Enlightened Aging – Building Resilience for a Long, Active Life

Book Preface

As a physician-scientist, I have wanted to publish a book for mainstream audiences about our discoveries in healthy aging for a long time. And now that this project has come to fruition, I realize our timing could not have been better. What a unique era this is! Peak numbers of baby boomers are starting their retirement years just in time to benefit from the emerging science of healthy aging. Never before have so many people lived to be ninety, ninety-five, or one hundred years old. And never before have so many people in late middle age had the chance to learn so much about growing old from their elderly parents’ experience. If ever there was a time to become enlightened about our prospects for a healthy old age, it is now.

These lessons come with great urgency—especially considering the huge demographic wave that is already sweeping our nation. This force will only become more powerful with time. The U.S. Census Bureau predicts that the population aged sixty-five to eighty-nine will double between 2010 and 2050. Meanwhile, the number of people ninety and over will more than quadruple.[1]

The implications of this shift are unknown because nothing like this has ever occurred before. Most forecasters are beset with worry and expect unprecedented difficulties for societies and individuals. But I hold a different view. Mine is optimistic, based on many factors. One is my experience studying and caring for thousands of elderly people who embrace aging with resilience and equanimity. The other is faith in my own generation and its proclivity for activism, problem solving, and community building in the face of any number of challenges. Add to this our growing scientific understanding of how to prevent or postpone age-related illness and disability, and I see that boomers have many reasons to expect a better experience of aging than their parents’ generation had. Of course, I haven’t always had this optimistic view of aging. In fact, when I took my first foray into geriatrics research in 1978, this whole business seemed rather mysterious (albeit fascinating) to me. I had been hired as medical director of the new University of Washington (UW) Geriatric and Family Services Clinic, founded by psychiatrist Burton Reifler. It was a dynamic time for the field as we were just beginning to realize the significant effects that various forms of dementia—and Alzheimer’s disease in particular—would soon have on our aging society. There were lots of “firsts.” For example, the husbands of two of our original patients established the first self-help group for caregivers of people with dementia, a movement that eventually led to the formation of the national Alzheimer’s Association.

We were also discovering just how much we had to learn. I had recently completed a chief residency in internal medicine at UW Medical Center and felt rather confident in my knowledge and abilities. But in our newly formed clinic, I was quickly humbled by what I didn’t know. This awareness drove me to the library, where I read everything I could find about the scientific underpinnings of gerontology and geriatrics. But in working with patients and families, I realized most of what I had learned in medical school, in my training, and from the journals didn’t correspond to what we were finding in clinical experience. So we began to collect observational data and publish scientific papers about our findings. This led to research grants, launching our careers in research on aging.

Fortunately, I had been part of the Robert Wood Johnson Foundation’s Clinical Scholars Program, which included training in the science of epidemiology at UW’s School of Public Health and Community Medicine. Our focus included chronic disease epidemiology—that is, the study of long-term conditions that predominantly affect older people. One key lesson was the importance of studying chronic diseases as they occur in general populations rather than studying them only among people who have been referred to specialty clinics for care of specific conditions. This helped me understand the gaps in my education to date. My training had been based on research in specialized, referral populations—mostly in younger people with rare conditions, not the kind of people we were seeing in our newly formed clinic. Previous findings didn’t reflect most people’s experience with Alzheimer’s disease and other dementias. Going forward, we could look for opportunities to fill this breach.

With this background, my colleagues and I received an award from the National Institute on Aging (NIA) to develop an Alzheimer’s disease patient registry—the kind of resource cancer researchers have long used for systematically collecting data among larger, more generalizable populations. Our partner would be Group Health Cooperative, a large Seattle-based health plan that provided comprehensive health care and coverage for hundreds of thousands of people in Western Washington.

With access to Group Health members’ medical records and other data, we would be able to capture nearly 100 percent of each study participant’s care experience. This would give us a better window into how large, broad-based populations were experiencing dementia and other age-related conditions.