Leadership for a Longevity Population

Peter Martin pxmartin@iastate.edu

Human Development and Family Studies Iowa State University

Overview

• Introduction • Focus on the Longevity Population • Demographic Changes

• Longevity Hot Spots • Lessons Learned

• Health Behaviors and Longevity • Physical and Functional Health • Emotional Health • Cognitive Health • Environmental Support • Personality and Resilience

• Longevity Education and Prescription

Defining the Longevity Population •Increased life expectancy (living longer) •Living longer + living well •Living longer without disability •Compression of morbidity

The Longevity Dividend

•The economic and health benefits that would accrue to individuals and societies if we extend healthy life.

Jay Olshansky

Demographic Changes and Longevity

Demographic Changes

•Age group of the 90+ fastest growing segment of our population

He & Muenchrath (2011)

Population Change, 90+ Population

There will be a rapid increase in the population that is 90 years and older. In 2050, we expect more

than 68 million people 90 years and older worldwide.

Source: United Nations – Profiles of Aging 2013

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198019801980

201320132013

203020302030

205020502050

100+

95-99

90-94

Year

World Population – 90 Years and Older, (in thousands)

53

475

1802

441

2889

13140

1241

6285

22289

3392

15513

49475

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100+95-9990-94

1980534751,802

2013441288913,140

20301241628522289

205033921551349475

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Life Expectancy By Country Rank Country LE Men Rank Women Rank

1 Japan 84.6 82.0 1 87.3 2

2 Andorra 84.2 80.8 8 87.6 1

3 Singapore 84.0 82.0 2 85.6 5

4 Hong Kong 83.8 82.0 2 85.6 5

5 San Marino 83.5 82.0 2 85.0 11

6 Iceland 83.3 81.4 6 85.2 9

7 Italy 83.1 80.4 10 85.8 4

8 Sweden 83.0 81.4 6 84.6 13

9 Australia 83.0 80.5 9 85.5 6

10 Switzerland 82.8 80.4 10 85.4 7

…

42 U.S.A. 79.8 77.4 32 82.2 35

Source: World Health Organization

Longevity Hotspots (“Blue Zones”)

Longevity Hot Spots – “Longevity is a Way of Life”

The Oldest Person Ever: 122 Years and 164 days (1875-1997)

Madame Calment claimed that an occasional glass of Port wine along with a diet rich in olive oil-- were the keys to her longevity.

Here are sample photos of the World's Oldest Documented Person, Madame Jeanne Calment of France, when she was 40 years old (in 1915) and then when she was 120 years old (in 1995).

Currently Oldest Person

"I didn't want to be dominated by anyone.“ Emma Morano-Martinuzzi

Name Country Age Gender

1 Emma Morano-Martinuzzi

Italy 117 F

2 Violet Brown Jamaica 116 F

3

Nabi Tajima Japan 116 F

Life Expectancy Differences

Centenarians per 10,000 state population

Centenarian Studies

Georgia Phase 1: 137 centenarians Phase 2: 55 centenarians Phase 3: 287 centenarians Iowa Rural Aging: 104 centenarians and nonagenarians Exceptional Longevity: 178 centenarians Heidelberg 91 centenarians Japan • 22 centenarians Total Number: 874 nonagenarians and centenarians

The Secret of Longevity

The “Fountain of Youth,” painted by Lucas Cranach the Elder in 1546, illustrates our long fascination with immortality.

The “Fountain of Youth” in Japan: Onsen

Exceptional Longevity

Genetics and Family

Longevity

Personality

Environmental support

Physical and Mental Health

Health Behaviors

Activity

Core Dimensions of Exceptional Longevity

Activity and Health Behaviors Lesson 1

Poor Health Behaviors

Smoking, poor diet and physical inactivity were the causes of 35% of U.S. deaths in 2000.

The Good News: Smoking Rates Have Declined

U.S.A.

Nutrition: Typical Meals in Three Countries

Nutrition: Typical Meals in Three Countries American Meal

Japanese Meal

German Meal

Community Connectedness in Japan

Community Connectedness in Sardinia

The Okinawa and Mediterranean Diet

• Eating a plant-based diet (green and yellow vegetables)

• Limiting sugar and grains • Eating more soy and other legumes • Using herbs and spices instead of salt to flavor

foods • Enjoying meals with family and friends. • Caloric restriction: Only eat until you are 80% full:

“Hara hachi bume.”

Inactivity

Activity - Exercise

Stairs

Bicycles

Gardening

More Stairs

More Stairs

Activity – Arts and Crafts

Centenarian playing the sanshin

Eisā – originally performed by young people to honor the spirits of their ancestors.

Centenarian poetry book

Benefits of Physical Activity

• Physical health benefits • Increases “good” cholesterol • Prevents diabetes, high blood pressure, and colon cancer, maintains

healthy bones and muscles, joint mobility

• Mental health benefits • Reduce distress, anxiety and depression, increases social support,

cognitive functioning

• Financial benefits • In the United States, increasing physical activity could reduce direct

medical costs by $77 billion annually. • In the United States, inactive women 45 years and older had at least

double the health care costs of their active counterparts

31

Lesson for Leaders

• Healthy living needs to be encouraged • Individual responsibility

• Communities need to support healthy living • Healthy communities, age friendly communities, bike-friendly

communities

• Focus on three primary health behaviors • Smoking • Eating • Exercise

• Educational programs should focus on life-span behaviors • Teach early, teach late…

Physical and Functional Health Lesson 2

Physical Health “Healthy centenarians do not exist…”

(Andersen-Ranberg et al.,2001) Most common causes of death: Cardiovascular disease Cancer Breast cancer (10.8% GCS – 3.0% TCS) Lung cancer(1.2% GCS – 0.0% TCS) Respiratory diseases (3.3 GCS – 7.7 TCS) Diabetes (8.6% GCS – 4.3% TCS)

The prevalence of major diseases (except for cardio-vascular disease) among centenarians is very low.

Subjective Health Questions

How would you rate your overall health at the present time? ◦ 21% Excellent ◦ 49% Good ◦ 21% Fair ◦ 9% Poor

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Excellent

Good

Fair

Poor

Rating of Overall Health

21

49

21

9

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Rating of Overall Health

Excellent21

Good49

Fair21

Poor9

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Activity and Functional Capacity

Martin, P., Poon, L. W., Kim, E., & Johnson, M. A. (1996). Social and psychological resources of the oldest old. Experimental Aging Research, 22, 121-139.

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PhonePhonePhone

WalkWalkWalk

ShopShopShop

CookCookCook

HouseworkHouseworkHousework

MoneyMoneyMoney

60-69

80-89

100+

Percent

98.9

96.8

74.4

94.5

83.9

11.5

95.6

88.2

20.8

100

91.4

41.3

94.5

81.7

24

97.8

90.3

42.3

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PhoneWalkShopCookHouseworkMoney

60-6998.994.595.610094.597.8

80-8996.883.988.291.481.790.3

100+74.411.520.841.32442.3

Changes in Activities of Daily Living

Randall, K., Martin, P., Bishop, A., Poon, L. W., & Johnson, M. A. (2011). Age differences and changes in resources essential to aging well: A comparison of sexagenarians, octogenarians, and centenarians. Current Gerontology and Geriatrics Research, 2011, 1-12. doi: 10.1155/2011/357896

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BaselineBaselineBaseline

20 months20 months20 months

40 months40 months40 months

60 months60 months60 months

60s

80s

100+

Follow-Up Testing

ADL

12.88

12.38

7.73

12.77

12.02

5.87

12.66

11.66

12.54

11.3

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60s80s100+

Baseline12.8812.387.73

20 months12.7712.025.87

40 months12.6611.66

60 months12.5411.3

Care and Health Behaviors

Skin Protection on a Sunny Day

Universal Health Care

Mouth Protection

Lessons for Leaders

• Maintain Physical and Functional Health (cardiovascular disease, cancer, diabetes, ADL)

• Individual responsibility • Communities need to support physical and functional health

• Healthy communities, age friendly communities, bike-friendly communities, health care

• Focus on three primary areas • Activities of daily living • Maximize health insurance coverage • Maintain high strength levels

• Educational programs should focus on life-span behaviors

Emotional Health Lesson 3

Age Group Sexagenarians Octogenarians Centenarians

Variable n M (SD) n M (SD) n M (SD) F

Dysphoria 88 0.85 (1.64) 86 0.73 (1.43) 131 0.98 (1.37) 0.78

Fatigue (WAV) 84 1.57a (1.70) 84 2.30b (1.17) 128 3.34c (1.47) 32.21***

Anxiety 88 0.49 (0.86) 90 0.52 (1.00) 134 0.51 (0.92) 0.03

Mental Impairment

87 1.00a (1.10) 89 1.46b (1.23) 128 1.34a,b (1.15) 3.81*

Hopelessness 87 0.39a (0.87) 88 0.55a (0.90) 139 1.04b (1.14) 12.58***

Summary Score

80 11.10a (2.91) 79 11.52a (2.59) 117 13.40b (3.58)

15.43***

Note. WAV – Withdrawal-Apathy-Vigor. Means with different superscripts are significantly different from each other. *p < .05. **p < .01. ***p < .001. Temple-Scheetz, L., Martin, P., & Poon, L. W. (2012). Do centenarians show higher levels of depression? Findings from the Georgia Centenarian Study. Journal of the American Geriatric Society.

Depression or Fatigue?

Emotional Health

Poon, L. W., Martin, P., & Margrett, J. (2010). Cognition and emotion in centenarians. In C. A. Depp, & D. V. Jeste (Eds.) Successful Cognitive and Emotional Aging (pp. 115-133). Arlington, VA: American Psychiatric Publishing, Inc.

Emotional Health

Poon, L. W., Martin, P., & Margrett, J. (2010). Cognition and emotion in centenarians. In C. A. Depp, & D. V. Jeste (Eds.) Successful Cognitive and Emotional Aging (pp. 115-133). Arlington, VA: American Psychiatric Publishing, Inc.

Lessons for Leaders

• Seek positive experiences • Individual responsibility

• Communities need to support emotional health • Provide meaningful activities for older adults, oldest-old

• Focus on three primary areas • Fatigue • Positive experiences • Usefulness

• Educational programs should focus on oldest-old

Cognitive Health Lesson 4

Cognitive Health, Iowa Centenarian Study

0

5

10

15

20

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Perc

ent

SPMSQ Scores

Frequencies of SPMSQ scores at baseline (N = 152)

Margrett, J. A., Hsieh, W-H., Heinz, M., & Martin, P. (2012). Cognitive status and change among Iowa Centenarians. International Journal of Aging and Human Development, 75, 317 - 335. doi: 10.2190/AG.75.4.b

Cognitive Health, Iowa Centenarian Study

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Baseline Time 1 Time 2 Time 3 Time 4

SPM

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ore

Occasion

Individual change in SPMSQ scores across baseline and 4 follow-up assessments occurring during an 8-month period (n = 28)

Margrett, J. A., Hsieh, W-H., Heinz, M., & Martin, P. (2012). Cognitive status and change among Iowa Centenarians. International Journal of Aging and Human Development, 75, 317 - 335. doi: 10.2190/AG.75.4.b

Lessons for Leaders

• Maintain cognitive health (challenging activities) • Individual responsibility

• Communities need to support cognitive health • Involve oldest old adults in community activities

• Focus on three primary areas • Activity • Memory training • Challenges

• Educational programs should focus cognitive training

Environmental Support Question 5

Social Support: “There are people I can depend on to help me, if I really need it”

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Strongly Disagree

Disagree

Agree

Strongly Agree

Series 1

0

5.3

25.4

69.3

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Series 1

Strongly Disagree0

Disagree5.3

Agree25.4

Strongly Agree69.3

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Community Connectedness

Family support is important – More social support is related to better health, memory functioning, and longer life

Spending Time Together

Helping Each Other

Sharing Emotions and Feelings

Town Square Festivals

Social Support

Picnic during cherry-blossom season

Meeting at the Market

Lessons for Leaders

• Maintain social engagement • Individual responsibility

• Communities need to provide social engagement opportunities for old and very old adults

• Focus on three primary areas • Association (time spent) • Affect (quality time) • Assistance (help)

• Educational programs should be social engagement opportunities

Personality and Resilience Question 6

Robust, Resilient Personality

Adapted centenarians are • not likely to worry • extraverted • open to new experiences • quite agreeable • conscientious individuals

Big-5

Personality

-8

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Self ReportsProxy Reports

Martin, P., da Rosa, G., Siegler, I., Davey, A., MacDonald, M., Poon, L. W., et al. (2006). Personality and longevity: Findings from the Georgia Centenarian Study. Age, 28, 343-352.

Lessons for Leaders

• Maintain resilience • Individual responsibility

• Communities need to support resilience • Focus on three primary areas

• Relax • Be conscientious • Accept

• Educational programs can teach resilience

Implications for

Gerontology Education

•Degree Programs at Iowa State University • Undergraduate Minor • Graduate Minor • Gerontology Certificate Program (online) • Master’s Degree in Gerontology (online) • Master’s Degree in Gerontology (on campus) • Doctoral Degree in Gerontology (on campus)

Curriculum

Core Courses

•Geron 530: Perspectives in Gerontology •Geron 534: Adult Development •Geron 540: Nutrition and Physical Activity in Aging •Geron 545: Economics, Public Policy and Aging •Geron 563: Environments and Aging •Geron 577: Aging in the Family •Geron 584: Program Evaluation and Research Methods •Geron 594: Professional Seminar in Gerontology

•12 credits of electives: Elective courses are offered in areas such as biological aspects of aging, gender and aging, spirituality, creativity, cognitive aging, sexuality, mental health and aging, long-term care, gerontechnology, and contemporary concepts in design.

Summary

• Longevity is the Social Revolution of the 21st Century • Core Dimensions of Healthy Longevity

• Health behaviors • Physical and functional health • Mental health and emotions • Cognitive health • Social engagement • Resilience

• Individual Responsibility • Community Responsibility • Educational Responsibility

Age (Cecilia Payne Grove at 100)

Age is a quality of mind If you have left your dreams behind, If hope is lost If you no longer look ahead If ambitions fires are dead – Then you are old

���Leadership for a �Longevity Population�OverviewDefining the Longevity PopulationThe Longevity DividendDemographic Changes �and LongevityDemographic ChangesPopulation Change, 90+ PopulationLife Expectancy By CountryLongevity Hotspots �(“Blue Zones”)Longevity Hot Spots – �“Longevity is a Way of Life”The Oldest Person Ever: �122 Years and 164 days (1875-1997)Slide Number 12Life Expectancy DifferencesCentenarians per 10,000 state populationSlide Number 15The Secret of LongevitySlide Number 17Core Dimensions of Exceptional LongevityActivity and Health Behaviors�Poor Health BehaviorsThe Good News: Smoking Rates Have DeclinedSlide Number 22Nutrition: Typical Meals in Three CountriesNutrition: Typical Meals in Three CountriesSlide Number 25Community Connectedness in SardiniaThe Okinawa and Mediterranean DietInactivityActivity - ExerciseActivity – Arts and CraftsBenefits of Physical ActivityLesson for LeadersPhysical and Functional HealthPhysical HealthSlide Number 35Slide Number 36Changes in Activities of Daily LivingCare and Health BehaviorsLessons for LeadersEmotional Health�Depression or Fatigue?Slide Number 42Slide Number 43Lessons for LeadersCognitive Health�Cognitive Health, �Iowa Centenarian StudyCognitive Health, �Iowa Centenarian StudyLessons for LeadersEnvironmental SupportSlide Number 50Community ConnectednessTown Square FestivalsSocial SupportLessons for LeadersPersonality and ResilienceRobust, Resilient PersonalitySlide Number 57Lessons for Leaders�Implications for �Gerontology EducationCurriculumSummaryAge (Cecilia Payne Grove at 100)