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Book Forum: GERIATRICS   |    
Successful Aging
RICHARD BALON, M.D.
Am J Psychiatry 1999;156:791a-792.
View Author and Article Information
Detroit, Mich.

by John W. Rowe, and Robert L. Kahn. New York, Pantheon Books (Random House), 1998, 265 pp., $24.95; $12.95 (paperback published by Dell).

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As our life expectancy gets longer, we are getting older as a society. However, society has a predominantly negative view of aging and old people. Old age is viewed as a time filled with disease, troubles, and nothing to look forward to. Some people, however, age successfully and remain very active until their last days. The rest of us wonder how they do it.

In 1984, the John D. and Catherine T. MacArthur Foundation assembled 16 scholars from major disciplines relevant to aging to develop the conceptual basis of a "new gerontology." This "MacArthur Study," which was actually a coherent set of dozens of individual research projects, focused on the positive aspects of aging. Two leaders of this group, John Rowe and Robert Kahn, summarized the results of this study for the general public in Successful Aging. The book deals with three fundamental questions about human aging: What does it mean to age successfully? What can each of us do to be successful at this most important life task? and What changes in American society will enable more men and women to age successfully?

The introduction to this book, titled "Aging America—The New Longevity," discusses the increasing life expectancy, the possible limit of the human life span, and the fact that seniors are different today from the seniors of earlier times. Chapter 1, "Breaking Down the Myths of Aging," dispels such myths as, "To be old is to be sick" and "You can’t teach an old dog new tricks." The authors emphasize that there is increasing evidence that the rate of physical aging is not determined by genes alone and that lifestyle factors have a powerful influence. Chapter 2, "The Structure of Successful Aging," defines successful aging as the ability to maintain three key characteristics: low risk of disease and disease-related disability, high mental and physical function, and active engagement with life. Chapter 3, "Usual Aging," discusses the risks of and reversal of usual aging. Chapter 4, "Nature Versus Nurture in Aging," outlines the influence of genes and environment in the various diseases of old age. Chapter 5, "Avoiding Disease and Disability in Late Life," focuses on the prevention and detection of cancer, heart disease, and other problems of old age. It emphasizes the role of exercise in almost all prevention strategies. Chapter 6, "The Role of Exercise and Nutrition in Maintaining Health," expands on the role of physical activity in maintaining good health and adds a discussion of nutrition, especially vitamins. Chapter 7, "Beyond Exercise: Strategies to Maintain and Enhance Performance in Old Age," stresses that those who have higher mental function are also more likely to maintain physical function. Chapter 8, "Maintaining and Enhancing Mental Function in Old Age," emphasizes that decreases in mental function can be prevented and that older people can increase their mental abilities. Chapter 9, "Marketing Youth: The Pills, Potions, and Lotions of Anti-Aging," demonstrates that most of the anti-aging agents, such as dehydroepiandrosterone and melatonin, cannot be endorsed as fountains of youth. Chapter 10, "Relating to Others," stresses the impact and importance of social connectedness for health and states that giving support is more important than receiving it. Chapter 11, "Productivity in Old Age," dispels the myth that old people are not productive. Finally, chapter 12, "Prescribing for an Aging Society," discusses strategies for our society to make full use of the abilities of older people and suggests what the government can do.

The main message of this interesting book is that successful aging is largely determined not by genetic inheritance, as commonly believed, but by individual lifestyle choices in diet, exercise, pursuit of mental challenges, self-efficacy, and involvement with other people. This is a very optimistic and important message. The book is written for the general public, but geriatric psychiatrists will find it useful in discussions with their patients as well as recommended reading. Finally, we can all learn from this book how to modify our lifestyles in older age so that we can age successfully, thus beating our genes. Watching my 86-year-old father-in-law working—translating book after book, cracking jokes, and reading one mystery after another—I realized, as this book suggests, that there really is a way to age successfully.

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