The Longest Season
Chapter 1
Preface — Part 1
ON A WET, DARK NIGHT IN JANUARY 2018, I PLOUGHED through the pools of water that covered the black road heading for a town in the middle of Ireland. I was to give a lecture on ageing and health to the townsfolk. During the miserable journey, my despondency deepened at the hopelessness of ever attracting an audience on such a bad night. Hosted in a cold hotel which usually catered for funerals and weddings, it was billed as ‘the first lecture of an all-Ireland tour to share new research by a Trinity College academic’.
The ballroom was large, cold and empty; the small lectern seemed out of place and lonely, staring down on a mass of empty gold wedding chairs. The overhead projector was too old to be compatible with our PowerPoint system, so my PA headed off into the night to source alternative technology. Mumbling to myself, ‘I must be mad,’ I encountered the shy hotel manager who completed my gloomy apprehension by apologising on account of a competing event across the street, the ‘Mission’. I hadn’t heard that term in so long. The Mission is a long-standing Irish tradition, an annual event where the local Catholic church hosts preachers and sermons from visiting religious orders. My heart sank: in rural Ireland, the Mission would be inequitable competition.
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Yet little by little, the hall started to fill. People of all ages bustled in: 30-year-old mums with kids, 50-, 60-, 70-year-old men and women. Two buses pulled up outside and disgorged their prattling contents from the surrounding countryside and villages. Next, residents from a care home shuffled in, transported by a kindly local volunteer police officer in full uniform. The space began to warm with mounting chatter, growing laughter and the clinking of china. The local GAA football club was serving tea, coffee and cakes, and on display were Ireland’s two most prized sporting trophies: the Sam Maguire and Liam McCarthy cups, provoking photos and more banter from the swelling crowd. A local children’s band set up their instruments; the audience took their seats and, to the rhythm of lively jigs and reels, I settled in to begin my first of many such lectures.
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Afterwards, I met with the audience, who were brimming with questions and comments. I was taken aback when some remarked that they had never attended a lecture previously, ‘apart from the priest’s sermon on a Sunday morning’ (ironic, in light of the Mission across the road they had now missed). This was chastening. Many asked if I had written down the content of the lecture and whether there was a book that covered the information I had shared, thus planting the seed for this publication. The book is a distillation of the content of the lectures and a tribute to the joy I experienced in sharing the knowledge and experience on the road trip of a lifetime. Time and time again, patients, work colleagues and friends have told me how they hate the thought of growing old. People in their forties and fifties say they try not to think about it because for them it carries such negative overtones. And yet, the science in this field is vast and moving ahead very rapidly. When I was a young doctor, it was almost non-existent but over the past 20 years it has exploded. The field continues to evolve at a pace, providing us with good evidence that the ‘last lap’, as one of my patients calls it, can actually be the most relaxed, worthwhile and enjoyable period of our lives – particularly if we prepare for it.
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Part of that preparation is understanding what factors determine ageing and what we can do about it, in a timely fashion. Have you ever paused to wonder why we are living longer? A baby girl born today will live on average three months longer than her sister born last year. In 1800, you could expect to live to 40; 200 years later, that has more than doubled and we can expect to live to 85 and beyond. When I was starting my medical career, it was an unusual event to have a patient of 100 years or more in the hospital and we would flock to view this rarity – this is not uncommon today.
I was first wooed by clinical ageing when I was a young trainee doctor and the fascination for why we age continues to drive my curiosity and research. Then and now, engaging with patients and learning from their life stories guides answers and solutions, raising the obvious questions about why some people appear resilient to ageing while others ‘age early’.
The Blue Zones hold many of the secrets that can help answer these questions. They are five places around the world, in Sardinia, Italy; Okinawa, Japan; California, USA; Nicoya, Costa Rica and Ikaria, Greece, all beside the sea, which have the highest proportions of centenarians worldwide. People of the Blue Zones don’t just live longer but are fitter and stronger and less likely to get sick in old age. They are more likely to live healthy and physically active lives beyond 100.
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In this book, I have built on the knowledge we’ve gained from studying the Blue Zones to share the up-to-date science underpinning successful ageing. The cornerstone of successful longevity in the Blue Zones comprises several fun things: having a purpose in life, being curious, having lots of variety, laughter, friendship and enjoying a sense of belonging and close, strong connections with friends and family, including shared meals, wine and much more. Since the discovery of the zones and the factors that determine the healthy longevity of those who live there, there has been much research into why these things affect ageing and the biological reasons that underpin why Blue Zone people live so long and so well. How could something like having a purpose each day affect us biologically so that cell ageing slows down? And why have we evolved to need to have a purpose to survive? Knowing this, how can we ensure that we retain purpose in our lives every day? These are some of the questions that will be explored in these pages.
My book takes a whistle-stop tour of the key up-to-date learnings from my cumulative experiences as a clinician and as a researcher in this field. What makes this book unique is the distillation of cutting-edge research taken from one of the most comprehensive multidimensional research studies worldwide (which I lead), coupled with over 35 years of clinical experience in ageing medicine, illustrated by colourful patient histories collected over the years.
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I have been privileged to establish and direct a groundbreaking research study of ageing, which has followed almost 9,000 adults aged 50 and older. Since 2009, the Irish Longitudinal Study on Ageing – TILDA – has generated over 400 research publications. The study covers all aspects of life, from sexual activity to food, to physical health and brain health, genetics, childhood experiences, expectations, friendships, finances and much more, to inform the complex picture that explains why and how we age. No one aspect drives ageing; it is a combination of factors – and many are within our reach to manipulate. Drawing on TILDA and a host of other similar sister studies, I have been careful to ensure that the information included here is rigorously evidence based – no ‘fake news’. I am as clear as I can be of the strength of evidence behind the information and shy away from anything that is conjecture. I stress this because a good friend in the States recently directed me to a ‘brilliant’ book (a bestseller) on a health and well-being topic. She did this in good faith, thinking that I would get ‘inspiration’ from the writing. I began reading it but I never finished the book as many of the definitive statements made by the author were based on supposition and not evidence based. I was taken aback at how my well-read friend could have been so gullible. There is another reason I wanted to write this book. During my years as a clinician and researcher, I have witnessed a welcome transition in patients’ expectations and curiosities. People are much better informed and consequently more engaged in the process of diagnosis and treatment, with both patients and practitioners moving slowly but surely towards shared decision-making and deeper awareness of a holistic approach to health and ageing. The medical profession more and more incorporates ‘quality of life’ and determinants of overall well-being into discussions with patients. The profession has gradually stepped out of traditional clinical silos and learned to interrogate wider life experiences that contribute to diseases and age-related processes. In my early days as a physician, medicine was much more didactic: the doctor ‘told you what to do’. Part of the change in culture has come from sharing wider knowledge of all of the components that make up successful treatment responses, including lifestyle, relationships and attitudes. A stark memory from my early days in training abides. It was the morning of a traditional mammoth ward round, with a senior clinician, a nurse, three junior doctors and two medical students all circled around a patient’s bed on an open 16-bed ward – a daunting sight for any patient.