Chapter 4
You Are as Young as You Feel — Part 2
These findings tell us a few important facts, such as that ageing starts early and that it affects most body systems at once. Why did some 38-year-olds act, look and feel older? The almost 12-year biological age difference was due, in the main, to adverse experiences in youth. However, it is not all doom and gloom. The factors which speed up the epigenetic clock are all modifiable – they are within our control and by doing something about the circumstances that trigger epigenetic ageing, we can influence it at all stages in life. It is never too late to change, though the earlier change occurs, the better. Moreover, not all 38-year-olds who said they were subject to low mood or stress experienced accelerated ageing. Many were resilient to the psychological factors affecting biological change. Noteworthy is that, in the main, these resilient participants had positive perceptions, positive attitudes and optimism despite adverse circumstances. Perceptions of ageing, feelings of control and emotional responses to getting older are all important factors. This brings us full circle back to my 85-year-old patient and to Eileen Ash, both of whom had positive perceptions, positive attitudes, self-esteem and optimism. It has been argued that perception affects how we age because people who ‘feel their age’ have diseases or disorders that accelerate ageing and colour their perceptions. But a number of studies from our group and others have now confirmed that we are ‘as young as we feel’, independent of disease status. In other words, perceptions can override other factors which might otherwise limit physical ageing. Simply feeling younger than one’s chronological age slows the pace of ageing, irrespective of diseases or disorders. This is because a positive attitude towards ageing changes cell chemicals in a beneficial manner, possibly by reducing inflammation within the cell and thereby changing the methylation status and epigenetics of the cell. One of our studies showed that people who feel close to or at their chronological age are more likely to develop physical frailty and poor brain health in subsequent years than people who claim to feel younger than their chronological age. This was still the case when we adjusted the analyses to take into consideration any illness or disease at the beginning of the study. When perceptions are negative, they result in declines in self-confidence, self-esteem and satisfaction with life, as well as declines in physical and brain health. Negative perceptions make it more likely that someone will experience diseases such as heart disease, suffer heart attacks in later life and die early. This brings me to the important influence that language, media and attitudes of friends, family and society have on how we perceive ourselves and how challenging it can be to remain resilient in the face of negative stereotypes. If someone or something continually tells you that you are old, it is hard not to feel old. Researchers from Yale University showed how quickly ageing perceptions can change an individual’s physiology and how the changes become embedded and chronic with exposure to repeated negative stereotypes. In their experiments, adults were exposed to a series of words to describe ageing. For positive stereotypes, these were terms such as ‘accomplished’, ‘advise’, ‘alert’, ‘astute’, ‘creative’, ‘enlightened’, ‘guidance’, ‘improving’, ‘insightful’, ‘learned’ and ‘sage’. The negative stereotypes included ‘Alzheimer’s’, ‘confused’, ‘decline’, ‘decrepit’, ‘dementia’, ‘dependent’, ‘diseases’, ‘dying’, ‘forgets’, ‘incompetent’, ‘misplaces’ and ‘senile’. Participants underwent both mathematical and vocabulary tests that put them under stress after exposure to the stereotypes, while a number of physiological tests were performed to ascertain the biological impact of the mathematical and vocabulary stress tests.
Chapter 1: You Are as Young as You Feel
Those exposed to the negative stereotypes demonstrated unwanted excessive physiological responses, with higher blood pressure, higher heart rate and reduced skin blood flow, thereby showing that negative ageing stereotypes rendered the participant less able to mitigate the stress responses. The influence of positive ageing stereotypes, on the other hand, led to more modest physiological responses to stress. In other words, positive stereotypes helped participants deal with stress.
In another research study by our group, adults aged 50 and older were asked to say how much they agreed with 17 statements, such as, ‘I have no control over how getting older affects my social life’; ‘As I get older, I can take part in fewer activities’ or ‘As I get older, I get wiser’; ‘As I get older, there is much I can do to maintain my independence’. The more these older adults agreed with the negative statements like the first two, and the less they agreed with the positive statements like the last two, the worse their attitudes towards ageing and the more likely they were to experience accelerated physical and cognitive ageing over the following eight years. For example, negative attitudes towards ageing were associated with a decline in walking speed, worse memory and poor performance on a number of other brain tests. This was true even after we accounted for overall health, medications, mood, life circumstances and many other confounders. In other words, perceptions had an independent influence on the physical and mental health pace of ageing.
Chapter 1: You Are as Young as You Feel
Furthermore, the science showed that negative attitudes affected how different health conditions interact. Frail participants with negative attitudes had worse mental abilities compared to participants who were not frail. However, frail participants with positive attitudes had the same level of mental ability as their non-frail peers. So, once more, positive attitudes and positive perceptions were protective, emphasising that we really are as young as we feel. Even if we have health problems, attitude still dominates. When I shared these data with a retired eminent cardiology colleague he responded that he was convinced of the powerful effect of ‘mind over heart’ and how much stress and perceptions could even influence heart attacks. He shared the following story: ‘In 1980, a patient came to see me privately one afternoon and I quickly learned that he had severe angina. I performed an exercise test that confirmed limited blood supply to the heart muscle. I told him that I thought he should undergo coronary angiography to define the anatomy of the blood vessels to the heart. He was very upset as he did not want any invasive procedure and I had to spend some considerable time to convince him that this was necessary. Finally, he agreed and I got him a bed on the private floor of a London teaching hospital where there was no heart monitoring at the time. I was called at 7am the next morning to be told that the nurses had found him dead in bed. Of course, this could have been the natural progression of his disease but his negativity impressed me and made me feel that this contributed to his sudden death.’ On a somewhat lighter note, it is underestimated how much sexual activity is linked to ageing perceptions. Sexual activity is an important part of life for the majority of couples and strongly linked to quality of life – the sexually active have better quality of life, even in old age. In our research, sexually active older adults have more positive perceptions, are less likely to consider themselves old and less likely to believe that ageing has negative consequences. All of these attitudinal factors contribute to superior quality of life and younger biological age for sexually active couples. As evidenced by my colleague’s patient, older adults with negative attitudes about ageing live 7.5 years less than those with positive attitudes, mostly because of higher rates of heart diseases. Our research confirms the link between ageing perception and death. Because we had collected details of many aspects of life and health as part of our study, we were in a position to show that perceptions independently affect early death. So, our own perceptions of ageing and the influence of society on those perceptions are very important to healthy longer lifespan – how we perceive ourselves as ageing is quite literally a matter of life or death.
Chapter 1: You Are as Young as You Feel
As Young as You Feel is a 1951 comedy film starring Marilyn Monroe. When printer John R. Hodges (Monty Woolley) is forced to retire at age 65, due to company policy, he decides to do something about it. Dyeing his hair black, he poses as Harold P. Cleveland, the president of his former employer’s parent company, and goes on an inspection tour of his old workplace with the firm’s nervous, mystified executives in tow. Afterwards, Hodges complains about the lack of experienced, older employees, causing company president Louis McKinley (Albert Dekker) to change the policy. Hodges delivers a rousing speech about the virtues of the older worker. He receives a standing ovation, the newspapers praise him and even the stock market rises on the optimism generated. When the deception is discovered, Hodges has been so successful in turning the company around that Cleveland offers him a job advising him on public relations but Hodges turns him down. In changing the company’s ageist attitude and policy he has achieved what he set out to do and is content with the outcome.
Policy initiatives such as mandatory retirement allow employers to force employees to retire at a certain age, usually 65. Mandatory retirement was widespread in the US in the 1960s and 1970s, and still is common in many European countries. Yet, by an extension of the Age Discrimination in Employment Act in 1978, US Congress outlawed mandatory retirement before the age of 70 and in 1986 abolished it altogether. Retirement was redefined. It was no longer an automatic shift in gears from work to non-work at a set age but rather a voluntary withdrawal from the work force at the age that best suits an individual’s abilities, interests and career plans. If only this approach was more widespread.