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Paradox of Aging:
The Older We Get, the Better We Feel

Presently, there are about 40 million Americans aged 65 and older, with the fastest-growing segment of the population older than 80. Traditionally, aging has been viewed as a period of progressive decline in physical, cognitive, and psychosocial functioning, and many Americans today view aging as the No. 1 public health problem.

But this negative view of aging contrasts with results of a comprehensive study of 1,006 older adults in San Diego by researchers from the University of California (UC), San Diego School of Medicine and Stanford University. Results of the Successful Aging Evaluation (SAGE) study, which comprised a 25-minute phone interview followed by a comprehensive mail-in survey, were published in the December 7, 2012, online issue of the American Journal of Psychiatry.

“While there is a growing public health interest in understanding and promoting successful aging, until now little published research has combined measures of physical health with cognitive and psychological assessments in a large and randomly selected sample,” says principal investigator Deli V. Jeste, MD, a distinguished professor of psychiatry and neurosciences and the Estelle and Edgar Levi chair in aging.

The SAGE study included adults aged 50 to 99, with a mean age of just over 77. In addition to measures that assessed rates of chronic disease and disability, the survey looked at more subjective criteria, such as social engagement and participants’ self-assessment of their overall health. “Sometimes the most relevant outcomes are from the perspective of the subjects themselves,” explains Jeste, who also is the director of UC San Diego’s Stein Institute for Research on Aging and current president of the American Psychiatric Association.

The study concluded that resilience and depression have significant bearing on how individuals self-rate successful aging, with effects that are comparable with that of physical health. “Even though older age was closely associated with worse physical and cognitive functioning, it was also related to better mental functioning,” says coauthor Colin Depp, PhD, an associate professor of psychiatry at UC San Diego School of Medicine.

After adjusting for age, a higher self-rating of successful aging was associated with higher education, better cognitive function, better perceived physical and mental health, less depression, and greater optimism and resilience.

Participants were asked to rate the extent to which they thought they had “successfully aged,” using a 10-point scale and their own concept of the term. The study found that people with low physical functioning but high resilience had self-ratings of successful aging similar to those of physically healthy people with low resilience. Likewise, the self-ratings of individuals with low physical functioning but minimal or no depression had scores comparable with those of physically healthy people with moderate to severe depression.

“It was clear to us that even in the midst of physical or cognitive decline, individuals in our study reported feeling that their well-being had improved with age,” Jeste says. This counterintuitive increase in well-being with aging persisted even after accounting for variables like income, education, and marriage.

Jeste suggests the take-away message for clinicians is that an optimistic approach to the care of elders may help reduce societal ageism. “There is considerable discussion in public forums about the financial drain on the society due to rising costs of healthcare for older adults—what some people disparagingly label the ‘silver tsunami.’ But successfully aging older adults can be a great resource for younger generations,” he says.

The findings point to an important role for psychiatry in enhancing successful aging in older adults. “Perfect physical health is neither necessary nor sufficient,” Jeste says. “There is potential for enhancing successful aging by fostering resilience and treating or preventing depression.”

— Source: University of California, San Diego Health Sciences Center