Successful Cognition and Emotional Aging

edited by Collin A. Depp, PhD, and Dilip V. Jeste, MD. American Psychiatric Press, Inc, Washington, DC, 2010, 419 pages, $50.00 (paperback).

In many areas of health care, there is now increasing enthusiasm for describing pathways to greater wellness rather than focusing more exclusively on impairment and pathology. Perhaps no area is in greater need of this rebalancing of emphasis than geriatric health care, given the forceful negative influence of ageism and the tendency for clinicians to treat disease in the elderly but to overlook education about optimizing health. Clinicians who have sought to understand more fully the liabilities of aging while also acquiring practical guidance in psychoeducation for the promotion of wellness will find much of value in Successful Cognitive and Emotional Aging.

A particular asset of this book is its broad scope. The first of its 3 sections, a descriptive overview of our knowledge base on positive cognitive and emotional aging, contains informative reviews of the frequently covered areas of pharmacotherapy, nutrition, and physical exercise. In addition, there are compelling discussions of spirituality’s role, the definition and value of wisdom, and the adaptive characteristics of centenarians. The second section reviews biological aspects of positive aging, with particularly thoughtful discussions of animal models, resilience, and the meaning of cognitive and brain reserve. In the final section, practical guidance is given regarding health-promoting prevention and intervention strategies. A chapter on physical activity acknowledges the obstacles to sustained participation in an exercise program and suggests practical approaches to increasing adherence. The chapter on nutritional factors offers expert guidance on dietary considerations. Additional chapters address pharmacologic approaches to successful cognitive and emotional aging, the role of technology, the ways in which defenses increase resilience, and the value of a model program in which older adults are integrated into an intergenerational school to facilitate younger learners’ education while themselves partaking of a unique growth experience.

One area that could have been more fully discussed, perhaps, is the economic forces that impact on health behaviors and health care in the later years. Excessive unemployment among individuals who wish to work, credit card debt, medical bankruptcy, avoidance of unaffordable care, high rates of poverty, and inadequate living circumstances are obstacles to wellness among the elderly, and both caretakers and society bear high costs that might be reduced by greater emphasis on preventive care in middle age and beyond.

As Gary W. Small, MD, notes in the foreword to this collection of essays, we are “living longer but, unfortunately, not necessarily better” (p xix). The challenge of exploring ways to live better rather than simply longer is met head on by the editors and authors of this volume, and they have produced a remarkably good book, well-edited, up to date, expert, and comprehensive. This is a volume that deserves to be widely read and thoroughly digested by clinicians and policy makers.

James M. Ellison, MD, MPH

jellison1@partners.org

Author affiliations: Harvard Medical School, Boston, Massachusetts. Potential conflicts of interest: None reported.