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George E. Vaillant's

Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development

"We all need models for how to live from retirement to past 80--with joy," writes George Vaillant, M.D., director of the Harvard Study of Adult Development. This groundbreaking book pulls together data from three separate longevity studies that, beginning in their teens, followed 824 individuals for more than 50 years. The subjects were male Harvard graduates; inner-city, disadvantaged males; and intellectually gifted women.

"Here you have these wonderful files, and you seem little interested in how we cope with increasing age ... our adaptability, our zest for life," one of these subjects wrote to Vaillant, a researcher, psychiatrist, and Harvard Medical School professor, about how he was using this information. Vaillant took this advice to heart. In Aging Well, he presents personal narratives about people from these studies whom he interviewed personally in their 70s and 80s. He describes their history, relationships, hardships, philosophies, and sources of joy. We learn their perspectives and what makes them want to get up in the morning.

We also learn what makes old age vital and interesting. Vaillant discusses the important adult developmental tasks, such as identity, intimacy, and generativity (giving to the next generation), and provides important clues to a healthy, meaningful, satisfying old age. Health in old age, we learn, is not predicted by low cholesterol or ancestral longevity, but by factors such as a stable marriage, adaptive coping style (the ability to make lemonade out of life's lemons), and regular exercise.

Vaillant is empathetic and sometimes surprisingly poetic: "Owning an old brain, you see, is rather like owning an old car.... Careful driving and maintenance are everything." He freely includes subjective observations and interpretations, giving us a richer picture of the people he interviewed and insights into their lives. Aging Well is recommended for readers who are interested in learning about the quality-of-life issues of aging from the people who have the most to teach.
-- Joan Price;

Other reviews

This groundbreaking sociological analysis is based on three research projects that followed over 800 people from their adolescence through old age. Subjects were drawn from the Harvard Grant study of white males, the Inner City study of non-delinquent males and the Terman Women study of gifted females, begun respectively in 1921, 1930 and 1911. In all three studies, subjects were interviewed at regular intervals over time, a design that prevented observations from being skewed by the distortions of memory and allowed for analyses that distinguished effect from cause. Vaillant (The Natural History of Alcoholism), a psychiatrist and professor at the Harvard Medical School, brings a nuanced point of view and an acceptance of the project's limitations. (Those followed were not randomly selected and were overwhelmingly Caucasian.) Nevertheless the author makes compelling use of his data, which is based on intensive contacts with a variety of subjects. Vaillant posits that successful physical and emotional aging is most dependent on a lack of tobacco and alcohol abuse by subjects, an adaptive coping style, maintaining healthy weight with some exercise, a sustained loving (in most cases, marital) relationship and years of education. This is good news since factors that cannot be altered, such as ancestral longevity, parental characteristics and childhood temperament, were among those ruled out as predictors. The book's academic tone will reassure some readers and put others off, but Vaillant's arresting interviews with selected subjects (recounted here) and his ability to learn from the subjects make this an outstanding contribution to the study of aging. National publicity.
-- Publishers Weekly; 2001

An unavoidable task of the living is to change with time. Change is psychologically painful. Combined with the physical reality of stiff joints, facial wrinkles, and frustrating forgetfulness, aging is neither relished nor revered by our society. We empower ourselves with antioxidant vitamins, wrinkle-reduction surgery, and hair dye to prevent, reverse, disrupt, delay, or disguise the aging process. We prove our value by maintaining a ridiculously fast pace with an effervescent smile. We define our self-worth according to the many external modifiers that proclaim our youth. We are caught up in a fantasy that belies reality -- every day, our mind and body grow older. The first definition of the verb "age" provided by Merriam-Webster's Collegiate Dictionary, ninth edition, is "to become old: show the effects or the characteristics of increasing age." The definition is nonjudgmental but is equally uninspiring. Whatever aging is, we do not need to welcome it. The second definition causes us to step back: to age is "to acquire a desirable quality by standing undisturbed for some time" or "to become mellow or mature." In his book Aging Well, George Vaillant takes this second definition of aging to a new level. Using a unique data base of standardized interviews exploring the psychological health of nearly 700 men beginning in 1939, he investigates whether important and potentially destructive situations in youth (e.g., disinterested or abusive parents or poverty) affect the psychological makeup of adults. Each participant was extensively reexamined at five-year intervals, allowing the assessment to evolve as individual development proceeded. The primary focus of the book is the characterization of healthy men and women in their 70s and older. The data on women are scant -- there are only 40 follow-up interviews from an original cohort of 300 women -- but this data base is better than most with regard to longitudinal research in women. The book presents astonishing observations that do not always fit social myths. Unfortunate circumstances in youth do not doom a person to an unhappy adulthood: "What goes right in childhood predicts the future far better than what goes wrong." Friendships with younger persons enhance the enjoyment of old age; these successful friendships are not so-called relationships in which the elderly are coddled by the young. Instead, the elderly give more than they take. A few observations add to the already overwhelming evidence that certain factors are associated with a healthy lifestyle. Cigarette smoking and alcohol abuse are more than bad habits; they destroy us. Exercise improves our ability to enjoy life. The style of the book is enjoyable. Carefully chosen case histories (with names changed to protect confidentiality) are used to illustrate the technical points. The tendency toward simplicity is studiously avoided. Rigidity in thinking is not always maladaptive. Wisdom is multifaceted, and its definition changes with the circumstance. Successfully aging women do not take care of others but rather enrich the lives of other, younger people by sharing current experiences with them. For nonscientific readers, Aging Well will provide the stimulus to reexamine their life and to determine whether they are doing everything possible to age well. The book will help readers systematically evaluate whether they have the infrastructure needed to age well. Aging Well may lead scientific readers down that bumpy road named "psychiatry." They may feel threatened by the apparent judgments passed by the interviewers on the lifestyles of the participants. If so, such readers should read the appendixes first. These explain why and how the cohorts were established, who paid for this work, and what was expected from the results. There are vignettes of immature and mature defenses to an imaginary traumatic event, followed by rating scales that lead to scores, which in turn lead to the separation of participants into "happy-well" and "sad-sick" categories. After finishing these appendixes, readers will then appreciate Vaillant's humbleness and nonjudgmental approach. During the course of 30 years of work, Vaillant had to admit that the shape and scope of his own developmental concepts kept changing as the study progressed. Although we all have anecdotal experience that aging can be fun, this book provides the only available longitudinal assessment of the factors that will permit us to age well. Aging well is giving to others. It is accepting our limitations with humor and dignity. It is cultivating the sparks of interest into our own eternal flame.
-- Margo A. Denke, M.D. ; New England Journal of Medicine; July 11, 2002

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