Ageing is a universal journey, yet for those of us who are considered fortunate enough to experience this, it is all too often fraught with challenges. Whilst ideally, old age should be a time where we experience the benefits of increased wisdom, respect, peace, and quality free time, for many, these benefits either do not exist, or if they do, they are far outweighed by the physical, emotional, mental, and environmental challenges encountered. This is most apparent in the western world, where modern society, with its fast paced and increasingly self-centred and intolerant approach to life, sadly has little time or respect for the needs and value of older people.
The Centre for Ageing Better, in their report entitled “Our Ageing Population/The State of Ageing 2023/24”, gives us the following statistics:
In England, in the last 40 years, the number of people aged 50 and over has increased by over 6.8 million (an increase of 47%) and the number of people over 65 has increased by over 3.5 million (an increase of 52%). 4 in 10 of us are now over 50. There are 10 million people aged 65 and over, constituting 18% of the population. The number of people aged between 65-79 is set to increase by a third over the next 40 years whilst the number of people aged 80 and over is predicted to double (over 6 million). A quarter of all people over 50 now live alone, and by 2043 it is predicted that over 4.5 million people aged 65 and over will live alone. By the age of 70 – 74, one in three women and one in four men are disabled.
What is becoming increasingly clear, is that as a population, we are not only living longer, but in far too many instances, we are actually suffering longer. As a society, we have come to accept, and more critically believe, that illness, weakness, disability, and cognitive impairment are an inevitable part of ageing, yet this is simply not the truth. Unfortunately, until we properly challenge this misperception, we will remain the orchestrators of our own decline and demise in old age.
This traditional view of ageing as a period of unavoidable decline is fortunately increasingly being challenged by neuroscience. Neurogenesis, the process of generating new neurons, continues into adulthood, and research suggests that this may counteract age-related deterioration in cognitive, emotional, and mental health. Studies show that the adult human brain remains remarkably plastic, capable of structural and functional renewal through neurogenesis, particularly in the hippocampus, a region central to memory and emotional regulation.
Neurogenesis
Neurogenesis is the process by which new neurons (nerve cells) are created in the brain. For a long time, scientists believed that neurogenesis only occurred during early brain development, and that once we reached adulthood, our brain had stopped producing new neurons. Recent research has revealed that neurogenesis continues to take place throughout our lives, particularly in areas of the brain associated with memory, learning, and emotional regulation. This discovery has profound implications for our understanding of the ageing process and our capacity to influence it. If our brains can continue to generate new neurons as we age, this means that we all have the potential to maintain or even improve cognitive function as we grow older.
The process involves several key steps which begins with stem cells. These are special cells that have the ability to develop into different types of cells, including neurons. These stem cells differentiate into immature neurons. Over time, these new neurons mature, form connections with other neurons, and integrate into existing neural networks. The discovery of adult neurogenesis shows that the adult brain is much more plastic than once believed, meaning that it can change, grow and adapt over time.
Neurogenesis also enhances cognitive resilience, improves mood regulation and is protective against neurodegenerative diseases. Higher rates of neurogenesis in the hippocampus have been linked to better memory and cognitive function. Even in older adults, maintaining neurogenesis can help preserve mental sharpness. Neurogenesis is also linked to emotional health. Studies suggest that increased neurogenesis may reduce the risk of depression and anxiety, common mental health challenges that are often associated with ageing. In conditions like Alzheimer’s Disease, there is a significant reduction in neurogenesis. By promoting the growth of new neurons, we may be able to slow down the onset of these diseases and protect the brain from damage. In short, neurogenesis means that we can protect and even enhance our brain health as we age. The more we understand this process, the more we can take steps to protect and encourage it.
How can we boost our neurogenesis?
The exciting thing about neurogenesis is we all have the power to promote it. While our genes play a role, (a role which can be influenced by epigenetics) research suggests that lifestyle factors can significantly affect how much neurogenesis takes place in our brains. Some of the most effective ways to boost neurogenesis are:
Exercise
Regular physical activity, especially aerobic activity, has been shown to increase neurogenesis, particularly in the hippocampus. Exercise promotes the release of growth factors like brain-derived neuropathic factor (BDNF), which supports the growth and survival of new neurons.
Diet
Eating a brain healthy diet is vitally important to aid the process of neurogenesis. Foods rich in antioxidants, omega 3 fatty acids, and polyphenols (berries, nuts, fish, leafy greens) can support brain health. There is also evidence that intermittent fasting, which triggers autophagy (the body’s way of cleaning out damaged cells) may promote neurogenesis.
Mental stimulation
Engaging in activities that challenge the brain, like learning new skills, playing puzzles, reading, or learning a language, can encourage neurogenesis. The brain thrives on novelty and challenges, which stimulate the formation of new neural connections.
Sleep
Getting enough quality sleep is essential for neurogenesis. During sleep, the brain consolidates memories, clears out waste products, and restores and rejuvenates. Chronic sleep deprivation can inhibit neurogenesis, so prioritising good sleep is a key factor in brain health.
Stress management
Chronic stress is one of the greatest enemies of neurogenesis. Stress hormones like cortisol can reduce the production of new neurons. Finding ways to manage stress, through activities like meditation, mindfulness, conscious breathing, yoga, or other relaxation techniques, will support neurogenesis.
Social connections
Staying socially engaged and maintaining strong relationships can also benefit the brain. Studies have shown that social interactions can stimulate neurogenesis and improve cognitive function.
The Okinawa Centenarian Study (OCS)
The Okinawa Centenarian Study is a population-based study on 100-year-olds and other elderly people carried out in Okinawa, Japan. Okinawa is a region with one of the world’s longest life expectancies and highest number of centenarians per 100,000 population. The study was established in 1975 and reviews the diets, exercise habits, genetics, psychological and spiritual practices, and social and behavioural patterns of more than 3000 participants. Its aim is to understand why so many Okinawans reach extreme ages in good health. The results emerging from this study are illuminating in that they are telling us that healthy and happy old age is strongly linked to the synergy of nourishing food, natural movement, purpose, spirituality, and community.
In other words, what is becoming increasingly clear is that The Story of Health is just as important at this stage of life as it is in any other, and if we want to increase our longevity and health in our later years, it provides us with the perfect road map to achieve this, starting with how we care for ourselves today. As such, The Story of Health and the Okinawa Centenarian Study are very effective lenses through which to examine the process of ageing, the issues faced by the elderly and how best to positively influence these areas.
The Story of Health and the Okinawa Centenarian Study
The Story of Health is the centrepiece of The Reach Approach, and much is documented about it in numerous articles on our website. Below is an overview of how the four key elements of The Story of Health (mind, body, spirit and environment) intersect with the Okinawa Centenarian Study. We believe The Story of Health should be at the heart of every conversation to do with human advancement and well-being.
Body
As the body ages, it can become more susceptible to physical limitations and illness. Chronic conditions, such as arthritis, heart disease, diabetes, and osteoporosis are common among seniors. The CDC reports that 80% of older adults have at least one chronic condition, and 68% have two or more. These conditions can lead to mobility issues, pain, isolation, and increased dependence on the support of others. Another study featured in the publication Age and Ageing informs us that in 2015, 54% of people aged over 65 had two or more health conditions. By 2035, researchers estimate projections could rise to 67.8%.
Nutrition and physical activity can also become more challenging with age. Seniors may face decreased appetite, dental issues, financial issues, and difficulties in meal preparation which often leads to poor dietary and nutritional habits. Limited mobility resulting in a lack of exercise often further exacerbates the issues and accelerates the decline.
Improvements
When we look at The Story of Health, particularly through the lens of neurogenesis, we can see that there is so much that we can do to avoid what is now seen as the inevitable story of ageing, and how we can begin to turn things around. The answer is self-care and the application of The Story of Health in a person specific, flexible and creative way. The body needs a minimum of 90 nutrients (60 minerals, 16 vitamins, 11 amino acids and 3 EFAs) on a daily basis for it to function optimally and create/retain health and vitality.
Where appetite is reduced and eating is difficult, we need to become more creative in finding solutions. Understanding the importance of hydration is a lifelong necessity, but as we age, the role and impact of water on our mental and physical health increases. This is because a small decline in water, as little as 2%, has an impact on three essential aspects of what it means to be human, perception, personality and performance… and any decline in these changes our experience of reality. This is why hydration should not be a peripheral issue if we want to age gracefully.
Salads, soups, smoothies, and stews (the 4 Ss) are a highly effective means of ensuring our body’s needs are met. Where there are problems with eating, digesting and food preparation, soups, stews and smoothies are an especially good way of combining many food items into an easily prepared and digestible form ensuring the delivery of multiple nutrients. Supplementation is also fundamental at this stage in life, to ensure that where there are shortfalls through diet, the gaps are bridged in a person specific way through good quality supplements.
Exercise and movement is another area in which we need to become creative. Movement is an essential factor in keeping us mobile and healthy in the latter stages of life. The World Health Organisation recommends at least 150 minutes of moderate-intensity aerobic activity per week for older adults. Physical exercise, particularly aerobic activity, has been shown to increase hippocampal volume and improve memory in older adults.
The Okinawan Centenarian Study has found that the Okinawans do not follow the trend of illness and disability in old age and states that “Much of the longevity advantage in Okinawa is thought to be related to the traditional Okinawan diet, which is low in calories yet nutritionally dense, especially with regard to phytonutrients in the form of antioxidants and flavonoids.” It is described as being vegetable and fruit heavy but lower in meat, refined grains, saturated fat, sugar, salt and full-fat dairy products. Interestingly there are two Okinawan cultural habits that stand out:
Hara hachi bu – this is a cue to mindful eating and means to eat until only 80 percent full. Nuchi gusui – this can be best translated as “let food be your medicine” and reflects how there is little distinction between food and medicine as many of the foods, herbs and spices consumed by the Okinawans have medicinal properties.
Another element that stands out in the OCS is the importance of lifelong movement. Activity is naturally built into day-to-day life so that rather than structured workouts, Okinawans regularly participate in activities such as walking, gardening, farming, household chores, and martial arts like Tai Chi.
Mind
Mental health is a significant concern for the elderly. Cognitive decline, including Alzheimer’s Disease and other forms of dementia, affects approximately 5.8 million people in the US, around 1 million in the UK and across Europe, 7.85 million. Issues such as depression, anxiety, and loneliness are also worryingly prevalent. According to the National Institute of Mental Health, nearly 20% of adults over 65 experience some form of mental health concern, yet many go unidentified and untreated. Stigma around mental illness and a lack of access to mental health professionals exacerbate the issue. Life transitions such as retirement, bereavement and loss of social roles can contribute to a sense of purposelessness and social isolation.
Improvements
To combat these challenges, proactive mental stimulation and emotional engagement are vital. And so, we find our way back to The Story of Health! It’s important that we encourage lifelong mental dexterity. There are so many ways to do this, which include engaging in crosswords and puzzles, learning a new language, studying or researching something of interest, singing, dancing, and practising introspective activities that help change our inner narrative. Employing the mind in such creative ways calls upon the neuronal community to create a culture for positive change.
Also fostering a spirit of forgiveness and gratitude are so important to avoid what we describe at Reach as the rocking chair of regret. With a slowing down of pace and an increasing awareness of our own mortality, it is all too easy to become consumed by those things that we wish we had or hadn’t done. Time spent making peace with the past is invaluable as it frees up our minds to appreciate the present more and fear the future less. Resolution creates time, space and healing.
When we’ve made peace with the past, it becomes easier to steer our minds and hearts along the path of gratitude. A review of 70 studies involving responses from over 26,000 people found a correlation between higher levels of gratitude and lower levels of depression. The review states that “Studies have found that people with higher levels of gratitude report more optimism, positive affect, and satisfaction with life. People high in gratitude also have higher self-esteem and evaluate themselves more positively”.
At a time in life when it is easy to feel less empowered and more helpless, meditation and mindfulness are invaluable tools to help us find and maximise our true and unperishable power. The more we can make our minds sanctuaries of peace, the less we are impacted by what is going on around us. A 2018 study published in the National Library of Medicine states that “Promising evidence exists in older adults that meditation reduces stress, anxiety, depression, insomnia, feelings of loneliness and social exclusion, and cardiovascular risk factors”.
Alongside this, mindfulness, meditation, and psychological well-being have been associated with increased cortical thickness and hippocampal neurogenesis, positively impacting on neuroplasticity and age-related declines. What this means is the brain is actively engaged in regeneration and is encouraged to find the best routes for upliftment and success, thereby, in spite of the ageing process, enhancing the quality of our lives.
A study entitled “The Synapse Project: Engagement in mentally challenging activities enhances neural efficiency” tells us that cognitive engagement, such as learning new skills or languages, promotes synaptogenesis (when neurons fire together, they wire together) and may delay the onset of dementia-related symptoms. In the conclusion, the author states “Although there is much more to be learned, we are cautiously optimistic with respect to the possibility that age-related cognitive declines can be slowed or even partially restored if individuals are exposed to sustained, mentally challenging experiences”.
Stress and elevated cortisol levels suppress neurogenesis by lowering the rate of cell proliferation. However, exercise, learning, rewarding social experiences, and housing in an enriched environment, increases differentiation and survival of new neurons and buffers against aged-related decreases in neurogenesis.
Environment
Environment plays a crucial role in shaping the daily experiences of older people. Many live alone, in housing that may not be suited to their physical needs. Urban areas can be inaccessible, while rural areas can lack necessary services.
Social integration is another environmental challenge. Ageism, or discrimination based on age, is pervasive in modern society and contributes to the feelings of irrelevance and invisibility among the elderly. Media and marketing often portray youth as the ideal, and governmental policy demonstrates decreasing respect, appreciation, and care for the elderly. Social isolation and loneliness are real concerns for the elderly population, and as illustrated in the research literature, have a damaging impact on mental and emotional health.
Improvements
Environment is such a crucial element of well-being and is sadly too often overlooked. With ageing and feelings of loneliness and alienation, senior citizens can neglect this aspect, not always recognising its importance to their mental health. Therefore, cultivating a sanctuary of peace and creating order at home will assist in promoting peaceful and orderly minds.
In addition, healthy and mutually respectful relationships and friendships are invaluable in supporting well-being and vitality as they help to ward off the threat of loneliness and isolation. This is because they create community and connection, giving one a sense of belonging, which is a fundamental need of the human condition, enabling us to feel safe, seen, heard and valued. What also helps with this is fostering a sense of meaning and purpose, which is at the heart of the Ikigai philosophy (described under Spirit later in this article).
The Okinawan Centenarian Study also highlights the importance of ‘moai’ and describes it as an informal group who meet regularly. In times of need, moai provide financial and emotional support to each other. In Okinawa there are many support networks that centre around friends and neighbours, which provide companionship, financial help, emotional support, and that all important sense of belonging. This strong social web helps to buffer stress and keeps older adults integrated into society.
There is so much that we can learn from this study, and in a society where the elderly seem to be so disenfranchised, it’s important that we are all playing our part to recognise both the issues facing our older citizens and their immense value. After all, most of us will in time become members of this under-appreciated segment of our society.
Spirit
The well-being of the spirit is something that is often overlooked when considering the well-being of the elderly. Many older adults grapple with questions of legacy, meaning and loss. The transition from a career to retirement can create a void in meaning and purpose. Additionally, the death of peers and loved ones can leave older people feeling isolated and grief-stricken.
Religious disconnection is also more common today, which means that older citizens may not experience the sense of belonging and community that can come with a shared spiritual belief. We are not advocating that individuals pursue a religious faith (unless of course that’s what they want to do), what’s important though for many is to have something to anchor their faith to.
Improvements
Finding purpose in later life is essential to well-being (ideally, we would find this purpose early in life and adapt and maintain it throughout our lives). In Japan there is a word, ‘Ikigai’, that encapsulates the motivation to rise each morning and describes the thread of meaning woven through daily life. While often translated as ‘reason for living’ or ‘purpose in life’, ikigai is more nuanced than this. It refers to the personal and deeply subjective sources of fulfilment that make life worth living.
The term Ikigai is composed of two Japanese words, ‘Iki’, meaning life, and ‘gai’, meaning value or worth. It describes the intersection between what an individual loves, what they are good at, and what sustains them emotionally or materially. In contrast to some Western ideology which equates purpose with career or achievement, ikigai can be found in small, everyday pleasures like tending a garden, sharing tea with a friend, learning a poem, singing, sharing, in fact the list is endless. In Japan, ikigai is seen as an evolving relationship with the songs of the heart that is nurtured throughout an individual’s lifetime.
It is often associated with movement and physical activity, whether that be things like walking, gardening, or using our skills to create something. The OCS tells us that one of the reasons that so many residents maintain an active lifestyle into their nineties, is because movement is not treated as exercise in the Western sense, but as a natural byproduct of living with purpose. In terms of spirit, ikigai offers a sense of coherence, belonging and being true to ourselves. With that comes gratitude, happiness, and inner peace.
Another Japanese study that investigated the relationship between Ikigai and mortality found that “Subjects who did not find a sense of ikigai were associated with an increased risk of all-cause mortality”.
It’s important that we deeply understand just how critical our sense of purpose is. Our spirit is phenomenally powerful and has the capacity to move mountains. However, to realise this limitless power we must allow our spirit to thrive in a position of growth. We need to address the needs of our minds and bodies so that the spirit is not pulled down through the survivalist tug of war between them that is generated from neglect and stress. We also need to ensure that our environment is as supportive as possible, providing the optimal conditions for growth.
Given the primacy of the spirit, we must understand the importance of a kind, benevolent mental pose. The spirit thrives where love and compassion are found in abundance. The spirit thrives at the shores of forgiveness and gratitude. The spirit is at its very best when engaged in giving without counting; altruism beats at the heart of what it means to be human. When we create such an internal culture, bound together with meaning and purpose, we can become forces of nature, and our story of health is complete.
Non-Negotiables
To maintain a strong story of health plan for life we need a set of non-negotiables, a set of pledges and promises to ourselves, that we keep. Those who live in accordance with their non-negotiables are destined to a life where the mind, body and spirit are locked together in love and are beautifully nurtured by their environments.
We hope it has become clear that ageing really does not have to mean a decline in quality of life. By addressing the interconnected elements of mind, body, spirit, and environment, we can create supportive frameworks that enhance health, happiness, and peace of mind, ensuring that the golden years are truly golden – filled with purpose, health, and joy.
Also see: Neurogenesis and What is Neuroplasticity