E. Religion and Spirituality                               Return to the Beginning

We all know of elderly patients who have used their religion and spirituality to cope with serious illness, but can faith actually affect the length and healthiness of one’s life? Findings are mixed. Some studies show that the longest-lived do tend to make religion and spirituality an essential part of their lives. Other studies do not find a difference (Purdy, 1995; Vaillant, 2002). It may be that a strong faith is less important for those who are well, but does help those who are sick cope with their illness. In fact, patients who have “religious struggle” because of their illness are more likely to die (Pargament, Koenig, Tarakeshwar, & Hahn, 2001).

1. A Strong Faith and Optimism

When spirituality does make for better health, it may be because those who have a strong faith may be more optimistic. Those who go to religious services and engage in private prayer tend to be both more optimistic and have better health (Krause, 2002; Ai, Peterson, Bolling, & Koenig, 2002).

2. The Social Benefits of Religion

Elders who participate in some organized religion may also have more opportunities to make and be with friends, which we have seen is important to healthy aging. Some believe that the emotional support they find in their religious organization is responsible for their closer relationship to God which in turn leads to greater optimism (Krause, 2002). Health promotion programs for African American middle-aged and older women conducted in churches have also been very effective (Yanek, Becker, Moy, Gittelsohn, & Koffman, 2001).

F. Life Circumstances

What about what happens to us? Do our life experiences affect how long we will live and how healthy we will be? Those who live to be 100 or more are a diverse group. They are rich, poor, educated and not, from large families or small ones, living in mansions or in shacks with no indoor plumbing. In fact, the “average” centenarian in the Georgia study had a grade school education and an income of only $4,000 to $7,000 (Purdy, 1995). However, information gathered from the whole population shows that life circumstance does make a difference.

1. Income and Education Say a Lot

Education and income seem to be the most important life factors leading to good health. Patients with more education and income have fewer disabilities and better mobility, hand coordination, visual acuity, and cognitive functioning (Administration on Aging, 2001; Snowden, Ostwald, Kane, & Keenan, 1989). Overall, more educated people have half the disability rate of less educated people (Cutler, 2001, cited in Korczyk, 2002.).

One link between education, income, and health is occupation. Experts have suggested that those with more education and income are healthier because they were more likely to have had less dangerous white collar jobs (Redfoot & Pandya, 2002).

Also, income certainly affects access to care. Last year, Medicare HMO patients had a 20% to 34% increase in their out-of-pocket costs. Those in the poorest health paid an average of $4,783 (Gold & Achman, 2002) for out-of-pocket health costs. Elders who survive on low fixed incomes may be forced to choose between care, food, medication, and shelter, all necessary to good health.

However, the “nun study” seems to show that education itself can improve health. Those nuns who had more education lived longest even though they had the same income as those in their orders with less education (Snowden, 2001).

Why is education so important? It may be related to the positive effects of mental activity discussed before. Those with more education may have been motivated to stay in school by their natural intellectual ability. Or perhaps people are more likely to enjoy reading and other intellectual activities if these became a part of their everyday lives during their years in college.

2. Leaping The “Gender Gap”

Being a woman means your average lifespan is 5.4 years more than a man’s (National Vital Statistics Systems, 2002). While the gap is closing, most likely due to medical advances, for many years older women have had significantly longer lives and more years without disability than older men (Redfoot & Pandya, 2002; AARP Andrus Foundation, 2002). Why? Besides the purely physical differences between men and women, greater longevity may be linked to the fact that women tend to have more physician visits and medications (Bosworth & Schaie, 1997). In addition, women tend to have stronger support networks (Barker, Morrow, & Mitteness, 1998; Liebler & Sandefur, 2002).

3. The Long-Lasting Effects of Discrimination

African-Americans live an average of 5.7 fewer years than whites (National Vital Statistics Systems, 2002). In addition, minority elders are much more likely to say that their health is “fair” or “poor” than white elders (Administration on Aging, 2001). Poor health among minorities may be related to access to care. “Minority elderly Medicare beneficiaries are less likely to receive specialized services, such as angioplasty, coronary artery bypass graft surgery, or hip fracture repair. Only 43% of black elders received flu shots in 1998 compared with 65% of white elders” (Davis, 1999, p. 11). Previous discrimination by the health care system may also contribute. A study of African-American elders showed that a “lack of confidence in formal health care system” was a barrier to good health (Dancy & Ralston, 2002).

4. Who Needs a Happy Childhood?

But what about early life? Does that predict which of your patients will live longest? Apparently, having a happy childhood affects well being for many years, but the effects are gone by old age (Vaillant, 2002).

G. Genetics

Some, but not all, of the healthy oldest-old should thank their genes. Researchers from the New England Centenarian Study have found gene may explain some of the genetic basis their for very long lives (Perls & Terry, 2003). In that study, “50% of centenarians have first-degree relatives and/or grandparents who also achieve very old age, and many have exceptionally old siblings.” Children of centenarians also appear to have less cardiovascular disease, diabetes, and mortality (Perls, undated, p. 2). However, the Georgia Centenarian Study also found many over age 100 whose families were not long-lived (Purdy, 1995).

H. But Should My Patients and I Buy Green Bananas?

As we have seen, very long-lived people share physical, mental, social, spiritual, and environmental characteristics. At the same time, one aspect of health may have many be influenced by many factors. The Seattle Longitudinal Study found the risk of cognitive impairment was reduced by all of the following: lack of cardiac and other chronic diseases, 2) high income and a good environment, 3) intellectually stimulating environment, 4) being flexible in attitude at midlife, 5) a husband or wife with good cognitive functioning, and 6) continuing high levels of “perceptual processing speed.” (Seattle Longitudinal Study, undated).

Exactly how all the relationships work together will depend on the unique circumstances of each patient. While it would seem unlikely that a computer program can calculate how everything we have discussed can predict an individual’s longevity, the New England Centenarian Study feels confident they have created just that. Interested in how all the elements of your life may affect how long you will live? Just for fun, you may wish to log onto the “Living to 100 Life Expectency Calculator” at www.livingto100.com. After putting information into a survey the Calculator will tell you how many years it calculates you are likely to live.