from physical and mental exercise, social interaction and cessation of smoking at any time of life.

Avoiding Disease and Disability

The risk of disease increases with age. Some conditions can be prevented or, if not, discovery of these conditions at an early stage increases the chance of a cure.

  • Cancer: Prevention and Early Discovery
  • Heart Disease: Reducing the Risk
  • Stroke Prevention
  • Osteoporosis: Prevention and Early Discovery
  • Dementia
  • Vaccination

Cancer: Prevention and Early Discovery

Ask your physician for more information about these suggestions for preventing and detecting cancer.

Breast Cancer

Prevention: Several factors that have been associated with breast cancer are moderate to heavy alcohol intake, obesity and hormone replacement therapy (HRT). Many postmenopausal women take hormone replacement therapy to replace hormones that are no longer secreted naturally. The loss of hormones after menopause is linked to osteoporosis (bone deterioration) and an increased risk of heart disease. The relationship between HRT and breast cancer is controversial, but women who have taken high doses for many years appear to have a higher incidence of breast cancer. However, the benefits of receiving HRT have been well-documented and the risks must be measured against the rewards.

Early Discovery: A monthly breast self-examination, an annual breast examination by a trained practitioner and annual mammograms for women over the age of 40 are the best methods for discovering breast cancer in its early stages.

Cervical Cancer

Prevention: Cancer of the cervix is more common in smokers.
Early Discovery: The American College of Obstetricians and Gynaecologists recommends routine annual Pap smears and pelvic examinations. Women with a history of abnormal Pap smears or previous cervical cancer should follow the advice of their treating physician.

Colon and Rectal Cancer

Prevention: High dietary fiber and low animal fat intake may be protective and has other benefits as well. Some evidence suggests that regular aspirin may decrease the risk. In some studies, hormone replacement therapy has also been associated with a reduced risk of colorectal cancer.
Early Discovery: Those over 40 years of age should have an annual rectal examination and, possibly, screening for fecal occult blood. Persons with a family history of bowel cancer, who have inflammatory bowel disease or who have previously had polyps removed from their bowel should discuss the need for more extensive screening with their family doctor.

Prostate Cancer

Prevention: Other than aging, the risk factors for this condition are poorly understood.
Early Discovery: An annual rectal examination and a blood test for PSA (prostate specific antigen) is recommended.

Lung Cancer

Prevention: Stop smoking.
Early Discovery: There is no effective screening test at present.

Skin Cancer

Prevention: Sunlight has been linked to skin cancer. Protection from intense sunlight, particularly between 10am and 2pm, is recommended. Sunscreen and protective clothing can prevent sunburn which is a high risk factor for skin cancer.
Early Discovery: See a physician promptly if you find a skin lesion that bleeds or that has changed size, shape, thickness or color.

Heart Disease: Reducing the Risk

Cholesterol: Persons with tendencies to high cholesterol should be monitored. High levels of cholesterol can be reduced by replacing saturated fats with unsaturated fats in the diet. Stopping smoking, exercising and taking 1 - 2 ounces of alcohol per day are thought to help maintain good cholesterol levels.

Smoking: Stop smoking. There are remarkable benefits at any age. The risk of coronary heart disease falls rapidly regardless of the age when you stop smoking.

Hypertension (high blood pressure): Exercise and diet with a physician's guidance plus medication if required will bring blood pressure levels down. Exercise early in life delays hypertension. Strict glucose control has been shown to reduce the "small blood vessel" complications of diabetes mellitus and may lessen the risk of heart disease.

Obesity: Being overweight is a risk factor for heart disease and also tends to increase blood pressure and make glucose control in diabetes more difficult. Stressful lifestyle worsens coronary heart disease.

Post-Menopausal Hormonal Replacement Therapy: Hormone therapy reduces the risk of heart disease but should be balanced against the possible increased risk of breast cancer.

Aspirin: Daily intake of aspirin should be monitored by a physician. Aspirin thins the blood and reduces clotting.

Antioxidant Vitamins: Vitamin C, beta-carotene and vitamin E are antioxidants. Studies have suggested that vitamin E may reduce the incidence of heart attack in men, and reduce the numbers of fatal heart attacks in postmenopausal women. According to the MacArthur study, more work needs to be done before vitamin C and beta-carotene can be said to reduce the incidence of heart disease.

Homocystine, Folic Acid, Vitamins B12 and B6: Homocystine is an amino acid found in the blood. The higher the level of homocystine, the greater the risk of vascular (blood vessel) disease. Fortunately, it has been discovered that folic acid counteracts the action of homocystine in the body. Folic acid (folate) is easily included in the diet in uncooked leafy green vegetables, liver, fruit, meat, dairy products, cereal and flours. The MacArthur Study recommends that older persons take a daily folic acid supplement of 400 mcg just to be sure they're getting enough folate.

Folic acid can have adverse effects on individuals susceptible to vitamin B12 deficiency. For that reason it is recommended that older persons taking folic acid supplements also take 1 mg of vitamin B12 (cobalamin) each day.

There seems to be a connection between Vitamin B6 deficiency and increased risk of heart disease. A daily supplement of B6 may reduce that risk.

Stroke Prevention

A stroke can happen in one of two ways. In the first case - Ischemic Stroke - blood flow to the brain is blocked because of blood clots or cholesterol plaques in blood vessels in the neck. In the second case - Hemorrhagic Stroke - a blood vessel in the brain ruptures and blood passes into the brain tissue.

The most common cause of these damaging attacks is hypertension or high blood pressure. As with heart disease, a physician can prescribe medication and recommend diet and exercise plans to lower blood pressure and reduce the risk of stroke.
Smoking increases the risk of stroke. When a person stops smoking (regardless of their age) there are measurable reductions in the risk for stroke.

Osteoporosis: Prevention and Early Discovery

Osteoporosis refers to a loss of bone mass per unit volume. This loss of bone density increases susceptibility to bone fractures. The most common fractures are in the hip, spine, wrist and ankle. The humped-back appearance of some osteoporosis sufferers results from fractures and compression of individual vertebrae.

Prevention: Stop smoking. It is also important to look at weight-bearing exercises that encourage bones to become stronger, hormone replacement therapy and calcium in the diet.
Early Discovery: In the book Successful Aging, Rowe and Kahn say that screening for osteoporosis should only be used if the physician plans to treat the disease. The tests should not be done on a man who is a non-smoker, in good health and active with no evidence of bone problems. This applies also to active, non-smoking, post-menopausal women who started hormone replacement therapy at the beginning of menopause and have no risk factors or clinical evidence of osteoporosis. If there is a need for screening tests, Rowe and Kahn recommend the Dual Energy X-ray Absorptiometry test (DEXA). This test is able to provide information about the entire skeleton.

Hormone Replacement Therapy (HRT)

Women on hormone replacement therapy take estrogen or a combination of estrogen and progestin. The medication comes in pill form or as a patch. Estrogens act to prevent rather than restore bone loss - they are therefore most useful if taken before extensive bone loss occurs. For some women there may be increased risk of uterine or breast cancer if there is a family history of these conditions. Women who continue to smoke are not ideal candidates for hormone replacement.

Calcium and Vitamin D

Calcium is one of the mineral building blocks in bone. Taken as a dietary supplement, calcium slows age-related bone loss up to ten years after menopause. A total daily intake of 1500 mg of calcium is recommended for women not on HRT, 1000 mg for women taking HRT and 1000 mg for men. Since the average diet includes 700 to 800 mg of calcium, a supplement of about 300 to 800 mg is suggested. Vitamin D (800 IU each day) is needed so the body can absorb the calcium. Milk is a good dietary source of calcium and vitamin D.


Calcitonin is a hormone that affects the amount of calcium stored in the bones. It is given to some care recipients with established osteoporosis. It is available as a nose spray or as an injection and should be taken along with calcium supplements.


Two forms of these drugs are well known - Didronel and Fosamax. They work to increase the density of bone and as a result decrease the number of fractures suffered by people with confirmed osteoporosis. They are especially effective for bones of the spine, hips and wrists. The drugs should be taken with calcium and vitamin D supplements.


Dementia is not normal aging. It was once thought that dementia, or senility, was an inevitable consequence of old age. Some forgetfulness and slowing down of mental processes can be expected with age, but this functional loss does not normally threaten an older person's independence.

When dementia strikes an older person, the results can be devastating for both the affected person and their caregiver. The older person suffers personality change, loses independence and eventually all personal interaction. This is especially heartbreaking for the caregiver who is no longer recognized as a relative or close friend.

In Successful Aging Rowe and Kahn discuss two major forms of dementia - Alzheimer's Disease and Multi-Infarct Dementia. Their focus is on prevention as part of successful aging.

Prevention of Alzheimer's Disease

Earlier theories that environmental agents including mercury, aluminum and viruses might hasten the onset of Alzheimer's Disease have not been borne out by research. Post-menopausal hormone replacement is believed by some to prevent or delay Alzheimer's Disease, though this is unconfirmed. Another preventive measure may be nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs such as aspirin and ibuprofen are commonly used for arthritis. There seems to be some evidence that long-term use of these drugs prevents decline of cognitive (understanding, problem-solving) abilities. But once again, more proof is needed.


Flu Vaccine: New strains of influenza develop every year in the Far East. This allows time to develop vaccines for the viruses before they reach North America. All elderly persons should receive annual flu vaccinations. If a reaction to the vaccine occurs, it is usually localized to the site of the injection, lasts only for a couple of days and rarely interferes with normal activities. Flu vaccine should not be given to individuals who have experienced a severe allergic reaction to chicken eggs or egg products. Those with a history of Guillain-Barre Syndrome should discuss the issue with their physician.

Pneumococcal Vaccine: Research from the MacArthur Foundation provides support for giving pneumococcal vaccinations to people over the age of 65 to prevent pneumococcal pneumonia. It is also useful for any adult with an increased risk of pneumococcal infection or who is at risk of suffering a complication from such an infection. One vaccination is effective for 6 years. Routine booster doses of this vaccine are not recommended but revaccination may be considered after 6 years for some people.

Tetanus Vaccine: Tetanus is a serious illness and can be fatal. Tetanus vaccination involves a series of 3 doses that should be supplemented with booster shots every 10 years even into old age.

Maintaining High Cognitive and Physical Function

Research from the MacArthur Study of Successful Aging suggests that loss of mental and physical function is an avoidable consequence of aging. Physical exercise promotes vitality, mental sharpness, physical strength, balance and overall wellness. In their book Successful Aging John Rowe and Robert Kahn recommend regular moderate exercise, like gardening or walking, several days a week. Each effort should be enough to burn off 1000 calories. This will maintain your fitness level. Even if you have never exercised, it's never too late to start. You will have more energy, be steadier on your feet and less likely to fall and, best of all - you will extend your useful life.

Aerobic Exercise vs. Weight Training

Walking, calisthenics, jogging, dancing, hiking, swimming - any of the exercises that get your heart and lungs working - are good for flexibility and increase your endurance. Weight training, on the other hand, builds strength. Muscles get bigger and, most important, stronger. This activity is not restricted to young bodybuilders. Even people in their 90s recovering from hip surgery can benefit from supervised weight training. Both kinds of exercise are beneficial and the ideal situation is a balance of both. An activity like gardening with walking, bending, digging and lifting is a good combination. A slow start is best for the person who has been inactive for a long time.

A program of regular exercise keeps the mind active and helps reduce depression. Some slowdown of mental processing and problems recalling names or numbers are not uncommon. Successful agers keep their minds sharp with reading, word games, mental puzzles and interesting conversations.


This can be a problem for older people, particularly those living alone. Fortunately, if they have a caregiver, there is someone to provide nutritious and appealing meals.
Older people are prone to dehydration because they have less muscle mass to conserve water and the kidneys are not as efficient at keeping water in the body. This means most older people should take in about one and a half to two liters of fluid each day. (Persons with heart or kidney disease should take the advice of their physician). The fluid can be juice or other beverages as well as water. Bear in mind that caffeine (in coffee and tea, for example) stimulates the kidneys to produce more urine, causing a net loss of fluid from the body.

Calories from fat should be no more than 30% daily.

Carbohydrates from sugar, potatoes, pasta and bread should be 55 to 60% of the daily calories. Sources of fiber should be included - 20 to 30g of fiber is the ideal.

Older people need about 12% of their daily calories to come from protein. This provides the resources needed for wound repair, immune-system vitality and muscle strength.

Proper nutrition gives an older person the fuel they need for their life-extending physical exercise.

Staying Involved with Life and Living

There are two important ways to stay involved in life. First is interaction with people. Second is contributing to life in some meaningful way.

Interaction With People

Interaction with others fills two needs for the older person. In times of need, they may be able to seek help with the everyday tasks. But more important, contact with others provides conversation and exchange of friendship. Caring about other people gives everyone a reason for living. Life remains interesting and it has a purpose. Staying involved prevents the isolation that can ruin mental and physical health.

Contributing to Life

Contributing something valuable to life builds self-esteem at any age but this is especially important for older people. Their contribution can be paid or unpaid activity in the community or it can be as simple as baking a special pie or building a birdhouse. The contribution is appreciated and valued by others and in turn the older person values him or herself.

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