Aging Well surprising guideposts to a happier life.. is the ~50-year follow-up (published in 2002) of the Harvard Study of Adult Development, which was first reported in the 1977 publication by the same George Vaillant, MD, of Adaptation to Life. This report provides the continued longitudinal study of the Harvard College cohort which was first enrolled in the late 1930s.
This book tries to tackle the subject of positive, or successful, aging. The author defines and then examines life satisfaction; social relationships; and physical health. With regard to life satisfaction, he opines, “…whenever I write pedantically of successful aging – think joy. The heart speaks with more vitality than the head…there will be many paths…there will never be a right way. But the goal is straightforward; How can we make the trip to three-score-and-twenty a journey that we will be glad we made?”
When he begins to discuss relationships with others as a component of positive aging, he further defines: “…successful aging means giving to others joyfully whenever one is able to, receiving from others gratefully whenever one needs it, and being greedy enough to develop one’s self in between.” Ultimately, it was necessary to consider physical health, disability, and death as they applied to healthy aging. The author considered both objective and subjective components of physical and emotional health.
Among the most important findings reported in this book, for me, were:
1. All of the subjects continued to change over the course of their adulthood, as they had in their youths. Put another way, change, including many changes for the better, did not stop at some arbitrary age, like 50. As long as they lived, the subjects continued to change.
2. Repression, or forgetting, continues throughout our lives. Memories change, as do our interpretations of the things we remember. In the author’s words, “Maturation makes liars of us all.”
The author described himself as a psychiatrist who had previously studied schizophrenia, alcoholism, heroin addiction, and personality disorder, and then took up the comparison of healthy and not-so-healthy, aging. He reported that for him the most important findings from this chapter of the longitudinal study were:
• Good people in our lives help us cope with the bad things that happen.
• Healing relationships are facilitated by gratitude and forgiveness. These two concepts seem much more important and feasible for mature, translated older, than younger people.
• A good marriage at age 50 predicts a good marriage at 80. Besides surviving to age 80, it is important to note that for many of the vignettes, the marriage at 50 was not necessarily the first marriage.
• Alcoholism was associated with unhealthy aging, and the author surmised that this was largely due to the erosion of social supports. In other words, we are talking of substance abuse sufficiently severe to lead to the dissolution of personal relationships and families.
• The most important observations regarding retirement as described below.
• Physical and mental health have subjective and objective components. Beyond simple survival, the author felt a subjective sense of wellness and/ or functionality were more important than many objective measures.
From a medical perspective, I was intrigued by the factors which did and did not appear to be associated with longevity. With regard to predicting a long survival were; no heavy smoking; no alcohol abuse; stable marriage (importantly in many cases, a second marriage); exercise; not being overweight; and the use of mature psychological defenses, which the author repeatedly refers to as ‘the ability to make lemonade from lemons’. As reported in Adaptation to Life, the most mature coping methods were altruism, sublimation, suppression, and humor. Conversely, as Dr. Vaillant wrote, “Surprisingly, by age 70 parental social class, stability of parental marriage, parental death in childhood, family cohesion, and IQ – variables important to young adulthood – were no longer predictive of outcome.”
Another useful compilation from this book is the four basic activities that appeared to make retirement rewarding;
• Making new friends, particularly after the deaths of parents, and other loved ones
• Learning how to play or do things primarily for fun not compensation. Admittedly, this is what my wife and best friend, calls 'a high-priced headache', namely it is an option only for those who have saved enough to cover, food, shelter, and healthcare!
• Exercising creativity, which necessitates having the time to do so.
• Lifelong learning.
The author defined social and emotional maturity in terms of sequential mastery of life’s tasks. A contribution of this study is to contrast the sequential tasks of childhood and young adulthood as listed by Erik Erickson, with a comparable sequence for older subjects. I found the definition of the 6 sequential tasks that this book posited for older people, to be particularly helpful:
1. Identity: who am I? What do I value?
2. Intimacy: interdependent, reciprocal, committed, and contented relationship
3. Career consolidation: Having established a career with which one feels contentment, having received adequate compensation, a sense of competence, and commitment
4. Generativity: being a part of something which lives on after we are gone; guiding the next generation
5. Keeper of the meaning: contributing to the continuation of values and a sense of justice
6. Integrity: the acceptance of one’s one and only lifecycle as something that had to be and accepts no substitutions.
I highly recommend this book to thoughtful and curious, elderly readers.