What is successful aging? According to a 2018 article in Forbes, “The term successful aging was made popular in 1987, when the scientists John Wallis Rowe and Robert Kahn published an influential book entitled Successful Aging. Rowe and Kahn stated that successful aging involved three main factors: (1)
being free of disability or disease, (2) having high cognitive and physical abilities, and (3) interacting with others in meaningful ways.”

The term itself sounds like an oxymoron, like jumbo shrimp. Success is usually associated with upward bound things like achievement (she got the highest score on her math test), money (that lucky guy could afford to retire early because his invention made him independently wealthy), or power (she grew up on the wrong side of the tracks yet now she’s the mayor). On the other hand, aging is linked with downward trending things like physical deterioration (he just had his second knee replacement), cognitive decline (I can’t remember what we did last Thanksgiving), and purposeless isolation manifested as depression (Uncle Syd just sits alone on the porch all day).

A new study by Goshen, et al. (2022)^[i] finds that the healthier your diet, the more likely you are to live long while maintaining physical and cognitive function. But, how can you measure healthy eating?

Healthy Eating Index (HEI)

Did you know that a score can be assigned to how healthy your diet is? The Healthy Eating Index (HEI) is a scoring system that evaluates how well a set of foods aligns with national dietary guidelines. The score ranges from 0-100, and is based on 13 dietary components. The higher the score, the better the diet:

• Scores greater than 80 reflect a good diet
• Scores 51-80 indicate a diet that needs improvement
• Scores below 51 suggest a poor diet.^[ii]

The Goshen study used the 2015 version of the HEI (HEI-2015) to score the dietary patterns of their study group members, noting that HEI-2015 has been “previously used to describe diet quality in worldwide populations and subpopulations.”^[iii]

Diet and successful aging

The Goshen study particularly looked at the “oldest old”, those persons aged 80 and above. The authors were interested in both longevity and successful aging, noting that this population is “more heterogeneous in function and might be differentially affected by unique risk factors and health promoting factors.

To gather data, they tapped into the 2005-06 Israeli National Health and Nutrition Survey of Older Adults (persons at least 65 years old at the time of the survey, mean age 74.6). As part of the survey, participants’ dietary patterns were recorded based on 24-hour recall. The study authors found that those with higher HEI scores had, on average, healthier lifestyles and higher economic status.

Roughly 12 years later, telephone outreach in 2017 identified 604 surviving individual able to participate in interviews and evaluations, and of those, 596 were included in the successful aging analysis (mean age 84.1). Using the original dietary information as baseline, the authors calculated HEI-2015 scores for each participant; scores ranged from 13-94. The team gained longevity and successful aging data using: • Nutritional assessment (HEI-2015)

• Preserved physical function
• Preserved cognitive function
• Self-rated health status (“How would you rate your health status?”)
• Mental well-being (absence of depression)
• Mortality/cause of death (available through national records)
• Additional covariates (education level, Activities of Daily Living, physical activity engagement, smoking)

After statistical analysis, their findings revealed that at baseline, those who had higher HEI-2015 had (on average) higher education and income levels, better self-rated health and fewer functional limitations (tended to be more physical active) and better cognitive function. 12 years later, those who met the criteria for successful aging followed the same trends, with “… higher levels of education, higher household income, and higher HEI-2015 scores and were more physically active than participants who did not meet the criteria…” Thus, higher dietary index points to longer life and more successful aging.

In their concluding discussion, the authors wrote:

…higher diet quality was associated with longevity and successful aging in the subsequent 12 years. … Our results suggest that the association between diet quality and mortality, as previously demonstrated among younger age groups using different diet quality measures (eg, Alternate Mediterranean Diet, Dietary Approaches to Stop Hypertension), is maintained in the oldest-old age group.

The obvious conclusion is, you CAN eat your way to a long and healthy life! Not only that, you don’t have to embrace a specific diet plan, just follow the guidelines. You can download a copy of the most recent Dietary Guidelines for Americans here. Happy eating!

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Goshen A, Goldbourt U, Benyamini Y, Shimony T, Keinan-Boker L, Gerber Y. Association of Diet Quality With Longevity and Successful Aging in Israeli Adults 65 Years or Older. JAMA Netw Open. 2022;5(6):e2214916.
[ii] Basiotis P, Carlson A, Gerrior S, Juan W, Lino M. The Healthy Eating Index: 1999–2000. Washington, DC: USDA, Center for Nutrition Policy and Promotion, CNPP-12; 2002.
[iii] Goshen, ibid. NOTE: all subsequent quotations are from the Goshen published study)