Book Review
Artful Aging
Review by Charles R. Meyer, M.D.
Aging well is a skill developed through training and practice.
Age happens. As days become years and years become decades, the face staring back at us in the mirror changes, the morning walk to the bathroom gets a little slower, and we say “Oh, you know, what’s his name?” a lot more. Most of us just let it happen, accepting its relentlessness, the inevitability of the biology that works on us clandestinely with each passing day. But Yale surgeon Sherwin Nuland, M.D., says we shouldn’t passively coast into old age. In his book The Art of Aging: A Doctor’s Prescription for Well-Being, Nuland suggests that we should learn aging. As with any skill, aging well requires training, apprenticeship, and continual practice.
Part of learning aging is understanding what happens to our body and mind with advancing years, and Nuland devotes a long chapter to explaining the changes that happen to the brain, heart, muscle, and skin as we age. In that chapter, he first invokes his oft-repeated mantra: Although some changes are inevitable or genetic, most are modifiable with physical and mental activity, which can cheat the clock. For Nuland, society’s focus on calendar events such as turning 65 promotes artificial age milestones that don’t relate closely to biological capabilities: “Each of us is his or her own cohort. No number can define us as middle-aged, or elderly, or the oldest old. We can be defined only by what we have become. Whatever else aging may represent to us, it is first and foremost a state of mind.”
And that state of mind can mitigate not only the erosion of years but also the invasion of disease. Nuland presents example after example of people who have weathered disease and disability and eventually led useful, productive lives into their 80s and 90s. One of Nuland’s more prominent and remarkable prototypes is Baylor University cardiovascular surgeon Michael DeBakey, M.D., who continued to operate until he was 90, then continued teaching and publishing, and eventually, at the age of 96, survived the surgical repair of a thoracic aneurysm (an operation that he pioneered) and returned to work. Nuland’s analysis of DeBakey’s “vibrant longevity” focuses less on his favorable genetics or his spare diet and trim physique and more on his mental approach to life. DeBakey’s wife credits his success to “love—surrounded by the love of his patients,” and Nuland speculates that a helping profession such as medicine can provide rewards that could have some life-sustaining benefits. DeBakey’s mind is electrically eclectic, full of a wide swath of knowledge, medical and nonmedical, and open to new information, what Nuland calls the “anticipation of the interesting.”
Nuland acknowledges that not all of us can be wielding scalpels or writing papers until we’re octogenarians. We all will encounter limitations, and adopting the right balance between the strictures imposed by age and the drive to “get out of that chair despite it all” is the key to healthy aging. Although much of it is attitude, like cultivating a healthy self-image, which Nuland calls the “foundation stone for all successful aging,” part is fostering the Platonic synergism between sound minds and sound bodies. Nuland recounts his personal journey into exercise starting at about age 60, which he credits with age-defying mental and physical benefits.
Nuland is willing to defy age with mental and physical exertion, but he decries the promotion of cellular and genetic manipulations to extend the human life-span championed by Cambridge University computer scientist Aubrey de Grey. Nuland describes downing pints of ale in Cambridge’s famous Eagle Pub while being regaled with de Grey’s vision of extending human lives to hundreds of years, a vision that Nuland concludes ignores vast demographic and ecological implications and is a flight of hubristic swagger.
And so, Nuland’s prescription is “use it or lose it” from middle age on out. All of us should be in training, learning to meet aging successfully and gracefully when it happens: “Old age must be based on a foundation built during the decades that precede it; it is not enough to do the best we can when the years have already overtaken us. Beginning in middle age, we must study how to be old, in somewhat the same way that we, when growing up, studied to be adults and prepared for the coming responsibilities by educating our minds and strengthening our bodies. In its own way, aging is an art form—in itself a type of creativity.” MM
Charles Meyer is editor in chief of Minnesota Medicine.