A Research Definition of Healthy Aging

Each of the six dimensions of aging was significantly associated with each other—roughly as strongly as height correlates with weight. Of the 237 Harvard men active in the study, 62 men were categorized as Happy-Well. These were men who had experienced objectively and subjectively, biologically and psychologically good health in all six dimensions. Such Happy-Well men could be defined as follows: Prior to age 80 they spent no years physically disabled—either objectively or subjectively. In addition, compared to their peers in the study, their social supports were in the top three quarters, their mental health was in the top three quarters, and their life satisfaction was in the top two thirds.

Forty of the 237 men were classified as Sad-Sick. These were men who by age 80 had experienced at least 5 years of subjective or objective physical disability. In addition, all of these 40 Sad-Sick men were classified as psychosocially unhappy in at least one of the three psychosocial dimensions: Mental Health, Social Support, or Life Satisfaction.

Sixty of the 237 men died after age 50 and before age 75. They were classified as Prematurely Dead. We often think of death, especially premature death, as an act of God; a tumor striking down the innocent in the flower of youth. (This was one reason that the 12 deaths from the College sample before 50 were excluded: six men were killed in action in World War II and the others in freak accidents or from rare genetic illnesses.) There were other early deaths even more senseless and tragic, but these deaths were the exceptions. By this I mean that prior to death the 60 College men who died prematurely (i.e., after 50 and before age 75) were almost as psychosocially impaired as the surviving Sad-Sick men. Prior to death all but 18 of these 60 men had suffered poor social supports or poor mental health or were dissatisfied with their lives.

I followed the same procedure for categorizing the health of the 332 participating Inner-City men who survived past 50 and for whom the study had complete records. In contrast to the College sample, half of the 44 early (i.e., before age 50) deaths were due to some form of self-neglect. At age 65 to 70 there were 95 Happy-Well, 114 Intermediate, 48 Sad-Sick, and 75 Prematurely Dead by age 65. Although the proportions of Inner-City men in each outcome category were almost identical to those of the Harvard men, it should be noted that the Inner-City men were 10 years younger.

Clinical Examples

I hope the life stories of Alfred Paine and Richard Luckey, who introduced this chapter, will make my operational definitions of the Happy-Well and the Sad-Sick come alive, so that the concept of positive aging becomes more than mere platitude or value judgment. (Names and identifying details have been altered to protect anonymity.)

The ancestors of Alfred Paine had been successful New England clipper ship captains. All his grandparents had graduated from high school. One grandfather became a merchant banker and the other president of the New York Stock Exchange. His father had graduated from Harvard, and his mother from a fashionable boarding school. From childhood on, however, Paine was the unlucky owner of a handsome trust fund—unlucky because of how he obtained it.

When Alfred Paine was only 2 weeks old, his mother died from the complications of childbirth. When he was only 2 years old, his father died, too. So it was that the orphaned Paine became an heir. As an only child, Paine was bottle-fed by a variety of surrogates and raised by his grandmother and aunt. They were old and did not enjoy the challenge of dealing with an energetic young boy who was also a head-banger. In adolescence, Paine was a lone wolf.

In college, Alfred Paine was often in love. But it appeared to the study staff that, for Paine, being in love meant having someone to care for him. His multiple marriages were all unhappy—in part because of the alcoholism that he maintained that he did not have, and in part because he was frightened of intimacy. At 50, Paine answered “true” to the statement “Sexually most people are animals” and “I would have preferred an asexual marriage.” But he did not complain. Thus, of his second marriage he could write, “I have doubts about the real value of marriage…the state of my own marriage, which is excellent, has nothing to do with my philosophizing.” But his “excellent” marriage soon ended in divorce. Positive psychology must be assessed by what people do, not what they say. In old age, Paine's third wife was protective and loving toward him. In return, he was quite disrespectful and uncaring toward her. Before he died, I had asked how Paine and his wife collaborated, he replied, “We don't. We lead parallel lives.”

At 47, Alfred Paine recalled the ages from 1 to 13 as the unhappiest in his life. At age 70 Paine changed his story and believed that the ages from 20 to 30 were the unhappiest. But there had never been a time that Paine was happy. It was only that Paine, as I have suggested, was not a complainer. He had never sought psychotherapy, and none of his doctors ever called him mentally ill. Early on, however, his wife volunteered, “I wish he'd be analyzed not only for our sex life but for his ulcer and to give me someone to talk to.”

Subjectively, Paine described his own physical health as excellent; objectively, his health was anything but. In fact, by age 68 he was seriously overweight, was afflicted by hypertension and gout, and suffered from obstructive pulmonary disease—the result of lifelong smoking. On paper, he could sound assertive. For example, in 1947, he favored a preventive war with Russia—“Let's go all out and get it done”—and during the Vietnam War he was in favor of using hydrogen bombs. But his occupational life documented his real-life timidity. “Security was the brightest part of my job,” he confided. “I haven't the guts to go out on my own as a man of the world.”

When I interviewed Paine at 73, he appeared to me like an old man in a nursing home. Both his kidneys and his liver were failing, and he was cursed with a mild dementia, the result of a drunken automobile accident. He was at least 30 pounds overweight and looked 10 years older than his age. There was no question that he was physically disabled. He was the only College man in the study to have lost all his teeth.

Although he had made a good living in middle management over the years, Paine's handsome trust fund had evaporated, and his pension had eroded through multiple divorces and tax troubles. His house looked as if furnished from yard sales. The only exception was the elegant Cantonese porcelain umbrella stand that stood guard by the front door, in mute testimony to the fact that his New England ancestors had waxed rich in the China clipper trade. Little other than television now absorbed Paine. He rarely left his sofa. At no time in his life had he ever had hobbies or learned to play.

Alone of all the men who returned the age 75 questionnaire, Paine refused to answer the part that dealt with life enjoyment. Thus, his unacknowledged lack of joy in life could be inferred from his behavior. Over the past 20 years, there was no area of his life, other than his religious activities, in which he had expressed satisfaction. Admittedly, in questionnaires he said nice things about his children, but during the interview when I asked him what he had learned from them, he responded irritably, “Nothing. I hardly see my children. They hardly let me see my grandchildren.” Turning to questionnaires from his children, one daughter saw him only every 3 years; one daughter saw him once a year and viewed her father as having “lived an emotionally starved life,” and at age 35, Alfred Paine's only son believed that he had never been close to his father.

In terms of social supports, Paine, orphaned at age 2, had no siblings and he was close to no relative. Since the age of 50, he had engaged in no pastimes with friends. When I asked him at 73 to describe his oldest friend, he growled, “I don't have any.” He rarely talked to anybody on the telephone. His only confidante was, occasionally, his wife.

Only Paine's religious affiliation was strong. He was proud that he was a committed Episcopalian, and he went on religious retreats, which brought him real satisfaction. Sadly, although these retreats reflected the only social network he possessed, after age 72 he could no longer afford to go on them. Paine could not care for teeth, his money, or his soul.

At age 73, Paine could climb stairs only with difficulty. He had great difficulty walking even 100 yards; he was unable to drive at night, and he had had to give up golf because of his gout. On his last questionnaire, in a shaky hand, Paine, age 75, referred to his general health as “very good” and reported that he had no difficulty in physical activities. Both his wife and his doctor, however, saw him as seriously impaired. The very next year Paine was placed in a nursing home; a year later he died from his multiple illnesses. (For research purposes, Paine was classified with the Sad-Sick rather than with the Prematurely Dead because he survived past his 75th birthday.)

Having followed the easy path and described negative aging, let me describe positive aging. Richard Luckey tells a different story. At 70, when looked at through the eyes of their internists, Richard Luckey's objective physical health had seemed actually worse than Alfred Paine's. Luckey had high blood pressure, atrial fibrillation, a cardiac pacemaker, pancreatitis, and was “status post back surgery.” He was even more overweight than Paine. On the basis of all this, the study internist classified the 70-year-old Luckey as disabled. But being ill is very different from feeling sick. Truth is revealed through follow-up.

From age 70 to 80, Paine sickened unto death, while Luckey's health only got better. Luckey not only said his health was excellent, but by age 75 his objective health could no longer be classified by the study internist as disabling. Luckey had completely recovered from his pancreatitis. His “status post back surgery”—which loomed so ominously to the study internist when Luckey was 70—turned out to have been 30 years in the past. Indeed, at age 76 Luckey spent 2 months downhill skiing in Vail. True, he still wore a pacemaker, and, true, his blood pressure remained high. But in his doctor's words—not just his own—“Mr. Luckey continues to enjoy relatively good health…he continues to be active physically and also mentally. He is now writing a book on the Civil War.” As Luckey himself expressed it, “I have done less chain sawing, but I still split wood.”

Another crucial difference between Paine and Luckey was that Luckey had friends with whom he exercised regularly. In addition, he had never smoked, and he used alcohol in moderation. But, of course, as the song suggests, it is easier to “button up your overcoat” and “take good care of yourself” if you belong to someone, and Luckey had always enjoyed social supports. At the risk of oversimplification, Richard Luckey's mother had loved him as a child, and a half century later, “Almost everything we do,” he trumpeted, “is family oriented. We have practically no social calendar.” His wife amplified, “We rarely go out, but we will have groups for supper such as the church fellowship group or the basketball team for a weekend of skiing, or a vestry meeting at the house.” Without a social calendar, Luckey was also commodore of his distinguished West Coast yacht club. Actions speak louder than pencil and paper questionnaires—a fact that future research workers in positive psychology must learn to embrace.

In its efforts to define positive aging, the study asked each man to describe his relative satisfaction over the past 20 years with eight different facets of living. Remember, Alfred Paine had chosen to leave that part of his biennial questionnaire blank. In contrast, Richard Luckey described not only his hobbies, his religion, and his income-producing work as highly satisfying, but, more important, he experienced his relationships with his wife and with his children as highly satisfying. His wife and children's questionnaires revealed a similar satisfaction with him. Luckey's daughter had described her parents' marriage as “better than my friends”; then, for good measure she had added two pluses. Luckey's wife gave her marriage a 9 out of 9, and, clearly, the marriage had worked even better for her husband. Luckey was close to his brother, with whom he skied regularly in the winter and fished regularly in the summer. He stayed in very close touch with, and took great pleasure from, his children and his grandchildren. His recreational activities included active involvement not only with his brother and children but also with the other sailors of his yacht squadron. Subjectively, Luckey perceived himself with relatively few close friends and would have liked more. Objectively, his friendship network was very rich.

It was so easy for Luckey to take in, to metabolize, any love that he was offered. When he was 60, he wrote in the study about his father, who had died 20 years before, “I have never completely gotten over Dad's death. I will always remember him as the finest man I ever knew.”

Wondering how the Luckeys still played together while the Paines led “parallel lives,” I asked how his marriage had lasted for 40 years. With Churchillian simplicity, Luckey replied, “I really love Chrissie and she loves me. I really respect her, highly esteem her, and she is a real person.” On her recent questionnaire Chrissie wrote the study, “My husband is my best friend; I like looking after him. We have grown closer and fonder every year.” There were 50 years of stable marriage to back up their words. In 1970, Luckey and his wife had sailed by themselves from San Francisco to Bali. The trip led to many months of close cooperation and shared physical labor. On the journey Luckey illustrated his sailing journal with his own watercolors.

All during his 15 years, Luckey had loved writing and painting for fun. At 77, he had put on a solo exhibition of his marine watercolors. “With painting,” he added dreamily, “you forget everything, and that is why it is so very relaxing.” In church, Luckey sang both solo and in the choir. “I don't have a day when I don't have something to do that I want to do…creativity is absolutely necessary for someone to be healthy.” Ten years before, with no more intelligence than Paine, Luckey, at age 67, told the study that he had “just finished a screen play and sent it to a literary agent.” No, it was never performed, and to my knowledge his book on the Civil War is still unpublished. But as Luckey had written to the study at 70, “I am living in the present—enjoying life and good health while it lasts. I think very little about the past or future, and I don't take myself very seriously.”

Ten more years of follow-up revealed that Luckey died at 83 of heart disease. As of this writing, 60% of the 40 Happy-Well at 80 are still alive and 12 have reached 93 years of age; 13% of the Sad- Sick are still alive and none have made it to 93.

The Predictors of Healthy Aging

To many it seems as if heart attacks and cancer are visitations from malicious fate and that much of the pain of old age seems in the hands of a cruel god—or at least of cruel genes. The whole process of growing old sometimes feels completely out of our control. In addition, there is much data, well represented by the Whitehall II study (Marmot et al., 1991), that emphasizes the importance of social class to successful aging. But blessed with prospectively gathered data, I was astonished that fate was relatively unimportant. Much of a septuagenarian's positive aging or lack of it is determined by factors already established prior to age 50. What seemed even more astonishing was that these factors are more or less controllable.

Ten years ago, a leading gerontologist, Paul Baltes, acknowledged that research had not yet reached a stage where there was good causal evidence for predicting healthy aging (Baltes & Baltes, 1990, p. 18). True, there have been several distinguished 10- to 20-year prospective studies of physical aging (Baltes & Mayer, 1999; Busse & Maddox, 1988; Rowe & Kahn, 1999; Shock, 1984; Thomae, 1987). All have contributed valuable understanding about the course of old age. But none of these studies have followed their subjects for more than 25 years, and few knew what their members were like before 50. In contrast, the Study of Adult Development has illuminated predictors that at 50 could foretell whether a man would be enjoying his 70th or 80th year—or 90th year (Vaillant, 2012). I shall identify these predictors one by one. But first let me note variables that, surprisingly, did not predict successful aging.

Six Variables That Did Not Predict Positive Aging

Seven Factors That Did Predict Positive Aging

Table 35.3 illustrates the factors that did predict positive aging. Five factors assessed prior to age 50 did predict healthy aging for both cohorts. A sixth protective factor, education, was important to aging well for the Inner City men but was not really applicable to the College cohort whose education was too homogeneous to be a differential predictor. A seventh independent predictor, exercise, was available for the College men but not for the Inner City men. The univariate importance of these predictors is illustrated in Table 35.3, and each variable was important to positive aging when the others were controlled (Vaillant, 2002).

For all dependent and independent variables a low score is healthy. All values and variables (if different) for the two samples are presented as College/Inner-City.

n = 237 (College sample); n = 332 (Inner-City sample); n.s. = not significant, unbold correlations p < .05, bold correlations p < .001

Spearman rho (two-tailed) used throughout

Conclusion

The protective factors in Table 35.3—a stable marriage, the ability to make lemonade from lemons, avoiding cigarettes, modest use of alcohol, regular exercise, persevering with education, and maintaining normal weight—allow us to predict positive health 30 years in the future.

Sixty-six College men—still in good health at age 50—possessed less than four protective factors. At age 80, not one—not a single one—of these men was among the Happy-Well; and 21, or almost a third, were among the Sad-Sick and 3 times as many as expected were dead. All seven men who, like Alfred Paine, had less than two protective factors at age 50 were dead by age 80. In contrast, 44 College men had all six factors present; 25 were among the Happy-Well, and only one was among the Sad-Sick.

Although the average Inner-City man at age 50 tended to have fewer protective factors than the Harvard men, the power of these protective factors was the same. For example, there were 52 Inner-City men who at age 50 enjoyed both good health and five or more protective factors. Twenty years later, only 2% of such men were among the Sad-Sick or Prematurely Dead, and 33 were among the Happy-Well. There were 37 Inner-City men who were not disabled at age 50 but who possessed less than two protective factors. At 70, 25 were among the Sad-Sick or Prematurely Dead and only three were among the Happy-Well. In other words, positive aging to an extraordinary degree is controllable and thus teachable by positive psychology.

Of course, there are exceptions. Some people are struck by lightning; others are crippled by someone else's stupidity or die from malignant genes. But the vast majority—at least in these two White male cohorts—of septuagenarians are products of their own, often involuntary, behavior.

The good news, however, is that most of us—if we start young and try hard—can voluntarily control our weight, our exercise, and our abuse of cigarettes, at least by the time we are 50. And with hard work and with the help of able intervention, we can improve our relationships with our most significant other, achieve abstinence from alcohol, and use fewer maladaptive defenses. Indeed, the fellowship of Alcoholics Anonymous offers a valuable object lesson to positive psychology. I do not wish to blame the victim, but I do wish to accentuate the positive. Whether we live to a vigorous old age lies not so much in our stars or in our genes as in ourselves.

Summary Points

• The mission of positive aging is to add more life to years, not just more years to life.
• The Study of Adult Development is unique because it has followed a sample of men over a 70-year period in order to determine the predictors of positive aging.
• Results show that much of a septuagenarian's positive aging or lack of it is determined by controllable factors established before the age of 50.
• Six factors that do not predict positive aging are ancestral longevity, cholesterol, parental social class, warm childhood environment, stable childhood temperament, and stress.
• Seven factors that do predict positive aging are not being a smoker (or stopping smoking young), adaptive coping style, absence of alcohol abuse, healthy weight, stable marriage, exercise, and more years of education.

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