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Is Successful Aging Possible in the Face of Dementia?

Is Successful Aging Possible in the Face of Dementia?

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CONFERENCE REPORTER

Editor’s note:  This article is a summary of a presentation on this topic that Dr. Agronin gave at the 2017 US Psychiatric & Mental Health Congress in New Orleans, Louisiana. Dr. Agronin is Vice President for Behavioral Health and Clinical Research at Miami Jewish Health in Miami, Florida.

We tend to have a dichotomous view of aging. Aging can be great, we imagine, but only if we maintain good physical and mental health into our later years. On the other hand, we imagine aging to be a horror if dementia or some other painful and debilitating condition develops.

These dueling perspectives reflect the reality of aging today: the average life expectancy has increased into the high 70s, while at the same time rates of dementia continue to rise, making Alzheimer disease (AD) the sixth largest killer. Is there a third perspective on aging with dementia that can provide some degree of hope?

Persons with dementia can still retain the capacity to experience humor, joy, and mutual interactions. Therein lie the seeds of a new perspective on aging.

Let’s begin by considering what it means to age successfully. Erik Erikson1 suggested that developing a sense of integrity was the key task in later life, enabling us to overcome feelings of despair over lost opportunities and grow the strength of wisdom. John Rowe and Robert Kahn2 suggested a more specific concept of “successful aging” defined by a decreased risk of disease and disability, robust mental and physical functioning, and active engagement in meaningful activities.

A number of key longitudinal studies of the most successful (and long-lived) aged individuals have found them to have strong marriages and other relationships, healthy defense mechanisms, and conscientious personalities.3,4

We can extend this notion of successful aging even further, based on the strengths of aging that continue to emerge and develop over time. As we age, we gain more knowledge and experience; we learn lessons that enhance our judgment; we face failures that teach us humility and enhance our empathy for others; we experience heightened levels of creativity; and with the ever-approaching horizon of life, we can gain greater acceptance, insight, and spirituality.

Put together, these age-emergent factors help us to develop a wide range of strengths and roles that constitute wisdom. Such wisdom is supported by research showing that well-being and longevity are increased by positive attitudes towards aging, a sense of purpose, and the ability to adapt to change.5-8

This whole calculus changes, however, when someone is suffering from dementia. It seems difficult if not impossible to say someone is aging “successfully” when they have progressive cognitive and functional loss. Erikson himself, towards the end of his own productive career, suggested that there was a final stage of life where despair threatened to become the dominant force due to daily struggles and losses.

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