The Art and Science of
As the population of the “oldest old” grows, UGA
researchers are probing their secrets of longevity—often combined with
high levels of function—and developing better ways to support centenarians
as well as other older adults
Annie Mays Larmore, a centenarian of 102 years, sums up her accumulated wisdom on aging with this oft-repeated admonition: "Grow old, but don't get old."
Annie Mays Larmore of Atlanta has lived through two world wars, the Great Depression, the civil rights movement, Neil Armstrong’s moonwalk, and, most recently, the election of the nation’s first African-American president. Clearly, the world has changed in her 102 years of life, but so has she. Larmore sums up her accumulated wisdom on aging with this oft-repeated admonition: “Grow old, but don’t get old.
“To grow means that you accept change, adjust to change,” she explained. And “growth implies activity. You must stay active—physically, mentally, emotionally, and spiritually.”
Centenarians such as Larmore are what researchers call the “oldest old,” living well past the life expectancy of someone born in 2009—78 years—and roughly doubling the life expectancy of the generation into which they were born. The Georgia Centenarian Study, based at the University of Georgia and now running for more than 20 years, has been learning from people such as Larmore some of the behavioral, nutritional, and biological factors that have allowed her and others like her to reach their 100th birthday and beyond.
Unfortunately, most older adults don’t fare as well as Larmore. But new insights into aging, in fields as diverse as nutrition, cognitive science, and housing, are helping to improve their lives. “Older adults can have a very high quality of life,” said Distinguished Research Professor Leonard Poon, director of the UGA Institute of Gerontology and principal investigator of the Georgia Centenarian Study. “Being old doesn’t necessarily mean being frail.”
A demographic time bomb
Demographically speaking, Georgia is a young state; just 10 percent of its population is over age 65, compared to the national average of 12 percent. But the fact that people 65 and older are the fastest-growing segment of the state’s population means that tremendous challenges are shaping up. UGA demographer Doug Bachtel says the figure that’s most telling is the state’s age-dependency ratio, which is the number of people 65 and older divided by the number in the workforce. A low ratio means that the state has plenty of workers, relatively speaking, to support its dependents, so the load per worker is light.
Georgia’s age-dependency ratio is 15 percent at present, though Bachtel expects that figure to rise. He notes that the counties comprising metro Atlanta and Athens have healthy ratios—between 8 and 13 percent—but rural areas, which have seen so many young people flee in search of jobs, have ratios of up to 45 percent. “As your age-dependency ratio increases, you have fewer people to work in factories and run businesses, and fewer people with the incomes to support shopping, schools, and recreation,” said Bachtel, a professor in the Department of Housing and Consumer Economics. “It’s a demographic time bomb.”
One implication of Georgia’s aging population is that the state, which currently ranks 41st in the number of physicians per capita—will have to educate thousands more physicians. To help meet that need, UGA has partnered with the Medical College of Georgia to create the MCG/UGA Medical Partnership Campus in Athens. The first class of 40 medical students is expected to enroll in 2010. By 2020, the partnership is expected to educate 60 new medical students per year—for a total of 240 students—in Athens.
“In addition to helping expand medical research in areas related to aging,” said Barbara Schuster, the first dean of the Medical Partnership Campus, “I hope we can imbue medical students with the knowledge and skills to care for the healthy elderly as well as to help improve the lives of those with chronic illnesses.”
While Georgia currently is a relatively young state in terms of older residents, its demographics are rapidly changing. From 1993 to 2003, the percentage of Georgia's population 65 and older grew by a whopping 18.7 percentÑnearly twice the national rate of 9.5 percent. And from 1995 to 2000, Georgia had the nation's eighth-highest increase in net migration of older adults. Researchers project that by 2030, 16 percent of Georgia residents will be over 65, presenting major public health and transportation challenges.
The Secrets to Living to 100
People often ask Leonard Poon, director of the UGA Institute of Gerontology and principal investigator of the Georgia Centenarian Study, if there is a secret to living to 100—that is, becoming a “centenarian.”
“There isn’t any one secret,” he answers. “There are many paths to longevity and a lot of individual differences among centenarians. And I see that as good news because most people may then have a chance of reaching 100, depending on their strengths.”
Poon’s research, though, has found some commonalities among centenarians, which include:
- High levels of family and social support
- An engaged lifestyle that includes volunteering, travel, and life-long learning
- A tendency toward a relaxed and stable personality
- A personality that is dominant when the need arises; Centenarians generally aren’t pushovers.
- A cluster of genes that appear to promote longevity and protect against degenerative diseases such as Alzheimer’s
- A high level of spirituality that helps the individual cope with life’s stresses
- Good diet: Centenarians eat breakfast regularly and tend to consume more carotenoids from orange and yellow vegetables.
Studies by UGA nutritionists Joan Fischer (above left) and Mary Ann Johnson show that many older adults suffer from nutrient deficiencies, especially vitamins D, B12, and calcium. Nutrient deficiencies make the elderly more vulnerable to chronic health problems such as osteoporosis, anemia, and mental impairment.
A vital component of good health is proper nutrition, something that Mary Ann Johnson, the Bill and June Flatt Professor of Foods and Nutrition, is passionate about. As we age, the skin becomes less able to synthesize vitamin D, while the stomach becomes less effective at secreting enzymes that help release vitamins, such as B12, in foods. Johnson’s research has revealed that subtle deficiencies in vitamin D can reduce muscle strength and mobility in older adults, while deficiencies in vitamin B12 can result in poor cognition, elevated risk for heart disease, anemia, and hearing loss. “A lot of problems that in the past were dismissed as normal aging may actually be subtle problems related to nutrition,” said Johnson.
To share her findings with the people who can benefit the most, she and her graduate students conduct health-promotion programs across the state on nutrition, the benefits of exercise, and the management of chronic diseases such as diabetes. “It’s been a great partnership between the university and the community,” said Johnson. “We’re providing older adults with information they can use, and they’re providing us with information we can evaluate for our research, while the students get real-life training.”
Similarly, professor of kinesiology Elaine Cress works with seniors in Athens to develop exercise interventions that allow them to lead fuller lives. In a study that received international media attention last year, Cress found that older adults can lower their risk of disability and increase the likelihood of maintaining independence by a whopping 41 percent just by participating in a walking exercise program (see our Research Interview with Elaine Cress in this issue).
Kinesiology researcher Elaine Cress (above right) developed a test to measure the performance of everyday tasks such as carrying groceries, sweeping, and getting up from floor level.
One of the most feared aspects of aging is a gradual but inexorable mental decline that steals memories and, ultimately, the ability to function on one’s own. Stephen Miller, professor and chair of UGA’s Clinical Psychology Program, is combining traditional memory-assessment techniques with advanced brain-imaging technologies to better understand how changes in brain structure and function affect independence. He has found that memory is only one aspect of maintaining independence; multitasking—the ability to process multiple pieces of information and solve more than one problem at once—is equally important. Through the UGA Memory Assessment Clinic, Miller and his staff provide information for referring physicians, patients, and their families that they can use in identifying modifications, such as memory aids, to maximize older adults’ independence.
Nourishing the brain
Centenarians are living proof that people can retain their cognitive faculties well into their senior years. While genes certainly play a role in keeping the brain healthy, lifestyle is important, too, says Stephen Miller, professor and chair of UGA’s Clinical Psychology Program and director of the UGA Memory Assessment Clinic.
What’s good for your heart is also good for your
brain, he said. Poor diet and lack of exercise lead to changes in blood
vessels that impair people’s ability to nourish their brains while significantly
increasing their likelihood of developing type 2 diabetes. This disease
attacks the brain in two ways—by damaging blood vessels and by preventing
the brain from using blood sugar properly.
Staying mentally active can also nourish the brain. Crossword and sudoku puzzles are great brain exercises, said Miller, but even more challenging to your brain is social interaction. Listening, processing information, formulating your own ideas, and then expressing them are among the best workouts for your brain.
Addressing social needs
Understanding the biological aspects of aging is a major focus of the UGA Institute of Gerontology, but its researchers are also helping older adults manage the social aspects. Anne Sweaney, professor and head of UGA’s Department of Housing and Consumer Economics, says that most people aren’t prepared for the housing challenges that come with aging. In her research, which explores cost-effective ways to improve the accessibility of homes, she has found that universal design principles—such as step-free entrances, wide doors that accommodate wheelchairs, and a bedroom and bath on the first floor—allow older adults to stay in their homes longer, while options such as manufactured housing provide more affordable homes.
“Our students need to understand the full spectrum of what it means to be an older adult"
“One of my goals is to develop a
completely accessible manufactured house that could serve as a demonstration
for the community,” she said. “Students, faculty, builders and consumers
could see what a manufactured house looks like and how pleasing its universal
design features can be.”
While many older adults receive care, one in 10 grandparents provide care for a grandchild for at least six months, often because of parental divorce, substance abuse, financial problems, or military deployment, said Stacey Kolomer, an associate professor in the School of Social Work. Care-giving seniors face challenges when raising grandchildren in a world very different from that of their own children, much less from the one they grew up in themselves. To help them cope, Kolomer is working with the Athens Community Council on Aging to expand a program that provides case management, nursing, and legal services to older care-givers.
She is also infusing the study of aging into the social work curriculum by partnering with the Athens campus of the Medical College of Georgia School of Nursing. Social work and nursing students learn about the special needs of older adults in joint classes, forging relationships that often prove invaluable after graduation. “Our students need to understand the full spectrum of what it means to be an older adult,” Kolomer said. “I spend a lot of time fighting stereotypes about aging. Older adults are as diverse as any other group.”
Many of the UGA researchers studying aging are also involved in the Georgia Centenarian Study. The scope of the study is so broad, in fact, that it comes up often in conversations among researchers across campus who study aging. Since it began in 1988, the study has resulted in more than 100 peer-reviewed scientific publications, with plenty more to come. “We probably will be writing papers based on our data for the next 10 years at least,” said principal investigator Poon.
Larmore became a participant in the study in 2005, motivated by her desire to contribute to society and by her belief that people aged 100 and older are a distinct group whose numbers are certain to grow. In many ways, she typifies the lifestyle habits and personality traits that are common among centenarians. As a librarian at Mercer University and later the Atlanta Public Libraries, she relished social interactions, hosting puppet shows, summer reading programs, and other events that allowed her to connect with others.
Upon retirement in 1973, Larmore became active in a gardening club, a stamp club, her college alumni association, and other groups. She has wide-ranging interests, from flowers to Japanese art, and considers herself a spiritual person who prays and reads the Bible daily. She laughs heartily when telling stories about her great-grandchildren, who lovingly call her “me-ma.” Larmore feels obligated to help people in need, but she also knows that scam artists see her and other seniors as easy targets, so she keeps her guard up. And while she reads the Atlanta Journal-Constitution daily, she doesn’t let world events intrude on her peaceful existence. “If you can do something, then do it,” she said. “But don’t worry about things you can’t change.”
Larmore eats “old-fashioned food,” meaning plenty of fruits and vegetables and no fast food or junk food. She exercises daily, taking walks in her backyard, and also does 25 minutes of callisthenic-type exercises. “I watch my health very carefully,” she said, noting that her subscription to the Harvard Health Letter keeps her up to date on advances in medicine.
She’s not without health problems, of course. She’s had arthritis for the past 45 years and last year she suffered a heart attack. When Larmore turned 94, she made the decision to move in with her daughter. “The thing I hated most,” she said, “was giving up my car keys and the privilege of going where I wanted, when I wanted.” Even worse, she said, is that all the people she grew up with are now gone, leaving her behind like “the last leaf on the tree.”
But Larmore, an optimist, said the good still outweighs the bad. Her long life, she said, has been a privilege that allowed her to realize her sense of purpose. When asked about that purpose, she didn’t skip a beat: “To do as much good as I can, and to share myself and whatever I have with others.”
(Sam Fahmy is a science writer in UGA’s Office of Public Affairs).