1. Resilient Aging Gregg Warshaw, MD University of Cincinnati OAGE Conference Dayton, Ohio March 28, 2014

3. Myth #1 To Be Old is to Be Sick

4. Self-rated Health

5. ADL/ IADL Limitations National Health Interview Survey, 1999 data. CDC. NCHS. Percentage

6. Myth # 2 You Can’t Teach an Old Dog New Tricks

7. Myth # 3 The Horse is Out of the Barn

8. Myth # 4 The Secret to Successful Aging is to Choose Your Parents Wisely

9. Myth # 5 The Lights May Be On but the Voltage is Low

10. Myth # 6 The Elderly Don’t Pull Their Own Weight

11. What is Aging?

12. Aging Is not a disease Occurs at different rates among individuals within individuals Does not generally cause decline in function or significant symptoms

13. Usual Aging Functioning well AT RISK for disease and disability MOST older adults

14. Usual Aging: RISKS Decline in reserves in organ systems Decline in immune/recuperative power

15. Successful Aging... If we can figure out how to get the Baby Boomers to arrive at old age in better shape: Society’s health care costs will be reduced Life-long personal resources will be saved Families will be less burdened

16. Rowe & Kahn (1987)’s definition: Few or no age-related declines Implies that it is possible to reach advanced age relatively free of age-associated disease and functionally intact Paradigm shift, but number of persons experiencing this type of “successful” aging is minority

17. Successful Aging vs. Resilient Aging Alternate definitions “Minimal interruption of usual function” “Doing the best with what one has” Shifts the focus from minority to majority Major differentiator: extent to which a person can have a chronic disease or functional disability and still be considered to be aging successfully Schmidt (1994); Baltes & Carstensen (1996).

18. Resilient Aging Avoid or manage chronic illness and disability Engage independently or with support in most normal activities of daily living Maintain cognitive function Able to cope with physical, social, and emotional changes Sense of control of life

22. Determinants of Successful Aging Biologic Aging Disease Health Behaviors Social Supports

23. Normal Physiologic Effects of Aging Copyright © 2010 Pearson Education, Inc.

24. Determinants of Successful Aging Biologic Aging Disease Health Behaviors Social Supports

26. Determinants of Successful Aging Biologic Aging Disease Health Behaviors Social Supports

27. Lifestyle Choices Diet Exercise Smoking Drinking

28. Rather than seeking permission to exercise, you should have to get permission to be sedentary. Maria Fiatarone, M.D.

29. Source Undetermined

33. Benefits of Exercise Weight loss Decrease central adiposity Increase lean body mass Blood pressure decline Aerobic capacity increase Insulin sensitivity increase Increase bone mass Increase muscle strength Increase perceived well being

34. Determinants of Successful Aging Biologic Aging Disease Health Behaviors Social Supports

35. Social Factors Marriage Family Friends Religiosity Work Volunteering

36.  Resiliency  Independently functioning  In good health at least to the age of ninety.  Few centenarians are obese  Substantial smoking history is rare Source: Perls T., Silver M., Lauerman J, 1998 Centenarian Characteristics

38.  Regular exercise  Healthy diet  Avoid tobacco  Alcohol in moderation  Correct use of medications  Screen for disease and treat early  Education about caring for illnesses  Strengthen social network Health Promotion Needs to be a Major Focus for Geriatrics/Gerontology Professionals

39.  Prevention of premature death  Delay of the onset of chronic diseases  Postponement of disability related to chronic diseases  Higher quality of life  Greater participation in the life of the family and community  Reduction in medical care costs, especially hospitalization and nursing home costs Reasons for Geriatrics/Gerontology Professionals to Focus on Health Promotion/Disease Prevention

40.  Longevity is a splendid trend in the United States  Successful, resilient aging is complex  Exercise, Exercise, Exercise  Achievements of centenarians demonstrate that physiologic aging can allow for late life independence, productivity, and pleasure To Summarize…

41. “Age is not a particularly interesting subject. Anyone can get old. All you have to do is live long enough.” —Groucho Marx (1890-1977)