Live to be 100: Dreams, Genes and Yogurt
Uncovering the secrets of a long life
When my mother died, several of us gathered after the funeral and wondered out loud, “how did she do it?” Live to 89, I mean. She was, as it happened, eating and walking and talking until the day of her death. Still, we knew full well that most of her life she had been only in fair health, at best. Asthma, strokes, knee replacements, a craniotomy, an endarectomy, multiple serious skin cancers, and repeated shoulder dislocations had plagued her. These were topped off by a profound dementia that left her not knowing her own name. No wonder we were bewildered to see her live to almost ninety. After watching her final decline, is it any surprise that we asked, “Is this in store for us? Will we inherit the dementia along with the longevity?”
My mother lived with my family, and I had seen just how cruel her last years had been. My first thoughts were, “If I’m going to live that long, I want to be in better shape. What can I do?” I happened on a book, aptly titled Healthy at 100, by John Robbins (yes, of Baskin-Robbins.) It’s a fascinating exploration of cultural groups who claim great longevity: the Vilcabamba in Ecuador, the Hunza of Pakistan, the Abkhasia of the Caucasus (think yogurt), and the long-lived people of Okinawa. By the time I finished the book, I was ready to start my next day with radishes, topped by a bit of watercress.
Fortunately, caution took hold. I ate a muffin instead, and that’s how I found the strength to do more sleuthing. It seems that longevity is on everyone’s mind right now. So it’s important to know what questions to ask. How do you sort out the bogus from the scientifically supported?
When it comes to what leads to a long life, no one can say with certainty. Bill Mead, 80 in August, and still a weekly columnist for the Tehachapi News says, “I’m not sure why I feel fine. I have been moderately overweight most of my life.” He admits to loving Omaha Steaks and has the triple bypass to prove it. In his column, bestirring himself to move the TV remote is always a highlight. “The only healthy regimens I have maintained are not smoking and never working at a job I didn’t enjoy.” My mother took what I consider toxic levels of vitamins, exercised regularly, and remained overweight her whole life. She, too, worked until she was 80 at a job she loved. Jeanne Calment, the current holder of the record for a long life (122 years), smoked until she could no longer hold a cigarette. So who knows? But researchers can and do point to significant trends.
Life Expectancy and Longevity
There is, to begin with, confusion over life expectancy and longevity because the two terms are often used interchangeably. Life expectancy is just a statistical average that is useful for the study of large populations. For a woman in the United States, life expectancy is slightly longer than for a man; taken together they average about 77.6 years. Strictly speaking, you can do nothing to change your life expectancy. It’s determined by factors affecting the lives of millions of people. So if, for example, you are an Asian–American woman living in Bergen County, New Jersey, you have the longest life expectancy – 91 years — of anyone in this country. If, on the other hand, you are a Native-American living in North Dakota, making it to 60 is doubtful. These figures, at least, are the most recent findings of the Harvard School of Public Health and the Harvard University Initiative for Global Health.
Longevity is a slightly different matter. Longevity is how long a person will live under ideal circumstances. So here it makes sense to refer to practices and habits that can have a direct effect on how long you live. Of course, this is where the sleuthing gets interesting. Researchers need to ferret out which factors make the most difference. Some are focusing on genes (nature), including those genes that predispose us to illness or grant immunity from it, and those, that in themselves, might produce longevity. Other scientists are concentrating on the environment (nurture). Environment, here, means what we do with our bodies.
In an interesting study that shows how different factors must be sorted out, in 2004, the Department of Nutrition at the Harvard School of Public Health issued a report that showed that increased body fat and reduced physical activity are both strong and separate predictors of premature death. You can be active but still risk premature death if you are fat, and you can be lean and run a similar risk if you don’t exercise. Intriguingly, the Masai of Kenya do not suffer the effects of a high saturated fat diet. Is it because of genetic protection, or do the plants they also eat “inoculate” them against heart disease? Or is it the exercise required to live their nomadic life?
Can attitude make a difference? In speaking with a friend of my sister, Ida Mae Harris, who will be 95 soon, she said, “attitude is everything. That and faith.” Mrs. Harris is the oldest person in her assisted living residence, Spring Harbor, and she recently made a commercial for it. Despite two and a half years of ongoing chemotherapy and feeling “like a wet dishrag,” she forges ahead filling her days with activities but mostly “being open to people.” It is not hard to see how she was able to continue working until 72, thriving on the routine and associations.
Whether it’s attitude, or karma, what seems increasingly clear is that while genes can have some impact on longevity, particularly in some groups, environment also plays a definite role. So, for instance, when researchers look at the people of Okinawa, a group with undisputed longevity, what they see, despite any immunity that genes might confer, is that when subsequent generations stray from the largely vegetarian diet of their elders, the younger offspring begin to show an increase in the diseases of aging like diabetes and cardiovascular problems.
Looking at the Data
How to sort this all out? Start with verifiable data. One reason the Okinawa population is so useful for studies is that, Japan, through a family registry system that has existed since 1879, is the only country with proof of its citizens’ ages. In earlier studies, like those of the Hunza, the Vilcabamba and the Abkhasia, many subjects fudged their facts. For reasons ranging from wanting to avoid conscription to enjoying the adulation, many super-elderly exaggerated their ages. Even in the United States, reliable records date only from the 1940s, long after our current centenarians were born.
It also helps to observe a large group of study subjects over a sustained period of time. One invaluable source of epidemiologic information has been the Brigham and Women’s Hospital based Nurses’ Health Study, the source of the above noted linking of fat and activity. Over 100,000 nurses have been included in this study, and it has provided data for innumerable research efforts.
The New England Centenarian Study at Boston University Medical Center is another long-term project. Started by Dr. Thomas Perls in 1995, this study currently has 1,500 subjects; at present it’s the largest comprehensive study of centenarians (people who live to be one hundred) in the world. What Dr. Perls and his colleagues have found is that people who live to an old age have generally been healthier all along. Few are obese. There is no strong smoking history. Most handle stress better than others. Plus, exceptional longevity seems to run in families.
Many children of centenarians appear to be on the road to a long life themselves, with substantial delays in the development of cardiovascular disease and diabetes. One finding of great interest to me was that Alzheimer’s disease is not inevitable with aging and that many centenarians (75 percent) were still independent, on average, at 95.
Otherwise, these elders show wide variations in background. Some have little or no education, while others did post-graduate work. They have been very rich and very poor. Dietary patterns were not notable; some were vegetarians, and others ate a diet rich in saturated fat. And despite the fact that most of their friends and relatives die earlier, centenarians are almost never lonely.
Do these varied studies have anything to teach us? Yes, both in terms of public policy and in terms of personal habits. For instance, one notable feature of the Harvard study I’ve cited is that the life expectancy statistics did not change appreciably due to income, infant mortality, violence, HIV, or lack of health insurance. Seems counterintuitive, doesn’t it? But these factors explained only small differences; the real disparities come more from chronic diseases like cancer and heart disease and by injuries stemming from avoidable risk factors like alcohol. So where should public monies go? Where should we focus our educational efforts? Are our educational efforts in sub-acute settings as important to health care as what we do in the intensive care unit?
And what about the interesting but largely discredited studies of remote populations? Of the folks in Shangri La? Even if these populations don’t have anyone living until 120 or even 100, doesn’t the fact that their elderly seem extraordinarily active and fit mean something? Couldn’t commonalities like a low calorie diet, largely fruit and vegetable based, and constant physical exercise — along with a less frenetic but engaged lifestyle — contribute helpful ideas to nurses? After all, our profession is physically and emotionally grueling, so much so that a large percentage of practitioners leave it while they are just beyond middle age.
Elizabeth Hanink, RN, BSN, PHN, is a Los Angeles-based fireelance writer. She has experience in maternal-child health, critical care and home health nursing.
This article is from workingnurse.com.