Photographs by Len Rubenstein
By 2020, 55 million Americans—or about one in six—will be age 65 or older. Their collective health presents challenging societal issues. But if you or someone near and dear to you will be among those 55 million, the issues are also personal—and that’s where this story comes in: How do we grow old gracefully—and healthily—in the early 21st century?
In the coming decade, healthy aging will be about your brain as well as your body. It will be about your emotional state and your level of social engagement. And increasingly, it will be in your hands, as healthcare moves toward a more patient-centered model, driven by unsustainable costs and by the reaffirmation of an old saying: An ounce of prevention is worth a pound of cure.
Prevention will still be about familiar prescriptions such as diet and exercise, says Terry Fulmer, dean of the Bouvé College of Health Sciences. But Fulmer, a nationally known expert in geriatrics, says rising costs and an aging population will require new questions and new answers. “How do we apply technology to self-care and self-management of our health? How do we reconfigure the nature of caregiving?” Fulmer asks. “Because chronic disease and disability management will be bigger challenges.”
In the following pages, Northeastern faculty members talk about these trends and their impact at the individual level: the interaction of cognitive, emotional, and physical well-being, and what you can do to maintain a healthy mind and body; motivational approaches to exercise and healthy eating; the growing role of “smart” digital programs, such as virtual coaches, cheerleaders, and companions; the impact of home and community environments; and, when prevention alone is not enough, the latest on that pound of cure—developments in medical research to combat diseases and chronic conditions associated with aging.
NO PAIN, NO GAIN
Under the Affordable Care Act, hospitals are now subject to financial penalties if their readmission rates for Medicare patients are deemed excessive—a sign that the healthcare system is making prevention a priority.
In this environment, it is smart to be an active participant in your own healthcare, and, if you are north of 40—the age when we start to lose muscle mass—the experts say that exercise should play a central role.
We know a lot about why fitness is important, says Northeastern health sciences associate professor Carmen Sceppa. Muscle loss can be a downward spiral to disability, and the metabolic risk factors of aging, such as diabetes, hypertension, and obesity, are all worsened by a sedentary lifestyle.
Derek Isaacowitz, associate professor of psychology, says studies have also linked higher levels of physical activity to emotional well-being in older adults.
But what healthcare professionals have yet to unravel is how to overcome the obstacles that discourage middle-aged and elderly people from establishing daily exercise regimens.
Those obstacles include lack of the right motivational tools, lack of knowledge (or “health literacy”), lack of economic wherewithal, and often a mix of all three.
Solving these issues requires a targeted approach: Personalize people’s fitness goals and give them a greater sense of ownership, say Sceppa and Bouvé colleague Elizabeth Howard, associate professor of nursing.
These solutions range from peer-led support groups to virtual Web-based exercise coaches and smartphone apps that track your habits and reward healthier choices.
Northeastern faculty members have seen promising results in their own research. For example, one study led by Howard showed that tying exercise to specific life goals—being able to dance at a grandson’s wedding or get on a plane to visit family—could prove to be a useful motivational tool.
But more research is needed, Howard says. Studies involving environments with swimming pools and workout rooms, she says, don’t reveal much about how to help seniors living in public housing—communities in which health literacy is mixed and neighborhood exercise options are few.
Ultimately, achieving behavioral change, says Howard, means “moving people in the right direction without telling them what to do.”
A Healthy Aging Workout
Good physical health requires a minimum of four to five hours of physical activity a week, with a fairly consistent level of exercise each day. Here are the minimum recommendations from the Centers for Disease Control and Prevention for adults 65 and older.
>150 minutes of moderate-intensity aerobic activity, such as brisk walking, each week
>75 minutes of vigorous-intensity aerobic activity, such as jogging or running, each week
>2 or more days of muscle-strengthening activities that work all major muscle groups each week
One word: Plasticity
Researchers in aging talk about the theory of brain plasticity. Regular, sufficiently high stimulation promotes cognitive health, which is critical to overall well-being. Our experts’ recommendations:
>Play mind games. Crossword puzzles, Sudoku, and brain teasers are all great ways to exercise your mental pathways.
>Learn the piano, read beyond your usual genres, take a different route to work—anything that forces your brain away from the familiar.
The Positive Side of Aging
Older adults have surprisingly high levels of happiness, says Derek Isaacowitz, and it may be related to how they regulate their emotions. The associate professor of psychology used eye-tracking technology to study precisely what his research subjects were looking at, while rating their moods, moment by moment.
The data revealed that younger people tended to engage more with negative images, whereas older adults looked away, distracting themselves. Whether due to age or experience, they appear to adjust their mood by looking for more positive messages, Isaacowitz says.
You Don’t Need a Fancy Gym
It turns out that community-based exercise programs are as effective as high-priced gyms at getting older adults into a physical-fitness routine.
Carmen Sceppa collaborated on a multiyear study, the People Exercising Program, which illustrated the benefits of fitness classes taught by trained peer-group volunteers from the community.
The result? More classes, more participation, and heightened social support in the community. Sceppa, health sciences associate professor and interim department chair, is seeking funding to scale up the PEP model. The numbers:
>149 peer fitness instructors trained
>97 strength-training classes established in senior and community centers
>119 peer instructors who established or taught at least two 12-week classes
>2,217 adults aged 50 to 97 who enrolled, all with chronic medical conditions
HEALTH ENCOUNTERS OF THE DIGITAL KIND
Mobile phone apps that help you make smarter, highly customized choices about nutrition and fitness. Web-based virtual exercise coaches and health advisers. Websites that serve as community-health bulletin boards for sharing ideas, resources, tips, and encouragement.
Digital technology promises to be a source of valuable tools to promote health and healthy behavior among an aging population. But what about the stereotype that the elderly aren’t suited to computers?
Not true, declares Stephen Intille, who is leading a team developing mobile phone applications. Intille, who holds joint appointments in computer science and health sciences, believes it is “unfair to say that older adults can’t use a well-designed computer interface.”
Although his interfaces are not designed specifically for older adults, Intille’s goal aligns with their needs: a stream of personalized information, in real time, that enables people to understand and improve their health-related choices—where to eat, for example, and whether to turn dining out into an occasion for a vigorous walk.
Tim Bickmore sees computer technology taking on related but more specific tasks, highly targeted to people’s needs. The professor of computer science is creating Web-based “relational agents”—in effect, healthcare avatars—that can function as exercise coaches, social companions, nurses, and home health aides.
Bickmore’s prototype avatar, “Tanya,” is programmed with complex computational algorithms that enable it to take in and process information about individuals.
Tanya can converse naturally about everything from your medical history and hospital discharge instructions to family stories and favorite baseball teams—and if your team loses, Tanya can offer sympathy.
Although apps and avatars are still in the development stage, existing digital technology is already showing its potential to push healthier behavior—reaching out to people in the virtual space to sustain a community-wide conversation about health.
Andrea Parker, assistant professor of computer science with a joint appointment in health sciences, says these interactive websites encourage members of the community to share their experience and knowledge about healthy eating, exercise, and other related topics. In that way, she says, “advancing good health can be a form of community activism that promotes wellness through collective action.”
These technology-based approaches appear to offer the greatest benefit to communities with low health literacy—a group that makes up 36 percent of American adults, according to Bickmore.
And in a society where social isolation can be a serious health problem for the elderly, these digital solutions offer connection—whether through a simple interactive website or Tanya’s sophisticated algorithms.
Pep Talk From Tanya
In a recent study funded by the National Science Foundation, computer science professor Tim Bickmore tested the effectiveness of his healthcare avatar, Tanya, in helping Boston Medical Center geriatric patients improve their mobility through a walking regimen. An excerpt from Tanya’s conversation with one patient named Matthew:
Tanya: Matthew, you said you would talk to me today, and you did. Congratulations! I really appreciate you keeping your promise.
Matthew: You’re welcome.
Tanya: How are you feeling today?
Matthew: Great. How are you?
Tanya: I am doing great, thanks! Keep wearing your pedometer, and we will talk about setting a goal in a few days.
Tanya: So, one way to get motivated about self-improvement is to think about someone you admire. Who in your life inspires you, Matthew?
Matthew: A friend.
Tanya: Do you have a close relationship with this person?
Tanya: I am glad to hear that. It is good to be around people you admire. What do you admire about them? Is it a specific quality or something they do?
Matthew: I admire their actions most.
Tanya: When you are walking, think about the qualities they embody that motivate them to do these actions. Think about how you can apply the qualities you admire in them to motivate yourself to continue striving for your goals.
Smarter Choices with Your Smartphone
Northeastern’s faculty is breaking new ground in the field of personal health informatics, creating interactive tools that enable people to take greater charge of their own care.
Soon, one of those tools could be your smartphone. Stephen Intille and his research partners are combining external sensors with the device’s internal features, such as GPS, to collect and synthesize real-time data about your habits, location, and choices.
Whenever your phone detects a smart choice, it will offer positive reinforcement—an encouraging voice message from a spouse, for example.
This integration of computer science specialties—data analysis, machine learning, and human-computer interaction—has the potential to reshape several fields in personal healthcare, and Intille is collaborating with faculty researchers on several other such projects.
Touch-screen Time with Your Doc
When an elderly patient visits a doctor for the first time, says Andrea Parker, the process of providing information—about symptoms or medical history—is usually one-sided.
“Normally, the doctor controls the process,” explains the assistant professor of computer science and health sciences.
However, inspired by a recent study that showed adults over 60 preferred “surface computing,” using large, tablelike machines with upward-facing touch screens, Parker sees expansive possibilities for the technology. She would like to explore the idea that the wide array of touch-screen options would allow patients to take a more active role in conveying information to their doctors.
“Patients can engage with the doctor more,” Parker says. “The surface touch screen gives them a shared platform” for communication.
Get Your Game On
Nursing professor Elizabeth Howard believes you are never too old to sharpen your mind. And it appears you may never be too old to play computer games.
A pilot study Howard led at a long-term-care residential facility supports both assertions. At the Hebrew Senior Life Center in Boston, 22 residents between the ages of 83 and 103 played touch-screen computer games—challenging their memory, attention, planning, and computational skills—for 90 minutes a week. Half of the participating residents had mild cognitive decline going into the study.
After 12 weeks, all 22 improved their scores. Perhaps most surprising was that in the game Strings, which targets mental flexibility, the patients with the highest level of cognitive impairment improved the most.
HEALTHY COMMUNITIES BY DESIGN
A five-day heat wave in 1995 killed an estimated 750 Chicago residents, most of them elderly and poor. The hardest hit neighborhoods, says Northeastern environmental sociologist Phil Brown, had something in common: They lacked a social network. People did not check on their neighbors, and some died, alone.
That tragedy starkly illustrates the importance of living environment to the middle-aged and elderly, says Brown, and it’s a factor that affects health in a variety of interconnected ways.
Start with the fact that social isolation significantly increases mortality in older adults. In unsafe neighborhoods, the elderly are less likely to get out of their homes, increasing isolation and inhibiting physical activity.
Green spaces, such as parks, encourage physical activity and play a role in emotional health, says Brown. The professor of sociology and health sciences cites studies showing that green space in and around healthcare facilities lowers the incidence of depression and even promotes recovery from illness.
Environment also affects nutrition, says Katherine Tucker, professor of nutritional epidemiology and director of Northeastern’s Center for Population Health and Health Disparities.
“Low-income neighborhoods, particularly in urban areas, suffer from a lack of access to healthy foods at an affordable price,” says Tucker. “The primary shopping option is the corner convenience store.”
The income divide and the health disparities it causes play into the broader environmental issue, says Brown. “How do we design living spaces that are more human? How do we create healthy communities that are accessible?”
Some answers can be found in Brown’s experiences. At Brown University, he helped found an initiative that brought fresh fruits and vegetables to Providence convenience stores. And he has seen Rhode Island’s program to expand farmer’s markets throughout its cities and towns widen the availability of healthy food and increase opportunities for social connection.
Experts are also exploring the creation of highly localized peer-led advocacy groups and Web-based health communities designed to move people to form actual communities.
Andrea Parker, assistant professor of computer science and health sciences who is focusing her own work in that area, says health-promoting interactive tools should be developed with that larger goal in mind.
“I want people to feel that they have important things to share beyond a website post,” she says.
Healthy Eating for Healthy Aging
Health sciences professor Katherine Tucker is a nutritional epidemiologist with a strong focus on prevention of chronic conditions associated with aging. Her preferred diet for older adults is the Mediterranean diet: high in vitamins and protein from fish, yogurt, fruits and vegetables, nuts, legumes, whole grains, and olive oil, and lower in simple carbohydrates, such as pasta and rice. Here are a few of Tucker’s recommendations:
It’s a myth that older adults don’t need protein. Combined with daily exercise, it helps people avoid loss of muscle mass. Low-fat dairy is a great source.
Magnesium and vitamin B6 promote energy and good metabolism. Find B6 in meats, whole grains, vegetables, nuts, and bananas, and find magnesium in spices, nuts, whole-grain cereals, coffee, tea, and green leafy vegetables.
Vitamin B12 is vital to nerve health. If you are middle-aged or elderly, take a supplement; natural B12 is bound to a protein, and as people age, the digestive system loses the ability to unbind the vitamin.
Coffee offers protective effects against diabetes. Choose hot or iced tea, or coffee with milk.
Yogurt and milk maintain bone mineral density, helping to prevent osteoporosis.
Not all fats are bad. Up to one egg a day provides good protein and promotes eye health.
The era of petrochemicals and plastics has given rise to compounds that are implicated in higher rates of obesity and related conditions, such as diabetes and cardiovascular disease.
These compounds are known as “obesogens”—or endocrine disruptors—and there’s a strong body of federally funded research indicating that they get into our air, water, and food supply from a variety of sources and disrupt the regulatory function of hormones.
Although industry-funded studies dispute any conclusive link, some of those suspected sources include chemicals used in consumer and commercial products. Bisphenol-A, for example, is used to harden plastics and can be found in food and beverage containers. Phthalates are added to a wide variety of products, from building materials to cosmetics.
“People can learn what products contain these chemicals and avoid them,” says University Distinguished Professor of Sociology and Health Sciences Phil Brown. “But the answer is not so much individual choice; the answer is to get manufacturers to change and get the regulatory world to change.”
To learn more about obesogens and related consumer product safety issues, Brown recommends checking out the Environmental Working Group.
TREATMENT: A POUND OF CURE
Ailments that afflict older adults—such as heart disease, cancer, Alzheimer’s disease, and infectious diseases—are the focus of research approaches that would have been impossible to imagine two decades ago.
Some are avenues of medical research that are only beginning to emerge: developing models based on systems biology to fully understand the biological processes and networks that underlie many diseases, creating nanomanufactured molecular “machines” to repair damaged tissue, or growing neurons from stem cells to replace those destroyed by neurodegenerative diseases. One or all of these may be the future of curing disorders associated with aging. But first, there are many fundamental questions to answer.
Heart disease researchers, for example, are strongly focused on drug therapies to elevate the level of HDL—so-called “good” cholesterol. But there are different types of HDL particles, and those differences are not yet well-understood.
Skim the long list of National Cancer Institute-funded projects and you’ll find that that some basic questions are unanswered. What causes prostate cancer, and why are African-American males more prone to it? Is there a correlation between obesity and cancer? What is the relationship between diet and certain common cancers in middle-aged men and women?
Alzheimer’s disease, the nation’s sixth leading cause of death, remains such a puzzle that doctors can offer no firm recommendations for prevention and have no effective therapies for slowing its progression.
But recent advancements—in genetics, in scanning technology and data analysis, in nanotechnology, and in our understanding of biological networks—promise to supply these answers, and some of those advancements are taking place at Northeastern.
In the realm of systems biology, for example, the university has significant research assets. The university’s Barnett Institute of Chemical and Biological Analysis recently announced a technology alliance with analytical instruments giant Thermo Fisher Scientific that will further the institute’s expertise in protein characterization and biomarker analysis. And the Center for Complex Network Research, a world-leading center for network science research, is building on the results of the Human Genome Project to map genetic linkages among diseases.
A range of other research centers at the university are advancing our knowledge in areas that will contribute to healthier aging, from nanomedicine-based drug development to more efficient healthcare processes built on engineering principles.
Experts across multiple disciplines often collaborate on these projects, the trend for innovative research in the field.
“Our college focuses on four varied areas: drug discovery and delivery, urban health, self-care and self-management, and healthy aging,” says Bouvé dean Terry Fulmer. “But you learn pretty quickly how interconnected they are.”
Mapping Your Genetic Quirks
Disease prevention and treatment could become the ultimate in personalized medicine if the holistic concepts behind systems biology can be effectively applied to healthcare.
Scientist and medical doctor Leroy Hood, a systems biology pioneer, says disease should be treated as a product of a complex biological system and its unique cellular interactions. In this approach, specialists would literally map your network of genes, proteins, and molecules. That map, in turn, would enable physicians to target disease prevention and treatment in a way that accounts for every singular quirk of your genetics and metabolism.
The end goal of this new understanding of the body’s “network of networks,” says Hood, is what he calls “P4 medicine,” referring to the four Ps as personalization, prediction, prevention, and participation.
Speaking at Northeastern last fall as part of the Profiles in Innovation Presidential Speaker Series, Hood said, “P4 medicine will have profound implications. It will significantly reduce the cost of healthcare by allowing for earlier disease diagnosis. Patients and diseases will be stratified, such that we will know how individuals will respond to certain medications.”
Ground zero for this untraditional approach is the Institute for Systems Biology in Seattle, co-founded by Hood in 2000 to integrate the ideas and insights of innovators across the disciplines, including biologists, geneticists, computer scientists, chemists, engineers, mathematicians, and immunologists.
A Look at the Bright Side: Some Surprising Numbers
If you’re a baby boomer, you’re swimming in numbers, and they don’t always make you feel good about aging. But not all the data are so dire. Here are a few stats that put a more positive spin on how your health might fare during your golden years.
>16% The decline in deaths from heart disease in the U.S. between 2000 and 2010. It’s still the leading cause of death among Americans, but the number is going down.
>23% The decline in stroke deaths in the U.S. between 2000 and 2010. It’s fallen from the third to the fourth leading cause of death in America.
>89% The United States’ five-year survival rate for breast cancer—the highest among the 34 nations in the Organisation for Economic Co-operation and Development.
>65% This five-year survival rate for colorectal cancer in the U.S. is the second highest in the world; only Japan’s survival rate is higher.
>50% The decrease in your chances of premature death if you quit smoking even as late as between the ages of 60 and 75.
>76% Percentage of people surveyed, age 65 and over, who rated their health as good, very good, or excellent during 2008 to 2010.
Sources: National Center for Health Statistics, Deaths: Final Data, 2000 and 2010; OECD Health Data, 2012; World Health Organization;
“Older Americans 2012,” Federal Interagency Forum on Aging-Related Statistics.