The Mysteries of Aging
We can understand why the circle of life includes death, but aging is different. Why would an organism evolve to deteriorate as it grows older? How does it benefit us as a species to have eyesight dwindle, mobility decline, stamina evaporate, bones wither, and bellies get bigger? As a scientist and a gerontologist, I assure you that these losses and indignities no longer need to define the last decades of our lives. When we ask people in the United States how long they want to live, they usually say between seventy-nine and a hundred years, and in one study, the median number of years was ninety, but those responses are influenced by the effects of old age that people have witnessed, and the past does not dictate the future. An average U.S. life span of eighty-nine is just the current norm. When people can live beyond one hundred while maintaining their faculties and enjoying good health, we might feel shortchanged if we only make it to ninety-five.
Growing old may seem as normal as growing up, but when we look closer, we see that it’s a complex and often painful mystery. And it’s a mystery we must solve because aging poses a dramatic increase in our risk of having every chronic disease. The major risk for all types of cancer is aging, and so is the major risk for diabetes and Alzheimer’s. We have a hundred- to thousandfold greater chance of dying from aging than of dying from other risks like obesity or high cholesterol.
Everyone talks about cholesterol contributing to cardiovascular disease, but it’s only a threefold risk, whereas aging is a thousandfold risk for dying from cardiovascular disease. Cardiologists have argued that cardiovascular disease is just accumulation of plaque over time, but we know from autopsies of people in their twenties that plaque can start to form early on. For the first forty or fifty years of our lives, we can deal with those plaques, and they are actually dynamic—forming and going away. After age fifty, we start to lose the ability to control plaque accumulation because some of the biological processes that controlled it, decline. Some evidence suggests that a series of changes or mutations makes an organism likelier to die from loss of cells or from cancer, other evidence suggests it’s an increase in inflammation levels or oxidative damage that causes aging, and still other results suggest that aging occurs when our bodies lose the ability to activate the stem cells that keep our other cells healthy. All these theories have merit, but none of them alone is enough. To the degree that they’re true, they all drive aging together.
Most chronic diseases are united by one primary cause—the biology of aging itself. While there are genetic and environmental bases for many age-related diseases, aging increases our chances of contracting them more than any other factor alone. Aging is the main reason for the global epidemic of chronic diseases. The World Health Organization (WHO) estimates that these age-related diseases are responsible for about 70 percent of the global death rate and 80 percent of U.S. Medicare costs, which the WHO projects will cost the global economy more than $30 trillion by 2030. While life expectancy in the United States ranges from 74.7 years for West Virginians to 81.3 years for Hawaiians, research shows that the average American enjoys only 67.7 healthy years. So nobody can logically argue that we don’t need to accelerate our ability to increase health span—the span of good health. But based on health-adjusted life expectancy (HALE), the United States is not doing well with this. In fact, we’re doing worse than the European Union and ten other countries ranked in a report by the Aging Analytics Agency, coming in dead last after China. The three-hundred-page report points out that this is despite the fact that, among developed countries, the United States spends the most on health care per capita, at $9,892. Unfortunately, that number is predicted to grow an average of 5.5 percent a year through 2026, and if that happens, by 2027, health care spending will represent 19.4 percent of gross domestic product.
If we don’t make some dramatic changes in how we approach health and instead continue to treat one disease at a time, the best we can hope for is exchanging one disease for another. Making matters worse, these age-related diseases tend to accumulate and lead to functional decline. Often, surviving one onslaught only buys time for another onslaught. We’ve all heard about someone who had a stent installed or had coronary bypass surgery to prevent a heart attack and then died from a different chronic disease a few years later. Treating one disease at a time or targeting just one organ rather than targeting aging is a miserable approach—and it’s not working. When I started on the quest to understand aging, most of the research had been focused on the causes of aging, so I decided to approach the problem from the opposite side and find out what delays it.
When I entered the field, scientists like George Martin, one of the fathers of modern gerontology and a mentor to me, were trying to solve the mystery of aging predominantly by studying children with progeria, rare syndromes that age people far faster than what is considered normal—in effect, their biological age races ahead of their chronological age. But although those studies were extensive, the findings didn’t unlock many secrets of aging. So I thought that instead of studying people who age rapidly, we would study centenarians—those lucky folks who appear to be far healthier and more youthful than their years would predict. Centenarians are extraordinary because even as their chronological age ticks relentlessly forward, their biological age hangs years or even decades behind.
Studying centenarians led us to ask many questions, but the biggest one was:
Can we prevent or delay aging?
The answer is yes.
We still have a lot to learn, but the promise I can make is that help is on the way, thanks in part to the secrets of “SuperAgers” like the centenarians in our studies at the Albert Einstein College of Medicine’s Institute for Aging Research, which I founded. For them, the outlook is entirely different—all the chronic diseases are delayed. We experience old age and illness as one and the same thing, whether it’s diabetes or Alzheimer’s, Parkinson’s or cancer, but at seventy, the SuperAgers have twenty to thirty more mostly disease-free years ahead of them. My research team and I are on a mission to find out how these people are living such long lives in such remarkable health. Each time we unlock one of their secrets, we explore how we can use what we learned to benefit everyone else.
What Makes SuperAgers Stay Healthy?
Many centenarians pass the hundred-year mark almost effortlessly. Whereas most people are ill for an average of five to eight years prior to death, centenarians tend to maintain most of their abilities and are ill for only about five to eight months before their deaths. While we expected many of the centenarians we studied to be diagnosed with cardiovascular disease, Alzheimer’s, and Parkinson’s at higher percentages, they weren’t. That said, it’s important to clarify that centenarians’ bodies are not young. Many of them have some limitations like poor eyesight or hearing, some have less mobility than others, and arthritis is common. But the major diseases are delayed, and at the age of their retirement, many of them were not seeing a doctor and had no medical expenses. Surprisingly, the health care costs of the average person who lives past one hundred are only 30 percent of those of the average person who dies in their seventies.
* * *