University Place Positive Aging Series Carol Ryff, "Resilience In the Face of Later Life Challenges" 7/23/2010  UP 461   cc >> Welcome to today's Positive Aging Lecture. My name is Ann Albert. I am director of Supporting Active Independent Lives. This marks our fifth Positive Aging Lecture. Our sponsors of this lecture series are Continuing Education at the University of Wisconsin, Oakwood Village, and Supporting Active Independent Lives. Our presenter today is Carol Ryff. She'll be speaking to us about resilience in the face of later life challenges. We're honored to have Carol with us here today to share her findings and research about this very important topic. Carol is the director of the Institute on Aging at the University of Wisconsin. Her research centers on the study of psychological well-being, an area in which she's developed multidimensional assessment scales that have been translated into over 25 different languages and used in studies worldwide. 

Since 1996, she has edited four books on these topics and directs the Midlife in the UW National Survey funded by the National Institute on Aging. We welcome you here today, Carol. Thank you. (applause) >> So thank you for your welcome. I think everybody can hear me, right? This sounds fairly loud to me. So raise a hand along the way if I fade out and you can't hear me. So I'm delighted to be here speaking about my favorite topic, resilience, and I hope by the end of my presentation you will have an understanding of what I think resilience means and how it is that some people manage to achieve it over the course of their lives. So I'm director of the Institute on Aging, as was noted in the introduction, and what we're trying to do at the aging institute at UW Madison is to promote through excellence in research, education, service and practice, the health and well-being of the rapidly expanding aging population. Here you are. And I would say this is a topic that I'm very interested in, both as a scientist and a researcher, but I'm also very interested in it as I follow the aging of people in my own family, my parents, aunts and uncles, and even as I make sense of my own aging. 

So I guess the good news about aging is that it's a journey of adventure, that those among us who are lucky will be able to actually experience it. We emphasize strongly at the UW Institute on Aging positive aging, and I hope I will give you a flavor for what we mean by positive aging as I go through my comments. It turns out all kinds of things have been written on the topic of successful aging, so if you were to browse the aging section at Borders or Barnes and Noble, you would find all kinds of topics like this. Some of these books are written by academic researchers, but some of them are written by and for the general public. And they are summarizing what have we learned about how people can age well. And this little graphic I think is actually an important point in illustrating, in my view, what successful aging is about. Let me begin with the observation that successful aging does not mean that you lead a life that is problem free. If you live long enough, virtually everyone will experience some degree of loss and adversity, and we know from the scientific research the big population epidemiological studies that you will deal with chronic conditions, increasing health challenges. So when we think about aging in the life course, the adult years in particular, of course initially we're primarily interested in prevention. The first line on this slide. 

We want to promote a disease-free optimally functioning period of life for as long as possible. But, as I said, if you live long enough chronic conditions are going to crop up in your life. And you will deal with some restrictions on your functional capacities. And in that phase of your life, successful aging is defined as actually being able to maintain as much independence and functional capacity as possible. Resilience is also very much about recovery. Recovery after acute events, which can be acute health events but they can also be acute social and psychological events. And so the goal in the resilience framework is to reestablish, regain as much functioning as possible after you've gone through a loss or a major health event. So the message here is successful aging is a kind of changing target. It's a changing target depending on the challenges that you are confronted with. And resilience, to zero in on what exactly do I mean by resilience, it turns out resilience is studied a lot in the scientific world, both in childhood and in old age. 

In childhood, resilience is studied by following children who have grown up under extreme poverty or children who have grown up with alcoholic or schizophrenic parents. And the good news is that people who have studied such children with very difficult beginnings is that many of these children actually do well in their lives. And so there's, of course, interest in trying to understand what accounts for the fact that some of them have done well. And the research that we do in adult development and aging, we define resilience as the capacity to maintain or regain your well-being. And I'll explain what I mean by well-being shortly. To regain, maintain your well-being in the face of challenge or adversity. And some of the challenges that we have studied are experiences of relocation in later life, many older persons are in care-giving roles and we've studied their capacity to maintain or regain their well-being in the face of care giving. We've looked at well-being in the face of illness or chronic conditions. As I said, we've studied people who live with an alcoholic. We've done a lot of research on daily stress, how people are able to maintain their well-being in the face of daily stress. 

And I'm particularly interested in the well-being of people who are socioeconomically disadvantaged. And by that I mean people who were never able to get a college degree, people who have gone through life with limited educational attainment or they may have limited incomes. They've never really had high job status. But interestingly enough, some of these people have very high well-being. And I will argue that I think their capacity to hang on to their high well-being is an important protective resource as they age. And it has a lot to do with how their physical aging unfolds. So this is just a slide that says lots of people have studied resilience in adulthood, actually across the life course. There's a big literature on resilience. And I think it's really interesting because it's basically not defining successful aging as a problem-free life, which I think doesn't characterize probably anybody in old age. It's more about how do you engage the problems and the challenges and the difficulties so that they don't greatly compromise your quality of life. 

So our approach to studying resilience, it's very much mind-body. We think that resilience is not just about getting your attitude right, that certainly matters, but resilience is also about how your mind and your psychological outlook actually influences your body. The brain is obviously involved, and we're trying to integrate that piece as well. So our approach is what we call studying health and well-being in later life through an integrative approach. And that's what we mean by academic words like multidisciplinary. And what that means is I don't study aging just as a psychologist, which is my disciplinary training, I collaborate with people who study the medical aspects of aging, the biology of aging, people who study economic aspects of aging, it requires an integrative approach. And that's really what we're pursuing in our studies. So let me just say a little bit about aging bodies. I think it's good to begin with a metaphor. This is a pretty good example of an aging body, wouldn't you say? Particularly compared to this. 

(laughter) We know we would all prefer, metaphorically, to be captured by the first image. And here's a really interesting example of a kind of human version of that. A woman who, at the age of 100, still takes a dance class. So she's probably, in terms of her fitness and her functional capacity, she's probably way out there in terms of an exceptional older person. But it's important for us to see that these models are out there because they can serve as kind of inspiration, I guess. Here's a male version. This guy is only 72. He's barely out of adolescence. (laughter) But he's also remarkable. This is a picture about his participation in a triathlon at age 72. 

How about that? The aging mind, we care about that. And there's a lot of comedy about what happens to the aging mind. (laughter) This is a good one, isn't it? Memory loss occurs even for Superman. And then there are these endless wonderful cartoons about aging couples, Bob and Shirley, did I finish what I was saying before? The response is, finish what? Before what? So those are funny and actually let me just say for those of you who may experience some degree of memory loss or difficulty retrieving things from your memory, particularly more short-term memory, that's normal. That's normal. So there's a point at which it moves into indicators of more serious cognitive impairment. But some degree of retrieval difficulty with aging is normal, and I think people need to understand that. I experience it now myself, and so I tell myself I just can't remember that name. It's okay Carol, you'll get it in a minute, settle down. But when we think about the loss that some people experience with aging, it's also, in the purpose of in the spirit of inspiring ourselves, it's important to remember these incredible examples of later life achievement. 

So Michelangelo lived more than 400 years ago. In his 70s and 80s he completed the Last Judgment in the Sistine Chapel in St. Peter's Basilica. And then I like to show this slide about great late life events. So Michelangelo, Sophocles from eons ago wrote Oedipus Rex at age 75. Ben Franklin invented the bifocal lens, something we are all grateful for, when he was in his late 70s. Gandhi launched India's independence movement in his 70s. Helen Keller published her famous book at age 75. Wisconsin's own Frank Lloyd Wright completed the Guggenheim at age 91. Arthur Rubinstein wrote his book "My Many Years" at age 92. I don't know if any of you have ever looked at some of the photography of Imogen Cunningham, wonderful photography of old people which she published in her 90s, and it was about imagery of old people after 90. 

And then how about this, Mae West starring in Sextette at 85. Incredible, right? So these people, I think, are really valuable for us to reflect on. Even if you see them as kind of far removed from your own experience, they're important for conveying what's actually possible in the later years, even among uniquely talented, driven, ambitious people. So at UW Institute on Aging coming back to our work, we focus on what we call these integrative pathways to health and well-being in aging. And that means we pay attention to assessing what's going on in the body. So the imagery here points to different aspects of things we study, cardiovascular risk factors, bone health, what's going on at the cellular level, but we also do a lot of assessment about what's going on in people's work and family lives, their engagement in their communities. I'm particularly interested in what I call healthy minds, people's emotional well-being, the extent to which they are meaningfully and purposefully engaged in life, how that's instantiated in their brains. And then, of course, there's the part about health behaviors. What you eat, how much exercise you get, your sleep. These are all critical ingredients on this pathway to healthy aging. 

So in our scientific studies we've been going after this hypothesis, I guess you could call it, or proposition, and that is that positive psychological social factors contribute to better regulation of various biological systems in the body measured by things like your stress hormones or inflammatory processes within your body or cardiovascular risk factors. So we are doing research to show that people who have high well-being have a more positive biological profile. And that more positive biological profile, we argue, is actually going to be instrumental in keeping them functional and maintaining good health for longer periods of time. These ideas are anchored in some work that I published over a decade ago about health, about the meaning of health. So it turns out in the current medical world health is almost exclusively defined as illness and disease. But if you look at the historical record, for example, if you go back to the Oxford English Dictionary and you look at a definition of health from 1000 AD, you find that health is defined as spiritual, moral, and mental soundness, well-being that is. Or even the World Health Organization over half a century ago defined health as the state of complete physical, mental, and social well-being. That conception of health actually got left behind in medical models of health, but now that we are doing a good job of defining what well-being is and learning how to assess it so that we can quantify it because if we can't quantify it we can't actually do rigorous scientific research on it. So we've learned how to define well-being, how to measure it and that gives us an entirely new scientific agenda which is investigating the biology and the neuroscience, neuroscience is my code word for the brain, the biology and the neuroscience of well-being to ask this question, does well-being afford protection against illness and disease? And if so, how does it work? What are the mechanisms? That's the part the scientists are so interested in. Let me just note, for those of you who like to read about aging, I think this is actually a very good book whether you like Jimmy Carter's politics or not. 

This is an incredibly well-written book about the virtues of aging. And in this book he asks himself what is good health and answers, "More than being able-bodied, it involves self-regard, control over our own affairs, strong ties with others and purpose in life. These things don't just evolve automatically, they have to be sought and maintained. The key point is that physical and mental activities strengthen each other and provide the necessary foundation for successful aging." The fact that these good things in life have to be sought after, pursued, is consistent with another wonderful book called "The Conquest of Happiness" by Bertrand Russell. He made the point that happiness does not just fall into our mouths like freshly ripened fruit. It's something we have to actively seek, we have to work at. And how we do that, I think is part of what I would like to explicate as I move through this. So in the scientific circles, these are some of the words that we use to, sorry this is fading out, am I doing okay? >> Yes. >> Okay. These are some of the words that we use to capture what well-being is. 

There's a group of components of well-being that fall under the heading of eudaimonic well-being, which actually goes back to the writings of Aristotle, who wrote in the Nicomachean Ethics, he first asked the question, what is the highest of all human goods? And he answered that it is about eudaimonic well-being. It's not just contentment and happiness, which actually are captured under the hedonic components of well-being. Asking how happy are you, how often you feel positive emotion, are you satisfied with your life. But eudaimonic well-being is more making the most of our talent and potential. And there's no period in life in which that is not relevant. It is relevant for every step of the way that your life has purpose and meaning, that is you have goals and objectives to live for, things that get you out of bed in the morning. That you feel you are growing and developing as a person. That, I think, is tremendously important in the later years of aging that people continue to expand their horizons, take in new experiences, new areas of knowledge, whatever they might resonate to that you don't ever get to a place where you assume I know everything I need to know. Certainly cultivating positive relations with others is a key component of high quality living, well-being. Feeling that you can manage the environment around you, something we call environmental mastery, is a key component of well-being. 

Self-acceptance means positive self-regard, but it's deeper and richer than that. It also means that you can forgive yourself, that you know something about your own limitations, perhaps things in your life that did not go the way you wanted, and with aging there needs to be a kind of coming to peace with that, accepting yourself and your life for what it is. And then autonomy, it turns out, in my cross cultural research we're now doing a lot of collaborative work in Japan and I've come to appreciate that autonomy is a very western component of what it means to be well. Autonomy is essentially marching to your own drummer, feeling that you can live by your own beliefs and convictions even if they may go against the conventional wisdom. So this slide basically repeats. In the middle here in the pie you see the six components of well-being that I just gave you a kind of brief verbal definition about. I did not think up these components of well-being. They came from the works indicated in blue that I read over a period of time and tried to integrate and distill into a coherent formulation of what psychological well-being is. And then we developed tools for measuring it. Much in the same way that psychologists measure people's values and their attitudes or their personality traits, we asked them to answer lots of questions. 

And their answers to these questions go through rigorous psychometric analysis where we establish the reliability and the validity of these, what are called, self-report assessment tools. And it's with these self-report assessment tools that we can now begin to look at how well-being is linked with biology and with what's going on in the brain. We are studying these things in the context of this national study of Americans that I currently direct. It's called MIDUS, the acronym stands for Midlife in the US. It was a study begun in 1995 funded by the John D and Catherine T McArthur foundation. It involved over 7,000 Americans between the ages of 25 to 75. And about nine years later we got a large grant from the National Institute on Aging to do a longitudinal follow up of these people, which we have now completed, so we have 9 to 10 years of longitudinal data on these people, numerous, numerous questions about their psychological and social well-being, their work and their family life, but at the second time of assessment we also began measuring in great depth and detail what we call biomarkers, numerous indicators of stress hormones, inflammatory markers, cardiovascular risk factors, we also began, for subsamples of these individuals, assessing brain function, structure and function. It's all collaborative research. You've perhaps heard some other investigators from the study who are working on it. This is a slide that shows you what we initially learned at baseline about these six aspects of psychological well-being and how they fare as a function of age. 

So this is data for women, and above each of the three age groups what we have plotted are the average scores on these six components of well-being for young, midlife, and older aged women. Many things you see look like they are fairly steady across these age periods. For example, positive relations with others doesn't look like it varies much as a function of age, or environmental mastery, the white line. Autonomy for women looks like it may actually show some increments with aging. But notice the steeply downward trajectories on purpose in life and personal growth with aging. And we see that same downward trajectory in the data for men. These are the green lines and the, I don't know, pink, purple, I guess you're seeing purple, I'm seeing pink. Those downward trajectories on the sense that your life is purposeful, meaningful, you've got goals and activities that contribute, reasons for getting out of bed in the morning and the sense that you're continuing to develop as a person, learn new things, broaden your horizons, that we saw these initial cross-sectional decrements on those aspects of well-being was very upsetting to me because I carry this mantra of positive aging and I want to see the evidence that, on average, things look pretty positive. This was just cross-sectional research so it could have been that it's not necessarily that these things are getting worse as people age. It could be that there is what the researchers call cohort differences, that maybe these older men and women never really had higher levels of purpose and personal growth compared to the other age groups, but we now have longitudinal data and our longitudinal data made clear that these average changes on declines of what I would call the most existential aspects of well-being, those aspects of well-being that are about your sense of meaningful engagement in your life and your sense of self-realization, those things on average are declining, but here's the critical message. 

There's a lot of variability around those averages in later life. That's just a point that adds together all the scores for men and women in that age group, and there's a lot of variation around those averages, and that variation ends up being very important when we start building these bridges to biology, as I will explain. These slides I think are important too. This is where we compared levels of self-reported well-being as a function of educational status. So there's college at the far right, some college, high school, less than high school. So what you see here is strong evidence that well-being and education are positively related. And you see the same kind of finding here for men. But note for women I think it's a steepward upward trajectory of well-being scores as a function of education, which I think may actually reflect cohort differences in women's opportunities for increased educational attainment. In any case, this is a great story if you're well educated, right? But, and I bring exactly the same point to these findings that I bring to the aging findings, those lower levels of well-being among high school educated or less individuals are averages and there are people at that level of educational attainment who have high well-being and it does good things for their biology. So the point I think I'm making here is that a lot about our well-being is something we can work on, go after. 

As Bertrand Russell said, make it a conquest. So the linkages to well-being and biology, these are just examples of some of the biomarkers that we are connecting well-being to. So neuroendocrine regulation is another term for stress hormones, like cortisol, epinephrine, norepinephrine, immune function is where we're measuring a lot of inflammatory markers such as interleukin-6, c-reactive protein, vaccine antibody responses. And then there's the cardiovascular risk factors, those are I think more commonly thought about by people on the street because those are things that get assessed when you go to the doctor, your weight, your blood pressure, your cholesterol levels. HbA1c is glycosylated hemoglobin, that's an indicator of risk for diabetes, it's called glycemic control. We do assessments of sleep, sleep is very basic. And we measure it both subjectively and objectively. And then in collaboration with Richie Davidson we are also measuring various aspects of neurofunction, brain assessments related to well-being. So some of these, I'm just going to go through these quickly and I apologize for this, it's kind of the dry scientific part. But the truth is I'm a scientist, I'm not a performer, so I'll try to make this as interesting as possible and get through it without belaboring the details too much. 

An initial publication linked well-being to biology, and it was based on data we had from a longitudinal sample for aging women. This was not MIDUS data, it was a prelude to the MIDUS study. And we found that aging women who had higher levels of well-being, especially things like purpose in life and good quality relationships with others, they had lower levels of cardiovascular risk measured by these various indicators, and they had better neuroendocrine regulation, lower levels of daily stress hormones measured with salivary cortisol. They also had lower inflammatory markers. They slept better at night. This was another study with the same older women where we linked, we brought in a particular biomarker, interleukin-6, that is a precursor to numerous disease end points, and we found that both social relationships and sleep quality were important influences on interleukin-6, and I don't have time to go through that. These are some recent publications, not from our group but from other people who are now starting to study things like purpose in life, and this is a recently published study showing that purpose in life contributes to longer life in community dwelling older people. The first graphic on the top basically says older people in the community sampled over a thousand individuals. If they had higher purpose in life, they had fewer depressive symptoms, less disability, lower levels of neuroticism, fewer medical conditions, and they tended to have somewhat higher income. The graphic at the bottom, you can probably barely see those two lines, but that's a graphic that plots in years what is your risk of death as a function of your level of purpose in life. 

So the black line at the top, the darker line, is for people who have low purpose in life, and you see that over the years of the study they were at notably greater risk for death compared to those in the light line who were people with higher levels of purpose in life. These same researchers who are in Chicago at Rush, they also linked purpose in life to Alzheimer's disease, mild cognitive impairment, again showing that purpose in life reduces the risk of Alzheimer's disease. The filled black circles indicate individuals who had high purpose in life, and what you see is that they had reduced risk of developing Alzheimer's disease over the six-year period of the study compared to those who had low purpose in life. And these are, I'm running out of time here, these are just more studies bringing in the neuroscience end of this research. So we find that those who report these subjective self-reports about well-being, they show more relative left prefrontal activation. In the neuroscience research of Richie Davidson, that's linked with a better emotional profile. And a more recent study, this one is hard to describe in just a couple of seconds, but this is a study where they brought people in for neuroimaging. So people are in the magnet, they're being exposed to different kinds of emotional stimuli, and then blood flow is being tracked in their brains, and the first finding was that those who react more quickly to negative emotional stimuli show greater activation of the amygdala. So that's just linking negative emotional stimuli to activation of the amygdala. But that effect is modified by levels of higher psychological well-being so that if you have higher psychological well-being, you're slower to actually recognize the negative stimuli and you have less activation of the amygdala and you also show increased activation of another part of the brain called the anterior cingulate cortex. 

And this is the punch line. These findings suggest that people high in psychological well-being effectively recruit the ventral anterior cingulate cortex when confronted with potentially aversive stimuli, manifest reduced activity and subcortical regions such as the amygdala, and appraise information as less salient as reflected in slower evaluative speed. So this is just evidence saying on one level it's not surprising it's just that we're finally now seeing the evidence, the concrete evidence that well-being is anchored in your brain, and it affects how quickly you respond to negative stimuli and whether or not negative stimuli activate other parts of your brain, such as the amygdala, that tend to be the place where a lot of negative emotional experience occurs. I think, unfortunately, let's see, how much time do I have? Another seven minutes. Okay. So we do case examples of resilient people because otherwise it's all about numbers and you can't get a flavor for who are real person is, and this is an example of a man who's actually in midlife, he's in the MIDUS study, and he is up against some very difficult things. And we know something about his reported well-being so here's the details about this man. He's 45. Works in a liquor store. High school educated. 

Here's his income. His wife, age 42, has cancer. She drives a bus. They have three kids. He grew up in a small town. Lives close to his parents. Religion is very important to him. He fought in the Vietnam War. And he's in good health except occasional back aches, and he smoked when he was younger. When we look at his scores on psychological well-being, those are his scores down at the bottom part of the graph, and we compare them with other men of his age and education group, we find that this man is standard deviations above the mean for his age group on positive relations with others. 

That means he reports having notably more positive relations with others than other men of his age group. The same thing was true for his reports about purpose in life, that's why the asterisk is there, and his self-acceptance. For the other measures of well-being he's comparable to other men of his age group. But then we look at his actual words about his life in some open-ended interviews. We asked about how he would evaluate his life in general. "So far it's been a good life. I have wonderful children, a decent wife, a little house in the country, and, you know, I'm not in debt up to my eyeballs. My life isn't perfect but nobody's life is perfect, everybody has ups and downs." We asked directly, what do you see as your life purpose? "Well, to help other people, raise my children, be as good as I can to the people around me, you know, my wife, my coworkers, neighbors, friends. Just try to be as good as you can until your life ends, and hopefully it will keep going after that. I'm sure religion has something to do with it, some type of God feeling, having well-being. 

That gives another little purpose of some sort." On caring for others, in particular his wife. "A lady who lives in my area, she knows my wife, she stopped me one time and said I should pat myself on the back for being so good, and I said why wouldn't I be there, where else would I be? And she said, 'Well, when I was having my lung surgery, my husband was out playing golf.' I think it's just common sense to be there. Caring comes very easy to me. I don't even think about it. I just do it." On his self-confidence. "I don't have a lot of self-confidence, I probably should have more but I think society knocks that down. I'm a high school graduate. I'm not a college graduate. I have no desire to go to college. I'm 20 years into this job. 

I don't make an exorbitant living but it's comfortable. I'm assuming I probably could have done a lot better if I would have pushed myself more but I didn't. But that's the way life goes." That's the self-acceptance part. What it means to have a good life. His view. "My life I think is fairly simple. And it's simple. I mean, we don't go out a lot. It's kind of tough anymore. Like taking the three kids to a ball game, like to see the Philadelphia Phillies. 

We can't afford it. Run us about 300 bucks, you know, to get in, have a couple hot dogs, some French fries, buy the kids a cap or something like that. So we don't do those things. We play a lot of board games at home. We have video games we play or we rent movies instead of going out to the theatre at seven, eight bucks a pop. We rent a movie, you don't see it right away but in six months to a year they're all out anyway. So we do things like that and that's a pretty good life." And this is critically important. It's about keeping a good news diary. Pay attention to the good things in your life everyday. "We went out to dinner, went to a private club," this is what did he do to make his life go well the day before, "then we watched a movie, just having peace and quiet was a big thing. 

When you're married and have a lot of kids, you don't get very much time alone. Then to have it alone with your spouse, that's incredible." And he also said, "I get lot of enjoyment out of playing music. Just in the past few days I sat down at the piano and played and that gives life enjoyment. It's relaxing, it's just relaxing." He told us there's a lot of negative in his life because of his wife. "Because of the very negativeness of having cancer she's a terminal patient, she's terminally ill. I mean this is what's going to get her eventually. But when you get bright spots, like for example when you she scanned Monday, tomorrow we'll be down in Philadelphia finding out how those scans went. If those scans went well, well that's a positive coming out of a negative situation. If those scans don't go well, we'll be a mess for a couple of days till, you know, we figure something out." This is resilience in action. So my last comments are just about the fact that well-being can be promoted. 

So if you happen to see yourself as maybe one of those people who see the glass half empty rather than half full or you know other people who suffer from depression and lack of well-being, there is encouraging research being done by Giovanni Fava using something called well-being therapy to show that even for people who are not naturally predisposed to see the positive in their lives, those things can be changed, and he does it, essentially, by having people keep a good news diary. It's low tech intervention. What you are required to do is keep a daily diary, and all you can write in your diary are about good things that happened to you that day. The diary is not a place to ruminate or carry on about what's wrong with your life. The diary is a place to record what's good in your life in a regular practiced way. And his research shows that people who practice well-being therapy, this is a slide showing the proportion of patients remaining in remission, that is they did not fall back into major depression. So the people who got well-being therapy, which is part of the cognitive behavioral therapy package, that's the top line, many fewer of those people fell back into major depression over the course of treatment compared to people who are just taking standard antidepressant medication. And then they did a six-year follow up and the six-year follow up showed essentially the same pattern. So these everyday low tech tools can make a difference in people's lives. It requires, though, an effort on the part of each individual to see and construe the positive in their life, savor the good even though there may be a lot of bad that you may be confronted with as well. 

So I am not, as director of an aging institute leading a major national study of aging, I'm not promoting immortality, I'm not promoting endless length of life, I think it's quality of life that really matters the most. We can learn from people who've lived a long time. They tell us what their own theories of positive aging are about. (laughter) And let me note I think this is a very mind-body theory from this centenarian. My final take home messages are these: Psychological well-being is a key ingredient of healthy aging. It promotes better biological regulation. It offers protection against external challenge in adversity. And most importantly it can be promoted, it can be learned even if it's not part of your regular daily experience. Thank you very much. Here's my email if you'd like any further information about any of this. 

(applause)