Longevity toolbox: Changes you can make for a better, longer life
Anyone who has ever visited a nursing home will have seen them, trapped in their recliners, mouths open and eyes blank, being fed liquids from sippy cups: elderly people who are entirely dependent on their carers. Some look close to death; arguably, their quality of life is so diminished they may as well be. It can be difficult to see these people. None of us want to envisage ourselves spending our final years that way.
But we ought to be envisaging it, says Canadian-American doctor and longevity expert Peter Attia. He believes we should be spending more time with those who are in their final 10 years – what he terms “the marginal decade” – and thinking about what we want for that time in our own lives. We need to focus on our endgame, says Attia.
“I ask every single one of my patients what they want to be doing in their marginal decade,” he explains. “The answers are usually quite ambitious. They might say they still want to be able to ski, for example. And so, I make them reverse engineer, and examine what they need to be doing now so that they have the strength, the lateral stability, the cardiovascular fitness, to still be skiing then. I’m not going to tell them they can’t do it. But if they are 50 and still skiing with ease now then they need to build up their resources to cope with the next decade or two of decline. Because decline is coming and it’s actually quite nonlinear. It really starts to hit us when we’re 75.”
Attia is based in Austin, Texas. At his practice, Early Medical, the focus is on guiding patients towards transforming their marginal decade into bonus years by building up their health and fitness to put them at a higher starting point, ready for when that inevitable decline kicks in. Generally, he asks them to list 10 to 15 late-life goals – anything from being capable of going out for a decent walk to carrying a bag of groceries or having sex – before coming up with a personalised strategy to achieve them.
This is healthcare for a wealthy elite. Every one of his patients undergoes a thorough investigation to see what their risks may be, then a team of experts develops an individual plan to mitigate those risks as much as is possible.
“With all our patients, the first month is pretty similar. We figure out everything that is known about you up to this point in time. So, we do an elaborate family tree, to understand everything about your relatives – how they lived, how they died, what their state of health is. Obviously, we take a very thorough look at your own medical history. Then we begin forward-looking data analysis.”
A battery of blood tests, scans and fitness tests follows. The bodies and brains of Attia’s patients are thoroughly explored.
“There is a finite number of things that are going to be a threat to your lifespan and healthspan,” he explains. “Within less than a year we want to have a very clear sense of how to rank those things in you. You’ll never eliminate risk entirely. The goal is just to be constantly chipping away and reducing it.”
If you discover that unfortunately you carry two copies of the APOE4 gene, a strong risk factor for Alzheimer’s, at Attia’s clinic you will work with a preventive neurologist to fine-tune your lifestyle with evidence-based strategies. When it comes to any aspect of your health, the more the deck is stacked against you genetically, the more effort you will need to make and the sooner you need to start, he says.
Falling eggs
Attia, who studied at Stanford Medical School, had set out to become a cancer surgeon, but was plagued by a recurring dream. In it, he was trying to catch eggs that were being flung at him from above, and was unable to prevent many of them crashing to the ground and breaking. This seemed to him to be an analogy for the kind of work he was doing. Because no matter how clever the surgery, many of his cancer patients would still die within the next few years. Those eggs were going to hit the ground.