"Old age" used to be blamed for so many losses: vision, hearing, memory, muscle mass, bone strength, healing quickly. It turns out, though, that healthy aging is a mix of genetics, luck and effort. You can't do much about the first two, but that last one is a matter of choice.

"You truly have to create your own successful aging," says Salt Lake geriatrician Dr. Fred Gottlieb, who counsels patients to use their bodies and minds in new ways, to find meaning and stay active.

It is that quest that drives Gertrude Fish, 92, to tai chi class every Wednesday at the West Jordan Senior Center. It's why 102-year-old Margarete Hicken slow walks around the block with her walker. When Donna Landes was 89, she was on hospice, her death apparently imminent. Six months of calisthenics and yoga later, she sent the hospice people packing.

The landmark MacArthur Foundation Study of Successful Aging found three things that most impact quality of life for the elderly: staying actively engaged, reducing risk of disease as much as possible, and maintaining high physical and cognitive function levels.

The researchers found older participants who had the best lung function declined least over time. The consistently active declined half as much as couch potatoes. And moderate activity was as good as strenuous activity.

Decline was also less among those who worked or volunteered regularly into their old age. Those positives stretched over to decrease cognitive decline as well.

• Muscle, metabolism and mass: Much of what you bring as assets into old age was accumulated early. Girls peak in bone mass at about 14 to 16, boys around 18 or 19, so bone-building exercise and calcium intake are crucial for children. Later, you'll store less calcium, and bone mass starts to dwindle. Weight-bearing exercise and calcium supplements slow that down. With less dense bones, an individual is more likely to be hurt in a fall — or to fall in the first place.

If you don't keep building muscle mass and maintaining flexibility, it gets harder to do simple things like dressing and you'll tire more easily. Over time, metabolism slows, so there's simply more of you, which is not healthy. It can be jump-started with strength training and other exercises. The more muscle you build, the higher the metabolic rate and the more energy you have.

You can also improve balance by simple exercises like standing on one leg with your eyes closed. People who exercise and eat well are also less likely to develop diabetes, high cholesterol and high blood pressure.

If all that's not reason enough, "We know those who smoke, have uncontrolled diabetes, don't exercise or have high blood pressure are at higher risk of Alzheimer's," says Dr. Norman Foster, director of the University of Utah's Alzheimer's research center and a professor of neurology.

• Hearing loss has been tied to depression, anxiety, paranoia and social isolation. Volume-induced damage is cumulative, so avoiding it when you're young makes a difference when you're old. Stay away from loud sounds, and if you can't avoid the noise, wear ear protection. Right now, hearing loss is irreversible.

• The biggest vision stealer for the elderly is age-related macular degeneration (AMD). Moran Eye Center's Dr. Paul Bernstein tells patients with the disease to take zinc, vitamins C and E, and beta-carotene to control the disease's progression. Not smokers, though, because the supplements increase the risk of lung cancer. (Smoking increases risk of AMD.) The supplements don't appear to help at early stages of the eye disease or against formation of cataracts — protecting your eyes from the sun is the best defense for that. Supplements may have side effects, so ask a doctor.

Some eye research suggests that lots of lutein (spinach, broccoli and other dark green, leafy vegetables) and zeaxanthin (corn, peaches, persimmons, mangoes) will decrease the risk of advanced AMD. Fish such as salmon that are high in omega-3 fatty acids may also lower that risk. Because of a dearth of scientific evidence, Bernstein takes no position on use of herbal compounds like bilberry, ginkgo biloba and eyebright.

• Staying engaged boosts body and brain. Gertrude Fish also crochets and does Swedish weaving and ceramics. Mary Jane Lyons, 85, makes hats for homeless men and exercises her brain with crossword puzzles.

Studies show that video games, puzzles, number games, brain teasers and computer games exercise the brain, improving memory and attention span. The greatest benefit comes from challenges that are not easy for you or that you don't do often, so a potter benefits more from math than from making art, while a tax attorney might benefit from learning French, since languages are typically a challenge, says Commission on Aging director Maureen Henry. Her grandmother, she notes, could do the Philadelphia Inquirer crossword puzzle every day without flaw but didn't know who her son was.

Whole industries are springing up around that brain-building concept. Most video gaming systems now have programs that target the elderly and "staying sharp." The Nintendo Wii is becoming a staple in nursing homes. Online "brain training" programs such as Lumosity are available by subscription. And LDS Hospital is using a program called Brain Builders to see if exercise helps those who already have Alzheimer's.

University of Utah gerontologist Scott Wright believes we should pay attention to people who are active and bright well into their old age. "Maybe there's something about their medical, physical, social and philosophical life we can learn from," he says. "Old age is like a land mine. If they stepped well, why not see where they stepped?"

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