If you're interested in living to an advanced age and still having a "a good life" something the Greeks attempted to define 2,400 years ago a new book by a Harvard psychiatrist offers some unexpected and invaluable insights.

Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development casts a spotlight on the behaviors that make for happy longevity and those that result in illness and early death. The conclusions in the book are based on a study of behavior that began with Harvard sophomores in 1938 and is the oldest, most thorough study of aging ever undertaken.

"Aging well involves both mental and physical health," says author George Vaillant, M.D., who began managing the study in 1970. "So when we talk about well-being, we're talking about two facets, not just one." For example, he notes, "alcohol abuse is bad for emotional and physical well-being. Smoking is only bad for physical well-being." Just as Benjamin Spock taught millions of mothers to anticipate child development and to understand what could be changed and what had to be accepted, Vaillant's book does the same for the later stages of life. The Study of Adult Development, using periodic interviews and questionnaires, follows three groups of elderly men and women, all of whom have been studied continuously for six to eight decades. First, there is a sample of 268 socially advantaged Harvard graduates born about 1920. Second, there is a sample of 456 socially disadvantaged inner-city men born about 1930. Third, there is a sample of 90 middle-class, intellectually gifted women born about 1910. All of these prospective studies (a "prospective" study is one that studies events as they occur, not in retrospect) are the oldest studies of their kind in the world. From these 824 individuals, the book attempts to generalize theories about behaviors that promote health and good living and those that don't.

One generalization and perhaps the most important to the average reader is that there are six factors at age 50 that have a great deal to do with whether you will get to age 80. The six are having a warm marriage, possessing adaptive or coping strategies, not smoking heavily, not abusing alcohol, getting ample exercise and not being overweight. Those who observe these factors are better at wending through what Vaillant calls "the minefields of aging." For these people, there is a statistically greater chance to achieve emotional and physical health. He calls them "the happy well." The happy well are those, he says, "who subjectively enjoy their lives and are objectively healthy." By contrast, the "sad sick" occupy another category. "The sad sick are people who feel and are sad and they feel and are sick." Obviously, one can have a majority of the six factors but be felled by a fatal compulsion. So Babe Ruth, a heavy cigar smoker, died of laryngeal cancer at age 53, even though he had a fine second marriage and possessed most of Vaillant's other factors. A gifted ballplayer, Mickey Mantle often repeated the line attributed to the 100 year-old Hubie Blake: "If I'd known I'd live this long, I'd have taken better care of myself." Mantle's marriage and then his health were ruined by alcohol. He succumbed to a cancerous liver at 63. Marilyn Monroe's failing was more subtle. It has to do with what Vaillant calls "taking people inside," the ability to internalize and be enriched by the love and caring of others.

"Look at that famous line when Monroe says to Joe DiMaggio [then her husband], You don't know what it's like to have 50,000 people cheering for you,' and he said, Yes, Marilyn, I do.' She was a beautiful person physically and quite a nice person and talented, so most people that knew her cared about her, but it did her absolutely no good, because she couldn't eat any of the fruit she couldn't take the love inside." Many of the answers that study participants send back offer excellent guides to living the good life. One question was: "What is the most important thing that makes you want to get out of bed in the morning?" An 84-year-old study member answered, "I live to work, to learn something that I didn't know yesterday to enjoy the precious moments with my wife." Other cases offer surprises. Anthony Pirelli was one of the socially disadvantaged inner-city subjects. His parents were born in Italy and barely spoke English. Pirelli grew up poor. Worse, his father was an abusive, alcoholic lout who beat his wife and children. A psychologist described the 13-year-old Pirelli as "unaggressive, sensitive, and fearful of parental disapproval." But the real lesson of his life was that he was not a prisoner of childhood: by age 30 he was a successful CPA and had a successful marriage. Now 70, Pirelli has survived open-heart surgery. He plays tennis, enjoys his retirement and says, "Life is never boring for me." Pirelli's case illustrates one of Vaillant's hopeful creeds: The past often predicts but never determines our old age.

Happily, Aging Well is free of the jargon and academic-speak that scares off would-be readers of scientific studies. The writing is clear, passionate and chock-full of poetic sentiments on aging. In one instance Vaillant reminds us of the words of Scrooge in Charles Dickens' A Christmas Carol: "Men's courses will foreshadow certain ends, to which, if persevered in, they must lead. But if the course be departed from, the ends will change." People can change; there is hope. But change is easier when you come armed with sufficient knowledge about how to change. Vaillant has provided that knowledge in Aging Well.

Golden oldies The study identified several factors that affect the quality of life as we age: It is not the bad things that happen to us that doom us; it is the good people we encounter at any age that facilitate enjoyable aging.

A good marriage at age 50 predicts positive aging at 80. But surprisingly, low cholesterol levels at age 50 do not. Alcohol abuse unrelated to unhappy childhood consistently predicts unsuccessful aging, in part because alcohol damages future social supports. Learning to play and create after retirement and learning to gain younger friends as we lose older ones add more to our enjoyment than retirement income.

Healing relationships a key component of aging well are facilitated by a capacity for gratitude and forgiveness.

 

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