Aging Options

Wall Street Journal: Voters Are Asking, “What’s Normal Aging?”

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Has there ever been a time in American political life where the issues related to aging have been more prominently on display? In recent weeks, as the American public has tried to process the fallout from the June 27th debate between Joe Biden and Donald Trump, many voters have been struggling to separate fact from political spin. At the core of the controversy lies one simple but challenging question: “What constitutes normal aging?”

This question obviously goes far beyond the climate of Presidential politics in an election year. Indeed, all of us will watch loved ones (or ourselves) grow older, and we’ll ask, “Is this normal, or does the behavior I’m seeing in my mom, my dad, my spouse, or myself reveal that something else is going on?”

With that as subtext, we turn our attention toward this timely article from the Wall Street Journal in which reporter Alex Janin explores issues related to growing old. Janin starts with the Biden-Trump debate but then takes a deeper look at how we might respond when so-called signs of aging start to become troubling. Let’s see where Janin’s article takes us. (Please note that a subscription may be required to access the Wall Street Journal article.)

Presidential Race Puts Aging Front and Center

“What does normal aging look like?” Janin asks. “That question has been at the center of a fervid national conversation since last month’s presidential debate, when 81-year-old Joe Biden’s struggles against Donald Trump, 78, set off widespread speculation about the president’s seeming decline—not to mention his political future.”

As Janin reports, regardless of whether Biden or Trump is elected in November, either would be the oldest U.S. president ever sworn in. Both men, according to Janin, “have slipped up facts or botched remarks in public, fueling attacks about their fitness from both sides.” This has heightened awareness of, and speculation about, the role of aging in the 2024 election.

With U.S. Getting Older, Interest in Aging is High

In his article, Janin echoes what we said above: for many families, this is familiar territory.

“Watching an older adult display signs of aging is all too familiar within many families,” says the article, “as are questions about what a slowed gait or confused speech signals, and whether an aging person can still, say, drive a car or live independently. Sometimes, aging is a steady decline; other times, it can appear to happen more rapidly.”

In the case of the two leading Presidential candidates, both maintain they are in robust health. But they do reflect shifting U.S. demographics. As older adults make up a growing share of the U.S. population, there is heightened interest in recognizing signs of healthy or abnormal age-related decline. The number of adults age 65 and older increased by 9.4 percent between 2020 and 2023, to nearly 60 million. 

Is Cognitive Decline an Inevitable Part of Aging?

“Aging carries an increased risk of developing conditions that can interfere with physical and mental health,” Janin writes. “Most older people have at least one chronic health condition and many have multiple. Signs of aging can appear differently for everyone, gerontologists and geriatricians say, so it can be hard to determine what is normal.”

For his article. Janin spoke with Dr. Mary Tinetti, Yale University professor and geriatrician. “People vary,” she told Janin. “Some people decline a little bit more in these areas, a little quicker. Some people maintain it and never decline.” This variation makes it harder for us laypeople to evaluate someone’s cognitive health based solely on observation.

“Normal” Decline versus Mild Cognitive Impairment

Another aging expert, Dr. John Rowe of Columbia University, explained to Janin that a distinction exists “between the usual mental decline that accompanies aging, and mild cognitive impairment, which can progress to dementia.”  The Alzheimer’s Association estimates that mild cognitive impairment affects roughly 12 percent to 18 percent of adults 60 and older.

Janin explains the difference. He writes, “Short-term memory deficits, such as misplacing keys or forgetting people’s names more often is generally nothing to worry about, aging specialists say. Memory lapses that affect daily life, like forgetting to pay the bills, missing appointments or getting lost in familiar places could signal something more serious.”

Columbia’s Dr. Rowe noted that a sudden onset of cognitive decline might be triggered by illness, injury, or reaction to medication. By contrast, changes in cognitive function tend to happen over months or years. Friends and family may see the gradual onset of symptoms such as disorientation, lack of social engagement, and apathy, which may be early signs of dementia.

Cognitive Testing is the Only Reliable Gauge

“Doctors use assessments of recent and long-term memory, recall, visual and spatial deficits and executive functioning to diagnose cognitive impairment,” says Janin. “Regular testing allows doctors to track trends over time, which is more powerful than looking at any one data point, geriatricians say.”

One Alzheimer’s expert told Janin that simple observation has its limits. “It’s very tempting to judge people in terms of their physical frailty or cognitive capabilities based on glimpses,” he says. “But an evaluation takes more than that.” Only comprehensive testing can reveal what’s really happening in the brain.

Some Decline in Physical Strength is a Normal Part of Aging

In his article, Janin notes that we all slow down over time. “People tend to lose strength, endurance, flexibility and organ function as they age,” he writes. “Balance and gait are often affected by these changes, which can increase the risk of dangerous falls.”  The likelihood of more significant health problems is significantly raised by smoking, obesity and diabetes.

But some behaviors do warrant further investigation, “Regular stumbles, trouble getting out of chairs, or stiff movement with limited arm swinging while walking could signal an underlying condition, such as arthritis or neurological conditions like Parkinson’s,” Janin adds. 

A small percentage (between 5 and 17 percent) of aging adults, says the Wall Street Journal article, can be further categorized as clinically frail.  “Frailty,” Janin explains, “[is] an age-related syndrome characterized by symptoms such as weakness, poor balance and unintentional weight loss. Those with frailty, which can be diagnosed with the help of specific assessment tools, are at higher risk of falls, disability and death.”

Aging Adults Have Good Days and Bad Days

Regardless of our age, we all have days when we don’t feel our best or sharpest. However, adds Janin, geriatricians say that the degree of variability between “good” and “bad” days is likely to be more pronounced as we grow older.

“The body and brain’s resilience, or reserve, declines as people age, so a poor night of sleep, mild illness or medication change can hit harder,” Janin writes. “A college-aged student might not be thrown off much by an all-nighter of studying, for example.” Not so with seniors. 

As Dr. Richard Stefanacci, geriatrician and professor at Jefferson College in Philadelphia, told Janin, “If you’re an older adult with a little bit less reserve and you’ve had a tough night, you’re on a medication that you’re not familiar with, or you’ve got a viral infection, you could have cognitive and physical issues as a result.”

Rajiv’s Take: Guard Your Health, Live with Purpose

We asked Rajiv Nagaich to comment on this report. As we expected, he has strong opinions and clear insight into the issue of age-related cognitive decline.

“I’ve been watching the news stories recently, just like you,” Rajiv notes. “I’m not going to comment on the political issues, but it has frustrated me to see so much conjecture and misinformation out there in the media about age-related aging. The real question you and I need to answer isn’t about what Joe Biden or Donald Trump should be doing – it’s about what we should be doing. How do we stay as sharp and mentally active as we can, for as long as possible?”

Rajiv says his first recommendation is to take care of our cognitive health as well as we can, and that means intentional lifestyle choices. “Look,” he says, “there’s a long list of things we can do to care for our brains and increase the odds of staying mentally sharp. Diet, exercise, sociability, mental stimulation, even getting hearing aids – all these have been proven to help keep the brain healthier.” (We covered this topic in this article we ran on the Blog just last week.)

“The second important thing you and I can do is to make the decision to live our lives with purpose,” Rajiv states emphatically. “There’s a famous on-going neurological study, commonly called the Nuns Study, that has shown how a group of aging nuns – women who were later shown to have all the plaques and tangles of Alzheimer’s disease in their brains – lived a full life with all their mental faculties intact. You would never know that, clinically speaking, they had Alzheimer’s disease! How did they manage? It’s because they lived for a purpose greater than themselves. In spite of the disease, their minds stayed sharp and clear until the day they died.”

Rajiv’s conclusion is clear: “Living a life filled with purpose, a life of service to others, is a terrific prescription for better brain health.”

Rajiv Nagaich – Your Retirement Planning Coach and Guide

The long-awaited book by Rajiv Nagaich, called Your Retirement: Dream or Disaster, has been released and is now available to the public. Retirement: Dream or Disaster joins Rajiv’s ground-breaking DVD series and workbook, Master Your Future, as a powerful planning tool in your retirement toolbox. As a friend of AgingOptions, we know you’ll want to get your copy and spread the word.

You’ve heard Rajiv say it repeatedly: 70 percent of retirement plans will fail. If you know someone whose retirement turned into a nightmare when they were forced into a nursing home, went broke paying for care, or became a burden to their families – and you want to make sure it doesn’t happen to you – then this book is must-read.

Through stories, examples, and personal insights, Rajiv takes us along on his journey of expanding awareness about a problem that few are willing to talk about, yet it’s one that results in millions of Americans sleepwalking their way into their worst nightmares about aging. Rajiv lays bare the shortcomings of traditional retirement planning advice, exposes the biases many professionals have about what is best for older adults, and much more.

Rajiv then offers a solution: LifePlanning, his groundbreaking approach to retirement planning. Rajiv explains the essential planning steps and, most importantly, how to develop the framework for these elements to work in concert toward your most deeply held retirement goals.

Your retirement can be the exciting and fulfilling life you’ve always wanted it to be. Start by reading and sharing Rajiv’s important message. And remember, Age On, everyone!

(originally reported at www.wsj.com)

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