This is more about successful ageing, and what we need to do or stop doing to achieve that, than chipped potatoes or how we cook food!
Fries refers to James Fries about whom more later; Linda Fried is a doctor working in the US who led a group of researchers who proposed criteria for the definition of frailty.
One way of defining ‘successful ageing’ is that we retain good physical, cognitive, respiratory and cardiovascular function well in to our 70s, 80s and even 90s.
Why does this matter? Although most of us are not particularly worried about death as we grow older, many of us fear the onset of chronic disease, loss of intellect and memory and becoming totally dependent on others. Given the choice most of us would avoid the slippery slope to physical frailty and disability.
How? In the 1980s James Fries (pronounced Freeze) challenged the assumption that medical advances and other changes which had occurred since the turn of the 19th/20th centuries would result in growing numbers of frail, feeble and even more expensive to-care-for elderly people. In other words more people would survive long enough to become frail.
Fries maintained that within broad biological limits we can choose not to age rapidly in certain physical and mental faculties. This concept has been termed the ‘plasticity of ageing’. In other words the ageing process, irrespective of our genetic make-up, can be modified by what we choose to do or not do.
He postulated that if we focused on health improvement and well-being, the quality of life rather than its duration, we could postpone the onset of chronic disease and disability. This became known as ‘the compression of morbidity’. In other words more of us would retain our vigour for longer, and less of us would experience chronic disease or need institutionalization as we age.
Of course eventually even the fittest of us would die from assumed multi-organ failure. Fries saw this as a ‘natural death’: free from diagnosis, intervention and institutionalization. And so say all of us!
So how do we reap our potential for health and well-being? What exactly do we need to do or stop doing which is going to make a difference?
Fries was responsible for some of the early research designed to find the answers to these questions. In a nutshell: people with better health habits not only survive longer, their disability ‘experience’ is postponed and compressed into fewer years at the end of life.
In his study published in 1998 in The New England Journal of Medicine, people in the ‘high risk’ group, who smoked, took no exercise and were overweight (as measured by a BMI ≥25.5), had a 50 percent higher mortality rate and nearly 100 percent greater odds of being disabled than the low risk group.
His ‘low risk’ group which included non-smokers, those who exercised for more than 240 minutes per week and were normal weight (BMI < 22.5) postponed the onset of disability by more than 5 years. Even the ‘moderate risk’ group postponed the onset of disability by more than 3 years in comparison.
Further evidence of the benefit of healthy habits was provided in another study published in The Canadian Medical Association Journal in 2012. This included people recruited when they were aged between 42 and 63 and followed up over 16 years. The health habits they looked at were smoking, alcohol intake, exercise, and eating fruit and vegetables daily.
If you practised all 4 of the healthy options: you didn’t smoke, consumed only moderate amounts of alcohol (≤14 units for women, ≤21 units for men per week), carried out 2.5 hours of moderate or 1 hour of vigorous exercise per week, and ate fruits and vegetables daily, you were more than 3 times as likely to achieve what they defined as ‘successful ageing’. Even if you only practised 2 or 3 of the 4 habits you still increased the odds of a significant benefit.
At the end of the 16 year follow up period only 20 percent of the cohort met the stringent criteria for ‘successful ageing’, which included measures of cognitive, lung and physical function as well as mental health.
One of the tests of physical function was a timed walk of 8 feet which is easy to do although having someone to time you is helpful.
Test yourself. You can do it: the 8 feet (2.44 metres) timed walk.
- Ask your partner or a friend to help with recording the time.
- Mark out a distance of 8 feet (2.44 metres) on any level surface (e.g. indoor hall or corridor; outdoor path, patio or driveway)
- Walk the distance of the ‘course’ as if you were walking down the street at your normal pace. (This is not a race).
- Stand at start. Time from when you “go” to when your first foot lands on the surface beyond the finish line.
How do you rate? The top 10 percent of a group of those aged over 70, both men and women, completed this within 3.1 seconds or less. Of course if you are younger or fitter you can complete this test in less than 2 seconds even walking at a ‘normal pace’ for you.
Want to walk a little further? Try extending the distance to 4.75 metres (a little less than 16 feet).
Follow the instructions above, marking out the longer distance and also measure your height in centimetres.
How do you rate? You are considered slower than normal if your time was:
- For men: greater than or equal to 7 seconds for height ≤ 173 cms; greater than 6 seconds for height > 173 cms.
- For women: greater than or equal to 7 seconds for height ≤ 159 cms; greater than 6 seconds for height > 159 cms.
Key messages:
- We can postpone the onset and duration of disability by adopting healthier lifestyle habits.
- In order for these habits to be effective we need to start to practice them as soon as possible, certainly in our 40s; but it is never too late.
- Although as James Fries says: “There is no one magic pathway to living a happy life of longevity and vitality”, learning and practising healthy habits will have significant benefits.
- These include regular exercise, attention to diet and weight, and a sensible approach to drinking alcohol. Even if you only achieve 2 or 3 of these healthy habits you may still realize significant benefits.
