We are responsible for our own successful aging. ItÍs not really life span that matters, itÍs health span -- how well we function physically, mentally and socially. Research scientists led by John Rowe and his colleague Robert L. Kahn, spent 10 years and twenty million of the MacArthur FoundationÍs dollars to study how people can age successfully. They went beyond defining successful aging as avoiding disease and disability to focus on maintaining mental sharpness, maintaining physical function and what they called ñengagement with life.î

      ThereÍs all kinds of good news. For starters, you are responsible. The lifestyle choices you make right now largely determine your health and vitality as you age. These choices turn out to be even more important than heredity in determining how well you function and for how long.

      The research dispels all kinds of myths: Only a very small (and declining) number of people end their lives in nursing homes; to be old is not necessarily to be sick; genetics are far less important than lifestyle to how you age; the aging body responds to change and is capable of startling improvement; and older people learn differently than young people but they do learn -- well. Research also confirms that we need each other. Dr. Rowe talks about how we move through life in a ñconvoy, î surrounded by others whom we need and who need us. This emotional support proved to be particularly important to men as they age.

      All the things common sense tells you matter, do. Nutrition is important. Research supports taking some vitamins and supplements (B6, folic acid, selenium, vitamin E, vitamin D3 and calcium) and avoiding others (DHEA and melatonin.) ItÍs no surprise that exercise is vital but it is surprising both that moderate aerobic exercise is as good as strenuous exercise and resistance exercise (weight lifting) is as important as aerobic.

      As we change our strategies to health promotion/disease prevention, we can reduce health care expenditures while life gets longer and healthier. There's an added bonus. This new way of thinking is also a viable way out of the Medicare problem.

      The hierarchy of successful aging begins with avoiding disease and disability. Accomplish that and you can actively change your life to increase the likelihood of maintaining or even increasing your mental sharpness and physical function as you age. Then youÍll be ready for the third element of successful aging -- engaging with life, remaining productive parts of our own personal ñconvoy.î How long we live and how well turns out to be largely in our own hands. And life, after all, is what aging successfully is all about.

Conversation 1

John Rowe tells Paula Gordon and Bill Russell about the three major scientific questions facing this country and the world in the next 50 years. æHe describes how dramatically the realities of being 65 years old have changed in the last 50 years and the science studying aging has changed in the past 10. He and his colleagues are shifting the focus from life span to health span, eager to learn how most older people can age successfully.

Conversation 2

Function is what truly matters according to Dr. Rowe. æHe compares two 75 year old men, one of whom might be in sitting in a nursing home while the other might be sitting on the United States Supreme Court bench. Dr. Rowe describes how MacArthur Foundation-funded research went beyond defining successful aging as avoiding disease and disability to focus on maintaining mental sharpness, maintaining physical function and what they called ñengagement with life.î He explains why the researchers concluded that we are, in large part, responsible for our own old age. He also details why the older you become, the less important genetics become. Dr. Rowe debunks myths about aging -- only a very small (and declining) number of people end in nursing homes, to be old is not necessarily to be sick, genetics are far less important than lifestyle to how you age, the aging body responds to change and is capable of startling improvement, and older people learn differently than young people but they do learn.

Conversation 3

Exercise, it turns out, is good for your brain. It is also good for physical function. And research showed that MODEST exercise is just as beneficial as strenuous exercise. It also has a cumulative effect. Dr. Rowe tells why resistance exercise turned out to be highly beneficial, even with 90 year olds in nursing homes. It builds strength and confidence and also decreases symptoms of depression. Dr. Rowe talks about the importance of nutrition to over all fitness, explaining why it is important that he and his colleagues have produced a research-based book to help people get through the clutter of diet and nutrition information that is too often based only on anecdotes.

Conversation 4

Dealing with oneÍs own health care providers has changed dramatically in the past 30 years. Dr. Rowe weighs in on what he thinks we should do for ourselves, how best we can use the resources of the medical establishment. He continues his discussion of nutrition, pointing out mid-life risk factors which in later life no longer apply. Cholesterol is his example. He tells what diet supplements and vitamins research found to be safe and effective and which he uses personally (B6, folic acid, selenium, vitamin E, vitamin D3 and calcium) and which ones he avoids (DHEA and melatonin.)

Conversation 5

Aging successfully is not about denial, imitating youth or living forever. ItÍs about living -- maintaining and maximizing physical and mental function. Dr. Rowe talks about two kinds of social support: instrumental support (often deleterious) and emotional support (particularly important for older men.) He describes how we all move through life in a ñconvoyî which we need to keep intact to age well. He champions engaging with life and urges a rethinking of what ñproductivityî means in America. He shows how central love and work are. (ñFreud got that part right.î) Dr. Rowe also explains how aging successfully is a way out of the Medicare problem -- when we move to a new health promotion/ disease prevention strategy, we can reduce health care expenditures while life gets longer and healthier. He tells why people mistakenly think of age 65 as when we get ñold.î

Conversation 6

Dr. Rowe acknowledges that their research reinforces a lot of good common sense. He challenges the obsessive and excessive concern older people incorrectly have about getting AlzheimerÍs disease, acknowledging the seriousness of the disease for those who are in fact affected by it. He describes how the brain changes over time and strategies to deal with those changes. The overall conclusion:ææWe are responsible for our own successful aging. The first part of successful aging is avoiding disease and disability. Then we can actively change our lives to increase the likelihood of maintaining or even increasing our mental sharpness and physical function as we age. Having achieved the first two, weÍll be ready for the third element to successful aging -- engaging with life.

Acknowledgements