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Happiness and Aging: Why Things Don’t Look Awful Cold

When patients complained about their aging and the prospects of aging, my cavalier remark was “it beats the alternative”. This phrase I’ve recently learned hearkens back to a remark credited to Maurice Chevalier, who in his later life became the symbol of glorious and glamourous aging: “Old age isn’t so bad when you consider the alternative”. In both of these remarks, there is an unstated belief that the changes of old age – declining mental abilities and speed of motion, stiffened joints and fading eyesight and hearing are to be feared.  Aging is a long slow decline that is not much fun and certainly not anything to look forward to. I am certain I believed this when I first began my work with patients and families with dementia and eventually had the opportunity to study aging and especially dementia. In fact, I actually resisted focusing on aging and dementia in the early years of my career. I didn’t want to be identified as someone with focused interest on aging and dementia.  Studying geriatrics and aging seemed a dismal place to devote my intellectual efforts. In those days, the field certainly was not popular and the specialty of geriatrics remains one of the least popular in all medicine.

I was probably caught up in the spirit of the 60s and 70s, which focused on youth and the glories of our youth. The heady times were characterized by a celebration of the youth culture and what came to be known as the Boomer generation’s willingness to challenge conventional ideas and especially conventional behavior. Our attitude at the time might be summed up by lyrics penned by Pete Townshend of The Who, a leading rock group of the time: “Things they do look awful cold/Hope I die before I get old”.

In my research and practice, (and as I grow older) I began to notice that “things ain’t what they used to be”, another phrase that we used to characterize the late 60’s and early 70’s. In fact, there are a lot of very happy people who are quite old, including persons with significant old age decline and problems.  The happiness I saw in the face of aging and the changes of old age surprised me. In addition to the celebration of youth culture of the times, I probably had inherited the dominant view, which for centuries has been that the life course is characterized by a general improvement in well-being and contentedness through middle age followed by a sharp decline towards death and the grave. Most of us inherited that view. It certainly fits with our celebration of youth and what seems a natural and universal desire to preserve youthful characteristics. However, the view that youth and youthful characteristics equals happiness and with age comes only changes associated with unhappiness is now known to be a myth.

Source: http://vladimiryakovlev.ru
Source: http://vladimiryakovlev.ru

I believe that the myth surrounding happiness and aging is harmful to all those approaching aging.  The coming epoch for baby boomers, as they enter old age can and should revolutionize our beliefs about aging and happiness. We should not go on with the mistaken belief that aging is all about unhappiness – – because it isn’t. The activism that has characterized the boomer generation, who challenged conventional wisdom and behavior during and after the late 60’s, can challenge this notion. Why accept that aging is all about being unhappy or less happy? Especially since we now know that belief is a myth?

Here’s a brief synopsis of what we have learned in the past couple of decades about happiness and aging. The evolution of my thinking about happiness and aging occurred over many years and continues to mature. One paper provided an epiphany moment in what has been a transformative journey in my own view on aging and well-being.  It involved a study published in 2006 where investigators asked a group of 30 year olds and a group of older subjects (mean age 68), which group they thought was likely to be happier, persons aged 30 or those aged 70. They also asked them to rate their own well-being using scientifically valid measurement scales. As expected, both groups thought the 30 year olds would be happiest. But the well-being and happiness levels reported indicated that older persons were the happier bunch.

Happiness and well-being research has emerged as a new branch of economics that seeks a more satisfactory measure than money of human well-being. Derek Bok, former president of Harvard University, wrote a thought provoking book called “The Politics of Happiness” where he establishes that there are valid scientific ways to measure happiness. Furthermore, well-being as measured by happiness is not well correlated with traditional economic measures of utility, money or, for countries, Gross National Product. Clearly, one is happier if one has enough monetary resources to meet basic needs.  But otherwise happiness is influenced by many factors beyond just availability of money. Economists are now trying to sort out determinants of happiness. Bhutan uses the concept of “Gross National Happiness” to guide its planning process, not its gross national product.  David Cameron, the current prime minister of the UK, has announced that the British government would start collecting figures on well-being.

There are already a lot of data on happiness in various national surveys. What is enlightening about this research, is that age emerges as one of the four main factors that determine happiness. The relationship with age is described as “U-shaped”, meaning it starts out fairly high, dips down and then rises again. Overall, in contemporary surveys people are relatively happy as measured by self-reported levels of well-being. From a study in the US , well-being is highest at age 18-21 and then drops steadily until about age 50-53. From that age onward, the level of well-being increases gradually, exceeding the high levels of the youngest adults in the survey by about age 70 and increasing into the highest levels until age 82-85 – which was the last age group in the survey. We don’t know if it might be higher at later ages.

So my original view, like Pete Townshend’s when he was a youthful 1970 rocker, that old age is unhappiness and misery is simply mistaken. The survey of 70 year olds that was an epiphany moment for me suggests that we were and are not the only ones who are mistaken. This view of old age as misery is also a pernicious one – one that needs to be changed. The large bulge in our population that the Baby Boomers represent can change that view as aging boomers move into old age.

Source: http://vladimiryakovlev.ru
Source: http://vladimiryakovlev.ru

It is important to understand why people might be happier in old age. What we can learn from that is also valuable for all those approaching old age. Perhaps the most significant factor that comes from our anecdotal experience with research subjects and is confirmed by research is the notion that there is a natural tendency towards greater acceptance of oneself and one’s life circumstances as we age. As we age, we naturally learn to accept who we are, rather than focusing on the need to figure out who want to become or what else we need to accomplish. For many people early adulthood and midlife consists of seeking a vast multitude of activities and possibilities – in our work, family and recreational life. Persons likely become more content when they have figured out what is most important for them and those in their life. Instead of a broad array of possibilities and activities, their lives become more focused. They focus on both what provides them with the most meaning – which is not just their own well-being but often and importantly includes the well-being of others.

People who “age well” not only focus on a more limited set of possibilities, they also have learned to generally set more realistic expectations. Disappointments of younger life, which can be a great source of stress and unhappiness, are less likely. People learn from experience what to expect and what is more likely. In old age, people do experience important and sometimes sudden loss of persons that are dear to them. But they also typically eventually recover and as they get older these losses, while not welcome are something less shocking.

Altered and more realistic expectations may be a key feature of what has been called the “wisdom” of aging. This does not mean people do not have expectations and goals – they in fact do. The goals are ones that are important and add meaning to their lives, they are typically fewer in number and more likely to be achievable, often on a day to day basis, especially as people go into late old age.

One striking feature that characterized many of our subjects in our large ongoing study of aging called the Adult Changes in Thought (ACT) Study, who ranked themselves “happiest” is that they remained active in their communities. This corresponds to happiness research findings that people who are employed are happier than people who are not. Among the most happy in surveys were those involved in part time voluntary or paid work, something that seniors are particularly well suited for. For example, several of our subjects are involved in a group called “Raging Grannies” who protest for social justice. Another retired botanist who is well over 90 years old works to inform the public about the danger of a proposed coal terminal – she wrote, printed, and distributed 2000 fliers and distributed them to ferry riders and leads nature walks on one of the beautiful islands in the San Juan islands. One of our 100 year old subjects worked as a beautician (hairdresser) for 49 years. When she retired she then volunteered to cut hair in nursing homes until her vision failed at 90. These are examples of people who stayed active and were uniformly seen as happy. And of course, happy people are healthier and are better able to handle stress and have better outcomes when they are beset by illness.

Source: http://vladimiryakovlev.ru
Source: http://vladimiryakovlev.ru

Our experience is that people who age well and experience happiness in late life have not just an optimistic attitude but also have figured out ways that work for them to handle challenges and the setbacks.  Most persons in our study have experienced challenges in earlier times that probably help them approach aging challenges and setbacks in ways that “work”. Many of the challenges are extreme – well beyond the pale of what I and our staff of interviewers have faced. When I asked one of our interviewers if she remembered people who were particularly resilient and happy in the face of adversity, she recalled an older Norwegian woman in her 90s who was part of a depression study.  When asked about stressful times in her life she recalled when the Nazis marched through her home town in 1940 and how she witnessed the murder of her adult daughter in Washington State. When asked about depression she replied: “Oh no, Honey, I just scrub the floor little harder”. We have several subjects who had their lives uprooted when they were moved to settlement camps at the time when Japanese Americans were forced out of their homes, often abandoning and then losing their property. It seems that the key to approaching old age with wisdom is a strong engagement with one’s community and immediate family. They invariably have hobbies and a keen interest in the world around them. They are not stuck in feeling sorry for themselves. They tend to acknowledge the changes of aging and adapt.

People find ways that allow them to cope with stress and what might be sources of unhappiness and despair. In these and many other instances, the challenges of old age seemed to pale by contrast to being occupied during the second World War, the tragic loss of an adult daughter or the disruption of a family home.  And, people benefit by finding ways to keep themselves busy and occupied.   More often than not they seem to follow the Buddha’s advice: “Peace comes from within.  Do not seek it from without”.  One study found that acceptance of what can’t be changed was a significant predictor of satisfaction in later life. This echoes the words of the famous Serenity prayer, authored by Reinhold Niebuhr and popularized by many groups but especially Alcoholics Anonymous:  “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference”.

Source: http://vladimiryakovlev.ru
Source: http://vladimiryakovlev.ru

From the research in this new field of economics, two personality traits stand out in analyses of traits associated with happiness: Neuroticism and Extroversion. Persons who are prone to guilt, anger and anxiety tend to be more unhappy whereas those who are more extroverted tend to be happier. While these two contrasting personality types seem self obviously to lead to more or less happiness, we see something in the people who stay happy throughout their late life that characterizes their activities:  that is an interest and commitment to help others – to think about not just their own happiness but to be caring for others. I recall that my aging father, even as he was beginning to fail, never failed to visit the severely impaired persons residing in the nursing home in the senior living compound where my parents lived. During these daily visits, he would usher himself in with a happy “Hello Sunshine” and “how are you today” to every resident, even those who may not have spoken a word for long periods of time. He cared for others. A sprightly 85 year old continues to volunteer at her Roman Catholic Church and its school, a 94 year old who had a stroke 3 years earlier continues to operate a tree farm and wins awards for the contributions his voluntary works provide the community. A woman who, as a retired social worker once said she would kill herself if she lost her vision, developed macular degeneration – a degenerative condition that leads to blindness. What did she do? She started a support group for people with limited vision at Group Health. These are people who are not only looking inward but look outward and gain life satisfaction from helping others right into very old age.

When I was in college, like a normal college student I looked for posters and art to decorate my room.  Sometime during those years, I encountered a poem called the Desiderata. It made a deep impression on me, which is why I placed it on the wall of my room. Now some almost five decades later, it is this poem, along with the Serenity Prayer and the thoughts of the Buddha that comes to mind as I think about what I and others have learned about why people might be happier as they age. I’m quite certain I could not have appreciated all the meaning of these beautiful words when I was younger. Today great masses of people, like me, who once may have thought of old age as a time of pain and unhappiness are now advancing into old age.

The Desiderata poem, written by a minister in the 1920’s, Max Ehrmann, contains great wisdom, a wisdom that is likely more apparent to persons entering into old age than it was for a young college student discovering late 60’s Flower Power rock and roll. Many people, some very well known, have found it inspirational for themselves and for others. The poem was discovered at American presidential candidate, Adlai Stevenson’s bedside when he died in 1965. He planned to use it in his Christmas cards but died before he was able to send cards that year. That story spread and the Desiderata became more widely known around that time. I suspect that’s why I became aware of it. Desiderata means “desired things” in Latin:

“Go placidly amid the noise and haste, and remember what peace there may be in silence.  As far as possible without surrender be on good terms with all persons.

Speak your truth quietly and clearly, and listen to others, even the dull and the ignorant; they to have their story.

Avoid loud and aggressive persons, they are vexations to the spirit.  If you compare yourself with others, you may become vain and bitter; for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans.  Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs; for the world is full of trickery.  But let this not blind you to what virtue there is; many persons strive for high ideals and everywhere life is full of heroism.

Be yourself. Especially, do not feign affection. Neither be cynical about love; for in the face of all aridity and disenchantment it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself.  You are a child of the universe, no less than the trees and the stars; you have a right to be here.  And whether or not it is clear to you, no doubt the universe is unfolding as it should.

Therefore be at peace with God, whatever you conceive Him to be, and whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul.  With all its sham, drudgery, and broken dreams, it is still a beautiful world.  Be cheerful. Strive to be happy.”

 

It’s time to rethink the relationship of aging and happiness. We do not need to buy into the myth of aging being a time of unhappiness. Knowing more about aging through experience and research provides the source for a new and much more optimistic and valid view of aging. The words of our wise forebears from the Buddha, to the Desiderata and the Serenity prayer give us a foundation to go with the new knowledge of aging and happiness.


Dr. Eric Larson, executive director of the Group Health Research Institute (GHRI) since 2002, is a member of the Institute of Medicine and an international leader in geriatrics research. Dr. Larson served as medical director for the University of Washington Medical Center and associate dean for clinical affairs at its medical school from 1989 to 2002. He is a member and past president of the Society of General Internal Medicine (SGIM), having received their highest honor, the Robert J. Glaser Award, in 2004. Dr. Larson is also a Master of the American College of Physicians (ACP).