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What It Takes to Have a Longer 'Health Span'

old woman listening to music
February 24, 2020

By Debbie Koenig

When you picture “old age,” do you think of someone stooped and slow, with memory loss and other health problems? In his new book, Successful Aging, neuroscientist Daniel J. Levitin, PhD, uses the latest research to show how you can stay vital and active into your 80s, 90s, and even beyond.

WebMD spoke with Levitin about the realities of getting older, which factors you can control, and why you should eat ice cream from time to time. Our interview has been edited for clarity and length.

WebMD: Let’s start with the title. How do you define successful aging?

Levitin: To me successful aging is when, as you go through your life span, at any age you’re able to derive pleasure from the things that have traditionally brought you pleasure, and maybe discover new, enjoyable things along the way. To remain engaged with the world and the people and ideas in it, rather than withdrawing into yourself. To have the mental and physical health to do the things you enjoy doing, of course within limits. But those limits are being shattered all the time, as we saw with Julia “Hurricane” Hawkins, a 103-year-old competitive runner who just took two gold medals and broke records at the Senior Games—she didn’t start running until she was 100.

WebMD: In the book you divide human lifespan into “health span” and “disease span.” Why make that distinction?

Levitin: It’s important for two reasons. One is that there’s an inordinate amount of money going into prolonging life, compared to looking at quality of life. In other words, we tend to throw a lot of research dollars at things that will kill you like heart disease and cancer, as we should. But we throw a tiny percentage of that into things like chronic pain or arthritis—things that contribute maximally to lost days at work or lost quality of life.

Nowadays, I think, talking about health span versus disease span as the two components of life puts us in a position to start having conversations with our loved ones and our doctors about how we want to live our lives. I think quality of life is a choice. You could live a super-long life but not a particularly engaged and happy one—in the extreme case, in a coma, but also gradations of that. Some people are interested in doing things that might not be healthful. For instance, I have a friend who had prostate cancer. His doctor told him he had to give up ice cream, and he loved ice cream. He worked through the numbers with his doctor. Without ice cream he could live another two or three years, with it just six months. He talked it over with his wife and kids and decided life wasn’t worth living without ice cream. This might seem trivial to some people, but it was his decision. Another friend was diagnosed with cancer and his doctor said, “Make all these changes and you’ll live five years instead of one.” He did them, and that was 20 years ago.

Obviously, these are not scientific studies. They're just the human side of things. But I want to promote a conversation to be had about the tradeoffs. If science says I can live to be 200 but spend the last 110 years in a stupor, no thank you. But that’s me—I’m not imposing my view on another.

WebMD: You talk about aging as a developmental stage like infancy or adolescence. How does thinking of it that way change the way we look at getting older?

Levitin: We’re dealing with a faulty narrative, is what it come down to. We used to think that at some point the body stops growing, let’s say at 21, but your brain might continue to grow as you develop new skills, until age 40, 60, 70. The old narrative is that from there, things start to peter out, that old age is characterized by declines, less and less of everything. But that isn’t true to the scientific literature at all.

Old age is just like any other developmental stage, with distinct advantages and distinct challenges. Older adults are better at some things. They’re not physically stronger and their stamina doesn’t increase, but it can plateau. I know people in their 80s and 90s who are running circles around people in their 50s. It underscores the idea that when we talk about aging, we need to distinguish between physiological age and chronological age. Chronological is the number, physiological is how well you’re doing. Some older adults see improvement in a number of cognitive capacities like decision making, problem solving, or happiness. The peak age of happiness is 82.

WebMD: Most of us think of aging in terms of the negative things that come with it, but you stress the positives, the advantages. Tell me about them.

Levitin: There are personality and cognitive changes. In terms of personality, older adults tend to experience more gratitude, and that might be feeding this peak in happiness. In our 40s and 50s in this culture, we tend to be oriented towards financial success or recognition, looking for accolades or money—material trappings. No matter who you are, you don’t have everything you want. But as people age, they’re not striving for material things, not feeling slighted if someone gets more recognition.

Older adults also tend to be more compassionate, more tolerant of differences, more empathetic, more relaxed about certain things. This shows up in grandparents: When you put them in charge of the grandkids for the afternoon, the kids are going to be allowed to do things those same people wouldn’t let their own kids do 30 years ago.

When you put together gratitude and compassion and tolerance, it can make older adults much better at solving a range of problems, particularly those involving conflicts between people.

Then, on a cognitive level, older adults are better at pattern matching, solving problems that require finding a solution to a current problem in something that occurred before. They’re better able to extract commonalities from disparate events. The medical example is radiology, which is based on pattern matching. You’re looking at blurry blobs of light, trying to figure out which are cancer and which aren’t. Having had lots of experience doing that makes you better at it. You want a 65-year-old radiologist, not a 30-year-old one. Same with surgery—you want the surgeon who’s done it 5,000 times.

WebMD: The book talks quite a bit about sleep and the role of the internal clock. Why is adequate sleep so important?

Levitin: Sleep is responsible for two really important things. One is the consolidation of memory, and the other is cellular repair and housekeeping mechanisms that happen most efficiently while you’re asleep. If you get less sleep than you need, both suffer. As you get older, they suffer more. We’ve seen misdiagnosed cases of Alzheimer’s where people with memory impairment are just sleep deprived. When you get rid of the sleep deprivation, the memory comes back and they don't have Alzheimer's after all. Loss of sleep also leads to compromises in immune system function.

There’s this old folktale that older adults need less sleep, but they don’t. Many only get five-and-a-half to six hours due to degradation of the sleep-wake cycle, but they still need eight or nine hours like the rest of us.

WebMD: Let’s talk about personality. You say it’s the biggest factor in whether you’ll live a happy and productive life—why is that?

Levitin: Ultimately you don’t have much control over what life throws at you, but you do control how you respond to things that happen. You can respond with resilience or fatalism; you can respond with grace or bitterness. Negative emotions serve an evolutionary purpose, but if you wallow in them, they affect your neurochemistry in ways that reduce the effectiveness of your immune system functioning.

The good news is you can change personality factors at any age. Some respond better to psychotherapy or meditation, inspiration from role models or supportive friends. Some respond to drugs—for instance, lack of resilience can be due to a neurochemical imbalance.

WebMD: You use an acronym about personality in the book, COACH: Curiosity, Openness, Associations, Conscientiousness, and Healthy practices. Why does that combination make such a difference?

Levitin: Those things capture the bulk of the factors that are under your control. If you get drafted and sent to war, or suffer repeated head traumas or a car accident—these aren’t things you can do anything about. But the COACH principles are. You can decide to be more curious about the world, more open to criticism or self-improvement. So that's the C and the O.

Associating with other people is something most of us naturally do, but some are more outgoing than others. As we get older, we tend to want to not meet new people. Not because we don’t like people, but we’re happy with the friends we’ve got. A woman I went to graduate school with, Barbara Frederickson who’s now at UNC Chapel Hill, found an underappreciated factor in happiness as well as healthy aging comes from what she calls micro encounters. Talking to your postal carrier, the checkout clerk at the drugstore, idle chitchat at the bus stop. These kinds of things make us feel more connected to the world and less alienated from it. And it complements studies that show that people who know their neighbors and talk to them now and then are by far happier than people who don't.

The H is healthy practices like diet, exercise, and sleep.

WebMD: And what about the second C, conscientiousness? You say that being organized, responsible, and practical is the biggest predictor of successful aging. Why is that?

Levitin: This is the most important variable on how we do at any age. A child who’s conscientious isn’t going to cross against the light, which makes them less likely to get hit by a truck. An adult who’s conscientious is less likely to wind up in prison because they follow society’s rules. If you’re conscientious and you think something’s wrong, you go to your doctor. You use tools like WebMD or NIH, you learn as much as you can so when you go to the doctor you’re prepared. Conscientious people tend to put away a little money for a rainy day or retirement, so they don’t wind up penniless. They tend to follow good diets. They tend to be more well-liked because they’re reliable and dependable, so they’re more valued in a work environment and by their friends.

WebMD: You say that we shouldn’t expect to lose our memory as we age. Why not?

Levitin: Some of us will lose our memory. But Alzheimer’s isn’t inevitable and it’s less common than people think. Part of the story is people are living longer than ever before. Looking at a 75-year-old 40 years ago, that person lived through the depression, they may have suffered nutritional deficiencies, they were probably smoking. Today people who’ve lived a healthy lifestyle are increasingly likely not to see memory impairment. There’s no physiological reason your memory wouldn’t stay intact into your 80s and 90s.

The other thing is that the stories we tell ourselves about memory are inconsistent across age brackets. Eighteen-year-olds have terrible memories—they lose cell phones, forget when the test is, forget their computer password. Seventy-year-olds have similar memory failures. The 18-year-old says, “I’ve got too much on my plate,” or, “I smoked too much pot,” but the 70-year-old says, “It’s Alzheimer’s. I’m doomed.” Same behavior, different stories.

WebMD: What are some changes readers can make today that will make them more likely to age successfully? Is it ever too late?

Levitin: It’s never too late, absolutely not.

The first thing to do is to have a good relationship with your doctor. Somebody you trust and can communicate with. If you don’t, find a new doctor. Then start with COACH. Work on developing conscientiousness, curiosity, openness. Try to maintain active associations with other people, especially younger people. And try to follow healthy practices with diet, sleep, and exercise. Maybe it’s enough to read a book, maybe you get psychotherapy, maybe you start a medication that’ll help you achieve these goals if you have a neurochemical imbalance.

I think it’s also important not to be too dogmatic. You probably don’t want a French fries and ice cream diet, but once in a while won’t harm you. It’s important to have some fun once in a while, don’t be too hard on yourself. You can stay up too late, have a drink—moderation is the key.

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