Live Long, Die Short (3 page)

This approach was a breakthrough because, up to that point, researchers on aging had approached the subject only as a process of progressive decline. The focus was on the “inevitable” infirmities and how to deal with them. The foundation, Jonas argued, should rather focus on vitality and resilience in the older adult and what it was that fostered these more successful outcomes. In 1984, the foundation assembled the Research Network on Successful Aging, a group of sixteen experts from a variety of age-related disciplines, and began what was to be a decade-long study on aging. They wanted to provide fresh insights into aging in America. Their findings forever changed our attitudes toward aging, jolting us from the Dark Ages of our understanding of this common human experience. Their major finding?
How we age is mostly up to us
, and that conclusion rocked our stereotypes of aging to the very core.

In the fall of 1991, in a taxi on its way to Chicago’s O’Hare International Airport, Larry Landry’s life took an unexpected turn—one that changed everything for him and perhaps for all of us. Larry, my brother, was the chief financial officer of the MacArthur Foundation, and he shared that taxi ride with Jonas Salk. Salk was filled with optimism. He had just heard the preliminary findings of the foundation’s study on aging. He told Larry that these findings had the potential to change the aging experience of all but that, to do so, the research findings would need to be applied. Larry pressed him further for clarification and Dr. Salk explained. Without
application, the findings would lie fallow. Applying them meant essentially bringing them to life: having the full understanding of what successful aging is could fundamentally change the very essence or culture of a community and a society. He suggested that a senior living community would be an ideal place to begin to show what might be possible. The small size, fairly homogeneous demographic, and possibility for peer and staff reinforcement of a better lifestyle were all characteristics of an excellent social research initiative.

The seed had been planted, and although it was planted in an unlikely place and would take years to sprout, it was in safekeeping. Larry had spent his career in the financial world and had held positions as chief investment officer and chief financial officer for various not-for-profit organizations. In 1998, he founded Westport Asset Management, a company dedicated to acquiring and developing continuing-care retirement communities. That same year, Drs. Jack Rowe and Bob Kahn, lead investigators of the MacArthur Study, published
Successful Aging
, an account of the study that explained the results and debunked multiple myths about aging. Larry was ignited by the book. He knew it was time: time to answer Jonas Salk’s challenge, time to make the findings of the MacArthur Study available to more people, and time to put them in a form that could change lives and societies. With Westport, Larry had access to precisely the communities Salk thought would be best to test the findings of the MacArthur Study. What he didn’t have were the people to make it happen.

And so, in the latter part of 1998 and early 1999, Larry persuaded Bob Kahn and an eclectic group of experts in aging to begin exploring how to apply the research findings on aging. They would essentially be a skunk-works for the application of successful aging. Thus, the Healthy Aging Working Group came into being. The group included, in addition to Larry and Dr. Kahn, Dr. Denis Prager, former director of the MacArthur Foundation’s health program and member of the Research Network on Successful Aging; Steven Blair, president and CEO of the Cooper Institute; Dr. Kathryn Hyer from the School of Aging Studies at the University of South Florida; Katie Hammond, a doctoral candidate in aging studies at the University of South Florida; and several senior-living-industry experts. Over the following months, two more members were added: Dr. Toni Antonucci, from the University of Michigan’s Institute for Social Research, and Dr. Gordon Streib, noted gerontologist and sociologist from the University of Florida. The group was formidable—but it would add one more unlikely member before it would be complete.

I spent most of my adult life as an Air Force flight surgeon. My task: keep aviators healthy and performing at their best. Trained as a physician, with specialty training in aerospace medicine and occupational medicine, I experienced a military career marked by exotic travel and unique experiences. My patients, more my friends and mates, were young, vibrant, highly capable people. So how was it that I landed in the middle of a movement to change the face of aging?

On a sweltering day in September of 1981, I sat in my office next to a legend: Brigadier General Charles Yeager, the first man to fly faster than the speed of sound. “Chuck,” as he was known to the rest of the world, had returned to Edwards Air Force Base in the Mojave Desert for a flight physical exam. Though retired from the Air Force and fifty-eight years old, he was still flying as a consultant to the Air Force and defense contractors. I was the chief flight surgeon at Edwards, an aviation buff, and totally in awe of the man sitting in front of me. Having completed the physical, General Yeager kicked back in his easy West Virginia way and told me stories of his more-than-illustrious career. At one point, he became quiet for a moment and then announced that he planned to break the sound barrier again on the fiftieth anniversary of the October 14, 1947, event. Most of us are reluctant to admit to huge mistakes we have made in life, but I’m owning up to this one. I responded to this announcement by telling
the
Chuck Yeager, the
Right Stuff
Chuck Yeager, that he would be seventy-four years old then. He quietly bored into me with those smiling, kindly, but now laser-sharp eyes and said, “What’s your point?”

That was my first lesson in ageism. The seasoned veteran instructing the young buck, saying that age is a number and that’s all. I kept in touch with Chuck Yeager, did several more physical exams on him, and derived a great deal of pleasure in hearing that he did indeed fly faster than sound on the fiftieth anniversary of the first time. And he did it again on the fifty-fifth anniversary, and on the sixtieth and, most recently, at the age of eighty-nine, on the sixty-fifth anniversary. This remarkable man helped me break some of my own barriers.

In 1995, after four years at the Air Force Surgeon General’s Office in Washington, DC, as the chief flight surgeon of the Air Force and after a total of twenty-three years of service, I left the military to join a large healthcare system that wanted to develop a world-class prevention capability. Three years later, the CEO gave me feedback that provided me an “aha”
moment. She told me my preventive efforts were highly successful but
were hurting revenue
. After twenty-three years in a military system that incentivized staying healthy—highly trained aviators were a key resource, as were the multimillion-dollar aircraft they flew—it was difficult to conceive of a negative side to prevention. I went home for the weekend deflated. Was there no place where there was incentive to keep people healthy other than in the military or the highly socialized countries of Europe and Canada? That Sunday evening my phone rang. It was my brother Larry calling.

He had been to Mayo Clinic recently and by chance met a former Air Force colleague of mine, Dr. Richard Hickman. In the course of their conversation, Dick Hickman talked about some of our assignments together and Larry began to think that I might be interested in helping older adults stay healthy and performing at their best, just as I had done with aircrew. He was calling to ask me to join the Healthy Aging Working Group that very weekend. I jumped at the chance.

When Larry had asked Dr. Bob Kahn to be a part of the Healthy Aging Working Group, Bob asked, “Why are you doing this?”

Larry’s answer? “Well,” he said, “it’s kind of self-serving.”

This answer was good enough for Dr. Kahn. It went to the heart of the goal: to help all older adults, in fact,
all people
, to age in a better way. When Larry asked me to join, I was looking for a commitment from him. I wanted to apply the research findings of successful aging in order to change public policy. I felt, and Bob Kahn knew, that to influence the lives of a few was a noble enough goal, but to influence public policy was to have a more widespread effect that would endure over generations.

Turns out I was not alone in these big dreams. And so it was that this unlikely mix from academia, senior living, and private consulting—with collective expertise in psychology, medicine, gerontology, nursing, exercise physiology, sociology, strategic planning, business administration, and marketing—took the momentous step forward to volunteer to change our myopic views of aging … and to do the right thing. The members of the Healthy Aging Working Group called themselves “HAWGs” and set out cautiously, in late fall of 1999, to explore what could be done to bring research to reality, to help older adults age successfully, as defined by the MacArthur Study and the book
Successful Aging
.

It was clear from the beginning that Dr. Kahn would be the guiding force. Over eighty years old himself, he had the professional and personal experience, the academic credentials, a remarkable ability to articulate complex ideas, and a keen intelligence that was both comforting and challenging for the group. From the beginning, he insisted that, although it would be difficult to measure the effect of any interventions, since this was social—rather than clinical or experimental—research, it was absolutely necessary for us to try. He also insisted on piloting (or beta testing) whatever approach we developed before proposing it as a widespread lifestyle intervention. Larry and the group agreed. It would make all the difference.

The MacArthur Study findings were clear: 70 percent of the physical difference and 50 percent of the intellectual difference between those who age in the usual way and those who aged more successfully was due to lifestyle—the choices we make every day. Those aging in a better way—successfully—exhibited and maintained three key behaviors or characteristics:

1. High mental and physical function
   
2. Low risk of disease and disease-related disability
   
3. Active engagement in life
   ¹
   

Rowe and Kahn, in fact, defined successful aging as the ability to maintain these three characteristics.

In a nutshell, we wanted to get people excited about living a life characterized by these traits. Our hypothesis was that if they did, it would result in a better aging experience, closer to my vision of aging like an autumn leaf. Our first task was to develop tools that would have multiple purposes: first, to allow us to assess the current lifestyle of any individual; second, to allow us to provide feedback to that individual in order to educate and motivate each to modify lifestyle as needed; and last, to provide aggregate measurement capabilities to assess the impact of our approach. We worked much like a trainer: evaluating current status, providing feedback, assisting in the development of an improvement plan, and clearly demonstrating outcomes.

So, our initial approach, now called Masterpiece Living, consisted of six steps: (1) educate older adults on the research findings and what indeed was
possible, (2) give them the opportunity to take the Lifestyle Inventory (an assessment of their current lifestyle), (3) provide feedback, (4) discuss the feedback in a one-on-one or group session with a lifestyle coordinator, (5) foster empowerment with a true coaching relationship, and (6) repeat the Lifestyle Inventory in a year. After nearly two years of intermittent meetings and prolonged discussions, it was time to pilot our approach. Would it work? Would older adults be willing to take the Lifestyle Inventory? Would the feedback motivate them to make changes? Would the likelihood of their aging in a better way change over a year?

We were eager to find out the answers, and find out we did. (The details of our pilot studies, further development, and eventual dissemination of Masterpiece Living is detailed in
chapter 18
.) The approach worked, and worked effectively. Older adults responded to the education, information, and attention and became avid and informed consumers of how they spent their time and how they lived their lives, and as they did, their risks for impairment plummeted. We spent several more years refining our tools, and we expanded our focus more and more on developing resources to transform the
environment
, the community itself, into places where people were stimulated to age in a better way. This involved high-level and sophisticated training, for we were dealing with environments that were the products of another time, when aging was about decline and the focus was on comfort, security, and care. Now, they were becoming centers for healthy aging, destinations for older adults who wanted to become the very best they could be.

In 2007, we felt that Masterpiece Living was ready. We knew we were not done refining it—in fact, we would never be done—but it was time to affect more lives, time to move out to more communities. Our journey from a taxicab ride with Jonas Salk to a validated approach to successful aging may have been a long one, but we were certain it had not been wasted time. We were part of a rising movement to change aging, to make aging the rich, vital, and rewarding experience it can be.