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“Grow old along with me! The best is yet to be, the last of life, for which the first was made. Our times are in his hand who saith, 'A whole I planned, youth shows but half; Trust God: See all, nor be afraid!”
― Robert Browning
Myth: Aging is immutable; it is all in our genes, there is nothing we can do about it
Many of us assume that our aging has been hard wired through our genes and that our longevity ultimately depends on how wisely we chose our parents and grandparents. On first glance the evidence seems compelling: identical twins have more concordant life spans than fraternal twins and it is easy to find kindreds with impressive longevity. In fact researchers have made careers of studying families with strikingly long lives. The challenge is that our genes interact with our activities, our lifestyle and our environment and having a genetic predisposition is not the same as having our genes determine our longevity. For example, even with a pedigree of extraordinary longevity it would be foolish to brandish a 7-iron on a golf course in a thunderstorm. When we look more closely at the strongest hereditary influences on longevity the trend is actually in another direction with diseases like malignancy that tend to shorten life.
While some of the genetic determinants of aging are clear, there is compelling evidence from a study of over 13,000 Swedish twins that suggests only 30 percent of our longevity relates to our genes (1). Thus, 70 percent of our aging is within our control. Moreover, only about half of the cognitive changes were related to heredity in the Swedish study. In the Nun study (we discussed in an earlier blog) there were two biological sisters who were each over ninety. The mentally active sister had no cognitive impairment while her less intellectually active younger sister developed dementia. The message of these and other landmark studies of aging and cognitive function is that mental activity sometimes can trump genetic predisposition.
We should not be so concerned about our genes that but rather how those genes are expressed. In some ways our genetic endowment is like a ski lift getting us safely to the peak of reproductive efficiency. Then it is our choice how to travel down the slope. Our journey can be exciting, risky and short or it can be better paced and leisurely. Our lifestyle choices really matter. We can let our genetic code mechanically play itself out or we can take charge to modify some of our genetic software through our lifestyle choices. This is good news because it means that our quality of life in old age is largely within our control.
Myth: Older people are not interested in sexual activity
Sexual activity does not have to decline with aging. The major reason sexual activity declines has less to do with performance capacity than with imagination and expectation. It is true that arousal and stimulation take longer the older we get. Erectile dysfunction does increase in men with increasing age, but not as much as has been widely believed. There is no evidence that aging has any significant negative effects on women’s sexual capacity or pleasure.
The evidence from survey data speaks for itself: about a quarter of men and a third of women aged 18 to 31 report being very happy with their sex life (2). That percentage jumps to nearly 50% for those over age 65. Moreover, 50% in this group continued to be sexually active and almost 40% wanted to have sex more frequently. Three quarters of the men and 70% of the sexually active women said they were as satisfied or more satisfied than when they were in their 40s. Perhaps we become less inhibited and feel more relaxed and confident as we age.
Sexual activity is positively related to longevity. In scientific studies married men live approximately 8 years longer than men who have never married while married women live 3 years longer than women who never married. The longevity difference seems to be related to reduced rates of cardiovascular disease and cancer. In another study men who had more than two orgasms a week were much less likely (nearly 50%) to die over the follow-up period compared to men having less than one orgasm a month. For women sexual satisfaction is positively correlated with longevity. Sexual activity and satisfaction does not have to decline as we age and the more we enjoy it the greater the benefits to our health and longevity. Perhaps the real secret is being in a stable and loving relationship.
Myth: Growing old means living in an institution in a state of dependency
The reality is not this pessimistic: no more than 25 percent of people will stay in a nursing home at any time in their lives, including short visits for rehabilitation. In 2012 just 3.5 percent of U.S. seniors lived in nursing homes. Like each of our aging myths there are half-truths and misconceptions that cloud the reality. Honest exploration of old age must acknowledge a chasm between rich and poor because societal, literary and historical biases tend to hide this. Moreover, old age is not a statistical fact; it is the last stage of a process of change, the culmination of life. The turning point from adolescence to adulthood is arbitrary only within narrow limits; the time of old age is ill defined. When is a man or woman's peak reached from which things decline? This is not easy to determine and it can be known with certainty only after a person's life is over.
One problem is that we lump all elderly people together and fail to appreciate older people as a heterogeneous group. Subgroups require careful definition and special attention: women, who constitute a large majority of our senior citizens; the "very old-old" age 90 and beyond, the fastest growing group of all; and people in poverty. Those who are dependent or disabled are an important subgroup but are not the majority of elderly people.
It is partly the fault of our society that decline with age often begins too early, and that it can be rapid and painful. We need to explore the problem of achieving high quality medical care for all older persons and the provision of other benefits across the broad cultural and ethnic diversity of our nation. Aging always takes place in the context of society and the current societal status of elderly people must be improved. But this will not address the real problem: older people must be treated as people. Our social policies must clearly reflect this commitment to human value. Old age puts society to the test - -what is the meaning of life for that society? How far and at what cost will society go for those who need care? Therefore, how responsible is the society?
We all have to confront the notion of irreversibility, of inevitable physical decline that will increase with age. As we have seen, the impact and degree of these changes is strongly determined by the individual and how people respond differently. Often the changes of the body mean less than the attitude adopted toward these changes. Clearly, the changes that occur affect men and women differently as women significantly outlive men. But to men aging may not be so physically harsh. White hair and wrinkles do not necessarily conflict with manly ideals. Men seem to have social advantages while women have biologic advantages.
Diseases limit our function more than our age. Aging is a process of growth and not a set of ideas or factors or changes to which we resign ourselves. Are physical changes with continual growth really declines? It depends on our perspective. Consider the ripple produced by throwing a stone in the water. The height of its wave decreases as the circle expands. Do we identify with the ripple in the water with its wave decreasing in altitude over time or do we identify with the expanding circle of consciousness that takes time to develop?
References
1. A concise review of the Swedish Twin Registry can be found in the Journal of Internal Medicine 252: 184-205, September 2002.
2. The major survey on sexuality in old age was "A study of sexuality and health among older adults in the United States." The New England Journal of Medicine 357:762-774, 2007.
