How to be happy and well rather than sad and sick

The world’s longest continuous study of physical and mental health has come up with predictors that individuals can use to determine how well they will age.

Since 1937, the study has followed 237 students at Harvard University and 332 socially disadvantaged youths from inner-city Boston through health, disease, and death.

“The study shows that successful aging is not an oxymoron,” says George Vaillant ’55, professor of psychiatry at Harvard Medical School and director of the study for the past 35 years. “You can add life to your years instead of just years to your life.”

Vaillant and his colleagues at Harvard University Health Services teased out seven predictors, which are at least partly under personal control, and, if adhered to before age 50, can lead to good physical and mental health at ages 70, 80, and older.

Some of them are old news, things like quitting smoking, exercising regularly, and not abusing alcohol. Others turn out to be surprises. For example, education trumps money and social prestige as a route to health and happiness.

“Despite great differences in parental social class, college-tested intelligence, current income and job status, the health decline of the 25 inner-city men who obtained a college education was no more rapid than of the Harvard College graduates,” Vaillant points out.

The six other controllable predictors include alcohol abuse, smoking, marriage stability, exercise, weight, and coping mechanisms.

Uncontrollable factors that affect successful aging include parents’ social class, family cohesion, longevity of ancestors, and childhood temperament. However, by age 70, these factors are no longer important. High cholesterol before age 50 also loses importance after a 70th birthday. Physical health at age 50 and major depression remain important throughout life.

Among college men still in good health at 50 were 66 men with fewer than four protective factors. At age 80, 50 of these 66 fell into the categories “sad and sick” or “prematurely dead.” Not one man was both happy and well.

In contrast, out of 44 college men who had six or seven controllable factors present, 25 ranked among the happy and well; only one was in the sad and sick catagory. “The predictive power of the factors under some personal control, was as great for the inner-city men as for Harvard graduates,” Vaillant notes.

Women and wellness

Vaillant also has researched predictors of successful aging in women, and found no difference. His report on men, co-authored with Kenneth Mukamal, appears in the June 1 issue of the American Journal of Psychiatry. The findings on both males and females will be described in “Aging Well,” to be published by Little, Brown in December.

Individual men and women working with their doctors can use these predictors to guide them to a happy and well old age. “As we get older, maintenance becomes more important than genes,” Vaillant comments. For example, physicians can be sure people with high blood pressure or diabetes take their medications, and can help those with depression and other mental illnesses.

Asked what advice he would give graduates, nongraduates, and alums attending Harvard’s June 7 Commencement ceremonies, Vaillant noted the following:

• A good marriage before age 50
• Ingenuity to cope with difficult situations
• Altruistic behavior
• Stop smoking
• Do not use alcohol to the point where your behavior shames you or your family
• Stay physically active. Walk, run, mow your own grass, play tennis or golf
• Keep your weight down
• Pursue education as far as your native intelligence permits
• After retirement, stay creative, do new things, learn how to play again 
  

  Death, marriage, and maturity

  Overall, the number of positive factors possessed by graduates of Harvard College kept them alive and free of disability longer than the inner-city men. The former reached every stage of death and disability about 10 years later than the latter. Accordingly, the study defined premature death as before 75 years for the college men, and before 65 years for the inner-city males. At age 65, 26 percent of the inner-city men were dead and 22 percent were disabled. At age 75, 27 percent of the college men had died and 14 percent were disabled.

  If you can make it past age 70, the uncontrollable factors do not matter as much, notes Vaillant, who is 66. Therefore, working on the controllable ones yields relatively more benefits.

  A marriage without serious problems before age 50 usually keeps getting better and the degree of control over life increases.

  As you might expect, the way people cope with life’s setbacks makes a difference. “Mature or adaptive defenses from age 20 to 50 are an important predictor of successful psychosocial aging,” the study report notes. Prior to age 50 almost two-thirds of the happy-well men, but only one-tenth of sad-sick men, had used mature defenses.

  “Life ain’t easy,” Vaillant points out. “Terrible things happen to everyone. You have to keep your sense of humor, give something of yourself to others, make friends who are younger than you, learn new things, and have fun.”

  Immature defenses, on the other hand, produce sad results. Don’t blame others for your problems, or deny that you have problems. Having imaginary rather than real friends causes more problems than it solves. So does distracting yourself by sipping scotch and watching television.

  “Aging happy and well, instead of sad and sick, is at least under some personal control,” says Vaillant as he sums up the 64-year study, which was supported primarily by the National Institute on Aging. “We have considerable control over our weight, our exercise, our education, and our abuse of cigarettes and alcohol. With hard work and/or therapy, our relationships with our spouses and our coping styles can be changed for the better. A successful old age may lie not so much in our stars and genes as in ourselves.”