Congratulations! You are part of the largest group of older Americans ever seen in our country. About 10,000 people turn 65 every day, and people aged 85 and older are now the fastest growing demographic in the United States. By 2050, it is projected that one in six people worldwide will be over 65. This makes healthy aging a global concern – but we also know aging is very personal.

To some of us, entering the mature years might feel like a time of endings. But this can also be a time of creating even greater whole person health. The more active and involved you remain, the greater your physical, mental, and emotional health can be. About the worst thing you can do is shut yourself off and assume the best is over. In many ways, despite challenges, the best is yet to come.

Your goal should be healthy aging based on how you define healthy. For some women, that means playing tennis twice a week. For others, it means getting to church every Sunday and taking care of the grandkids. We know one woman who is thrilled with the active life she lives even though she is in a wheelchair. Meaning and purpose become the most important guide to a life of wellbeing.

“Aging is not ‘lost youth’ but a new stage of opportunity and strength”
— Betty Friedan

So, before you dive into this guide, take a few minutes and think about what successful aging means to you. Write it down and, once a year, take it out and review it. How close are you to meeting your goals? Is there anything you need to change?

Then follow the advice here—and listen to your doctors and other clinicians—to ensure that the next decades are as successful as can be.

Yours in health,

Research on aging, and what defines “healthy,” has evolved dramatically over the past 60 years. In the 1960s, aging was viewed as a time of gradual decline and disengagement. The dominant theory suggested that successful aging involved naturally withdrawing from social roles and activities as a preparation for death.

By the 1980s, however, researchers had devoted quite a bit of time to studying how this perspective played out in reality. Among other findings, they discovered enormous variations in how older adults’ physical health and social, emotional, and cognitive functioning changed with time. Not everyone experienced a steep physical or mental decline, got sick, or withdrew from life.

Researchers started to distinguish between “usual aging,” with typical age-related declines due to the development of disease, and “successful aging,” maintaining high physical and cognitive function with low disease risk. This perspective emphasized that much of what had been considered inevitable in aging was actually the result of lifestyle factors and preventable diseases.

Moving beyond “success or failure”

When studying healthy aging, researchers have moved away from rigid “success or failure” definitions. Rather than saying someone is “aging well” or “aging poorly,” modern approaches recognize that health exists on a spectrum. Most older adults will be about average, somewhere in the middle of the spectrum.

This shift in perspective is important because it acknowledges the health of the whole person. Even if you have chronic physical conditions, you can still age well. The whole person health approach recognizes that resilience—the ability to adapt and maintain wellbeing despite challenges—may be just as important as avoiding disease.

Today’s approach recognizes aging as a complex, dynamic process that can be modified. Modern concepts of healthy aging emphasize:

• Maintaining the ability to do chosen and necessary activities, rather than just avoiding disease.
• Adapting to our changing bodies, minds, and abilities instead of trying to prevent all of them.
• Building resilience in order to bounce back from challenges.
• Balancing physical, cognitive, psychological, and social wellbeing.
• Creating supportive environments that allow us to take part in life as we wish, even with changing abilities.

Notice a pattern? Adjusting, making the most of what we can do, and adapting are key to healthy aging from a whole person health perspective.

The World Health Organization now defines healthy aging as “the process of developing and maintaining the functional ability that enables wellbeing in older age.” This definition acknowledges that while some physical changes are inevitable, with the right support and personal adaptations, we can live vibrant, meaningful lives well into advanced age.

When researchers interviewed people aged 75 and older about what wellbeing meant to them, the responses could be divided into four main categories:

Physical and environmental

• “You’re able-bodied, you don’t have any health problems and do your own work and [handle] problems you have to deal with in your routine.”
• Physical and financial security and the sense that “mentally everything [is] going OK.”
• Physical independence, financial independence, autonomy and decision-making and self-mastery.

Lifestyle and behavioral

• The ability to do things and be with people: “Feeling well enough to do everything you want to do and being happy to get up in the morning,” or, at least, “being able to do some of the things that you used to.”
• Keeping up to date and learning new things.
• Not being afraid of death, an easy death, a nice death, a painless death.

Mind and spirit

• A good mental perception of yourself and your environment and people and relationships around you.
• Absence of dementia, feeling good (mentally), having a good memory, absence of depression or cognitive problems.
• Self-acceptance and self-contentment. Focusing on the present, accepting others, “a positive outlook and a positive attitude”, tolerance, coping, adaptation and adjustment.

Social and emotional

• Living in harmony; having “a rich life,” “a balanced life,” “a normal life,” “a happy life,” “living in peace.”
• Being surrounded by people and having company.
• Doing things for the family (taking care of grandchildren or a partner), helping others, being a member of an organization, having social interactions and relationships with others.

Research finds three factors related to successful aging: maintaining your physical function, your cognitive function (memory, thinking, and decision-making abilities) and staying involved in social activities and productive pursuits. All these are intertwined. For instance, the more involved you are in social activities, the better your overall health and cognition.

Below, we’ll take a look at several areas of physical health where you can also apply whole person health, especially in the cognitive and social dimensions. One example is bone health. Working to maintain your bone health and strengthen your bones—physical health—can include changing your diet, exercising (alone or with friends!), and taking supplements. Strong bones, and the process of maintaining them, need all three ingredients of successful aging, including:

• Continuing to exercise and do activities you enjoy
• Getting out, working, socializing and traveling with a lower risk of falling (a major risk factor for serious illness and death)
• Being involved with friends, family and community.

All these factors help you build resilience and whole person health.

In addition to taking a relatively deep dive into keeping your bones strong, a key element of healthy aging for women, we will also look briefly at cancer screening and prevention; maintaining your memory and cognitive abilities; cardiovascular health; and friends and social connections.

Osteoporosis is called the “silent disease” because, like other silent diseases such as high blood pressure, osteoporosis has no initial symptoms. But, just like high blood pressure, it can kill you.

An estimated one in four women in the United States over age 65 has osteoporosis, in which bone breaks down faster than it builds, weakening the structure and increasing the risk of fracture. Indeed, a fracture, often of the hip or wrist, is often the first sign of osteoporosis.

In fact, more people are hospitalized for osteoporosis-related fractures than for heart attacks, stroke or breast cancer. And half of those fractures are hip fractures. The scary thing is that about half of those who experience a hip fracture will die within a year.

Step one is learning if you have osteoporosis or are at risk of the disease. It’s easy enough to do with a special x-ray called a DXA scan, which is a type of bone density scan. Current guidelines call for screening in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman with no additional risk factors. If you are diagnosed with osteoporosis or the condition that can lead to it, osteopenia, your doctor may recommend medications designed to prevent further bone loss or even help build bone.

Risk factors for osteoporosis

You have a higher risk of osteoporosis if you:

• Have a family history of broken bones or osteoporosis, or broke a bone after age 50.
• Had early menopause, or had your ovaries removed before your periods stopped.
• Have not gotten enough calcium or vitamin D throughout your life.
• Smoke
• Were on bed rest or physically inactive at some time
• Smoke (smokers may absorb less calcium from their diets)
• Have a thin or small body frame

Certain medications also raise your risk of developing osteoporosis. These include:

• Stomach acid reducers
• Steroid medications
• Some antidepressants, antipsychotics and epilepsy medications
• Thyroid replacement medication
• High blood pressure medication, blood thinners

However, there are numerous other things you can do to preserve and strengthen the bone you have and prevent breaking a bone. Keep reading to learn what you can do for healthy bone aging.

Exercise

If your only exercise is walking around the block, you’re not doing your bones much good. Bones are like muscles: they need to be challenged in order to grow and strengthen.

When it comes to building bone, you need exercises that force your body to work against gravity. This means moving against some kind of resistance, such as lifting weights. Even exercises using your own body weight as resistance, such as pushups and planks, can help. Other exercises, such as walking, jogging, or playing tennis, can help slow down the loss of bone, but aren’t as helpful for building it.

Keeping the muscles around your bones strong is important, too. For instance, strengthening your back muscles can reduce your risk of breaking the bones in your spine. This type of breakage is what causes that hunched, stooping posture you see in many older women.

Finally, you may want to try tai chi or qi gong. You can think of these ancient Asian practices as meditation with movement. They incorporate slow, graceful movements with deep breathing and are known for their ability to improve balance, motor function, functional mobility, step length and cognition. Practicing either can also reduce your risk of falls.

Check your local recreation department, YMCA or senior center for classes.

Eating for bone health

In an ideal world, you’ve been eating to maintain strong bones your entire life. In the real world, that’s probably not the case. However, as with most things, it’s never too late to start.

Calcium and vitamin D are essential for building and maintaining bone strength are calcium and vitamin D. While there are plenty of foods high in calcium, it’s harder to get the vitamin D you need from food alone. And without vitamin D, you’re not getting all the benefits of calcium. The two work in sync, and each needs the other to provide their bone-strengthening benefits.

The following table lists foods high in calcium.

Food sources of vitamin D include beef liver, cheese and egg yolks. Milk is fortified with vitamin D. If you take supplements, supplement, current recommendations are for 600 IU a day for women aged 51 to 70 and 800 IU a day for those aged 71 and older. Your doctor should also regularly test your blood levels of vitamin D to ensure you’re getting enough, but not too much. Most vitamin D supplements also include vitamin K, another important vitamin for bone health.

Foods High in Calcium

Preventing Falls

What’s the leading cause of injury-related deaths among those aged 65 and older? One word: Falls – and the fall rate is increasing as the population ages. More than one in four people aged 65 and older will fall every year, and nearly 30,000 will die as a result of that fall. In one study, a third of those aged 60 and older who had a ground-level fall (not down the stairs or from bed) died within three years.

You can do many things to prevent falling. The most important is to fall-proof your home, where one in six falls occurs.

Be safe on the stairs

• Have handrails on both sides of the stairs. Make sure they’re tightly fastened and use them when you go up and down.
• If you must carry something while you’re on the stairs, hold it in one hand and use the handrail with the other. Don’t let what you’re carrying block your view of the steps.
• Install bright lighting with light switches at the top and bottom of stairs and on each end of a long hall, and turn the lights on when you are in that area.

Prevent tripping

• Keep areas where you walk tidy. Don’t leave books, papers, clothes and shoes on the floor or stairs.
• Keep electric cords and telephone wires near walls and away from walking paths.
• Watch out for your dog or cat so you don’t trip over them.
• Check that all carpets are fixed firmly to the floor so they won’t slip.
• Avoid throw rugs or small area rugs.
• Arrange your furniture (especially low coffee tables) and other objects so they are not in your way when you walk.
• Place non-skid mats, strips, or carpet on all surfaces that may get wet.

Keep your balance

• Mount grab bars near toilets and on the inside and outside of your tub and shower.
• Use sofas and chairs that you can get in and out of easily.
• Use a special grabbing tool called a “reach stick” rather than standing on a chair or stepladder to reach something.

Be safe at night

• Use night lights to light your way around the house at night, or just turn on the lights if you get up.
• Keep a flashlight by your bed in case the power goes out.
• Keep your phone near your bed.
• Keep emergency numbers on speed dial on your cell phone.

Exercises to help you keep your balance

Balance is key to preventing falls. Here are several exercises you can do to improve your balance. Caution: You might want to have someone in the room with you if you have a risk of falling.

Tightrope walk

Place the heel of one foot against the toe of another as you walk across the room. Hold your arms out to the side, parallel to the floor, like you are walking a tightrope. Keep your eyes focused in front of you.

Single foot raise

Stand with your arms out to the sides, parallel to the floor. Lift one leg until the thigh is parallel to the floor. (If needed, you can hold onto a chair with one hand when you start.) Try to hold the position for 10 seconds. Repeat on the other leg. Do this balance exercise 5 times for each leg. Try to increase the time by a few seconds each day.

Standing up

This sounds easy, but we’ve made it harder. Stand up from your chair without using your arms. Try that 10 times a day.

Weight shifts

Stand with your legs hip width apart, then shift your weight to your right side so your left leg lifts off the floor. Hold for at least 15 seconds. Switch legs. Repeat 5 times on each leg. Try to increase the number of repetitions you do each day and the amount of time you hold your leg out.

Cancer risk increases with age, but many cancers can be prevented or caught early through screening and healthy habits. Staying up to date with recommended cancer screenings is one of the most effective ways to protect your health.

For women over 40, regular mammograms are still the best tool for early detection of breast cancer—usually every year or two, as recommended by your doctor. You should also be screened for signs of cervical cancer every 3 to 5 years. If you’ve never had any signs of cervical cancer, your doctor may stop this screening after you turn 65.

Colon cancer screening is recommended between the ages of 45 and 75 (you may start earlier if you have risk factors for developing colon cancer). You may be able to do an at-home screening test or, if you have a family history or risk factors for colon cancer, have a colonoscopy. Depending on the results, you may need to be rechecked with this test as often as your doctor recommends. If you smoke now or did in the past, talk to your doctor about whether you need lung cancer screening.

If cancer runs in your family, ask your doctor or other clinician about how often you should be screened, and for what. Today, there are some blood tests that can help detect cancers early, although these are not available everywhere.

Lifestyle choices also reduce cancer risk. Avoiding tobacco, limiting alcohol, maintaining a healthy weight, staying physically active, and protecting your skin from sun damage are all proven strategies.

You forgot where you put your keys, the name of that woman at the gym you see every day, and what you needed from the room you just walked into. Is it Alzheimer’s disease? Some other form of dementia?

Don’t panic. While it’s true that the majority of people with dementia are older, forgetfulness and memory loss do not necessarily translate into Alzheimer’s disease. The table below from the Alzheimer’s Association highlights the differences.

Source: Alzheimer’s Association

Can medications and supplements help?

While there are several drugs approved to help treat the symptoms of Alzheimer’s disease, there are currently no FDA-approved drugs specifically to help you maintain memory and thinking in the absence of specific disease. That’s why it’s important to focus on lifestyle approaches and consider herbal and nutritional supplements. Here’s what the research shows:

Herbal supplements

People spend billions on dietary supplements to enhance memory and brain health in the U.S. each year. However, the FDA does not review or approve them before they go on the market, meaning you may be buying something that gives you false hope. We created the table below based on research into which supplements are shown to help, which ones may have some benefit, and which ones haven’t been shown to help at this point.

No matter what you see in the table, however, always talk with your doctor or other clinician before starting to take any vitamins, minerals, or supplements. They can talk with you about possible side effects and interactions with medications you take or even foods you eat.

Are you at risk for dementia?

The greatest risk factor for Alzheimer’s disease and other dementias is age, followed by family history. You can’t control either of those. However, you do have some control over many other risk factors, including heart disease, diabetes, high cholesterol and high blood pressure. The best way to control those risk factors is through lifestyle changes: losing weight, reducing stress, eating healthy, quitting smoking and exercising regularly.

This is where the classic elements of a healthy lifestyle come into play: a diet high in healthy proteins, fruits and vegetables and low in saturated fat, sugar and processed foods; regular mental and physical exercise (preferably a combination of cardio and weight-bearing exercises) and stress management (meditation, yoga, deep breathing). Following your doctor’s instructions regarding medications is also important, as is maintaining a healthy weight.

Another risk factor for dementia is depression, which can lead to chronic inflammation. It’s why people who are depressed often talk about feeling “foggy” and unable to concentrate. Yoga and other forms of movement can improve depression and mood, and also lead to improvements in cognitive function, particularly attention, processing speed, executive function (decision-making) and memory. These improvements can happen in people with and without depression.

Heart health is central to aging well, especially for women. Heart and blood vessel disease—cardiovascular disease—is still the leading cause of death for women over 65. The good news is that you can manage or reduce much of the risk through lifestyle and medical care.

As we age, the shift in hormones after menopause can negatively affect your blood pressure, cholesterol, and blood sugar levels, raising the risk of developing heart disease and diabetes. Keeping track of these levels is essential. Talk with your doctor or other clinician about whether hormone therapy is an option for you, and make sure your blood pressure stays within a healthy range.

Exercise remains a cornerstone for heart health—both aerobic activities like walking or swimming and strength training help keep your heart and blood vessels strong. Don’t overlook sleep: poor sleep quality or untreated sleep apnea can increase heart disease risk. The weight-bearing exercise recommended for building and maintaining healthy bones will also help your heart and lower your risk of heart attacks and strokes.

Nutrition matters too. A heart-healthy diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats supports your cardiovascular system. Limiting processed foods, excess salt, and added sugars can make a big difference by reducing inflammation. You may want to download our free Mediterranean Diet pocket guide to review how to do this while still enjoying delicious food, social connections over meals, and even wine.

Finally, mental health and social connections play a surprising role in heart health. Stress reduction, mindfulness, and staying socially engaged can lower your risk of heart disease and improve your overall wellbeing. That leads us to another aspect of healthy aging: maintaining your (in-person) social network.

One of the most important components to successful aging doesn’t come in a pill bottle, a grocery store or even the gym. It comes from your environment. Specifically, the ability to stay engaged in your community and with other people.

Positive psychiatry research tells us that wisdom, empathy, and having a purpose in life can help protect against declines in memory and thinking ability, also known as cognitive changes. These qualities can also help protect you against anxiety, depression, and other emotional and mental issues.

One study of 56,436 US women ages 55 to 72 found that after controlling for individual health behaviors like smoking, physical activity and weight, one of the most important elements to healthy aging was a woman’s social network, that is, having close friends and relatives. Women without a close friend had four-and-a-half times worse physical function and more than five times less vitality. In fact, the researchers found the effects of a poor social network were just as devasting to the woman’s health as being a heavy smoker or extremely obese.

If you already have a strong social network, good for you! If not, try the following:

• Volunteer. There is always an organization that needs you. Good resources include the Corporation for National and Community Service, Senior Corps’ Foster Grandparent or Senior Companions program and the AARP Foundation Experience Corps, which helps children improve their reading skills.
• Meet up with others. Meetup.com is an online site that lists thousands of groups all focused around a single passion. You can find groups in your area that do everything from hiking and birding, to knitting, to playing the ukulele. Or you can start your own group based on your own interests. Many groups are also age specific, so if you want to hang with your peers, you can do that, too.
• Start a new hobby. Always wanted to learn to play the piano? It’s never too late. How about learning a new language? Ballroom dancing? Becoming a master gardener? The possibilities are limitless.
• Join a fitness program. Many of today’s gyms involve small facilities that nurture not only physical health, but a sense of community. These include your local YMCA, which offers the Fit & Well Seniors Program. CrossFit, F45 and Orangetheory. All are accessible regardless of your age. Participating in this type of community-focused exercise means you can tackle all three of the elements of successful aging—physical health, cognitive strength and social interactions—at once!

The reality is that we’re all aging. And we’re only going in one direction—forward! That doesn’t have to mean we decline physically or mentally, however. If you embrace a healthy lifestyle, stay strong and maintain social connections, then these later years could be some of the best in your life.

Measuring your healthy aging journey

Scientists have developed several ways to evaluate healthy aging beyond just counting chronic conditions or years lived. These “healthy aging scores” combine multiple aspects of whole person health, from how you are doing physically and mentally to how you feel about life and how involved you are in community activities.

At the Healing Works Foundation, we have developed a tool called the Personal Health Inventory. You can use it to consider different aspects of your own health and make sure you are prioritizing activities that give you a sense of meaning and purpose. Learn more about the PHI, with a link to the free downloadable survey.

Whole person approaches such as those in the PHI keep us from thinking too simply about healthy aging. You might be thriving in some ways even if you struggle in others. Healthy aging involves:

• Physical capacity (strength, mobility, ability to use your senses)
• Mental sharpness (memory, processing speed, problem-solving)
• Psychological health (emotional regulation, purpose, optimism)
• Social engagement (meaningful relationships, community involvement)
• Environmental factors (housing, transportation, healthcare access)

By paying attention to the whole person, you and your doctor can create personalized strategies for aging well that address your individual strengths and challenges, rather than focusing solely on preventing disease.

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