Living Longer, in Good Health to the End

By JANE E. BRODY
27 aug 2008--You don’t have to be an actuary or funeral director to have noticed the striking increase in the length of many Americans’ lives. The obituaries in this or any other newspaper show a growing number of people who depart this world in their late 80s or 90s, or even at 100 or older.
The fastest-growing segment of the population consists of people over 85, and by 2050 some 800,000 Americans will have celebrated their 100th birthday.
Doomsayers consider this a terrifying trend, bound to bankrupt Social Security and Medicare and overwhelm the ability of doctors and medical facilities to care for the burgeoning population of the oldest old.
But there is increasing evidence that the societal burden of increased longevity need not be so drastic. Long-term studies have shown that how people live accounts for more than half the difference in how hale and hearty they will remain until very near the end.
Many very old people have assumed “bragging rights” about their age and what they can still accomplish despite it, as Michael Kinsley wrote in The New Yorker in April.
At a pool in downtown Los Angeles, Mr. Kinsley encountered a stranger who interrupted his laps long enough to say, “I’m 90 years old.” The man, Richard Ibañez, a retired judge, died in November at age 97, but swam every morning until the last week of his life, his grandson, Christopher A. Karachale, wrote in a letter to the magazine.
A friend’s father, Irving Weinig, who lived in an assisted living facility in New York, requested new clothes for his 104th birthday so he could look spiffy when he had lunch with “the girls,” an activity he enjoyed until his death at 108.
And last spring the Island Nursing and Rehab Center in Holtsville, N.Y., boasted about a new resident, Nora Elizabeth Wright, who was turning 106.
All of these examples speak to a concept proposed in The New England Journal of Medicine in 1980 by Dr. James F. Fries of Stanford University: that adult vigor can be extended well into the ninth decade of life, with illness and disability compressed into a period that shortly precedes death.
Who Lives the Longest?
Many studies have examined the factors that predict the length of people’s lives, with nearly universal agreement that about 35 percent is determined by genes over which we have little or no control.
Dr. Nir Barzilai and colleagues at Albert Einstein College of Medicine found, for example, that individuals “with exceptional longevity” and a low incidence of age-related diseases have significantly larger HDL and LDL particles in their blood, a genetic characteristic that reduces their risk of developing cardiovascular diseases.
Scientists are searching for ways to extend healthy life spans by manipulating “bad” genes, but the potential exists now for modifying many of the environmental factors that account for the other 65 percent of longevity. And I suspect that most of us who hope to join the ranks of the oldest old would like to do so in a manner similar to that of Richard Ibañez and Irving Weinig — in rather good shape physically and mentally almost to the very end.
“Longevity is a Pyrrhic victory if those additional years are characterized by inexorable morbidity from chronic illness, frailty-associated disability and increasingly lowered quality of life,” Dr. William J. Hall of the Highland Hospital Center for Healthy Aging in Rochester wrote in The Archives of Internal Medicine in February.
New Habits Are Effective
Dr. Richard S. Rivlin, an internist and director of the nutrition and cancer prevention career development program at Weill Cornell Medical College, said in an interview that it was never too late to adopt habits that predict a healthy old age.
“While measures started early in life are most likely to have the greatest health benefit,” he said, “older people should never feel that turning over a new leaf at their age is anything but highly effective.”
He said there was clear evidence that measures taken in one’s 70s could help prevent “several important categories of disease, such as hypertension, heart disease, osteoporosis and even cancer.”
In The American Journal of Clinical Nutrition last year, Dr. Rivlin noted that changes in body composition, like loss of bone and muscle and accumulation of body fat, typically accompany aging and can affect health in a variety of ways: poor posture that impairs breathing; falls and fractures; loss of mobility; a reduced metabolic rate; and weight gain that can lead to diabetes, heart and blood vessel disease and some forms of cancer.
But these changes in body composition, he added, “are not an invariable accompaniment of aging.” Much can be done to limit and even reverse them, he said, including restricting calories and following a diet of high-quality protein and limited saturated fat and replacing simple sugars with whole grains rich in fiber.
The Importance of Exercise
A second critical measure for the “young-elderly,” as he calls 70-year-olds, is to “make regular exercise a part of their daily lifestyle,” including aerobic activities that raise the heart rate; weight-bearing activities that strengthen muscles and bones; and stretching exercises that reduce stiffness and improve flexibility and balance.
Another age-related concern is cognitive decline, which is more likely in people with metabolic syndrome, a cluster of modifiable risk factors that includes abdominal obesity, high blood pressure, insulin resistance and abnormal cholesterol levels. Dr. Hall cautioned against therapeutic nihilism in treating older people with such risk factors.
“Chronological age is a very imperfect determinant on which to base medical decision-making,” he wrote.
Dr. Hall’s comments were based on a 25-year study by Dr. Laurel B. Yates of Brigham and Women’s Hospital and her Boston colleagues of 2,357 men who were healthy at an average age of 72 when the study began. Of the 970 men who survived to at least age 90, the primary modifiable predictors of longevity were not smoking; preventing diabetes, obesity and high blood pressure; and exercising regularly.
“Compared with nonsurvivors, men with exceptional longevity had a healthier lifestyle, had a lower incidence of chronic diseases and were three to five years older at disease onset,” the Boston team reported in February in The Archives of Internal Medicine. “They had better late-life physical function and mental well-being. More than 68 percent rated their late-life health as excellent or very good, and less than 8 percent reported fair or poor health.”
Other long-term studies have also pinpointed exercise as the single most potent predictor of healthy longevity, in women as well as in men. It is not that very old people like Judge Ibañez can exercise because they are healthy, these findings indicate. Rather, they achieve a healthy old age because they exercise.