Creating a Healthy Further Life

Florence Clark, Ph.D., OTR/L, FAOTA

Fit for Life SymposiumFebruary 7, 2014

Name Age at Death • Elizabeth Woodville (White Queen) 55• Edward IV (White Queen’s husband) 41• Elizabeth of York (White Queen’s daughter) 37 • Margaret Beaufort (Red Queen) 66• Richard Neville (The Kingmaker) 42• Anne Neville (Kingmaker’s Daughter) 28• The Tudors

– Henry VII (Red Queen’s son) 52– Henry VIII (Henry VII’s son) 55– Elizabeth I (Henry VIII’s daughter) 69

The White Queen/Tudor Period(Mortality)

Birth Age Married Age of Death Cause

Catherine of Aragon

1485 24 51 Executed

Anne Boleyn 1504 29 32 Executed

Jane Seymour 1508 28 29 Died

Anne of Cleves 1515 25 42 Died

Kathryn Howard 1521 19 21 Executed

Catherine Parr 1512 31 36 Died

The Life Span of the Tudor Queens

Life Expectancy in U.S. Today

• Traditional Age - Groups– Childhood– Parenthood– Grandparenthood

• Adulthood I– Very busy, productive time, building careers, raising

children• Adulthood II– Stage of active wisdom preceding old age

Composing a Further Life: The Age of Active Wisdom

From: Bateson, M. C. (2010). Composing a further life: The age of active wisdom. New York: Vintage Books.

Adulthood II is an “improvisational art

form calling for imagination and the willingness to learn”

Composing a Further Life: The Age of Active Wisdom

Adulthood II

Long lives, Better health

Freedom from work

and raising a family

Rich Experiences

Wisdom combined

with activity

From: Bateson, M. C. (2010). Composing a further life: The age of active wisdom. New York: Vintage Books.

So how can we optimize the chances of staying healthy

during Adulthood II?

THEME:

We become what we have done

THE PERSPECTIVE ON HEALTHY AGEING THROUGHOUT THE CONTINUUM OF TIME

What to do:

Allegory of the Fountain of Youth

• Garden of Eden: “River of Immortality”

• Ayavanna: “Pool of Youth”

• Alexander the Great: “Water of Life”

Advice Through the Ages

44 B.C.E.• Cicero

1214-1294• Roger

Bacon

1484-1566• Luigi

Cornaro

1558-1609• Andre du

Laurens

1903• Sir Herman

Weber

• “We ought to take due care of our Health, and to eat and drink sparingly, and use moderate exercise, that we may be enlivened, and have fresher spirits, not be oppressed, and overloaded”

• Powers of the mind “become more refreshed and invigorated the more they are used.”

• Cicero, A Dialogue On Old Age, 44 B.C.

Longevity – 44 B.C.

• “Nothing hastens old age more than idleness.”– Andre du Laurens (1558-1609)

• “A temperate life would enable the body’s finite supply of vital spirits to last until life ebbed peacefully away between the ages of five and six score.”– Luigi Cornaro (1464-1566)

Longevity – 1500’s

• “By moderation and abundant exercise of body and mind, including walking, climbing and breathing exercises, I have escaped death from these causes, have greatly prolonged my life, and am now in good health in my 91st year.”– Case Study from Sir Hermann Weber, On Means for

the Prolongation of Life, 1903

Longevity – 1903 A.D.

“Heath risks such as smoking, physical inactivity, being overweight or obese, consumption of high fat diets, and inadequate fruit and vegetable intake are major determinants of morbidity and mortality.”

Longevity - 2000

Robert Butler, M.D., founder, International Longevity Institute, founding director of the U.S. National Institute on Aging, Pulitzer Prize winner, gerontologist

AGEING AROUND THE WORLDWhat to do:

Seventh Day Adventists

Bush Medicine

AyurvedaOkinawan Secrets

Traditional Chinese

Medicine

Hippocratic Medicine

• Abstinence from tobacco, alcohol, caffeine, and other drugs

• Low stress lifestyle• Vegetarian diet and drinking spring water• Weekly day of rest on the Sabbath• Regular exercise• Close-knit family structure• Prayer and worship throughout the

church community

Seventh Day Adventists: Loma Linda, CA

Longevity StatisticsLifestyle Factors Lifestyle factors can add up to

10 years of life expectancy in Adventists (Fraser & Shavlik, 2001).

Life expectancy of Vegetarian Adventists at age 30 Male: 83.3 years Female: 85.7 years

California Adventists are likely the longest living natural population in the world (Fraser & Shavlik, 2001)

• Hippocrates rejected the idea of spiritual causes or cures for illness, appealed instead to scientific reason

• Health was promoted by temperance and self-control

• Moderation in eating, drinking, sex, and exercise

• Striving for a balance among the four humors

Hippocratic Medicine: Ancient Greece

• Ayurveda– Rayasana branch dedicated to

rejuvenation and elder care– Plant extracts used to enhance memory,

improve mood, decrease inflammation, and improve cognition

• Taoism– Ageing process slowed by undertaking

effortless action, taking vital breaths, and eating magical foods such as ginseng

Eastern Models of Ageing

• Traditional Okinawan diet consists of vegetables, tofu, seaweed, and small amounts of meat or fish, is low in fat and calories but high in nutrients.

• Low stress and rigorous physical activity

• Many belong to an Okinawan-style moai, a support network providing financial, social, and emotional help throughout life

• Average life span of 86 years for women, 78 years for men is among longest in the world

Okinawan Secrets: Japan

CONTEMPORARY MODELS OF SUCCESSFUL AGEING

What to do:

• Reichstadt et al. (2007) found that older adults attribute successful ageing to these factors:– Positive attitude and adaptability to change– Sense of security and stability– Overall health and wellness– Engagement and stimulation

What do older adults believe contributed to their health and well-being?

From: Reichstadt, J., Depp, C. A., Palinkas, L. A., Folsom, D. P., & Jeste, D. V. (2007). Building blocks of successful aging: A focus group study of older adults' perceived contributors to successful aging. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 15(3), 194-201.

• Genetics• Staying active• Lifelong learning• Optimism / Love of Life

Helen “Happy” Reichert with her caretaker

The Secrets of Centenarians

• Kahn Family – All four siblings lived to be centenarians!

• Helen “Happy” Reichert, 108• Irving Kahn, 104• Peter Kahn, 100• Lee Kahn passed away in 2005 at

the age of 102Helen Reichert and Irving Kahn in Time Magazine

Easterlin, R.A. (2006). Life Cycle Happiness and Its Sources: Intersection of Psychology, Economies, and Demography. Journal of Economic Psychology/Elsevier, pp. 463-482.

What we have learned about occupational therapy’s role in facilitating healthy ageing

USC Division of Occupational Science & Occupational Therapy

Well Elderly Research Program

The USC Well Elderly Studies

1994-1997National Institutes of Health (R01 AG11810-01S1)

NIA, AHCPR, NCMRRAmerican Occupational Therapy Foundation

PI: Florence Clark, PhD, OTR/L, FAOTA

2004-2008National Institute on Aging (R01 AG 021108-01A3)

PI: Florence Clark, PhD, OTR/L, FAOTA

Florence Clark, Ph.D. Occupational TherapyRuth Zemke, Ph.D. Occupational TherapyJeanne Jackson, Ph.D. Occupational TherapyMichael Carlson, Ph.D. Social PsychologyLoren G. Lipson, M.D. Geriatric MedicineStanley P. Azen, Ph.D. Preventive Medicine, BiostatisticsJoel W. Hay, Ph.D. Pharmaceutical Policy & EconomicsBarbara J. Cherry, Ph.D. Cognitive PsychologyDeborah Mandel, M.A. Occupational TherapyKaren Josephson, M.D. Geriatric Medicine

USC Well Elderly Study 1 Team

Florence Clark, PhD Occupational TherapyJeanne Jackson, PhD Occupational TherapyStanley P. Azen, PhD Preventive Medicine, BiostatisticsChih-Ping Chou, PhD Preventive MedicineBarbara J. Cherry, PhD Cognitive PsychologyMaryalice Jordan-Marsh, PhD NursingBrett White, MD Family MedicineDouglas Granger, PhD Biobehavioral Health, Penn State Robert Knight, PhD Psychology, GerontologyMichael Carlson, PhD Social PsychologyRand Wilcox, PhD Psychology, StatisticsDeborah Mandel, MA Occupational TherapyJeanine Blanchard, MA Occupational Therapy

USC Well Elderly Study 2 Team

Lifestyle Redesign®

Lifestyle Redesign® is the process of infusing

healthy & meaningful activities and measures

into day-to-day routines.

Well Elderly Study 2: Intent-to-Treat Treatment (n=187) vs. Control (n=173)

Health-Related Quality of Life - SF36V2

Life Satisfaction - LSI-Z

Mental Health Depression - CES-DSocial FunctionVitality CognitionBodily Pain Memory - CERAD ns

Composite: Mental Visual Search ns

Composite: Physical ns Psychomotor Speed ns

General Health ns

Physical Function ns

Role Physical ns < .05Role Emotional ns

one-sided p values

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Lifestyle Redesign® Program

• Becoming hyper-cognizant of activity patterns– Notice and name activities– Learn the relationship of activities to health &

well-being• Physical, cognitive, social, emotional and spiritual

• Activity Pattern Analysis– Self-reflect– Identify barriers– Identify options and alternatives

1. Identify general healthy lifestyle practices

2. Perform a personal inventory of goals, strengths, & weaknesses

3. Bring the two together into a daily routine

• Can be delayed, even prevented, through lifestyle changes– Coronary heart disease– Certain cancers– Diabetes– Dementia– Arthritis

Age-related Diseases

Your plan must be customized to be sustainable

But it should include these components…

Based on Well Elderly research and The End of Illness (Agus, 2011)

• Follow your circadian rhythms• Become mindful of when you are at

homeostasis• Use technology to track your biomarkers and

activity pattern

1. Learning to listen to your body

• Through simple everyday practice– i.e. avoid wearing high heels, carrying heavy

purchases, wearing uncomfortable or binding clothes, using heavy suitcases, etc.

2. Trying to avoid chronic inflammation

• As much as possible, try to eat…– On a regular schedule– Cold water fish (i.e. trout, tuna, halibut) 3x per

week– A multi-colored diet– Red wine (if you wish) 5 nights per week• Unless you are at high risk for cancer

– A good-fat diet– Natural, non-processed food

3. Trying to eat a healthy aging diet

From: Agus, D. B. (2011). The end of illness. New York: Free Press.

• Some stress is normal and adaptive• Chronic stress is health-compromising

– Becoming aware of sources of chronic stress is important• Ways of managing stress:

– Finding ways to rest– Avoiding chronic stressors (as much as possible)– Spacing– Taking breaks– Just saying no– Escape– Personal therapeutic activities that are enjoyable, soothing

4. Minimizing your stress

• Genetic risk factors – Predisposition to common conditions

• Lifestyle factors can counteract these risks– Physical exercise changes gene expression

5. Knowing your risk factors

From: Agus, D. B. (2011). The end of illness. New York: Free Press.

• Eat, sleep, and exercise at predictable times every day• Engage in the social, productive, and spiritual

activities you value• Choose physical activities you enjoy (as much as

possible)– Consistent physical activities such as walking or dancing

can be very health-promoting • Take time to rest• Avoid sedentary activity as much as feasible

6. Incorporating health-promoting practices

• Explore what you care most about– Engage in life more profoundly– Explore your deepest priorities and potentials– Pursue new forms of meaning

7. Developing in new ways

From: Bateson, M. C. (2010). Composing a further life: The age of active wisdom. New York: Vintage Books.

• Taking action is self-perpetuating

8. Getting started