My son was nearly 12 lbs. at birth. When he was born, the obstetrician held him in the air, one hand on my son’s bottom, one hand cradling his head and neck, and said, “This is a record breaker!”

He was so long the measuring tape in the delivery room was not long enough to take his length measurement. The next day the nursing staff finished the job of compiling the usual birth stats by taping two measuring tapes together.

The day after he was born, the obstetrician told me my son looked like about a three-month-old. 

And so he did. My son’s physical development (weight, height and appearance) seemed to mismatch his age. 

A similar situation can happen at the other end of life with regard to the cognitive vitality and age of older adults. Everyday observers and scientists have long noted that chronological age does not always match well with older adults’ cognitive vitality (i.e. mental acuity; Anstey, Lord & Smith, 1996).

For instance, despite advanced age, some older adults maintain high levels of cognitive functioning. On the other extreme, social, psychological and biological factors may combine in ways that are related to accelerated decline and impairment in cognitive status (Dixon, 2011). 

Imagine if your age wasn’t measured in years, but in health and vitality. Some people, although very elderly, may have superb health. That would put their biological age at younger than their age in years. 

That is the basis of what researchers call “BioAge.” BioAge is intended to be an indication of functionality, vigour or health, that is measured not by years, but by that status of special markers (i.e. “biomarkers”) that relate well to the most basic, biological systems and processes that underpin aging (DeCarlo, Tuokko, Williams, Dixon and MacDonald, 2014; MacDonald, Dixon, Cohen & Hazlitt, 2004). 

Here’s how at least some biomarkers may likely work:

Many diverse factors have an impact on aging-related cognitive change (i.e. stability, improvement or decline). These factors act on the brain in ways that either support or deteriorate neurological health (Dixon, McFall, Whitehead and Dolcos, 2013). 

Factors that affect cognitive functioning often work by affecting levels of inflammation, vascular integrity and oxidative stress in the brain (DeCarlo et al., 2014). Interestingly, these same processes are importantly connected to aging-related processes elsewhere in the body, including aging-related decreases in muscle mass and sensory functioning (DeCarlo et al., 2014).

For instance, inflammation and oxidative stress are two mechanisms behind aging-related loss in muscle mass (i.e. sarcopenia), which may lead to decreased grip strength. Levels of inflammation and oxidative stress that promote the loss of grip strength may simultaneously affect the brain in ways that may negatively affect cognitive functioning (DeCarlo et al., 2014).

The upshot? Some factors that are clearly related to physical health and vitality (like grip strength) are also associated with cognitive status and resiliency (common cause hypothesis; MacDonald et al., 2004). 

Observers may wonder: Are there any biological markers known presently that could be used to predict who will get a neurodegenerative disease like Alzheimer’s?

That question is now a hot topic for dementia researchers, not least because if such biomarkers could be identified, they may act as important targets for Alzheimer’s prevention. Presently, important themes are emerging and being refined in this area of research.

Here’s a snapshot of information researchers know so far:

The Victoria Longitudinal Study, a large-scale study of human aging based in Edmonton, Alta., recently assessed the long-term cognitive status and change of a large group of healthy older adults (McFall, McDermott and Dixon, 2019). These adults did not have cognitive impairment, but like any group of older adults, they varied widely in terms of their level of cognitive ability, and their rate of change in cognitive ability over time.

Scientists were able to divide these older adults into three groups based on their level of cognitive performance and the pattern of change in cognitive abilities: A high-functioning group that showed above average and stable memory functioning over time, a normal aging group, and a lowest functioning group that had the lowest memory functioning and the greatest loss of memory functioning over time.

The scientists looked at 17 different biomarkers and lifestyle variables to see if they were useful for predicting individuals’ membership in each of the three groups. The results were complex, but the overall picture is one where specific biomarkers within certain age ranges predict important memory differences and change across time. 

This pattern of results makes sense, given a recent report that important targets for dementia risk prevention may also vary by age (Livingston et al., 2020). Early in life, higher education may pay the most dividends in terms of preventing late-life dementia. In midlife, hearing loss, hypertension and obesity may be key modifiable risk factors. In late life, diabetes, smoking, depression, physical inactivity and social isolation may be the most powerful targets for dementia prevention (McFall et al., 2019). 

This evidence seems to support the idea that the goal of high-functioning cognitive ability in late life is a lifelong endeavour (Livingston et al., 2020), with particularly important targets for ensuring cognitive health emerging sequentially across the life course. 

Some important takeaway messages stand out:

There is no doubt of an important connection between the health of the body and the health of the brain (DeCarlo et al., 2014). Generally speaking, adults should not underestimate the positive effect managing their health and overall vitality may have on maintaining high-level cognitive functioning throughout life (Livingston et al., 2020). 

Cognitive functioning in late life is likely affected by multiple risk and protection factors. Studies have converged on certain modifiable risk factors for dementia prevention that have special importance at certain stages of the life course: early life (education), midlife (hearing loss, hypertension, obesity) and late life (diabetes, smoking, depression, physical inactivity, social isolation) (McFall et al., 2019). 

By the way, are you wondering what your grip strength may mean about your cognitive abilities? In aging research, grip strength has often been combined with other indicators of physiological functioning (blood pressure, pulmonary functioning and body mass index, for example) and sensory functioning (hearing and visual acuity, for example) to form a composite biomarker measure. A 2004 study showed that one such biomarker-type combination of physiological and sensory measures, including grip strength, was an excellent predictor of aging-related cognitive change over 12 years, independent of actual age in years (MacDonald et al., 2004). 

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Our motivation to achieve is deeply embedded in our personalities. The desire for accomplishment and competence is not just a spinoff of youthful vitality; it will be present right into later years of life.

This is worth careful consideration, perhaps especially for high achievers. Aging is a heterogenous process. There is no stereotypical way everyone ages. The choices an individual makes in midlife in realms including their health, socialization and career affect their satisfaction and biological vitality as they age.

Two things stand out: First, human development is lifelong. It is important to appreciate and prepare for the fact that we will need to achieve and maintain competency into old age. Second, because the ways we approach life and decision-making affect our well-being and health, we must choose well. 

So what should adults aim at to increase the probability of life satisfaction and health as they age?

Generativity vs. stagnation: The essential challenge of adulthood

Famous psychologist Erik Erikson suggested that certain psychological and social achievements are necessary across the lifecourse for healthy aging. To Erikson, the conflict between generativity and stagnation is the essential challenge of adulthood.

Generativity is the capacity and extent to which adults nurture. It is relevant to any work that positively affects the future, including but not limited to work in family, occupational and professional domains.

Generativity is intimately related to the social life and relationship development capacitities of adults. Indeed, emotional intimacy (mutuality, sharing, connectivity, good will, love) with a significant other (spouse, partner) sets the stage for generativity and shares important characteristics with it. Whereas intimacy is an expression of connection and care towards one person, however, generativity is a broadening and turning outward of intimacy towards showing care and good will to society, family and community generally (Carver & Scheier, 2012).

Cognitive, emotional and physical effects of generativity

Research shows evidence of positive effects of generativity across multiple domains of function for older adults, including but not limited to boosts in cognitive functioning, emotional well-being and physical health. 

Strong, positive social connections likely protect generative adults from aging-related decline in cognitive function. Maher and colleagues (2017) define SuperAgers as persons over 80 years old with memory capabilities for events which are equal to or better than that expected for people between 20 to 30 years younger.

Memories of recent events (i.e. episodic memories, as compared to memory for facts and dates) are critically affected early on in neurological disease associated with aging (e.g. Alzheimer’s disease; Maher et al., 2017). SuperAger’s excellent memory capabilities align with better-than-average neurological integrity right into old age.

What may explain SuperAger’s superior neurological health and cognitive performance?

Maher and colleagues (2017) show evidence that individuals with good emotional well-being tend to have higher cognitive functioning as they age. SuperAgers have high well-being, which the research shows is attributable to their strong, positive relationships. The presence and nature of these relationships are significantly associated with the better-than-expected cognitive functioning and neurological integrity in SuperAgers in old age (Maher et al. 2017). 

Within the realm of physical vitality and health, research following older adults over a 10-year period showed that older adults with higher levels of generativity were less likely to pass away or incur a disability that affected their activities of daily living (Gruenewald, Liao, & Seeman, 2012).

Interestingly, it doesn’t take years to garner effects from generativity on health status: Older adults engaging in generative activities show a corresponding drop in inflammatory markers and increases in well-being over as little as six weeks (Moieni, 2020).

Being generative. Where to start?

There are four essential acts of generativity: To desire, to give birth to, to accompany, and finally, to let go (Becchetti & Bellucci, 2020). An important point stands out here. It makes sense for individuals to continue their generative journey from where they are presently at.

Do you desire to give back to your community? It may be time to give birth to a special project relevant to the present needs of your community. Have you nurtured a project or business and now feel it’s time to let go? Perhaps you ought to think about your desires again.

Generativity is accomplished in many ways, and in many domains. In professional life, generativity may come from creating organizations, passing family-run corporations on to the next generation, writing books, and contributing to professional boards and organizations in a way that helps mobilize, stabilize and strengthen future work within the profession, for example.

In civic realms, contributing to programs or projects that enhance critical community capacities are examples of means by which individuals live generative lives.

In family realms, child rearing and having a positive impact on grandchildren contribute to generativity. In fact, effects of generativity on cognitive function have been documented in grandparents who babysit grandchildren: Rate of decline in memory function is associated with hours of grandparent caregiving, with grandparents engaged in babysitting showing better resiliency to memory decline with age (Sneed & Shultz, 2019).

Generativity: The building block of resiliency and well-being in old age

Generativity is the substance that forms one’s sense of satisfaction with life in old age. An example from horseback riding is pertinent. Reining is often described as western dressage. The pinnacle move of a reining pattern is the sliding stop. There are two anomalies about the sliding stop. The first is that it rubs philosophically that a “stop” could be a pinnacle move: Stops usually come in life after all the excitement has been had. The second anomaly about the sliding stop is the process of achieving one. Horseback riders accelerate as hard as possible, hands forward, reins draped, urging the horse to accelerate right until the moment of cueing for the stop.

When that moment comes, the horse’s powerhouse rump and leg muscles are already engaged to power the acceleration. The stop then isn’t a total change in course: the horse’s legs, extended far under the animal’s body, and hooves gripping hard, are in the perfect spot for a dust-billowing, sliding stop.

That’s a lot like generativity in adulthood, and how it transforms itself into satisfaction in old age, even in the face of loss.

Generative adults grip hard by investing skills and abilities in a way that will create positive impact beyond their lifetimes. And when it’s time to stop, they are hopefully and expectantly positioned for a glorious sliding one. They aim well, so that retirement can be their pinnacle move of a lifetime, while simultaneously giving themselves the best chances of retiring with well-being, strong relationships and health.

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