Why do some of us age better than others? As our life expectancy grows, so does our pursuit to remain healthy and independent into our later years. Puget Sound-area researchers are now at the forefront of an effort to unlock the mysteries of longevity.
Zerline Aronin is blind in one eye and uses a walker for balance even inside her one-bedroom Capitol Hill apartment.
But she still cooks breakfast every morning oatmeal with fresh fruit before showering and making up the bed without a wrinkle.
By midday, she’s out the door in sensible shoes, pushing her walker to beat the stoplight at a busy Madison Street intersection. It’s a few blocks to feed a flock of waiting pigeons, then a few more to the grocery or over to the fire station to have her blood pressure checked. On an occasional Saturday she sets out to synagogue around the corner.
That’s several miles a week not bad for a 102-year-old.
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“What keeps you going?” her 53-year old granddaughter, Lynne Grams, often asks.
“I don’t know. But I just can’t wait to go outside tomorrow.”
Aronin a lifelong walker is a kind of poster great-grandmother for one of this century’s leading public-health challenges: how to help people stay strong, independent and happy as they grow old.
The impending age boom the oldest baby boomers reach 57 this year is hastening the quest.
The statistics are familiar. The number of Americans age 65 and older is expected to double between 2000 and 2030, rising from 35 million to 71 million, or about one in five people. At that time, roughly 1.6 million of Washington’s 8.4 million residents will be 65-plus.
At the start of the last century, the average American lived to age 47, typically succumbing to some infectious disease. Today thanks to better sanitation and nutrition, antibiotics, vaccines and a decline in smoking average life expectancy is at an all-time high of 77.2 years. Make that 79.9 years in King County.
Plenty at stake for state, nation
Despite this good news, huge challenges remain. Too many people still get sicker than necessary as they age, and too many die early from chronic diseases and injuries that are largely preventable.
What’s at stake if the challenges aren’t met?
For individuals and their families: quality of life. Even now many stressed-out middle-age adults are sandwiched between caring for their disabled parents and their children.
For the community: a vibrant resource. The healthier seniors are, the more they can contribute to society as workers, consumers and volunteers.
For the nation: a burgeoning health-care bill, already $1.4 trillion. It’s feared the generation behind baby boomers a smaller group won’t be willing or able to pick up the tab.
In response to this demographic crush, a revolutionary “healthy aging” movement is emerging across the country. It promotes prevention things like early health screenings, improved nutrition, exercise and chronic-disease management. And it’s driven by the conviction that both personal resolve and community support are crucial to changing behavior.
“We are responding to the challenges of our time,” said Josefina Carbonell, assistant secretary for aging at the U.S. Department of Health and Human Services. “To continue to improve the quality of health of older Americans, we need to take bolder steps much sooner.”
UW takes the initiative
The Puget Sound region is on the front lines.
Two years ago, the Centers for Disease Control and Prevention (CDC) selected the University of Washington as its lead in pursuing everything from more senior-fitness programs and better disease prevention to wider sidewalks and more convenient public transportation.
The UW’s Health Promotion Research Center is leading seven universities around the country, creating programs that can be scientifically proved to work then replicated nationwide. Helping minority elders and those who live in rural areas is a particular focus because they have less access to health care and prevention programs.
“It’s not simply a matter of exhorting individuals to eat better and exercise more,” said Dr. Jim LoGerfo, the center’s director.
The UW won the designation based in part on an extensive track record dating to 1986, when the UW was the first of its kind in the nation to specialize in public health, prevention and older adults.
“The UW prevention research center has helped shape national thinking about what we should be doing in public health and aging,” said Dr. David Buchner of the CDC.
One example: an exercise program featuring strength training and balance. Developed in partnership with Senior Services of Seattle/King County and Group Health Cooperative, Lifetime Fitness Program in September was named among the 10 best of its kind in the nation by the National Council on the Aging. The program soon will go international, when a trainer from Seattle takes it to Beijing at the Chinese government’s request.
The UW center plans an initiative next year to get older adults in Southeast Seattle more physically active. Medical clinics will help recruit sedentary patients, more neighborhood activities will be offered, and transportation will be improved so people can get to exercise classes or walking routes more easily.
Among numerous other initiatives:
Nationally known experts on aging, based primarily in Seattle, are producing landmark research on how to better manage chronic diseases such as arthritis, diabetes and late-life depression.
One government agency is working to create “elder-friendly communities” across King County, featuring everything from street lighting and sidewalk widths to transportation and physical activities. Its four-year plan aims to improve seniors’ well-being and their ability to “age in place,” and it’s linked to a statewide effort.
Nearly 40 organizations around Puget Sound are coordinating efforts and have, among other things, created Sound Steps, a pilot project that motivated 500 adults to start walking last summer. Members of the Healthy Aging Partnership represent public health, hospitals, parks and recreation programs and AARP.
Staying healthy a responsibility
The stereotype used to be that aging was a long wait for things to go wrong, for a steady, inevitable decline toward death. Increasingly, it’s believed that individuals have the opportunity even the responsibility to shape the quality of their later years.
Numerous studies in the past decade have shown that certain controllable factors regular exercise, immunizations, good nutrition and satisfying relationships can preserve independence longer, stave off most chronic conditions and prevent unintended injuries that kill people early.
Coming from a good gene pool might help in terms of risk for disease, but it’s hardly the whole answer.
“We’re beginning to understand it’s not inevitable you’re going to have heart disease in your 60s and die,” said Cheza Collier, manager of chronic-disease prevention and healthy aging in Public Health Seattle & King County.
“A lot has to do with how we’re living our lives and the environment we’ve created.”
Enormous work remains to turn back the tide of chronic disease and the notion that elders are throw-away people, Collier said.
Consider that about 40,000 older adults in the U.S. die from vaccine-preventable influenza and pneumonia every year. Immunizations can reduce hospitalizations and death from these diseases by 70 to 80 percent, yet nearly one-third of all older adults have never had a flu shot. About half haven’t been immunized against pneumonia.
Even with increased attention to chronic diseases, the reality is that 80 percent or more of all adults age 65 and over live with at least one condition such as heart disease or arthritis.
So the newest view recognizes that successful aging isn’t just about good physical health. It’s also about managing disability, disappointment and change and still finding joy in life.
“If anything is important when you’re growing older it’s to worry more about other people and less about yourself,” said Dr. George Vaillant, director of the Harvard Study of Adult Development.
Spirited ‘marvel’ going strong
Zerline Aronin has outlived her four siblings, two husbands and both of her children a daughter who died in her 20s from Hodgkin’s disease and a son who died three years ago at age 77. All of her intimate old friends and their children are gone. Last year she broke a wrist. Drastically limited vision prevents her from reading much anymore.
“I’ve enjoyed my life,” Aronin said. “There’s been some very unhappy things happen. But somehow or other I’ve passed them over because I had to. You go on living.”
Aronin, described as “a marvel” by her much younger neighbors, still attends Broadway High School alumni meetings, where they make a lot of fuss over her as the oldest living graduate (class of 1919). She can be seen walking the neighborhood at least two hours a day, five days a week.
She’s not supposed to walk all the way downtown alone anymore or stand on a stool to reach things in her apartment.
But, “I’m sure not going to ruin her spirit,” said her granddaughter, Grams. “If I said to her tomorrow you’re not going to be able to go to the store anymore, she’d be devastated.”
It’s never too late
Society can do a lot to help individuals age well, whether they’re taking control of their health early or getting a late start.
Three years ago at age 38, Enrique Palacios didn’t worry much about his health. To his credit, he had stopped smoking and drinking. But he had also quit playing soccer. He ate whatever he wanted including the tasty, greasy food at a Chinese buffet once or twice a week.
And worst of all he was ignoring a diagnosis of adult-onset diabetes, even though his father had the disease and died at 62.
Palacios, at 6 feet and 250 pounds, had felt healthy until the symptoms appeared: excessive thirst, frequent urination, weight loss. At his wife’s urging, he finally saw a doctor. The news was sobering: “You’re in really bad shape. You need to make radical changes in your life.”
He finally signed up for classes taught in Spanish to learn to manage his disease. He also started walking at least a half-hour every day and began eating more vegetables and fruit. His diabetes is now under control.
What’s the key to making such changes?
He’s honest with himself, he sets goals he wants to live to see his grandchildren and he tries not to slip up. Sometimes he prays for help. “As human beings we are weak,” he said.
Minorities get help with health
Palacios’ turnaround came in part because of a special emphasis on targeting specific minority groups.
Seniors of color have far greater poverty rates than whites. Poverty and poor health care often go together. African Americans, especially, have more chronic conditions such as diabetes and hypertension. Both African Americans and Native Americans have shorter than average life spans. An African American at birth can expect to live 10 fewer years than an Asian American, though different Asian cultures have varying rates for chronic disease and death.
To address these disparities, a variety of organizations are tailoring their messages.
The diabetes classes Palacios attended are offered under a program administered by Public Health Seattle & King County and provided in several languages to Latinos, African Americans and several Asian and Pacific Islander groups.
Other programs have a broader reach.
Take the award-winning Lifetime Fitness Program, which uses three-times-a-week low-impact aerobics, strength and balance training and is open to anyone for about $2 a class. Studies show the program improves function, mental health and social interaction. It also reduces pain and fatigue and saves on medical costs.
Johanna Holland, 83, managed a turnaround after joining Lifetime Fitness at Northshore Senior Center at the insistence of her children. Holland had become depressed a year ago after moving from California to Seattle to help care for her son-in-law, a disabled Vietnam veteran. She had fallen several times, began using a walker and secluded herself at home.
A year later, she no longer needs a walker. She’s caring for her son-in-law, plus keeping house so her daughter can work. She also is learning to mentor other seniors having tough times.
“I feel fantastic right now. I just can’t believe it,” she said.
Started in 1993 as a research project to measure the effect of physical activity on older adults’ health, Lifetime Fitness is offered in several languages at nearly 50 sites in Washington and has been replicated in several other states.
Communities plan for future
The idea that an entire generation of older adults may live longer and healthier raises a whole new question for society: How can communities best accommodate all the boomers in their twilight years?
Many experts on aging believe a key to helping people stay healthy and happy is to make whole neighborhoods and towns more welcoming to an aging population.
That’s the goal of the Southeast Seattle physical-activity project proposed by the UW’s Health Promotion Research Center. The project, expected to start next fall, will use lessons learned from programs such as Lifetime Fitness and apply them on a geographic basis. It will enlist help from neighborhood churches, medical clinics, community and senior centers and businesses.
The idea is to reach thousands of older residents and encourage them to get more active. They’ll receive information about exercise opportunities and a follow-up call from peer mentors. Area merchants might offer discounts to people who walk a certain amount. Results will be measured.
And aside from the Southeast Seattle project, a push to create elder-friendly communities is going statewide.
Helping others ‘age in place’
Residents in those communities would have basic needs met and would get help to stay socially involved and physically active. If a person became disabled, the community would offer services and caregiver support. That way more people could “age in place.”
All of Washington’s Area Agencies on Aging, 13 government, tribal and nonprofit groups, have adopted the idea.
It comes from a national demonstration project ongoing for three years in Puyallup and nine other U.S. cities.
Puyallup recently conducted a survey of its seniors to find out how the community can be more helpful. People didn’t know where to learn about services. They wanted more convenient transportation and paid employment. The city is also looking at ways to increase senior exercise and volunteerism.
At some point, other communities across the state including King County expect to collect similar information as a starting point for making changes.
A few elder-friendly efforts are under way in Seattle, on a very small scale. For example, the city’s 2002 housing levy encourages incorporating “universal design” principles in public housing possibly a door that slides open to accommodate wheelchairs, or a door handle that can be pushed with the side of a hand rather than a knob that must be twisted.
Aging and Disability Services, a city of Seattle division, also is suggesting to design teams how to make the Seattle waterfront and the Northgate area more accessible to older and disabled adults.
The agency’s four-year plan for elder-friendly communities offers more ideas, ranging from more pedestrian benches and longer stoplight settings at crosswalks to full-service senior centers and housing codes encouraging wider doorways.
The bigger context that’s being pushed is this: What’s good for older people in the state really benefits all ages.
Pam Piering, director of Aging and Disability Services, says this country has created places where it’s assumed people will be eternally young, eternally driving their cars, eternally walking up stairs.
“We can’t afford,” she said, “to build Peter Pan communities, which are communities for people who never grow old.”
Realistically, it may take decades for changes to take effect on a grand scale.
Meanwhile, Zerline Aronin’s community the younger residents and staff where she lives watch out for her. When she broke her wrist and went out walking with her arm in a sling, friends tattled.
Affection comes with the vigilance. Every year, friends throw her a birthday bash where she’s honored once again.
Aronin loves the care and attention. But she’s matter-of-fact about her secret to aging so well.
“I think it’s just natural for me to try and make the best I can of anything. You’re in this world. Unless you want to leave it voluntarily, I don’t know what else to do.”Marsha King: 206-464-2232 or firstname.lastname@example.org
TOMORROW: A study of Seattle’s Japanese-American elders, and what they can teach us about growing old