Chapter One

Successful Aging

In May 1987, Science magazine published a landmark essay on the scientific study of aging titled "Human Aging: Usual and Successful." It argued that aging is not necessarily a process of decline set in motion by some unknowable combination of heredity and environment whose outcome is fixed by middle age. This negative view of usual aging, sometimes called normal aging, is neither normal nor inevitable, wrote Dr. John Rowe, MD, President of Mount Medical School (now President and CEO of Aetna, Inc.), and Dr. Robert Kahn, PhD, Professor of Psychology and Public Health at the University of Michigan. From a Health Span perspective, they argued, proactive changes (interventions) can improve older-age health even when the new or modified behaviors begin in midlife or old age.

The Health Span ideas became the framework for a decade-long series of biomedical and psychosocial studies of aging and middle aging funded by the MacArthur Foundation. The research included clinical, laboratory, and demographic studies-including the Swedish Twins Study to examine "nature versus nurture" as it applies to aging.

Across all this research, one unifying principle was demonstrated repeatedly: While what happens in earlier stages of the Health Span certainly affects what comes later, interventions can have a positive impact on health even when they come later in life. Five years after stopping cigarette smoking, your chances of a heart at