How to live longer?
My conversations with patients frequently include the question: “How to live longer?”
We talk about the risk factors, genetic predispositions, and lifestyle changes. An interesting article caught my attention last month published in Jama “A Prescription for Longevity in the 21st Century Renewing Purpose, Building and Sustaining Social Engagement, and Embracing a Positive Lifestyle” written by Standford University Professor Dr. Phillip Pizzo.
Dr. Pizzo offered his point of view on a very important topic that we as primary care physicians frequently do not have time to discuss during 15 min scheduled patients visits. I was excited to see the validation of my time that is tricky to bill for by current healthcare billing rules, but something that I view as the most important question to answer: How to live longer successfully?
The United Nations projects that by 2050 the world population of “oldest-old” aged 80 years and above will triple to 434 million. By 2030 all baby boomers, those born between 1946 and 1964, will comprise approximately 20% of the US population. It’s a time for us as clinicians to rethink our role in serving our patients. Is it just about treating diseases? What is our role in positively contributing to our patients’ longevity besides “advising to stop smoking, stop eating fast food and exercise”, which are important, but is it enough?
There is a way to measure the factors that contribute to successful longevity. Researchers from Columbia University Mailman School of Public Health with Stanford Center for Population Health Sciences published the John A. Hartford Foundation Aging Society Index as a measure of successful longevity. It includes 5 domains ( each takes about 17-25% of the index value):
1)Productivity and Engagement: measures connectedness within and outside the workforce,
2)Well-being: measures the state of being healthy,
3)Equity: measures gaps in well-being and economic security between the haves and have nots,
4)Cohesion: measures tension across generations and social connectedness,
5)Security: measures support for retirement and physical safety.
What it means for us as physicians that we not only should be having longevity discussions with patients, but creating a longevity assessment and plan for the future of an individual’s sense of purpose, social engagement, and lifestyle choices. There is plenty of scientific data about:
purposeful activity especially caring for others decreasing all-cause mortality. A recent study of 6985 individuals in the Health and Retirement Study of adults older than 50 years demonstrated that a stronger life purpose was associated with decreased mortality.
Healthy eating, regular physical activity, mindfulness practices rightfully contribute to the modification of risk factors of dementia, obesity, cardiovascular disease, and cancer.
Avoiding loneliness and promoting social engagements improves the quality of life correlates with health outcomes. A meta-analysis of 148 studies involving 408 849 participants showed positive social relationships were associated with a 50% increase in survival, whereas poor social relationships were associated with a 29% increase in cardiovascular disease and a 32% increase in strokes.
Prescription of purposeful, socially engaged, fostering wellness living to our older patients is not new, but making it a priority in our healthcare is a new step and a new challenge. Teaching medical students and residents how to develop patient-doctor relationships that are trustworthy for patients to believe in our recommendation is the place to start.
