Breakfast with the Centenarians

The Art of Ageing Well

Daniela Mari, Denise Muir

• Publisher: Atlantic Books
• Year: 2019
• Print ISBN: 9781786494832
• eBook ISBN: 9781786494849
• Topic: Medizin
• Subtopic: Gerontologische Krankenpflege

Learn the art of growing old from the supercentenarians living life to the fullest. It's said that life begins at 40 - but that number is constantly revised upwards as we live longer and longer. With the number of centenarians having quadrupled in the last thirty years, more of us can now hope to reach the 100-year mark than ever before. But how can we navigate this journey with grace, dignity and style? In this charming and informative book, Daniela Mari - the Italian doctor caring for some of the oldest people on the planet - draws on her experiences as a renowned gerontologist to reveal the science behind a healthy, happy old age. It turns out that the world's centenarians can teach us a thing or two about ageing well. And the secrets are not always what you'd think. Informed by the latest medical studies and incredible stories of individual longevity, Mari shows how our lifestyles can far surpass the influence of our genetics and why a daily glass of liquor isn't the end of the world. From our sleeping habits and diet to the crucial importance of our passions and interests, Breakfast with the Centenarians is the essential handbook for a fruitful and fulfilling old age.

CHAPTER ONE

Ageing

Youth is happy because it has the capacity to see beauty. Anyone who keeps the ability to see beauty never grows old.

Franz Kafka

Attending Milan’s La Scala one evening, I came away rather annoyed at the rest of the audience. They had hissed at the performance of Carmen, directed by the visionary creator of experimental theatre Emma Dante, responding to her interpretation of the opera with indignation and displaying a hankering for the more traditional productions of old. This happens whenever classics are given a makeover and unconventional productions are staged. Personally, I found Dante’s work to be spellbinding, but unfortunately it sparked heated protest among others. As I came out of the theatre, I encountered a city getting ready for the festive season: the pavements were bustling, and Christmas lights and decorations twinkled over streets congested with traffic. It was a city so unashamedly artificial and far removed from the one of my youth. As I noticed this, I wondered to myself, ‘Is this what old age is? This withdrawal into ourselves? This disdain for anything new and different?’

A story I’d like to share with you about a friend of mine would suggest otherwise: he is 82 years old and has an outstanding career behind him as a marketing executive at a hugely successful firm. After retiring, he attained a degree in philosophy, and he is now studying for a master’s. A few months ago he invited me and a few other friends to attend a lecture by Elio Franzini, an esteemed professor of Aesthetics at the University of Milan. Our humble group – some with only a vague recollection of the subject matter from their schooldays; others who had cultivated a love of philosophy well into their adult years – accepted the invitation, curious to hear what the professor had to say. The lecture theatre was full, with young people occupying every available space, the floor included. We took our places discreetly and I felt an unexpected frisson of excitement as I watched our ‘young at heart’ group of genuinely mature students soak up the lesson on the Enlightenment with the enthusiasm and concentration of university students. A familiar question came to mind: ‘Are we really getting old? Because if we are – and maybe we’re not – when did this process that none of us is aware of begin?’

My writing this book is an attempt to answer that question. When I started it I thought, ‘I’m really going to do it, I’m going to find the answer to this and to all questions about ageing.’ Unfortunately, the task still eludes me. Despite a career spent studying the ageing process, it refuses to bend to my comprehension, determined to perpetually evade my grasp. I sometimes feel like I have only scratched the surface, as there is so much yet to discover.

What I have established, however, is that while medicine and biology undoubtedly help us to understand how we age, the process is so much more than the simple decline of millions of cells and genes. Every person is unique, and from the many I have worked with throughout my career, I have learned that to understand what ‘getting old’ means, we must often look beyond science for answers.

To the philosopher Arthur Schopenhauer, for example. When Schopenhauer realized his life was drawing to a close, he wrote a series of essays which were published posthumously in the form of a wonderful book called Senilia or ‘The art of Ageing’.² This short manuscript is full of anecdotes and memories, short notes and witty comments, and maxims that are hugely evocative but never tragic or commiserative. The author does not sound at all like an old man who has given up on life; quite the opposite, he is a man who continues to discuss music, mathematics, religion and Shakespeare, defending his beliefs tenaciously. He fights for his ideals and pours his knowledge and spirit into the pages of his essays, which are testament to an essential truth which is often not fully understood: as we get older, our muscles may go limp and our bones grow weak, but this does not mean that we, ourselves, become flaccid and fragile.

An interesting study of 180 novices from the American School Sisters of Notre Dame suggests a way to age with grace and dignity consistent with Schopenhauer’s enlightened approach.³ Back in the 1930s, the Notre Dame sisters had been asked to write an account of their lives, describing their most important experiences. They all mentioned key events from their childhoods, the schools they attended, their religious practices and the reason they entered the sisterhood. When researchers examined their diaries sixty years later, they found an intriguing inverse correlation between the expression of positive emotions and an increased risk of mortality in old age. Novices who had shown greater imagination and used richer language in the autobiographical accounts written in their younger years tended to live longer and were more intellectually and emotionally active than the sisters who had lacked ideas and enthusiasm in their youth.

The findings of the Nun Study are of seminal importance and can’t be emphasized enough, especially in a world in which the population is ageing at such a rapid rate. The number of elderly people living in the West has grown exponentially; the same is true in eastern hemisphere nations, such as Japan. In the UK, for example, the Office for National Statistics (ONS) found that while in 1996 the number of local authorities with more than 3 per cent of the population aged 85 and older was zero, by 2016 it was over half of local authorities.⁴

This global phenomenon started last century, as a result of declining infant mortality, improved hygiene, better diet, widespread vaccination programmes and the introduction of antibiotics. But the biggest gains in life expectancy since the 1980s can be traced primarily to fewer deaths from cardiovascular disease, made possible by new medical and surgical treatments, as well as health and disease prevention programmes that have increased public awareness. This tendency will most likely continue into future decades. It is estimated, for example, that the life expectancy of a 30-year-old male would be extended by fifteen years if cardiovascular disease risk factors – such as smoking, high cholesterol, high blood pressure and obesity could be eliminated.

To get a clearer picture of population ageing in Europe, consider that life expectancy at birth has risen by an average of ten years across the European Union (EU). Of the 743.1 million people now living in the EU, 18.9 per cent are aged between 53 and 71. Italy is a perfect example of the phenomenon – according to the country’s National Institute of Statistics (ISTAT), in 2015 there were 13,300,000 so-called baby boomers (the name given to the demographic cohort born in the boom years after World War Two, between 1946 and 1964, when birth rates spiked) out of a total 60,795,612 inhabitants. Similarly, in the UK in 2016, 18 per cent of the population was aged 65 and over, and 2.4 per cent aged 85 and over. These baby boomers now make up the older generations in society, and as they continue to age they pose serious challenges to health services in the developed world. It is interesting how greater longevity – living significantly longer than the average life expectancy – was the target of health policy for decades, but now that we have almost achieved it, this once-utopian endeavour may destroy the economies of many European and non-European nations.

At the start of the twentieth century, the average lifespan in England and Wales was 46 years and the main causes of death were respiratory illnesses like pneumonia, tuberculosis and complications triggered by flu. Average life expectancy has now reached approximately 81 years, and the main causes of death are chronic or degenerative diseases. This is unprecedented in the history of human ageing, and the remainder of the twenty-first century is likely to witness an even more rapid expansion of the elderly population. Clearly, this has not come about by chance. Social development, fuelled by advances in medicine, has played a key role in bringing us to where we are now.

Another surprising fact is that the number of centenarians living in Europe and other Western countries has doubled every year since 1960. Italy had only 49 centenarians in 1921, but an unbelievable 1,304 by 1981. At the beginning of 2015, ISTAT estimated that centenarians accounted for 19,095 of the country’s 60,795,612 inhabitants, a number which is expected to rise to approximately 100,000 by 2050. Meanwhile, in the UK, the ONS reported that there were 14,570 centenarians in 2015, four times the number in 1985; and in France, the National Institute of Health and Medical Research (INSERM) estimated in 2016 that 21,000 citizens were aged 100 or over, twenty times as many as in 1970. Based on these figures, healthcare is set to become the largest area of government expenditure throughout much of the developed world.

Before we dive into the unexplored waters of ageing, I’d like to start with some background. As I mentioned earlier, I’ve devoted a large part of my professional life to studying what it means to get older, and gerontology is very different from, let’s say, orthopaedics. Injuries to the skeletal system can cause serious pain and have far-reaching effects. The body has multiple bones in a myriad of shapes and sizes, and when we break one, it takes special care and treatment to heal it. The techniques used to do this all stem from very old and well-documented principles. Gerontology, on the other hand, is a relatively new branch of internal medicine. After all, what use would ageing studies have been in the nineteenth century, when a doctor’s sole concern was how to save his (mainly young) patients from the effects of war and epidemics? In a way, people didn’t age – or at the very least, growing old was a luxury afforded to the lucky and rich few. Doctors had to focus on more imminent problems.

At the birth of David Copperfield, in Charles Dickens’s famous novel, the sole concern at the forefront of Mr Chillip (the doctor) and Mrs Copperfield’s minds is delivering the baby alive. Physicians back then had no idea that ageing starts in the womb and that everything we do in life – including before it begins – shapes our life expectancy.

The truth is that ageing is an unstoppable and inevitable process which starts at birth and ends with death. It can be scientifically defined as ‘age-progressive decline in the physiological, biochemical and genetic functions needed to survive, conceive and reproduce’. The underlying causes are found in the interaction between intrinsic (genetic) and extrinsic (environmental) factors, as well as stochastic (random) events and so-called ‘epigenetic’ factors (a kind of mix of the above where environmental factors regulate how genes are expressed). With advances in research, we have come to realize that ageing is also the result of how all these factors interact, which makes the process unique to each individual. Of course, human life expectancy also varies from population to population: for example, a baby boy born in the UK between 2014 and 2016 can expect to live for 79.2 years and a baby girl for 82.9 years; while in other parts of the world – like Togo, Cambodia and Afghanistan – life expectancy is less than 40 years.

There’s an anecdote I’ve always liked because of how well it captures the unpredictability of ageing. In 1965, Jeanne Calment, a French woman living in Arles, signed an agreement at the age of 90 for the sale of her apartment to lawyer André-François Raffray, a man half her age. Under the equity release scheme they used, Raffray was required to pay a monthly rent to Madame Calment until her death, at which time he would inherit the apartment. The deal seemed too good to be true, but it backfired when the elderly Madame Calment, who had the energy and mental acuity of a teenager, lived until she was 122. She outlasted Raffray, who never managed to move into the apartment he had bought. In fact, Madame Calment was the longest-living person since modern scientific records began, and her age is currently cited as the maximum human lifespan.

At every stage of our existence, even at the very end, the human body is programmed to survive, not to age and die. However, the process of natural selection drives each species to establish a hierarchy of priorities, at the very top of which are growth and reproduction. In other words, we are programmed to focus on perpetuating the species, rather than fashioning bodies capable of lasting forever. When biologist Tom Kirkwood formulated his ‘disposable soma’ theory in the 1970s, he drew an analogy between ageing and the industrial practice of not wasting infinite resources on increasing the lifetime of products which will be used for a limited time.⁵ Kirkwood posited that, from an evolutionary perspective, we age because developing an immortal body would require too much energy. For most animals, humans included, energy is primarily earmarked for cell repair during the reproductive stage. Reproductive cells take priority, and all non-reproductive (somatic) cells are subject to deterioration and ageing.

The scientific voyage of discovery to uncover the secrets of ageing, longevity and life expectancy is, as you may already have guessed, quite an epic one. It began in 1961 when Leonard Hayflick demonstrated that there is a set number of times our cells can divide to form new cells.⁶ Called the Hayflick limit, this number determines an organism’s lifespan. Hayflick based his ageing theory on cultures of specific cells called fibroblasts, which are found in the skin and other tissues. He noticed that when adequate nutritional substances are present, embryonic human fibroblasts double up to fifty times before entering a senescence phase that, after a further ten cell divisions, ends with the extinction of the cell population – in other words, cell death.

Having made this discovery, Hayflick was later able to demonstrate that the number of fibroblast replications in different animal species is directly proportional to the maximum lifespan of each species (as shown in Figure 1).

Hayflick suggested that lifespan is linked to genetic factors, and that each species and each individual has their own ‘inner clock’ that pre-programmes the length of their existence. Writer-director Andrew Niccol seems to draw on this discovery in the 2011 film In Time, in which the characters are genetically modified to stop ageing at 25, when a timer on their forearm starts to count down the one year they have left...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Introduction
• 1. Ageing
• 2. When do we begin to age?
• 3. Cognitive decline
• 4. Active ageing
• 5. Learning from the centenarians
• Conclusion
• Acknowledgements
• Bibliography
• Notes
• Index