Measuring the Dash

Individuals in the United States paradoxically long for and dread old age. The alternative to growing old is an outcome few of us would prefer. But aging seems inevitably associated with decline. Independent choices, a hallmark of adulthood, can be lost between one day and the next with a heart attack, a stroke, or a fractured hip. Senior citizen discounts notwithstanding, our culture does not offer a valued place for elders. It becomes easy to focus on what we will certainly lose rather than on any uncertain gains associated with aging. And yet, we have examples of thriving elders. Former President Jimmy Carter won the Nobel Peace Prize in 2002 at age 78. Dr Benjamin Mays, a president of Morehouse College and mentor to Martin Luther King, Jr, and Andrew Young, published his autobiography Born to Rebel at 76. Celia Cruz, the Cuban American singer called the " Queen of Salsa, " whose songs earned 22 gold records, continued performing and recording until her death at 78. These people not only lived long, they lived well. How does one flourish over eight or nine decades? Joan Erikson was the wife and professional partner of the developmental psychologist Erik Erikson. Together they characterized eight stages of human development, from developing trust in infancy to encouraging generativity in old age (1). At age 90, soon after Erik's death, Joan began describing a ninth stage of wisdom that continued to include autonomy and growth. " But only if we've taken care of our bodies, " she stressed. " The consistent care necessary to keep the body machinery functioning in spite of age and deterioration is mandatory " (2). This issue of Preventing Chronic Disease explores the role of public health in healthy aging. Several authors describe current challenges in healthy aging in the United States. Gohdes and colleagues discuss age-related eye diseases; low vision and blindness rise dramatically with age in every race and ethnic group (3). Lai et al found that recovery from stroke in a Kansas population was related to sex, in part because prestroke functioning was lower in women compared with men in the study (4). Shenson and colleagues developed an index on the use of preventive services (Pap test, colon cancer screening, mammogram, and influenza and pneumococcal vaccines) in older Americans (5). The percentage of the population that achieved age-and sex-appropriate completion of these services ranged from 21% of …