Every morning I turn on my iPad and read on The Huffington Post that I can age gracefully if I simply eat healthy, exercise, perform my yoga exercises, and complete a few crossword puzzles every day. A quick appraisal of my life reveals that I eat fairly well, exercise three to four times a week, work at an intellectually challenging job, and interact daily with many people.
But I have to say, I must be doing something wrong. At age 67, despite all of my attempts at graceful aging, my body and mind are not getting the message that I should feel like I'm still 40. Sometimes, I think that a 30-year-old must have decided that 60 is the new 40.
Last week, as I ate a semi-healthy lunch with three of my colleagues, we all agreed that despite leading active and so-called "engaged" lives, we felt a bit less enthusiasm for most things than we did 10 years prior. I might even say less motivated. Remember, I still practice medicine, have been married to the same woman for 44 years, write regularly, exercise, play golf, and seem to stay fairly busy.
So, I have decided to call it apathy with a small "a." As we surveyed the dessert tray, the question came up as to whether apathy is part of "normal aging" and whether, like wrinkles, it may be an unavoidable part of getting older.
What Is Normal Aging, Anyway?
"Normal aging" almost seems likes an oxymoron, but there is such a thing. However, the truth is that most people are not fortunate enough to experience it. The majority of people deal with hypertension, diabetes, heart disease, arthritis and a wide variety of afflictions that may cause some level of disability. But, if we widen the net a bit, we can define "normal aging" as the ability to still function at an acceptable level despite a progressive decline in abilities. As we progress through this process, changes take place at various levels:
- Cellular: Our organs actually wear out. Besides the visible wrinkles on our skin, our kidneys and other organs work less efficiently.
- Psychological: There is a progressive decline in our ability to learn and process new information as well as handle complex information.
- Psychosocial: We may have difficulty adjusting to retirement or the loss of a loved one.
How Apathy Fits Into Normal Aging
Back at lunch we were discussing what level of inactivity is acceptable, because apathy can actually defined as a syndrome. Some of the components of apathy include:
- Lack of motivation
- Diminished goal-directed behavior
- Lack of initiative
- Absence of excitement
We all agreed that we all experienced these at one time or another, that in fact all people experience periods of apathy. But do these episodes become more frequent or intense as we age?
We know that apathy is common in people with Alzheimer's, chronic illness or depression. However, apathy also exists independent of depression and can be measured on a variety of scales. Here are some questions from the Apathy Evaluation Scale (AES) that asks a person to rate if an individual:
- "Gets things done during the day"
- "Approaches life with intensity"
- "Is less concerned about his/her problems than [he/she] should be"
- "Has initiative"
- "Has motivation"
My friends and I decided that it may depend on what day of the week we answer the questions, but we all agreed that despite all being highly successful, apathy with a small "a" might apply to us on some of those days.
Hey, We Are Not Alone
Brodaty and colleagues asked the question, "Do people become more apathetic as they grow older?" They studied 76 healthy people between the ages of 58 and 85 years and followed them for five years. The people underwent neuropsychological testing and MRI scans at the start and again at the end of the study. Each time, they administered the Apathy Evaluation Scale, and at the end of the study, found a significant increase in apathy with aging that did not correlate with any changes in the health status of the people. Although the exact cause of the increased levels of apathy was not clear, it did not surprise anyone sitting at our lunch table that apathy increased with healthy aging.
But guess what? There's no reason to despair. It is still a good idea to exercise, eat healthy, socialize with friends, find new sources of pleasure and manage your medical conditions. But, I will take a position contrary to many people who live in their workout clothes and own two juice-makers. It is okay to occasionally "piddle away the day." It is also okay if you do not attack a new project with the same enthusiasm that you might have 20 years ago.
Anyway, I think I will go take a nap now. But please don't forward this to the people who sign my paycheck.
For more by Richard C. Senelick, M.D., click here.
For more on aging gracefully, click here.
Follow Richard C. Senelick, M.D. on Twitter: www.twitter.com/RichardSenelick