Why we need to rethink what we mean by "old"

Vastly increased life expectancies require different approaches to caring for the elderly

Look what I can do!" exclaims Leoncia González. She leans forward on her walking stick, keeping her legs straight until, slowly but surely, she manages to touch her toes.

The 101-year-old is just one of a growing number of centenarians still enjoying rude health. "We are genetically programmed to live for 120 years," says José Manuel Ribera, a gerontologist and member of AEMAL, the Spanish Society of Anti-Ageing and Longevity Medicine. That said, he accepts that it is exceptional to live beyond 110, and that the real goal we should be aiming for is a healthy life up to the point of death, rather than simply living an eternity.

The rapid growth in recent years of people living up to and beyond 100 years of age is forcing us to rethink what the word "old" means. Are we old at 65, for example? It is also forcing us to think about how to provide for the elderly who manage to live for such a large number of years. There are currently around a quarter of a million people on the planet aged over 100, says James Vaupel, a research chief at the Max Planck Institute for Demographic Research.

So how many Spaniards will live beyond the age of 100 over the coming decades? Vaupel says that his team has seen a five-fold increase in the number of people in Spain making their century. Rosa Gómez-Redondo, a Spaniard working with Vaupel, says that the trend will continue for at least the next 20 years, but says that the team still has to carry out further research. That said, Spanish life expectancy has doubled in the last century, and is now around 84 years of age.

"Around a third of centenarians are still able to look after themselves. Another third is dependent to a greater or lesser degree. The other third are bedridden," she says.

At 108, Juliana García is one of the oldest people in Spain. She spends most of her time in bed. While the statistics reveal that Spanish women outlive their menfolk, they often suffer more in later life. Around 57 percent of women aged over 80 have some kind of disability, compared to 42 percent of men. Juliana is unable to stand on her own, and is largely unaware of what is going on around her. Her 77-year-old son Cosme, one of her nine children, lives with her, and she requires the help of a full-time nurse.

"She used to do the housework until she was 105, and she would even dance on special occasions. But now she is on the way out," says Antonio, another son, aged 71, as he sits by his mother's bedside. "His hands are very cold," says Juliana. She finds it difficult to talk, and her hearing and eyesight have all but failed her.

The gradual shutting down of the system, and the loss of the senses that accompanies it, is part and parcel of growing old. But the process affects different people at different ages. The main factors that decide how long we live are our genes, our lifestyle and external factors.

"Genes make up 25 percent of the story - the other 75 percent depends on the kind of life we live," says José María Serres, the president of AEMAL. Illness, of course, also plays a part. In fact, the seven people interviewed for this story all had one thing in common: they had never been seriously ill.

Doctors agree that a healthy old age depends on eating well - for example, the much-vaunted low-fat Mediterranean diet, which is also rich in fruit and vegetables. Leoncia says that her secret is regular exercise. She still walks up and down the stairs to her Madrid apartment, and stretches her arms and legs, despite suffering from Parkinson's Disease.

"She is quite something," says Darío Álvarez, the physiotherapist at her local health center. "She has a strong personality. She doesn't show her age, and she looks after herself 100 percent," he adds.

Asked how she has managed to stay so healthy for so long, 103-year Celia Álvaro's answer is similar to that of many old people: "I have always worked hard to feed my children, and I have always done a lot of sport." She even complains that she isn't allowed to lend a hand at the retirement home she lives in.

"Getting old is losing interest in what is going on around you," wrote the Spanish writer Azorín. Dolores Curiel, aged 101, says that she reads the newspaper every day. Many specialists agree that it is essential to remain interested in the world around us if we are to continue to live an active and healthy life. Dolores says that she acquired the habit of reading at an early age, traveling around Spain with her father, who was a member of the armed forces.

Spain has one of the oldest populations in the world. At present there are some 7,190 people aged over 100 years of age. Of these, 5,399 are women, almost twice the figure 10 years ago.

Andalusia is home to the largest number of elderly people in Spain, with 1,018 over the age of 100. The oldest woman in the country was from Andalusia: she died aged 114. Ángeles Herrera is 104, and lives in Mairena del Alcor, in Seville. "She understands everything - the only problem is that she is a little deaf," says her niece, holding one of Ángeles' 15 great-grandchildren. She too is able to look after herself, and only requires help to take a shower. "She eats what she likes, she drinks Coca-Cola, she can go to the bathroom without assistance, and she moves around on her own with the help of a walking frame," says her son, José Anaya.

She still has memories of her childhood. "I used to help the teacher at school, but what I loved best was to go and have tea with my father," she recalls.

Ageing, in scientific terms, is a process that worsens already existent health problems, according to academic Rosa Gómez, a teacher at Spain's UNED distance university. This explains the growing number of elderly people who require regular medical treatment. "The health system needs to get ready for what is coming," says Gómez.

At the Max Planck Institute, Vaupel and his colleagues say that their research into old age should help governments to "develop the policies that will help us deal with an ageing population and improve our quality of life when we get older." They have paid particular attention to the growing number of people aged between 105 and 109. "Studying this group will allow us to better understand how to meet the needs of those who will soon live up to 110," says Juan Manuel García, who is part of Rosa Gómez's research team. There are already 650 people on the planet aged 110 or over, 42 of them in Spain. "But most don't last much more than six months beyond that," says Gómez.

This raises the question as to when old age begins these days. We may retire at around 65, "but that doesn't mean that we retire from life," says Vaupel. "If a child today is going to live longer than his grandparents, why should he or she work longer? We could reduce the working day," he says.

Yasuhiko Saito, the scientist leading Vaupel's work, says that life expectancy is currently growing "at a rate of six hours per day." This has been the case, he explains, for the last 200 years. Japan currently has one of the oldest populations in the world. "In my country, people cut out meat and fat from their diets earlier than Europeans," he says.

But a healthy diet in itself is not enough. A healthy attitude to life is essential, as is maintaining friendships and family relationships. The doctor who operated on 106-year-old Elisa Blanco said that she would never walk again. But a year later, and with the help of her walking frame, she is making her way around the retirement home she lives in. "She is a happy person, she loves life, she still loves singing, as she did more than half a century ago when she working on the stage," says Carmen Molina, a nurse at the home.

Meanwhile, Trifón Cañamares has a similar outlook. He has just turned 100, and says that after a lifetime as a labor activist, he still wants to continue fighting for workers' rights.

"A lot of people these days can't be bothered to keep up the fight. I would like to be younger so that I can continue the fight. I have no intention of giving up until I am at least 120," he says laughing.

Leoncia González, aged 101, shows off her flexibility.
Leoncia González, aged 101, shows off her flexibility.BERNARDO PÉREZ

Not smoking: the key to a long life

Cigarette smoking is the main reason that men die younger than women in Europe (the average life expectancies are 75 and 83, respectively). That's the conclusion of a study by the Academic Unit of Public Health, part of the Centre of Population and Health Sciences at the University of Glasgow, in Scotland. Its research shows that diseases related to cigarette smoking, such as lung cancer, heart disease and lung problems, account for 60 percent of cases based on gender, while alcohol makes up a further 20 percent.

In Spain, where men die six years before women on average, smoking among women has increased from 23 percent to 27.2 percent, while in men, smoking is declining, having fallen from 55 percent to 42.1 percent, with a corresponding increase in tobacco-related deaths in women. In 1978, the figure was 1,281; in 2006 it had risen to 5,981.

"If we see risk factors leveling out between the sexes, then the difference in age at which people die will level out as well," says Bartomeu Massuti, the secretary general of the Spanish Lung Cancer Group (Gecp).

In Spain, 168 deaths in every 100,000 are due to tobacco, while 58 in every 100,000 are attributable to alcohol.

Current research shows that in Europe's northern countries, the gap between the age that men and women die is narrower. This has traditionally been explained by genetic or racial causes, says Massuti, but is now being attributed to women in northern countries having taken up smoking 20 years ahead of their Mediterranean counterparts.

But many doctors and scientists insist that the reasons for women's longevity is due to biology. "In the last two or three decades, the gap has narrowed due to lifestyle changes, along with the use of alcohol and tobacco," says Fernando Rodríguez Artalejo, a professor in public health at Madrid's Autónoma University, adding: "But this doesn't begin to explain the major differences between men and women."

Rodríguez Artalejo says that aside from biological differences, there are other key factors: "psycho-social disparities, which have to do with the role of women in society; differences in lifestyle, such as exposure to the risk of accidents in the workplace, or violent deaths, traffic accidents; all of these still tend to affect men more than women."

The reasons as to why women live longer than men have been debated for many years, and there is still no sign of consensus within the scientific community. But the question is of more than academic interest: "If we were able to establish the reasons, and these were factors that we could then begin to control, as has been the case with cigarettes and alcohol, then we could increase men's longevity, and this would have an impact on pensions and health spending," says Rodríguez Artalejo.

And as we live longer, researchers are discovering that growing numbers of Spanish retired people are spending most of their time looking after their grandchildren: around a third, in fact, according to a new report by the Health Ministry.

Over the last three decades, more and more women have joined the workforce. But low wages and inflexible working hours have made it impossible for many families to pay for healthcare, or to be able to organize their working day around the needs of their children. So their parents have stepped into the breach. Researchers say that grandparents who look after their grandchildren are contributing the equivalent of around 0.8 percent of GDP.

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