Aging Well with Dr. Dan Blazer, Part 3: The Role of Perception in Geriatric Health

Part 1, Part 2

Proverbs 23:7 says, “As [a man] thinks in his heart, so is he” (NKJV). When it comes to geriatric health, this statement has repeatedly proven true.

“Self-perceptions of older adults about their health and well-being may be at least as important as objective data for predicting the course of their health over time,” Laity Leadership Institute Senior Fellow Dan Blazer, M.D. wrote in a 2008 article that was published in The Geriatrist.

“Most clinicians treating adults focus on facts: facts about the behaviors of their patients (eg. the number of times a patient gets up at night to use the bathroom), facts about their physiological function (eg. lab values), and facts about their daily function ( eg. activities of daily living). Nevertheless, research has shown over the years that the perceptions of older adults about their health and well-being may be at least as important as facts,” he explained.

Asking a patient how he or she feels is a question too often ignored, wrote Blazer. Instead of inquiring about how many hours a patient sleeps at night, for example, a doctor could more perceptively ask, “Do you feel like you are getting enough sleep?”

There is “no better way to know the person than to explore the subjective feelings of the person---exactly what clinicians do when they ask, ‘How do you feel?’” he concluded.

In decades of research, Blazer has found that some elderly adults who are in good physical health rate themselves as having poor health and some who are in poor physical health rate themselves as having good health. These perceptions have consequences. The perception of poor health in otherwise healthy elderly adults is associated with depression and other predictors of mortality and the perception of good health generally leads to better outcomes.

Perception of one’s own social supports has consequences for physical health too.

“Interviewers working in community studies often report the incongruity that an older person may respond that family and friends don’t seem to care for her (or him), even as the interview is interrupted three or four times by family and friends checking on her status,” Blazer wrote.

“The ‘feeling’ of being embedded within supportive and caring relationships may be at least as critical to health outcomes as the actual supply of social resources,” he explained.

Believing that one’s basic physical needs are being met is another predictor of health outcomes. If an elderly person thinks he or she has adequate, safe shelter and enough money to provide for themselves, that person’s health is generally better than someone who feels physically insecure.

To illustrate the power of perception, Blazer tells the story of a group called the “mugwumps.” The mugwumps were mostly middle-to-upper-middle class well-educated Americans who lived at the turn of the twentieth century when progressive social movements were gaining strides.

“On the surface, the mugwumps should not have been dissatisfied, for they were actually doing better financially than during the depression of the latter nineteenth century,” Blazer wrote. But they were unhappy because they “experienced a significant sense of disadvantage when they compared themselves to the ‘plutocrats’ (or ‘robber-barrens’) such as the Vanderbilts, Fords, and Morgans.”

Likewise, Blazer speculates that “actual income and physical possessions may be less important as predictors of adverse health outcomes than perceptions of income and status inequality.”

He also wonders what an 80-year old is supposed to think when he or she is browsing the latest issue of AARP magazine and sees images of people in their fifties sailing, riding bicycles, and traveling to distant places when they can only manage a short walk.

“Questions naturally arise about how well one really is: ‘I feel pretty good but not that good. What’s wrong with me?’,” he writes.

Perception isn’t everything, however. Blazer notes that other factors like limited access to health care, poor health habits, real vulnerability as physical and emotional strength decline, and lower levels of social support contribute to comprised well-being, especially in economically disadvantaged elderly adults.

Clinical depression is verified predictor of mortality as well, but more than depression, Blazer says a lack of “hope, happiness, and enjoyment with life” influence health outcomes. In a decade-long study, Blazer and his colleagues found that a positive outlook on life protects against mortality.

Perhaps this is the lesson to take away from his extensive research: Not only do science and common sense teach us that we can’t always control the circumstances of our lives, but we can control how we think about those circumstances, Philippians 4:8 also exhorts us to meditate on things that are true, noble, just, pure, virtuous, and lovely. Doing so could lead to a longer, healthier, more productive life.

Image by Kevin Schoenmakers. Used with permission. Sourced via Flickr. Post by Christine A. Scheller.

Laity Leadership Institute senior fellow Dan Blazer, M.D., PhD. is vice chair of faculty in the Department of Psychiatry and Behavioral Sciences and Vice Chair of academic development at Duke University Medical Center in Durham, North Carolina. Dr. Blazer is a geriatric psychiatrist and an epidemiologist, and is the author of numerous books. He is also co-editor of Essentials of Geriatric Psychiatry, which is scheduled for release in 2012.