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"Aging Well" is a book that does not clearly establish what it wants to say specifically about aging. Is it a book about longevity or is it a textbook on adult development? A main purpose of the author is to convey the findings of a multi-decade study of three distinct groups totaling about 800 individuals as they aged: a male Harvard student cohort born in 1920; a male inner city cohort born about 1930; and a gifted female cohort born in California about 1910. However the emphasis is on the Harvard cohort, a group that most assuredly stands apart from typical American lives. All of the interviewees were at least 70 years of age by 2000 but the specific commonality of longevity seems to get lost in the author's focus on more general social and emotional developmental concerns. However, the author establishes little connection between longevity and such development.
Perhaps the biggest problem with the book is that only a very limited, and at times inadequate, overview is presented regarding various social and emotional developmental topics. The author bases the entire book on Erik Erikson's ideas about adult developmental stages, which in his interpretation consists of the sequential tasks of identity, intimacy, career consolidation, generativity, keeper of the meaning, and integrity. There is no discussion about the legitimacy of those ideas or whether there are alternative ideas. The principal means of elaborating on those views is by presenting mini-profiles of about 50 individuals throughout the book who supposedly have or have not attained a particular level of development. It is burdensome for the reader to be presented with so many case studies to weigh.
It is here that the author's subjectivity becomes most apparent as he is very inclined to label those surrounded by somewhat extensive social networks be they ones of family, patients, customers, or friends as having aged well. He takes no notice of single adults or childless couples; two situations that would undoubtedly have an impact on traditional socialization. In one case he lauds as brilliant a man who has focused on the tasks of intimacy and career for the first twenty years of his adult life and then turns to generativity, or nurturing the young. One wonders if his children would appreciate the twenty years of de-emphasis on them. Frankly, it makes the development laid out by the author seem questionable.
In addition, the author demonstrates little appreciation for the atypical life chances and economic standing of the Harvard cohort. He finds it quite commendable that one-half of the Harvard cohort remained in their full-time work at age 65, failing completely to understand that the career control of doctors, lawyers, professors, and business owners and executives of the Harvard cohort far exceeds the options available to most people. He basically sidesteps the entire topic of adequate retirement income, even regarding it at one point as relatively unimportant compared to learning to play.
The author also classifies childhoods as ranging from "the Loveless" to "the Cherished." But to what effect? It is found that the negatives of childhood generally do not translate into life beyond age 50 and certainly not to longevity. In deference to general adult development textbook mode, the author makes a brief jargon-laced foray into both maladaptive and adaptive defense mechanisms that is bound to leave most lay readers just baffled.
The author frequently refers to "healthy" aging, but, again, what is it? We do learn that ancestral longevity, cholesterol levels, stress, parental characteristics, childhood temperament, and ease in social relationships do not predict healthy aging. What does predict healthy aging? Among the Harvard cohort, no alcohol abuse, no heavy smoking, and not being overweight were the greatest predictors of healthy aging followed by some exercise, a stable marriage, and then mature defenses. Among the Inner City cohort, a stable marriage was found to be the best predictor of successful aging followed by the same top three of the Harvard cohort and then by 12-plus years of education and by mature defenses. A major disconnect in the book is a discrepancy where the text claims that mature defenses ranks as the second best predictor contrary to the data displayed in charts.
So what is learned from this book? Some adults develop more or perhaps differently than others. Some adults have lives that are more social than others. Some adults are happier than others. None of that is unique to aging. It could well have a lot to do with life's circumstances that are largely outside an individual's control. We do learn that the author is somewhat judgmental concerning the quality of various individuals' lives in old age. Adults without bad consumption habits stand a far better chance of living longer than those who abuse their bodies. It probably did not take a Harvard study and a book to know most of this. Maybe the lesson is to go to Harvard and live long.
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George E. Vaillant is well qualified to write this book. He is a psychiatrist at Brigham and Women's Hospital in Boston, a professor at Harvard Medical School, director of the Harvard Study of Adult Development, and a respected researcher. Harvard Medical School professors have been studying the basic elements of adult human development for more than five decades. Three separate cohorts of 824 individuals were selected as teenagers for different facts of mental and physical health and studied for the rest of their lives to observe the adult life cycle and to provide a theoretical framework for understanding how older people become fulfilled or not.
Harvard men were studied. In 1940, men who went to Harvard were rich, privileged, white, born to American born grandparents, and expected to equal or exceed their natural ability.
In 1939, Sheldon Glueck obtained funding to do a prospective study of 500 youth sent to reform school and 500 matched school boys who had not been in any legal trouble
at age 14. His wife restudied the groups at ages 17, 25, and 32. The control nondeliquent group had the same social risk factors that helped doom the delinquents-had repeated two grades or more in school, had foreign born parents, lived in blighted neighborhoods, and were from families known to five or more social agencies and more than two-thirds were on welfare. Valinti inherited the study when the subjects were 40, and subjects continued to have physical examinations every five years. At age 60, all but 2 of the 456 subjects were known to be dead or alive.
For the Terman Women Sample, Terman tried to identify most of the brightest children in his three city area. He asked teachers to indentify the brightest in each class. He learned that the unattractive and shy children tended to be overlooked so that he only captured about 80 percent of the bright children. He used the Stanford-Binet Intelligence Test to identify 1 percent of the California urban school children with IOs greater than 135 to 140 most of whom were born between 1908 and 1914. Four generations of investigators have followed the Terman men and women by questionnaires about every five years and by personal interviews in 1940 and 1950. The Terman women were not asked to provide regular physical exams. However, when compared to classmates, they had better nutrition, more humor, common sense, perseverance, leadership and popularity among their classmates. By age 80, they had half the mortality of white American women in their birth cohort.
In comparison, at age sixty-eight to seventy, the inner city men had the same physical decline as the Terman and Harvard cohorts at seventy-eight to eighty. The difference was attributed to less education, more obesity, and greater alcohol and cigarette abuse among the inner city cohort.
These cohorts seemed to demonstrate that it is social aptitude or emotional intelligence rather than brilliance or parental social class that leads to a well-adapted old age. Vaillant concluded that individual life style choices contribute a greater role than genetics, wealth, race, or other factors in determining how happy people are in late life. He found that " It is not the bad things that happen to us that doom us; it is the good people who happen to us at any age that facilitate enjoyable old age. Healing relationships are facilitated by a capacity for gratitude, for forgiveness.... A good marriage at age 50 predicted positive aging at 80. But surprisingly, low cholesterol levels at age 50 did not. Alcohol abuse -unrelated to unhappy childhood-consistently predicted unsuccessful aging, in part because alcoholism damaged future social supports. Learning to play and create after retirement and learning to gain younger friends as we lose older ones add more to life's enjoyment than retirement income. Objective good physical health was less important to successful aging than subjective good health.... It is all right to be ill as long as you do not feel sick" p. 13.
This research report can help us understand that we can do little to changer our genetic make-up, but we can change our habits so we avoid alcohol and smoking, eat a healthy diet, exercise to maintain a healthy weight, develop loving relationships, and continue to learn. These are important lessons for all of us wanting to age well, but it takes a sophisticated reader, knowledgable about research and willing to wade through research findings to read this research report. The book has 12 chapters, 11 appendices, notes, acknowledgments, and an index.