In my eight years here at HealthCentral, I have entirely neglected the topic of aging. Let’s see if we can start a new trend:
On Thursday, I attended a public lecture hosted by the International Bipolar Foundation, here in San Diego. The name of the talk was “Successful Aging and Mental Illness,” by Colin Depp of UCSD. Perhaps the best way of doing justice to the topic in the space of a blog post is to offer a few talking points. Let’s get started ...
First, some knock-me-over-with-a-feather moments: According to Dr Depp, “successful aging” was only first mentioned in 1960, and it took until 1987 before the term made it into a medical article. Even then, there is no expert consensus on what successful aging is. A 2006 review article co-authored by Dr Depp noted that 28 different studies came up with 29 different definitions.
Most of these studies focussed on aging from a physical disability perspective.
Successful aging is a novelty for the fairly obvious reason that until recently most of us never made it past middle age. Now, for the first time we have more people over age 60 than children. Not only that, people live longer without illness. Says Dr Depp: “This is the generation people have an opportunity to age well.”
So how do we age well? Dr Depp and his colleague Dilip Jeste decided to ask the experts, namely those with actual lived experience. This involved surveying an older population in San Diego. Their study will be published in the American Journal of Psychiatry.
As an aside, studies that solicit the wisdom of the people with lived experience are as rare as hen’s teeth. I am aware of only two in bipolar. I am sure they are similarly rare in schizophrenia. Significantly, Dr Depp is a co-author of one of those schizophrenia studies.
One of the things Dr Depp and his colleagues found is that the people in his aging cohort emphasized “adaptability” over being free from a condition. In other words, aging happens.
Dr Depp cited the “Nun Study,” which tracked a community of nuns for more than a quarter of a century, seeking clues into risk of Alzheimer's. The study yielded a number of intriguing findings (such as those who displayed greater literacy as young adults were less likely to succumb to Alzheimer’s at a later age). What Dr Depp found worth noting was that post-mortem brain exams yielded no one-to-one relation between pathology and neuro-performance.
In other words, the brain can compensate, say by increased blood flows to affected areas. Also, we can adapt by engaging in healthy lifestyle and other good habits. Aging is only 20-30 percent heritable. The rest is environmental, which means we are not helpless bystanders. For instance, according to a study that appeared in the New England Journal of Medicine in 2000, those who engaged in a healthy lifestyle (good diet, exercise, no smoking), reduced their risk of heart disease 80 percent.
Yes, but what about the brain? Dr Depp cited a Dutch study that found that optimistic people live longer.
Of course, having bipolar or depression or other serious mental illness militates against an optimistic mindset. According to a 2011 study in PLOS, males with bipolar can expect to lose 10 years of life compared to the general population, females 11 years. For depression, it is 10 years for males and seven years for females. By comparison, smokers can be expected to lose about seven years of life.
Besides optimism and diet and exercise, Dr Depp noted these other keys to successful aging: Cognitive stimulation, social integration, positive attitudes toward aging, and stress reduction.
If only we weren’t so depressed and miserable to begin with, we might be able to put all this into practice. Instead, we tend to do things that are bad for us, such as smoking and drug use and social isolation.
Besides, in our condition, who wants to live longer? I heard Dean Ornish speak to this very point at a lecture at the American Psychiatric Association annual meeting in 2009. As I reported on my Knowledge is Necessity blog at the time:
"What's sustainable," Dr Ornish said, "is not fear of dying but joy of living."
Dr Ornish is no stranger to depression, having experienced a severe episode that sidelined him from college. Loneliness and isolation, he said, increases mortality 3.7 times. Depressed individuals are more likely to over-eat, smoke, drink, and work too hard.
You would think that making a few simple changes would be easy, right?
"'Dean, you don't get it,'" his patients told him. "'These behaviors get us through the day.'"
Paradoxically, things look up as we age. Dr Depp pointed out that people tend to be least satisfied with life around middle age. But as we get past this trough, we find ways of recovering the optimism of our youth. A different kind of optimism, perhaps. Maybe one borne of acceptance, though not resignation. We adapt. When all is said and done, we really have no choice.
The purpose of this piece is to start a conversation. Please feel free to jump in. Comments below ...
Published On: November 17, 2013
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