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?
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.
Dr. Agronin is the author of How We Age and The Dementia Caregiver: A Guide to Caring for Someone with Alzheimer’s Disease and Other Neurocognitive Disorders. His forthcoming book, The End of Old Age: Living a Longer and More Purposeful Life, will be published in January. He reports no conflicts of interest concerning the subject matter of this article.
1. Erikson EH, Erikson JM. The Life Cycle Completed. Extended Version with New Chapters on the Ninth Stage of Development. New York, NY: W.W. Norton; 1998.
2. Rowe JW, Kahn RL. Successful Aging: The MacArthur Foundation Study. New York, NY: Pantheon Books, 1998.
3. Vaillant GE. Aging Well. Boston, MA: Little, Brown and Company, 2002.
4. Friedman HS, Martin LR. The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study. London, United Kingdom: Penguin Group; 2012.
5. Levy BR, Slade M, Kunkel S, and Kasl S. Longevity increased by positive self-perceptions of aging. J Pers Soc Psychol. 2002; 83: 261–270.
6. Carstensen LL. A Long Bright Future: An Action Plan for a Lifetime of Happiness, Health, and Financial Security. NY: Broadway Books, 2009.
7. Ryff CD, Singer BH. Know thyself and become what you are: a eudaimonic approach to psychological well-being. J Happ Stu. 2008; 9: 13–39.
8. Baltes PB, Baltes MM. Successful Aging: Perspectives from the Behavioral Sciences. Cambridge, UK: Cambridge University Press, 1990.
9. Emanuel EJ. Why I hope to die at 75. The Atlantic, October, 2014.
10. Cohen GD. The Mature Mind. New York, NY: Basic Books; 2005.