FEATURE — Winter 2007

Photo: ©Winsett/Corbis, Collage: Donna Boyd

Transforming Later Life

De-emphasizing disease and disability, professors across disciplines study and discuss ways that older adults can lead healthy, fulfilled, and civically engaged lives regardless of age.

By Judy H. Watts

While physiologist John Holloszy tests a way of eating that promises to stretch the human life span, gerontologist Dennis Villareal is discovering how people over 65 who may only look hearty can get strong enough to stride robustly through their years. At the same time, social work Professor Nancy Morrow-Howell is documenting older adults’ enormous capacity and will to serve society—and the mighty benefits volunteers accrue along the way. Her social work colleague Amanda Moore McBride is leading a new campus-wide institute that will help older adults of all ages play a lasting role in civic life.

Chia-Ling Chou (left), a WUSTL student in the Health Administration Program, and Michelle Engblom (right), a Saint Louis University doctoral student in counseling and family therapy, are in social work Professor Nancy Morrow-Howell’s Theories and Issues in Aging class. In her research, Morrow-Howell focuses on older adults and civic engagement.

For the sake of both individuals and society, analysis and innovation are imperative—and must translate into action soon. According to the U.S. Census Bureau, more than 36 million people were 65 and over in 2005. In 2050, the total will rise to 86.7 million. The first of an estimated 78.2 million postwar baby boomers born between 1946 and 1964 already have reached their 60s—the vanguard of an army of high achievers, overall, who pride themselves on being savvy, smart, and independent.

Later life promises to remain meaningful for this vast group of 43- through 61-year-olds—and others well into their 70s, 80s, or beyond—who are healthier (and with advances in research, getting more so) and better educated than any generation before them. Crushing social problems—poverty, disease, prejudice, intolerance and misinformation, illiteracy, terrorism, and the deteriorating environment and diminishing biodiversity—demand their attention.

Writing in the winter 2007-2008 issue of Generations, the Journal of the American Society on Aging, Morrow-Howell, who is the Ralph and Muriel Pumphrey Professor of Social Work, speaks of the need to transform later life in society. Bold minds throughout the Washington University community are on task through interdisciplinary units such as the Harvey A. Friedman Center for Aging and the Gephardt Institute for Public Service and with hundreds of important research and education grants. Following are examples of ways gifted, caring researchers on both campuses are working to help older adults become healthier, more fulfilled and, perhaps, a new hope for society.

Reinventing Retirement: Everybody Wins
Despite all evidence to the contrary, society clings to the stereotype that aged adults are debilitated, depressed, or demented—or hastening toward such infirmity. Similarly, retirement is widely considered an era of leisure—a time to step down, sit down, and lean back, since few opportunities for productive involvement exist anyway. The fact is, 80 percent of older people are fit and functional, Morrow-Howell writes in the winter issue of Generations, which she co-edited. Moreover, older adults want to be involved in meaningful roles, her research shows, and such activity is related to life satisfaction, health, and emotional well-being.

Pioneering exercise physiologist and gerontologist John Holloszy (foreground) is now leading a three-site, five-year study on the benefits of calorie restriction and aging. Charlie Lambert (center), research assistant professor, is helping with the study. Michael Decker (on treadmill) is among the study participants.

Although Morrow-Howell’s research and teaching over the past decade have centered on productive engagement for all older people and on their capacity, she emphasizes that activities with monetary worth (for example, volunteer service, working, and caregiving) are not the only valuable activities; artistic, relational, and religious pursuits are also important. However, our research focuses on activities with an economic return because we argue that society cannot afford for people to retire for 30 years without being productively engaged in important work that is needed! Morrow-Howell believes that the civic engagement of the older population will be critical to our older society.

New research she presented at the Gerontological Society of America meeting in November 2006 documented the multiple benefits of volunteering. When organizations studied gave older adults aged 52 to 90 roles that were important to the public, nearly 40 percent reported that their lives had improved because of the experience. Conflicts with family time were infrequent, and the volunteers felt meaningfully involved. Reactions were consistent across demographic categories.

Morrow-Howell also heads a Washington University evaluation team assessing a 20-city civic engagement program called Experience Corps (EC), in which older volunteers mentor students struggling to read and work with their teachers in inner-city schools. Morrow-Howell and her colleagues will determine whether reading abilities, classroom behavior, and academic skills became better, and whether EC volunteers’ physical health and functioning, emotional health, engagement, and personal identity improved. Preliminary findings are positive.

Staying Self-Sufficient Is Key
Until late in their lives, many fortunate adults take the accoutrements of well-being for granted. Their home is their habitat, mirroring their individuality. Inside, the Internet and printed publications often rival TV as sources of information and entertainment. Outside, automobiles are key to freedom and self-sufficiency. But as people age, living design, reading formats, and driving guidelines must change. Below are insights and new findings from three researchers who share their expertise in these areas at the Friedman Center for Aging.

The evolving home So much can be done at home to make life easier as people age, says Gyo Obata, B.Arch. ‘45, founding partner of Hellmuth, Obata & Kassabaum, and member of the Center for Aging’s community advisory board. Intergenerational housing tops his wish list, to ensure that older people are not set apart (or aside). Interiors should reflect principles of universal, inclusive design and serve every age and physical condition. Floors should be on one level, and large doors, wide hallways, kitchens equipped with low cabinets and countertops, and bathrooms with high toilets and grips conserve independence. (And chair lifts by stairs and residential elevators preserve mobility if there is more than one level.)

Information design for all ages “Older people are among the most intensive users of written and visual information,” says Ken Botnick, associate professor of visual communications and member of the Center for Aging’s executive committee. “Books are the ultimate multimedia tool. One can go forward and back, read and reread, and mark pages. But every aspect—the paper; the typeface design, size, and contrast; the length of lines on a page and the spacing in between—has to be considered in terms of how the changing eye adapts.”

The Web also becomes challenging as people age. “Much of what you see is simply bad book design copied into a completely unsuitable medium,” says Botnick, “plus boxes pop up, text jumps around, and ads are jammed onto pages. The more distractions, the less information older users retain.”

Miss Daisy is driving—but how well? “When physicians tell older adults they can no longer drive safely, it’s devastating,” says geriatrician David Carr (also see “Managing Successful Aging” feature in this issue). “What can we do to keep such people socially connected? This question isn’t asked enough by physicians and other health professionals involved in geriatric care. Yet, working with people to maintain mobility—what I call mobility counseling—can be as important to health and well-being as prescribing a needed medication.”

Carr and colleagues, a multidisciplinary team of professionals from institutions across St. Louis, hope to change this state of affairs. They have received five research grants in the past two years related to older adults and their automobiles.

Carr is collaborating with civil engineering Professor Gudmundur Ulfarsson on creating a traffic safety pamphlet for older adults that was funded through the Missouri Department of Transportation (see modot.mo.gov or call 1-800-800-2358). Carr also has been a co-investigator with Thomas Meuser, director of gerontology at the University of Missouri-St. Louis, on the AAA Foundation-sponsored project examining a 1998 Missouri law that provides a confidential mechanism for physicians and others to report drivers as unfit to a state driver licensing office. Early findings suggest that the law, which mandates an assessment by a physician, appears to be de-licensing drivers no longer safe due to various conditions of aging. A grant from MoDOT sponsored the creation of an aging and driving curriculum for law enforcement that is now being rolled out statewide through the Missouri State Highway Patrol.

Recent funding allows Carr to research driving fitness in stroke and dementia patients. If you have concerns, consider a referral to the new driving clinic, opening January 28, 2008, at The Rehabilitation Institute of St. Louis (314-658-3800).

A delegate to the 2005 White House Conference on Aging, Morrow-Howell noted in her report a general agreement among those assembled that service opportunities must be part of institutions’ very fabric and that businesses and corporations must do a great deal more. (Like the majority of delegates, however, she is strongly committed to Social Security, Medicare, Medicaid, affordable and quality long-term care, and transportation in a time of shrinking public budgets. And she does not want to strengthen a movement away from the concerns of low-income or function-impaired older adults.)

Calls for willing and able adults of all ages to help solve society’s alarming dilemmas increasingly will be sounded through the University’s Gephardt Institute for Public Service. Established with a sizable gift from former U.S. Congressman Richard A. Gephardt to attract both younger and older citizens to public service, the institute is directed by Amanda Moore McBride, M.S.W. ’95, Ph.D. ’03, assistant professor of social work. In addition to other initiatives, it has launched an international service pilot project for older adult volunteers with CHF International.

We promote service across the life span, McBride says, by inculcating an ethic of service through academically based service initiatives. We offer students and alumni opportunities to become engaged citizens. In particular, retiring baby boomers expect to apply their skills and expertise. We are developing ways to involve older adults in civic learning and service for sustained impact through the University and its nonprofit partners.

Possible projects at the institute include an educational series about civic life, a service-based alumni travel program, and intergenerational service projects.

Independence Days: Toward Longer, Stronger Lives
Living well remains the best revenge, but the definitions are changing fast. Living well today in large part means living healthfully—and in ways still being discovered—to combat secondary aging resulting from physical disease, disuse, or abuse. As for living long, most ideas about actually extending the maximum human life span have been the stuff of fantasy and sham. Slowing primary aging, the inevitable, gradual (yet too-rapid) process of visible and invisible physical deterioration throughout life, has eluded medical science.

Now John Holloszy, M.D. ’57, professor of medicine, is leading a three-site, five-year clinical study for the National Institute on Aging on the effects of severe calorie restriction on human beings. Twenty years ago Holloszy and colleagues found that such restriction in laboratory animals protected them against cancer and slowed the aging process. It’s the only treatment that does. The oldest food-restricted animals are 20 to 40 percent older than the oldest freely eating animals, Holloszy says.

His new study, CALERIE (Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy), aims to determine whether people of normal weight on a nutritious but severely calorie-restricted diet develop the same adaptive responses that laboratory animals do. That would tell us whether human beings’ aging is slowed and if they acquire marked protection against disease.

Associate Professor Dennis Villareal (left) talks with Peggy Dangos, a participant in his one-year Weight Loss and Exercise in Physically Limited Older Adults study. Dangos and others in a randomized group significantly improved their physical function by diet-induced weight loss and regular, three-times-a-week exercise.

Of course, sticking to a diet for more than six months—particularly the CALERIE regimen, which mandates 25 percent fewer calories than usual for two years—is inconceivable to many Americans. For this reason, Holloszy’s team tailors each ultra-low-cal diet to individual preferences, banning only empty calories. Participants must be between 25 and 45 years old, lean to slightly overweight, and free of diabetes, cancer, heart and liver disease, and AIDS. Fifteen to 30 minutes of weight training two to three times a week is recommended to help maintain muscle mass; doing more would cause excessive weight loss.

To date, only 18 of the 80 people needed from the St. Louis area have enrolled. “So now we only have to get another 62 over the next 18 months or so,” Holloszy says with his gentle laugh, adding when asked: “We’re way ahead of the other sites!” But he isn’t worried. “We’re only seven months into the study. And I can almost guarantee that people who stay with the program will have huge decreases in cholesterol and increases in high-density lipoproteins (HDL), or healthy cholesterol—meaning they’ll be at markedly less risk for heart disease. I can also guarantee a huge drop in blood pressure.” Based on an earlier pilot study, Holloszy also predicts low levels of inflammation, a marker associated with aging, and of certain growth factors involved in the development of cancer. Participants also will have reduced oxidative stress, or free-radical damage to their cells.

“Calorie restriction is not all-or-none,” Holloszy emphasizes. “Even more moderate degrees of restriction would have effects that are similar to what we expect in the study, though less marked.”

Holloszy theorizes that such calorie restriction probably could be safely started under medical supervision until about the age of 60. “Everybody is different, but after 65, muscle and cell loss accelerates, and calorie intake naturally decreases anyway.”

Successful study results would leverage benefits on many fronts. Calorie-restriction mimetics research (to find a pill that delivers the same benefits) is already under way in pharmaceutical and biotech companies and would accelerate. Publicity about the study would bolster a public campaign to help people lose weight. “Calorie restriction is not all-or-none,” Holloszy emphasizes. “Even more moderate degrees of restriction would have effects that are similar to what we expect in the study, though less marked.”

Holloszy’s pioneering earlier work demonstrated the enormous physical benefits of regular physical exercise for adults of all ages—even well into their 90s. He found striking improvement in frail older adults’ exercise capacity and ability to perform the activities of daily living—both help keep them out of nursing homes. He was the first to show that exercise training lowers blood lipid levels, improves heart function in middle-aged men, and increases glucose uptake in muscles—a landmark finding for diabetes treatment. His research lab also proved that exercise protects against secondary aging: diabetes, high blood pressure, obesity, coronary artery disease, osteoporosis, and loss of muscle mass and strength.

“But I’m convinced now that calorie restriction has much greater health benefits than exercise—greater protective benefits and very likely an extended life span,” he says. “On the other hand, exercise makes one stronger and provides more endurance; certainly calorie restriction does not have that effect.” He adds that people on calorie restriction are very lean, so significantly less demand is placed on their muscles to carry them around. (Anyone interested in participating in the CALERIE study, please e-mail calerie@im.wustl.edu. For additional information, visit http://calerie.dcri.duke.edu.)

In contrast, new work led by Dennis Villareal, associate professor of medicine, targets secondary aging. Villareal is leading the first study of obesity and frailty in adults over 65. In the elderly, a body-mass index of 30 or more contributes to frailty, an impaired ability to perform the normal daily activities essential to living independently.

“Obesity in later life contradicts the popular misconception that frailty equals muscle wasting or thinness,” Villareal says. “It is of particular concern because obesity and aging are additive: They interact to maximize the decline of physical function.” Aging brings an increased risk of arthritis, joint dysfunction, inflexibility, and weakness because of lost muscle mass—just at the time when obese older people need more muscle to move excess body weight around.

Unlike most other causes of frailty, obesity-induced frailty can be banished with weight loss and exercise. In his intervention study, Villareal hypothesizes that physical function will improve with both weight loss without exercise and vice versa—and that the two combined will have the greatest effect of all and result in less of the muscle and bone-mass loss that accompanies weight reduction at any age. Villareal also is studying the mechanisms by which exercise counters the negative effects of caloric restriction on muscle and bone.

Villareal says that while most people in the general population regain lost weight after a time, older adults in his study are highly motivated and maintain their loss longer. “Most are retired without other distractions,” he explains. “They love the social interaction and meet on their own afterward. It’s a very wonderful experience for us, and we try to show the world that it’s never too late to lose weight.” The older adults studied so far have experienced a dramatic improvement in physical function and have tolerated weight loss extremely well.

“Recruitment is still going on,” Villareal says. “Anyone interested in participating in a cost-free year of medically supervised weight loss and/or exercise, with free evaluations and testing is encouraged to call Michael Decker, research patient coordinator, at 314-747-4113.” Eligible participants include those who are 65 years and older, more than 40 pounds overweight, and without diabetes.

To mark its 25th anniversary, OASIS held a national conference on active aging in October 2007 in St. Louis. From right: Marylen Mann, OASIS chairman of the board and founder; Linda Nunes-Schrag, Hyattsville, Maryland; Sue DeRosa, Escondido, California; and Bill Browning, Houston, all OASIS members, serve on a panel during the conference.

OASIS Opportunities for Learning and Service
When older people are bored, disengaged, and useless, their health often suffers, and they can become burdens to their families and society, says Marylen Mann, A.B. ’57 (philosophy), M.A. ’59 (education), and chair of the Friedman Center for Aging’s community advisory board. And what a loss!

OASIS members are just the opposite. Mann founded the nonprofit organization, whose board she chairs, nearly a quarter century ago; today, 360,000 members in 26 cities nationwide are enrolled in challenging arts, humanities, wellness, and technology programs—and serving their communities in meaningful ways. Nearly 14,000 children have learned to read through OASIS’ Intergenerational Tutoring Program, for example. With support from the National Institute on Aging, Stephen Lefrak, professor of medicine, leads another OASIS program, Vital Visionaries. Now in 10 cities, it helps medical students understand the elderly at a time when too few physicians are choosing to specialize in geriatrics. The George Warren Brown School of Social Work will conduct the project evaluation. (Over the years, researchers throughout the University have led major studies involving OASIS programs.) In tribute to OASIS, U.S. Assistant Secretary for Aging Josefina G. Carbonell gave the keynote address at OASIS’ recent 25th anniversary conference in St. Louis. (Visit www.oasisnet.org.)

Co-moderator Jerry Kottler (left) talks with (center, from left) Eleanor Collinger, Francis Brownstein, and Connie King in the Lifelong Learning Institute’s course Reading The New Yorker. Karen Sterbenz (background) is also co-moderator.

Learning for a Lifetime

More than 40 classes as varied as What’s New in Economics, and Writing for Your Children’s Children (just two of those filled in advance for the fall 2007 session) are on the menu at the Lifelong Learning Institute (LLI). Henrietta Freedman, A.B. ’75 (psychology), who serves on the community advisory board of the Center for Aging and the Arts & Sciences National Council, established the LLI in the early ’90s for those 55 and older. Administered through University College in Arts & Sciences, LLI is a thriving hub of reading across disciplines, spirited discussion, and enormous enjoyment. Fans renew their LLI memberships year after year to take part in the not-for-credit peer-learning groups. (For more information, visit: http://ucollege.wustl.edu/lifelong.html, or call 314-935-4237.)

Judy H. Watts is a freelance writer based in Santa Barbara, California, and a former editor of the magazine.