Aging gets a bad rap. But disease, decline, and discomfort is far from the whole story. Dilip Jeste, professor of psychiatry and neuroscience at the University of California, San Diego and director of the UCSD Center for Healthy Aging, is challenging us to take another look.
In conversation with Nautilus, Jeste points out that some things get better with age, like the ability to make decisions, control emotions, and have compassion for others—in other words, we get wiser with age. The challenge to aging well, he argues, is to be optimist, resilient, and pro-active, allowing the benefits of age to shine through. The corresponding challenge for doctors is not just to increase lifespan, but to increase healthy life.
Nautilus caught up with Jeste earlier this month.
What is successful aging?
There are three domains of aging: Physical, cognitive, and psychosocial. Most people think about aging as physical aging, and that’s why there is a negative perception about aging and a bias against aging. In terms of cognition, again, there is something similar. Starting after middle age, say around 60 or so, memory and other abilities decline. However, psychosocial aging is really important, and that is usually not studied and that is not included in the concept of aging.
So what is psychosocial aging? It includes things like well-being, happiness, quality of life, control of emotions, socialization. Those are the kinds of things that matter a lot to people, and they need to be included. Successful aging mainly refers to better well-being, greater happiness, and not just arriving at old age, but thriving and even flourishing.
Doesn’t aging have to be stressful?
In older age, there is more stress in some areas. Physical illness, disability, the deaths of near and dear ones, financial problems, retirement, and a loss of sense of purpose, are all genuine stresses of old age.
What matters is how you respond to the stress. We have been doing a study of about 2,000 people from age 21 to 100-plus. We look at their physical health, cognitive function, and psychosocial functioning. What we find is that physical health declines after middle age, which is not a surprise. Cognitive function starts to decline in older age, not a surprise. But psychosocial functioning, including wellness, quality of life, and happiness, progressively improve with age. Older people handle stresses better than someone in their 20s and 30s. When you’re young and something goes wrong you might be crushed. When you’re old, and something goes wrong, you say, “That’s okay. There are other things that will go right.”
Do we get wiser as we age?
Empirical studies have shown that older people are better than younger ones in terms of control over emotion, knowing themselves better, making better decisions that require experience, and having more compassion and empathy toward others. These are the things I include in wisdom. So are things that are components of wisdom that can increase with aging.
Where do you think wisdom is located?
The neurocircuitry, in a broad sense, involves two regions. One is the prefrontal cortex, which is the newest part of brain evolution. It’s the part of the brain that makes us human. The second is the amygdala, our limbic striatum, which is the oldest part of the brain in evolution. This is something other animals’ brains have.
Wisdom is a balance between cognition and emotion. It's balance between selfishness and prosocial behavior. It’s a balance between the things that are helpful to you and the things that you should do because they are good things to do for societal survival. That is what this neurocircuitry reflects.
Are there strategies for successful aging?
Yes. There are quite a few strategies, and again, these are for successful physical aging, cognitive aging, psychosocial aging. There is strong evidence in favor of them. One is calorie restriction. Second is physical activity, exercise. Very important. Even people in wheelchairs can have some physical activity. Then there is keeping your brain active, doing something that is somewhat challenging. Not too stressful, but somewhat challenging. There is socialization, an appropriate degree of socializing. Then comes attitude and behavior, resilience, optimism, compassion, doing things for others, volunteering activities. What they do is they give a purpose to life, and that makes you happier. And there are other strategies like meditation for reducing stress.
Is there an area of aging research that you feel isn’t getting enough attention?
Yes. I really think that the focus right now in aging in general and especially in health care is on treating disabilities and illnesses. Instead of that, the focus should be on prevention. And the prevention doesn’t start at age 65. Aging doesn’t begin at age 65, aging begins at conception.
The strategies that I mentioned, like keeping a healthy diet, physical activity, keeping your brain active, social engagement, doing things for others—those things need to happen right from early childhood. We need to teach resilience and optimism in our schools to young and middle-age adults. If we did that, the prevalence of many diseases, like diabetes, heart disease, and stroke would go down significantly.
That’s why I really object to viewing aging as something bad, uncontrollable, a surprise, a disaster, something we want to avoid through anti-aging remedies. We should look at the positive aspects of aging and see how we can enhance them.
How do you feel about your own aging?
I feel actually with age I have learned from experience. I don’t know if I’m wise or not, that’s not the right question. But I do feel that I have become wiser over the years. Or I have become less unwise over the years, however you want to put it. I look around and see some role models who are doing wonderfully as they age, and then other people who waste their old age by being more rigid and complaining about things. So I think I find the research that I do is true to myself.
Geriatric Care is a series of articles exploring the work of the Centers of Excellence in Geriatric Medicine and Geriatric Psychiatry, sponsored by the American Federation for Aging Research and The John A. Hartford Foundation.