Finally, 2 other opportunities for enhancing the probability of successful aging are reducing social isolation and increasing stress-reduction skills. Loneliness may indeed be a risk factor for dementia,30 and hundreds of articles describe the buffering effect of social support against depressive symptoms. Social networks and motivation for social contacts appear to change over the life span,31 and interventions targeting social interaction need to account for these changes. There are a number of innovative intergenerational programs, such as the Experience Corps, which could enhance social support and engagement in productive, meaningful activity while benefiting the community.32
Given the literature on allostatic load and the importance of stress resistance in cellular aging, stress reduction may provide benefit in older people. Transcendental meditation (TM) is an intervention that has been evaluated in older people who are at risk for negative cardiovascular outcomes, and long-term follow-up provided provocative evidence that mortality rates were reduced in TM participants compared with a control group.33
Addressing depressionMajor mental illnesses negatively impact the modifiable aspects of healthy aging described above. For instance, depressed older persons are less likely to be physically active or engage in other positive lifestyle behaviors. Furthermore, depression is associated with heightened activation of the HPA axis. Therefore, research suggests that the modifiable aspects of healthy aging and the functional and behavioral aspects of depression appear to converge. Consequently, the impact of successfully treating depression may be far-reaching in terms of promoting healthy aging in older adults. Identifying and improving access to care for depression in later life is a significant public health concern, and multidisplinary approaches to depression care in later life are often needed,30 particularly those that integrate medical and psychiatric care.31
Even among older people with psychiatric illness who are institutionalized or frail, much can be done to limit or reduce "excess" disability (ie, disruptions to quality of life that extend beyond those associated with a primary illness and those that can be reasonably eliminated through available treatments).32 Reducing depression in the cognitively impaired elderly can be accomplished through structured behavioral treatments targeting positive affect via increasing participation in pleasant events.33 In addition to excess disability, disruptions in quality of life that may be a consequence of having a mental illness can be addressed. For instance, engaging in productive activity is one of the aspects of Rowe and Kahn's model of successful aging. Older persons with schizophrenia can participate in the workforce, and individually tailored vocational training that incorporates cognitive compensatory skills can positively impact multiple outcomes.34
Successful aging is an emerging area of science that awaits a definitive phenotype. However, it is clear that cognitive and emotional health is a key facet of successful aging, and, therefore, the mental health practitioner can be vitally involved in determining the health span of older adults. Late-life depression, for example, reduces the likelihood that an individual will engage in preventative health behaviors, such as physical activity and socialization; may relate to cellular aging through diminished stress resistance; is associated with diminished level of optimism; and can impair cognitive functioning. However, late-life depression is treatable, and successful detection and intervention by mental health providers can thus produce a far-reaching impact. For the psychiatrist working with older patients, treatment plans should incorporate proposed phenotypes of successful aging (eg, social engagement) as well as its predictors (eg, mental and physical activity). The Table summarizes a series of strategies for mental health practitioners to enhance the likelihood of successful aging.
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TABLE |
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| • Integrating physical and psychiatric care to the greatest extent possible 31 | |||
| • Detecting and treating depression 30 | |||
| • Encouraging regular aerobic activity and strength training 22,23 | |||
| • Encouraging mental activities/cognitive training 28,29 | |||
| • Stress reduction 18 | |||
| • Low-risk diet/caloric restriction 22,26 | |||
| • Reducing or eliminating unhealthy lifestyle behaviors (eg, smoking, drinking excessively) 27 | |||
| • Reframing negative/stereotypic views of aging 36 | |||
| • Enhancing access to behavioral and psychosocial interventions 30,37 | |||
| • Assessing use of antiaging supplements 35 | |||