Preface to You Are as Young as You Feel

I want to cheer when I recall her spirit and energy; it still gives me a rush of joy. Today, involving people in every step of care is commonplace and this is assisted by the availability of information on the internet. Practitioners are much better trained in communication. When presenting choices and offering full information, we gain a deeper understanding of the person, of what matters to them, why it matters, their expectations and the life experiences that shaped their presentation, decisions and thus our joint approach. More and more patients want to know why an illness or disorder occurs, to understand the background science of what may have gone wrong with their biology and to use this information to shape their decisions. So here, I have coupled how clinical disorders present as we age with the background biology that drives these changes.

I never ask a patient their age but rather base decision-making on an assessment of a person’s biological age derived from a traditional physical examination and history. No two 83-year-olds are the same: one can run a marathon and the other is a frail nursing home resident. Making a clinical treatment judgement is very different for each and not related merely to a number. Our experiences and circumstances in childhood years all contribute to biology of middle age and later years.

Preface

In fact, biological ageing starts very early on – by our thirties, it has become established in cells. By reading this book, you will discover the breadth of biological ageing and how much it varies from chronological age. Biological age can be measured by internal ‘biological clocks’. One study demonstrated a difference of 20 years in biological ageing clocks in adults as young as 38. Thus, age is not a number: our biological changes are what counts and the good news is that most of the factors that change our clocks are within our control to modify and improve – we control 80 per cent of our ageing biology. I have included some of the tests that we used in TILDA coupled with the expected normal results for your age and sex at the end of the book so that you can test yourself and see how you perform in measures which we know influence the pace of ageing. This book explores and details the centuries-long search by mankind for the elixir of youth and life. I am excited to share good scientific evidence to persuade you that you are as young as you feel, that there is a multitude of things that can be done to enhance enjoyment of the ‘last lap’ and ensure lifelong satisfaction, curiosity and pleasure.

Chapter 1: You Are as Young as You Feel

FOR ALL OF MY PROFESSIONAL LIFE I HAVE BEEN FASCINATED by how people’s attitudes influence not just ageing but their health. Recently, I had an 85-year-old patient with a mild chest infection who was very keen to return to full health speedily because she provides daily assistance to, in her words, her ‘elderly neighbour’. It transpired that her neighbour was 74 but frail and dependent on my patient who was more than happy to assist with care. It amused me to hear the patient describe someone 11 years her junior as elderly, while clearly not perceiving herself as such. She is typical of many people who do not ‘feel their age’, who believe themselves to be younger than their years, than their ‘chronological number’. For them, the popular mantra that today’s 70-year-old is yesterday’s 60-year-old is a truism, and this attitude aligns well with the current science.

Chapter 1: You Are as Young as You Feel

Eileen Ash is another great example of this. At the time of writing, she is one of the oldest women in Britain and still driving at age 105, having passed her driving test 80 years previously. When I read about Eileen, I was struck by her positive attitude and that she had always led and continued to lead an active and varied life. Despite being over a century old, Eileen continues to take daily brisk walks and does yoga – an activity that she took up in her nineties, an age when most choose to slow down. She says, ‘Some days I fancy doing the cat. Other days I do the cat and the dog. It makes my body feel much better. It keeps my muscles going.’ She demonstrates a positive, optimistic attitude with plenty of courage and self-belief, which has empowered her to take up new challenges at each stage of life without being inhibited by age. She doesn’t ‘act her age’ but rather continues to enthusiastically enjoy a full life; her chronological age does not interfere with her ambitions and approach to life and living. Eileen is a living embodiment of how one’s attitude towards age affects the speed at which biological ageing occurs. The science shows that her attitude helps to slow down both physical and cognitive ageing. My research group has done some interesting work in this area and shown how young or old one feels actually influences how quickly we age. In other words, the cellular processes which characterise ageing can be controlled by attitude and perceptions. From the yoga-loving 105-year-old to the 40-year-old who struggles to run a mile, we all know people who seem surprisingly young or old for their age. We can distinguish between two forms of age that helps to explain this discrepancy: chronological age is measured from birth to a given date. Biological age, also called physiological age, is a measure of how well or poorly the body is functioning relative to chronological age. We are born with a fixed number of genes – our DNA – but some of our genes can be switched on or off by factors such as diet, exercise and psychological approach and attitude. This switching on or off is called epigenetics. Biological ageing is defined by epigenetics, which occurs at all ages, and these changes in gene function speed up or slow down cell ageing. It explains the differences between biological and chronological ageing and why Eileen, at 105, appears and behaves ‘younger’ than others who are chronologically younger. Thanks to her positive attitude and because she has not stopped exercising throughout her life, Eileen has switched on protective genes which slow the pace of cell ageing. Epigenetics also explains why genetically identical twins who have the same genes but different life experiences and health behaviours age at different rates.

Chapter 1: You Are as Young as You Feel

Cells are more vulnerable to or better protected from damage depending on which genes are switched on or off. We can measure epigenetics from blood samples and use the results to better understand why some people, like Eileen, live longer healthy lives. For example, our research has shown that adverse childhood experiences, such as parental alcoholism or household poverty, and mental health problems, such as depression, poor diet and low education attainment, show up in our genes and link to health problems in later adult life. Measuring epigenetics means we can see how changes to our genes are driven by modifiable life factors – factors that both we as individuals and society can influence to control our biological ageing and therefore how long we live for. In other words, epigenetics explains the link between an individual’s attitude to age and actual cell ageing. To dig deeper into the science behind this and unlock some of the secrets behind successful ageing, we will first examine one of the world’s most important recent scientific achievements – the human genome. In June 2020, we celebrated 20 years since the Human Genome Project was launched. Thanks to the work done on this project, we can better understand the genetic changes which determine Eileen’s longevity. The Human Genome project was described by Tony Blair at its launch as ‘a revolution in medical science whose implications far surpass even the discovery of antibiotics’. Then-US President Bill Clinton rather more dramatically stated, ‘Today we are learning the language in which God created life.’ It was a revolutionary scientific endeavour of enormous scope and scale.