CGPR: For readers who aren’t familiar with your work, can you describe your clinical practice?
Dr. Lavretsky: I’m a geriatric psychiatrist by training, and I see older patients and their caregivers with mood and cognitive disorders, along with a broader range of neuropsychiatric conditions. I’m also an integrative psychiatrist. In our integrative psychiatry clinic, I treat patients with chronic pain or medical illness who want to address their mental and physical health together. I also direct a multidisciplinary long-COVID psychiatry clinic, which spans the full adult range.

CGPR: You’ve published on the concept of successful aging. How do you define it?
Dr. Lavretsky: Successful aging is usually defined as low risk of disease or disability, low cognitive decline, high physical health, mental well-being, independence, and engagement in life. That’s an achievable goal for some people, but it excludes anyone who develops a chronic illness or early cognitive decline, which is most of the aging population. I prefer the concept of flourishing, which has a specific meaning in psychology. It’s a state of optimal mental health characterized by high levels of emotional, psychological, and social well-being (Keyes CL, Am Psychol 2007;62(2):95–108). Flourishing allows for disease. Someone with arthritis, for example, can still maintain activity, social connection, quality of life, and a sense of meaning and contribution. Flourishing comes from Aristotle’s idea of eudaimonia, and it’s been applied across psychology, gerontology, and public health. It fits with how I think about resilience in the presence of psychiatric or medical illness. You can be aging and ill, and you can still live a fulfilled life.

CGPR: What factors matter most for flourishing and resilience in later life?
Dr. Lavretsky: The dimensions I look at are physical well-being (maintaining health, mobility, and energy); psychological well-being (positive emotion, optimism, and self-acceptance); a purposeful, meaningful life with a sense of contribution; social connectedness; autonomy (meaning the ability to keep making your own decisions); continued personal growth, like learning new skills; and a spiritual or existential dimension, which is the focus of my most recent book Living From the Soul. That dimension includes faith, reflection, gratitude, and finding peace with the transitions of aging, including loss of function and loss of partners. Resilience, as I use the term, is the capacity to recover from adversity, stress, or trauma, but there are other flavors too, like physical, cognitive, motivational, spiritual, and environmental resilience. They share the same core idea: People aren’t just surviving stress, they’re recovering from it and sometimes growing beyond where they started. That’s post-traumatic growth.

“Flourishing allows for disease. Someone with arthritis can still maintain activity, social connection, quality of life, and a sense of meaning and contribution.” - Helen Lavretsky, MD, MS

CGPR: How do you translate resilience and flourishing into concrete ideas with patients?
Dr. Lavretsky: I use social prescribing. I ask patients to identify three to five things that bring them joy and to build a daily practice around them. I do this a lot with patients with long COVID—many are young adults devastated by an unexpected loss of function. I also work on gratitude practice: What, in this moment, are you grateful for? Almost everyone can name something, even a sunset or a piece of music. Gratitude interrupts ruminating on the past or worrying about the future. I add self-regulation through breathing, and I address sleep, diet, and exercise, since movement is central to brain health. This framework grew directly out of the brain-health recommendations I helped develop as chair of the American Association for Geriatric Psychiatry and the American Heart Association, and it’s summarized in a recent review (Lavretsky H et al, Neuropsychopharmacology 2026;51(7):1347–1348).

CGPR: You’ve studied yoga and tai chi for late-life mood and cognitive disorders. How do these compare to other interventions, including other types of exercise or psychotherapy?
Dr. Lavretsky: My studies and others show effects on whole-person health. That’s brain, cardiovascular, and, for breathing-based practices, respiratory health (Lavretsky H et al, Am J Geriatr Psychiatry 2022;30(3):392–403). They reduce inflammation and modulate stress biology and biological aging, which underlie most disorders of aging, including cardiovascular disease, arthritis, and Alzheimer’s disease (AD). Some trials have found exercise has efficacy comparable to antidepressants for mild to moderate depression, though head-to-head data across modalities are limited (Gartlehner G et al, Ann Intern Med 2023;176(2):196–211). In practice, I start with what patients already do and enjoy. Someone who’s never done yoga won’t stick with it if I simply prescribe it, so I’ll layer breath awareness into whatever movement they already do before I ever say “yoga.” What mind-body practices add over aerobic exercise, or over a purely talk-based therapy, is explicit training in self-regulation and breath awareness.

CGPR: Loneliness and social isolation are major concerns in older adults. How do you evaluate and address them in practice?
Dr. Lavretsky: I spend time understanding a patient’s social network. I ask how many people they’re in regular contact with, and what the quality of that contact feels like to them. There’s no one-size-fits-all number. Some patients are satisfied with a single close relationship; others need many more. I use two simple screening questions, similar to how we screen for depression: Do you feel lonely? Do you have a support system, and are you satisfied with it? That self-rated satisfaction is what matters most. Structured tools exist, like the UCLA Loneliness Scale, but they’re not routinely used in practice. Technology since COVID has helped, though the data are nuanced. Video calls seem to reduce loneliness and improve quality of life for people in their 60s, but interestingly, not as much in those over 70 (Bonsaksen T et al, Int J Environ Res Public Health 2021;18(12):6284). It’s better than nothing, but there is no replacement for in-person presence. Physical closeness raises oxytocin and measurably improves mental well-being. I use technology as a bridge, not a substitute (Editor’s note: For more on loneliness, see our interview with Dr. Joo on page 5).

CGPR: Patients often ask how to maximize brain health. What misconceptions do you encounter?
Dr. Lavretsky: The biggest one is: “Alzheimer’s runs in my family, so I should expect it.” APOE ε4 is the strongest genetic risk factor for sporadic AD, but it isn’t a sentence. Even in carriers, healthy lifestyle habits lower dementia risk. The second is the search for a single silver bullet, usually a supplement or a specific number of cups of coffee. Brain health doesn’t work that way. It requires ongoing effort across several domains (Editor’s note: For more information on modifiable brain health targets, visit: www.thecarlatreport.com/brainhealthtargets). The Lancet Commission’s 2024 report identified 14 modifiable risk factors that could prevent or delay more than 40% of dementia cases (Livingston G et al, Lancet 2024;404(10452):572–628). Stress reduction is the hardest factor to quantify, but from my research, roughly 10 minutes daily of meditation or breathing practice seems enough to sustain a benefit. In my first study, most stressed dementia caregivers didn’t have time for a yoga studio, so we used a 12-minute chanting meditation, Kirtan Kriya (Lavretsky H et al, Int J Geriatr Psychiatry 2013;28(1):57–65). Compared with relaxing music, it improved depression, mental health, and cognition. Most people can manage 10 minutes a day.

CGPR: Beyond exercise and stress reduction, what else do you address?
Dr. Lavretsky: I go into diet and supplements: Can the patient maintain a Mediterranean-style diet, or do they need supplementation? For long-COVID patients, I routinely prescribe B vitamins for cognition and mood. For vitamin D, I aim for sufficiency, not a high target, so above 50 nmol/L (about 20 ng/mL). The evidence for vitamin D itself is mixed. The VITAL trial didn’t show a clear cognitive benefit, and the real signal shows up mainly in people who were deficient to begin with (Kang JH et al, Sci Rep 2021;11(1):23253). If someone’s deficient, I recommend repletion with 50,000 IU weekly until levels normalize, then move to maintenance. For mood, the depression trials suggest you need at least 2,000 IU a day for a couple months to see anything (Mikola T et al, Crit Rev Food Sci Nutr 2023;63(33):11784–11801). I also like fish oil for depression; the benefits are modest but real (Appleton KM et al, Cochrane Database Syst Rev 2021;11(11):CD004692). The antidepressant effect is really an EPA effect, so I look for an EPA-predominant product, 2:1 EPA-to-DHA or higher, delivering 1–2 grams of EPA daily. I also bring up probiotics and prebiotic foods, given the growing gut-brain axis literature.

CGPR: What about sensory health and staying active?
Dr. Lavretsky: In older adults, I always ask about hearing and vision. Hearing loss is the single largest modifiable risk factor for dementia. The data show that each 10-decibel worsening in hearing raises dementia risk by about 16% (Yu RC et al, Ageing Res Rev 2024;98:102346). If a patient isn’t hearing me well in the room, I refer for testing. On staying active, behavioral activation is extremely helpful, especially in older adults who aren’t doing much and have become isolated and reluctant to move. I ask for easy, small steps to increase engagement, and that gets them going.

CGPR: You’ve also written about wisdom in later life. How do you define wisdom clinically?
Dr. Lavretsky: Wisdom isn’t accumulated knowledge or intelligence. It’s the capacity for emotional regulation, compassion for self and others, and sound decision-making. It applies cognitive, emotional, and social abilities to navigate life’s complexity.

CGPR: Can wisdom be cultivated in late life?
Dr. Lavretsky: Absolutely, though I’d argue we should start earlier than we do. Resilience factors begin accumulating in utero and across the lifespan, and I’m somewhat concerned that younger generations aren’t being taught emotion-regulation skills that would serve them later. For the patient in front of me who’s 80, I’ll often suggest writing an autobiography for their children and grandchildren. That leads them to self-reflect and lets them articulate lessons learned. I also use structured life review, written or spoken, with an explicit goal of helping the person recognize and take credit for a life well lived, rather than dwelling on regret.

CGPR: How does a person’s psychological experience of aging shift across the final decades?
Dr. Lavretsky: There are good data showing that emotional well-being tends to go up with age. When you look at big population studies, older adults consistently score higher on happiness, meaning, and life satisfaction than younger ones, and the most distressed group is the youngest (Chen Y et al, JAMA Psychiatry 2022;79(10):1046–1047). I think part of that is learning to tolerate uncertainty, not sweating the small stuff. But what I see shift in the 70s and 80s is the burden of loss. “All my friends are dying” is something I hear constantly. That’s another thing to come to terms with; that’s the nature of life. Our culture tends to deny death as part of life, but I think we should treat it the way we treat birth. If we celebrate birth, we should also honor accomplishment at the time of death and dying. I write about the emerging role of death doulas, who make the final stages of dying beautiful for the person and their family. They recite poetry, they play music, they make the process of saying goodbye more bearable and more beautiful, and they create closure for everyone.

CGPR: Thank you for your time, Dr. Lavretsky.