What Centenarians Can Tell Us

Robert W. Griffith, MD
April 23, 2004

Professor Thomas Perls of Harvard Medical School is the founder of the New England Centenarian Study (NECS). This study provides information about the health of some of the nation's oldest people. He has distilled the most interesting results in his book "Living to 100". We provide the first of several extracts from the book here. Robert Griffith, Editor.

Introduction

Today, each of us is faced with similar questions: is living to old-age something we want? And how much are we willing to do to make our later years healthy? For those who are prepared to make crucial choices that will affect their long-term health and longevity, the NECS offers more than a motivational boost. It provides hard facts about the mental, physical, and emotional health of the world's oldest people, information that no one of any age can afford to ignore. Centenarians paint a stunning picture of aging's potential. They demonstrate that long life can mean a healthy, enjoyable life, a life with friends and loved ones close by, a life of satisfaction.

As nearly 74 million baby boomers -- the largest generation in history -- move into middle age and beyond, we suggest that, rather than vainly attempting to preserve fading youth, they face the real possibility of living to a very old age. The NECS has revealed the delights of the later years: The indefatigable men and women we have met have shown us that the landscape of old-age can be less like a desert and more like a wild prairie waiting to be transformed into an orchard. With the new information contained in this book, baby boomers have a chance to set new standards for health and longevity. We hope that "Living to 100" sparks this kind of enthusiasm in our readers, and shows them how much all of us can learn about aging, not only from books such as this one, but from the dignity, intelligence, and wisdom of older people themselves.

The numbers of centenarians are growing

Modern times have been more hospitable to the extreme old. In 1900, only one in 100,000 Americans was a centenarian. Today, centenarians are at least 10 times as common -- one in 8,000 to 10,000. In industrialized countries the number of centenarians is increasing at the exceptionally rapid rate of about 8% each year -- compared to a 1% growth in the general population -- and the centenarian boom is expected to gather strength. In 1953 less than 200 centenarians were living in France; today there are 3,000. Queen Elizabeth sends birthday greetings to about 300 centenarian British subjects in 1955; by 1987 she was signing 3,300 cards. Today there are about 50,000 centenarians in the United States.

Birthday cards for centenarians were once as rare as the folks receiving them. Now the Hallmark Company has found it profitable to sell cards for people celebrating their hundredth birthdays -- a sign of an important new market! Hallmark says that by the end of the decade, they expect to sell more than 70,000 centenarian birthday cards each year.

What is the New England Centenarian Study (NECS)?

Enthusiasm for the Centenarian Study runs high, and we have enrolled approximately 85% of the centenarians in the targeted towns. (Normally, the best-enrolled studies of older people attract about 40 to 45% of the eligible population.) Perhaps our high enrollment rate has something to do with the respect and reverence families feel about their centenarian relatives. Family members agree with us that there is something special about these matriarchs and patriarchs, and they are just as curious as we are to discover what it is.

We have met with 169 centenarians, administered neuropsychological testing to 74, performed personality testing on 60, and autopsied 13 centenarian brains. We continue to gather blood samples and information about family trees from them and their siblings to explore the genetic basis of longevity.

What's special about centenarians

A surprising feature of centenarians turns out to be not their sameness, but their heterogeneity and unpredictability. The incomes in our study range from extreme poverty to vast wealth. They come from all ethnic and racial backgrounds; about half are foreign-born, while close to half are Massachusetts natives. Their level of education ranges widely, from second grade to the doctoral level. Their physical status at age 100 also varies considerably.

We were astonished to discover how many centenarians were healthy and living in the community. Fifteen percent of our centenarians were still living independently at home, which means of about 7,500 centenarians nationwide may still live at home, cooking their own meals, balancing their checkbooks, reading their favorite novels, getting together with their families and friends, some even working! About 35% of our centenarians lived with their families, while the remainder lived in nursing homes. About three quarters of them suffered from some level of dementia, but the remaining 25% were completely free of significant cognitive disorders. The oldest subject in the study so far is 112 years old, and is still reading the New York Times at breakfast each morning.

As more centenarians enter the study, patterns in their health histories emerged. For example, centenarians do not suffer a long, gradual decline in health. About 95% of our centenarians are physically healthy and cognitively independent into their nineties, with low rates of mental illness and depression.

An unexpected initial finding

The Hebrew Rehabilitation Center for Aged's Research and Education Institute kept detailed medical records on 5,000 older patients, 2,500 living in nursing homes and 2,500 in the community. A computer program scored each subject's cognitive and functional status on a scale of 1 to 5. Ability to carry out mental activities -- like planning a day, knowing how to get from one place to another, being able to anticipate appointments -- and to do household and self caring tasks -- cooking, eating, and dressing -- were all included in the score. If accepted concepts about aging held true, the overall scores should have dropped for subjects in the later decades of life.

At first glance, analysis of the data bore out the conventional wisdom. Overall functional status declined gradually from the seventies to the eighties to the nineties. However, when the groups were divided into males and females, a strange trend appeared. The overall cognitive function of men in the nineties was actually better than that of men in the eighties. There are not enough data to indicate whether the oldest women showed a similar rise, but the suggestion was there: Men and perhaps women who lived into their nineties were healthier than men just a few years younger. They had less dementia. They were better able to take care of themselves.

After only a month's study of the subject, a wide discrepancy had already appear between what the scientific literature predicted about the oldest old and what we were actually observing in the dining rooms and activity areas of the nursing homes where we worked. While our ingrained biases told us "older equals sicker" our eyes told us that the oldest old were sometimes among our healthiest patients. We began to suspect that a previously undetected process may have been taking place. Perhaps rather than having survived disease, centenarians were more likely to have altogether avoided the chronic and acute diseases associated with aging in order to live to 100. What emerged from this sudden intuitive realization was the hypothesis that has become the study's guiding light ever since: One must stay healthy the vast majority of one's life in order to live to 100.

The older you get, the healthier you've been

Centenarians are the navigators who have successfully completed a long, perilous voyage. Somehow, this one relatively small group of people has nimbly negotiated the maze of maladies, mishaps, and military conflicts that commonly leads to death. Not only do they escape death, but by and large they escape ill health for most of their lives. And, as we have found, their experience has much to tell us about how to live, too.

Centenarians, who represent the gold standard for aging well, should be society's role models. They are our "resident experts", who can help shape the way we live. People who are serious about remaining productive, enjoying life, and managing health care costs must learn to follow their admittedly long paces.

Our next extract from Professor Perls' book deals with the beauty of the aging brain. You can buy his book "Living to 100" at Amazon, click here

Source

• Living to 100: Lessons in Living To Your Maximum Potential at Any Age. TT. Perls, MH. Silver, 1st edition, Basic Books, New York, NY, 1999

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