Take time today to prepare your patients for their golden years

November 1, 2004

Your young patients are more likely to survive to very old age than did previous generations. Will they flourish as senior citizens or be limited by illness and disability? In large measure, that depends on whether their families put into practice the advice you give—advice that comes out of an expanding body of remarkable, illuminating research.

Jump ahead 65 years. Envision the toddler who was brought to your office yesterday with otitis media as a Medicare recipient with the vigor for a regular tennis game, a new course of study, or a trip abroad. And that anxious preteen patient with an appetite for ice cream and video games? Decades from now, she's a retired software wizard, a yoga master, and a fledgling author.

Recent projections from the US government's Census 2000 indicate that your patients' odds of growing old are excellent. In 2000, people between 65 and 84 years old accounted for 10.9% of the US population; those 85 years and older, 1.5%.1 Compare that with census predictions for the year 2050: 15.7% of the population will be between 65 and 84 years, and 5% will be 85 years or older. Another estimate for 2050 suggests that 500,000 to 4 million members of the latter group will be 100 years or older!2

The question of greatest importance is how to best ensure that people remain healthy enough to enjoy a longer lifespan. Some of those who make it to the 100-year mark and beyond are of remarkably sound body and mind. Since 1994, the New England Centenarian Study (NECS) has been searching for the variables that allow this fortunate minority to age at a seemingly slower than average pace. Most study participants remained "functionally independent" into their 90s.3 An advantageous genetic profile may be at least partly responsible. When compared with a US birth cohort from 1900, female siblings of centenarians were eight times more likely to live to age 100, and male siblings were 17 times more likely to survive to their 100th birthday.4

Better understanding of what makes this group healthier than the majority of people could lead to new treatments for a number of ills. In the meantime, it's important-for clinicians and for everyone else-to remember that good genes are not likely to prevail over bad health habits. Ordinarily, genetics have roughly a 25% effect on life expectancy.7 "Most people have the genetic make-up to live into their mid to late 80s in very good health, and like centenarians, compress the time they are sick toward the end of their life," writes Thomas Perls, MD, MPH, lead researcher for the NECS.3 "Much of their ability to do so depends upon healthy behaviors, including a diet conducive to being lean, not smoking, and strength training. Promoting this philosophy will have a much greater impact now on many more people than our genetic research."

Early warning Charles A. Cefalu, MD, MS, professor and chief of the section of geriatric medicine at Louisiana State University Health Science Center, often sees 70-year-old patients who appear to be 85 or older as well as 75- or 80-year-olds who could pass for much younger. "It's the difference between successful aging, where your physiologic age is less than your chronologic age, or the reverse, where you age prematurely," he says. "What explains it? I'm a firm believer that early development of healthy lifestyles has a tremendous impact."