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The New Definition of Healthy: Living Life on Your Own Terms

Increasingly, people with chronic conditions consider themselves fully healthy—as long as they can live each day as they choose. Why the health care industry needs to get wise and catch up

spinner image an organizer toolbox filled with tools to manage chronic medical conditions such as healthy food hand weights supplements jump rope and vitamins outside of the box are artists paints and a brush and a pair of sneakers
Greggory Reid (Prop stylist: Anna Lemi/Plum Reps)

Angela Alexander could barely hold a paintbrush anymore.

The joint pain from rheumatoid arthritis had made pursuing her passion too painful. Then one night, she picked up a big brush and turned to her easel, determined to work — agony be damned.

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“This painting came out of me that wasn’t like anything I’d painted before,” she says. “Looser strokes. New colors. It’s taken me to a whole new level.”

Alexander, 50, of Asheville, North Carolina, paints exuberant, insightful portraits of animals — from family pets to wild bears. She has clients across the country, a studio and an exhibition space in a prominent local gallery in the River Arts District. To achieve this continuing success, she has learned to manage the fatigue and chronic pain of RA while also dealing with type 1 diabetes and its ​vision-threatening complication, diabetic macular edema.

“I take pain medications. I have an insulin pump. I’ve had eye injections. I do gentle exercise, get massages and go for walks with my dog, Ellie. I work with a team of doctors. And when I need to, I rest,” she says. “I’m blessed to have the tools I need. I want to always paint. It feeds my soul.”

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Angela Alexander
Will Crooks

Alexander’s pursuit of the life she loves is emblematic of a shift that’s radically redefining what “health” means for older adults with chronic conditions, a growing group that by 2020 had reached 71 million. Instead of the conventional “either/or” view of well-being — you’re either healthy or you’re sick — a surprisingly high percentage of older people reject the long-held notion that health is the absence of disease. We’re living life on our own terms: healthy and happy, with medical conditions.

The wellness paradox

“Healthy, with conditions” is the new norm for many midlife and older adults in the U.S. and around the world. In a large 2022 study of 21,503 older adults from Canada’s McMaster University, slightly more than half of the subjects had high blood pressure, 39 percent had arthritis and at least 20 percent had diabetes, muscle-and-joint problems and/or heart disease. Despite an average of three health problems per person, 58 percent rated their health as “very good” or “excellent.”

Even serious health drawbacks can’t seem to dampen our enthusiasm: When researchers from Baylor University’s Heart & Vascular Institute in Dallas did in-depth interviews in 2019 with 41 midlife and older adults, ages 57 to 77, living with life-changing medical issues such as kidney disease, COPD and/or heart failure, 81 percent said they were “very” or “pretty” happy. And in a 2022 AARP/National Geographic national poll, most midlife and older participants — from 2 out of 3 in their 50s to 8 in 10 in their 80s—had serious or chronic health conditions. Yet 77 to 83 percent gave their overall health top marks.

Indeed, survey respondents identified three factors that now define what we think of as “the good life”: physical mobility, mental acuity and social connections.

“Even if they have health issues, they’re really worried about: Can I still move? Am I still mentally sharp? Can I still connect with and see my family?” says Debra Whitman, chief public policy officer for AARP. As long as they have these three resources intact, respondents believed they could live happy and productive lives, with or without issues like diabetes or heart disease. “We heard in a variety of ways that the ability to be independent was important to people as they age,” Whitman says.

A kaleidoscope of factors fuels the “healthy with conditions” mindset — including an age-related boost in resilience and optimism, 21st-century medical advances, and a new openness about health challenges fostered in part by celebrities, politicians and social-media influencers celebrating their personal health journeys online and in the media. Wisdom and experience give midlife and older adults an edge here, too.

“You put things in perspective,” says cancer surgeon Elizabeth Shaughnessy, M.D., director of Cancer Survivorship & Supportive Services at University of Cincinnati Cancer Center and a breast cancer survivor. “There’s a certain amount of strength from dealing with past problems successfully.”

This “wellness paradox” doesn’t seem to be a matter of denial, or ignoring issues in order to feel better. Viewing our health in the positive can motivate us to take better care of ourselves, says social psychologist Jennifer Smith, assistant vice president and director of research at the Mather Institute, who studies resilience and well-being in older adults. It may even extend life, research suggests, by helping us come to terms with the reality of our health status.

Accepting a new normal

Three blocked coronary arteries and near-fatal cardiac arrest didn’t prompt Akil Taherbhai, M.D., a family doctor from Gadsden, Alabama, to change his personal health habits. But when his heart stents failed after five years, he faced up to a difficult truth: He had serious heart disease, and needed a bypass.

“I’m going to do a half-marathon in a year’s time,” he blurted out to nurses as he was wheeled into the operating room at age 61.

“I don’t know why I said this,” says Taherbhai, now 75, who has run three full marathons, two triathlons, climbed Mt. Kilimanjaro and jumped out of an airplane in the years since the procedure. He has also become a heart-health advocate, sharing his story with local and national groups. “Subconsciously, I knew I had two choices left; either continue this horrific end-of-life journey or make a concentrated, conscious effort to lead my life with purpose and productivity.”

The first step? Acknowledging he’d inherited his mother’s family’s genetic heart risks.

“My mother and my sister died from heart disease and kidney disease. My brother had a fatal stroke at age 52,” he says. “There’s high blood pressure, high cholesterol, diabetes and obesity.” Taherbhai switched to a plant-based diet, with help from his wife, Nafisa, a vegetarian. She also showed him how to meditate. It was a stretch for Taherbhai, who was used to working 10-hour days for months on end in his medical practice.

spinner image akil taherbhai holding up a small red pepper in his garden
Akil Taherbhai
Stacy Allen

“I had a Type A personality, everything under control,” he says. “Meditation is just being in the now. What it’s done is help me listen more to my patients and to talk to my family and friends rather than emailing and texting. Your mind can take your body to places you’ve never heard of.”

Getting older may have helped Taherbhai out as well. Research shows that optimism and resilience — the ability to bounce back quickly from a setback — increase with age. In a Penn State study of 3,493 adults ages 25 to 74, the oldest participants were up to five times more likely than the youngest to have serious health conditions. Yet they were the happiest — and least likely to feel sad or hopeless — no matter how many conditions they had.

“With aging and life experience we simply learn we can persevere,” says clinical psychologist Kristin Kleppe, founder of Orange County Health Psychologists in Irvine, California, whose specialties include aging and chronic conditions. “We just need to get up, dust ourselves off and keep on moving. We learn not to fear failure.”

Still, accepting that you have a chronic health condition and need treatment isn’t always easy, Kleppe notes. “It has to be done with a good dose of self-compassion.”

Same goes for the inevitable setbacks along the way.

“I have gone through this journey, sitting with folks who worked so hard to hit a certain number (on a medical test) and then it doesn’t happen,” Kleppe says. “This can feel defeating, but it comes back to perseverance and resilience. Seeing it as an obstacle, not a failure. Going back to your plan with a whole lot of compassion.”

That’s Taherbhai’s approach. While considering his options for treating his ongoing heart issues, he was busy doing what he loves — planning new speaking engagements, including at the annual meeting of the National Health Association. And making time with Nafisa to tend the purple peppers, tomatoes and squash in their sprawling backyard garden.

“I am healthy as a horse. Nobody can deny me that,” Taherbhai says. “I have a long line of seemingly insurmountable health problems. But I never let that define me.”

Joy in small things

Terlisa Sheppard, 56, has had recurrences of metastatic breast cancer for 25 years. Despite rounds of grueling chemotherapy and body-spanning side effects that led to a hip replacement, emergency brain surgery and ongoing fatigue, this retired accountant from Orlando, Florida, raised two daughters, stays active in national cancer advocacy and support organizations, and doesn’t pass up opportunities to get to the beach — or watch the sun rise and set on opposite sides of the Florida peninsula.

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“We called it chasing the sun,” she says. “My daughters and I threw everything in the car and drove from Cocoa Beach to Tampa for the sunset on the same day. It’s a wonderful memory you cannot erase.”

Since her diagnosis in November 1998, Sheppard says, family and friends have been constant supports. Sisters, sisters-in-law and nieces have all driven to Orlando to help her out. A neighbor has been bringing over homemade soup for more than 20 years. Her Christian faith picks her up, too. Sheppard says if she finds herself thinking, I’m just sick and tired of being sick and tired, she’ll flip that around and say, “ ‘You’re still here. Just have a little faith that you can move on to the next moment.’  ”

spinner image terlisa sheppard lacing up her sneakers for a walk
Terlisa Sheppard
Zack Wittman

Expecting good things to happen has proven mental and physical health benefits. For cancer survivors, resilience can help improve outcomes by “absorbing the shock of a cancer diagnosis,” helping to protect against depression and anxiety, and supporting the ability to stay social and keep on taking good care of yourself, according to a 2019 review in the journal Frontiers in Psychiatry. And a 2015 University of Michigan and National Institute of Aging study of 9,790 older adults found those whose optimism increased over four years had a lower risk for developing new health conditions compared to those whose outlook didn’t brighten.

Sheppard is currently cancer-free.

“My status is NEAD — no evidence of active disease,” she says.

For her, cancer is a manageable disease, thanks to medical advances in cancer testing and to the rise of long-term therapies that reduce risk for recurrence and are less toxic than older treatments.

Sheppard reports to the hospital regularly for ongoing infusions that target her breast cancer. She also walks 10,000 steps a day.

“I don’t ache as much when I walk. And my other health counts are better,” she says. “At one point I was borderline diabetic and was sent to a nutritionist at my cancer center. I’m grateful to have a great medical team.”

She recently spent the night in the hospital room of a friend’s goddaughter who also had breast cancer.

“She was alone,” she says. “I couldn’t dream of that.”

Taking health seriously

Dan Falcone plays his favorite music from the ’50s, ’60s and ’70s on Saturday nights as DJ of the Too Good Radio Show on WVBI-FM, a 43-watt noncommercial radio station near his summer cabin on Beaver Island, Michigan. He loves to travel, hang out with his grandchildren and mall walk on cold, rainy days.

“I call it my gym,” laughs Falcone, 69, a retired sales manager who has type 2 diabetes and high blood pressure. “I walk 35 to 40 miles a week and rarely miss.”

spinner image dan falcone in the dee jay chair at work
Dan Falcone
Nick Hagen

Despite a family history of the disease, Falcone didn’t take his own diabetes diagnosis too seriously at first. He was in his 40s, had a family and spent long days behind a desk.

“I kind of blew it off,” he says. “I thought I could take care of it on my own.”

Ten years later, his disease progressed to where he needed insulin injections.

“I never felt really terrible,” he says. “But my numbers were going up. And I gained weight.”

Everything changed after a chance meeting with a high school acquaintance, David Harlan, M.D., codirector of the UMass Diabetes Center of Excellence at ​UMass Memorial Health in Worcester, Massachusetts.

“Dr. Harlan told me I’d outgrown my pancreas, which was a polite way of saying I weighed too much,” Falcone says.

Falcone strapped on a Fitbit, started counting his steps and cut down portion sizes. He uses a health app to send updates about his weight and blood sugar to Harlan.

“I lost 60 pounds,” Falcone says. “My A1C (a test of long-term blood sugar levels) fell from a high of 10.8 to 7.” He’s off insulin and uses a combination of oral diabetes drugs plus a weekly injection of dulaglutide (Trulicity) to control his blood sugar. His blood pressure’s under control, too.

“If I hadn’t made changes, I don’t know where I’d be,” Falcone says. “I just needed the right motivation.”

Taking health conditions seriously every day is essential, but it can be grueling without motivation and support, Harlan notes. For people with diabetes, it leads to burnout and depression. “Mental health is an important part of this,” Harlan says. “When I was at the National Institutes of Health, I led a study involving people with uncontrolled diabetes. For the vast majority, they felt no one in the ‘health care system’ was listening to them.”

Asking your doctor about counseling and health-coaching options can help, Harlan says. So can understanding your own “why”—the reasons it’s important to stay healthy.

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“Don’t surrender,” he says. “Talk to someone about what you’re really trying to achieve.”

It’s worth it.

“It’s crystal clear that doing things that improve your numbers—your blood sugar, blood pressure and cholesterol—improves quality of life and longevity,” Harlan says.

Advances in diabetes care, such as new drugs that control blood sugar while also lowering risk for heart and kidney problems, have improved outcomes even more.

“They’re game changers,” he says.

Yet Harlan sees a bigger picture.

“I’m a people doctor, not a numbers doctor,” he says. “For me, health means the individual is healthy mentally, physically and spiritually. Life in balance. Good diabetes health is just good health.”

For Falcone, the “why’s” that keep him on track are his family, travel and music.

“I feel really healthy right now,” Falcone says. “I love life. How can you love life if you’re not keeping your health in check?”

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