Breakfast with the Centenarians E-Book

Daniela Mari

• Herausgeber: Atlantic Books
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 153

Veröffentlichungsjahr: 2019

Beschreibung

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.

Leseprobe

Breakfastwith theCentenarians

First published in Italy in 2017 as A spasso con i centenari by Il Saggiatore, Milan.

First published in trade paperback in Great Britain in 2019

by Atlantic Books, an imprint of Atlantic Books Ltd.

Copyright © Daniela Mari, 2017

Translation Copyright © Denise Muir, 2019

The moral right of Daniela Mari to be identified as the author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act of 1988.

The moral right of Denise Muir to be identified as the translator of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act of 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of both the copyright owner and the above publisher of this book.

10 9 8 7 6 5 4 3 2 1

A CIP catalogue record for this book is available from the British Library.

Trade paperback ISBN: 978 1 78649 483 2

E-book ISBN: 978 1 78649 484 9

Printed in Great Britain

Atlantic Books

An imprint of Atlantic Books Ltd

Ormond House

26–27 Boswell Street

London

WC1N 3JZ

www.atlantic-books.co.uk

A still from Frank Capra’s 1937 movie Lost Horizon, which immortalized the fictional utopia Shangri-La (© Alamy).

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

Introduction

What does ‘ageing’ mean? Is it the inexorable passing of time until you catch sight of yourself in the mirror one day and don’t recognize the person looking back? That moment in time when you realize the reflected you is no longer the way you see yourself in your head? But what time-spectrum are we talking about exactly? Is it the one that starts at birth but feels different as we progress through our twenties, forties, and into our sixties and beyond? Or is it the one that’s shaped by individual biological and life experiences, meaning it can vary from person to person?

Ageing is a complex, dynamic and ultimately variable phenomenon. When I was younger, for example, and had to juggle family, work and study commitments, all at breakneck speed, I saw old age as a time when I would finally be able to start working my way through the stacks of books piled everywhere (the only true ‘feature’ in my house), take that trip I’d put off for years, enjoy lots of free time, and finally stop worrying about how I look. After many years spent studying ageing, I realize that the most common scientific definition – the accumulation of changes in cells and tissues as we grow older, bringing about the increased risk of illness and death – is oversimplified and refers purely to biological ageing.

The first time I met my publisher to discuss this book, in a pretty fish restaurant in the centre of Milan, near the university where I had taught for many years, he asked me why I had become a geriatrician. All of a sudden, the distant memory of myself as a young student flooded my consciousness, like perfume filling the air when the top is taken off. In the mid-1970s, geriatric medicine was not a compulsory part of the medical degree programme, merely a ‘subsidiary’ exam. With the enthusiasm of youth, I thought I’d be studying the secrets of ageing and would discover a new Shangri-La (the Tibetan valley that was home to a community of especially long-lived monks, described by novelist James Hilton in Lost Horizon (1933),1 which was later adapted for the big screen by Frank Capra). But a meeting in a hospital outside Milan with the lecturer I wanted to supervise my dissertation brought me back to reality with a bump: the hospital had only one tiny ward and scores of elderly patients, many lying in corridors. He was so busy providing patient care, not to mention exhausted due to staff shortages and a lack of funds, that he had no time for anything else. It was only many years after graduating, when I found myself studying the blood profiles of a group of ultra-long-lived individuals, that my interest in ageing was revived.

The thing that fascinated and surprised me the most was getting to know these grand old individuals and being able to explore the worlds they’d grown up in – worlds so different to the one we know today. My work in the field has taught me that ageing is a complex phenomenon, and as such requires a humanistic approach if we’re to see beyond the purely biological. As my research progressed, the wider academic world also acknowledged that the demographics of the Western world had changed, as elderly adults accounted for an increasingly large chunk of the population. Geriatrics deals not only with the prevention and treatment of conditions afflicting the elderly, but also provides psychological, environmental and socioeconomic assistance. It is a discipline which is also known as gerontology (namely, the study of the biology, physiopathology and psychosocial aspects of ageing).

My experiences with older individuals and the clear need for more teaching staff in geriatrics were what made me want to be a geriatrician and choose gerontology as my field of study. It allowed me to focus both on teaching young people and on caring for the elderly. Breakfast with the Centenarians is the result of that decision, a choice I have never regretted.

Unsurprisingly, geriatrics is a fairly young area of study, given that we as a species have only recently been lucky enough to make it so far into old age. In the first chapter of this book, I try to convey just how fascinating the early studies of ageing were. Some of them even earned their authors a Nobel prize!

Like many of the myths surrounding the ageing process, to equate ageing with old age can be misleading – ageing begins from conception, and the second chapter explores our first years on earth.

The care aspect of my profession cannot be viewed separately from the scientific observation and research part – they are two sides of the same coin and their duality forms the backbone of this entire book, but Chapter 3 in particular. It looks at the issue of cognitive decline, which is a major concern as we grow old. Spending time with the many patients I have treated over the years, each with their own past, has shown me that cognitive decline depends on the experiences people have throughout their lifetimes. Our job as clinicians is to explore these individual histories and suggest treatments which don’t always have to be pharmacological. My own research delves into such experiences, primarily looking at the importance of art, music, culture and an active lifestyle in remaining healthy in old age.

The notion that lifestyle choices can substantially affect our ageing is one of the most exciting debates in current gerontological research, the objective now being to achieve what the World Health Organization calls ‘active ageing’. Chapter 4 looks specifically at this aim. I delve into new and innovative technologies that can assist us in this regard: robotics, for instance, has made the leap from the realms of fantasy to the real world as a viable research and treatment tool.

Coming full circle, in the last chapter I return to my early experiences in gerontological research, to a time in the 1990s when I embarked on the study of ‘successful ageing’, as it was becoming known. Centenarians, of which there are more and more in society (due to increased life expectancy and better access to healthcare in infancy, childhood and adolescence) are an extraordinary model of humanity, and a compendium of the many ageing theories proposed over the centuries.

Do centenarians hold the key to the elusive Shangri-La that we all seem to be seeking – now, more than ever? The road to the valley is a bold and valiant one, if we are to believe Frank Capra’s vision, so perhaps it is time to travel along it.

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.