Friday, August 30, 2013

When It Comes to Longevity, To Live or Not Live Long, Is Hardly The Question

The recent Pew Research Center Survey that revealed that Americans do not want to live past 100 continues to generate much fanfare. When I read the survey, I was hardly surprised that the average responder chose ninety as their ideal final age. With articles like, “Mom, I Love You. I Also Wish You Were Dead. And I Expect You Do, Too” that appeared two years ago in New York magazine, and the similarly timed “How to Die...What I Learned from the Last Days of My Mom and Dad” that was published in Time magazine, it shouldn't come as a surprise to anyone else. Both articles poignantly described how difficult the end of live is when you are among the oldest old and near death. They reaffirmed for most people a misguided view of aging in America. Fortunately, for those among you who aren't quite ready to set a deadline for your demise, both authors' circumstances were the exception to the rule and the benefits of living long outweigh the negatives.  More about that later.

Centenarians Among Us
Meanwhile, hardly a week goes by these days without some small town newspaper featuring a story about a local centenarian (no wonder, their ranks are swelling). Almost in lockstep, each story describes some secret longevity sauce uniquely offered by their age-wizened seer.  Most of us read such stories with a "that's nice," but don't otherwise think twice about it.  These centenarians are aberrations to most of us, something to be admired from afar, but not worthy of our aspirations. We may be intrigued by them, but most of us don't want to be them.  In addition, our society, unlike many others, has little reverence for the most aged among us. Why grow so old, we think to ourselves, to only feel neglected or unwanted?  Though we may be momentarily entertained by stories about the athletic triumphs of ninety-plus year olds like the recent article in the Wall Street Journal, most Americans prefer not to outlive their vitality, and apparently believe that means passing by age ninety.

Average Americans
As fate would have it, one of my patients last week when asked specifically how long he wanted to live answered without hesitation that ninety would suit him fine. Bemused, I thought to myself, "hello average American." When questioned what sway ninety held, he almost robotically responded that ninety was the age that he thought he would stop fully functioning and was prepared to move on. With all due respect to this patient and all the others who were surveyed by Pew and answered similarly, they may be wrong to choose ninety as their final age.  By the time we finished our visit, my patient agreed. Please let me tell you why.

The Race
I like to use analogies. In this instance, I used a racing analogy. When one races towards a finish line, the goal is to cross it, not reach it. Imagine, if the goal was to simply reach it. Given the momentum, the runner would have to slow done long before the goal in order to come to a complete stop at the goal. Similarly, to desire to die at ninety basically means that we choose to lose our vitality in our eighties. Vice a versa, if we wish to live to one hundred, it means that we are seeking to remain very vibrant in our eighties and early to mid-nineties.  Is that reasonable? Does it really make a difference what we think? It turns out yes. As gleaned from my extensive readings about centenarians, in most cases, the centenarians, and even super centenarians (over 110), expected to live long with many expecting to living even longer than they actually did. Attitude really does matter. It's not enough to simply expect to live long. Lifestyle and genetics play a role, but hoping to die by a certain age has consequences. 

Did You Ever Get An A?
Here's another, perhaps more pertinent, analogy.  Remember those school days you may wish to forget? Do you recall ever studying for a test in the hope of getting an A? If so, did you study 'just enough' to get an A or did you study all the material in the hope that would get you an A. Unless you are one of those geniuses of whom my children always claim never have to study to get an A, I posit that you reviewed all the material in an exhaustive fashion in the hope that you had done enough to get such A. Trying to do 'just enough' to get an A is highly unlikely to work because it isn't a complete approach. The same applies to healthy longevity.  If you simply aim to live to age ninety, you are assuming that unhealthy behaviors that may prevent you from living past ninety will also not impact your health pre-ninety. They will, and aiming for ninety is being shortsighted. 

The Facts About Longevity
So let's go back to the premise of the two articles that claimed that dying at an older age has serious drawbacks. The facts are that such conclusions are simply inaccurate. According to research conducted at the New England Centenarian Study (NECS) affiliated with Boston University, "90% of all of the centenarians [they studied] were still independently functioning at the average age of 93 years. Somehow, despite the presence of diseases, people who become centenarians don’t die from those diseases, but rather they are able to deal with them much better than other people and remain independently functioning more than 30 years beyond the age of 60." 

Compression of Morbidity
Furthermore, the NECS research reveals that when compared to controls, "nonagenarians (subjects in their nineties), centenarians (ages 100-104), semi-supercentenarians (ages 105-109) and supercentenarians(ages 110+)...had...progressively shorter periods of their lives spent with age-related diseases, from 17.9% of their lives in the controls, to 9.4% in the nonagenarians, down to 5.2% in the supercentenarians. In other words, the longer they lived, the less they suffered from disease. These findings support the "Compression of Morbidity" hypothesis.  

What is that, you ask? In 1980, a Stanford researcher named James Fries proposed the “Compression of Morbidity” hypothesis which states that as one approaches the limit of human life span, they must compress the time that they develop diseases towards the very end of their life and he proposed that people around the age of 100 do this. Although the NECS research shows that 43% of centenarians may suffer from age related illnesses before age eighty, and 42% suffered between eighty and one-hundred, most of the suffering was compressed to the last few years of life. Got it? The longer you live, the more healthy years you enjoy.

What that means for you is that the real reason to want to aim to live to one-hundred is that you will experience a far more pleasant eighties and early nineties, one mostly free of debilities and difficulties, if you succeed.

The Longer You Live, The Healthier You've Been 
Although it is true that living past your late nineties seems to require good genes (more in future blog), living to your mid-nineties is also a function of the lifestyle choices you make.  So the next time someone asks you how long you want to live, I hope you say "as long as possible" and mean it. Aiming beyond and high when it comes to longevity, like in the racing and school analogies, is the way to go.

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