of life.
It’s also worth noting that even before my mother was diagnosed with lung cancer—indeed, even before the cancerous cells in her lungs began growing out of control—she was aging. And in that way, of course, she was hardly unique. We know that the process of aging begins long before we notice it. And with the unfortunate exceptions of those whose lives are taken by the early onset of a hereditary ailment or a deadly pathogen, most people begin to experience at least some of the effects of aging long before they are impacted by the accumulation of diseases we commonly associate with growing old. At the molecular level, this starts to happen at a time in our lives that many of us still look and feel young. Girls who go through puberty earlier than normal, for example, have an accelerated epigenetic clock. At that age, we can’t hear the mistakes of the concert pianist.11 But they are there, even as a teenager.
In our 40s and 50s, we don’t often think about what it feels like to grow old. When I give talks about my research, sometimes I bring an “age suit” and ask a young volunteer to wear it. A neck brace reduces mobility in the neck, lead-lined jackets and wraps all over the body simulate weak muscles, earplugs reduce hearing, and ski goggles simulate cataracts. After a few minutes of walking around in the suit, the test subject is very relieved to take it off—and fortunately can do so.
“Imagine wearing it for a decade,” I say.
To put yourself into an aged mind-set, try this little experiment. Using your nondominant hand, write your name, address, and phone number while circling your opposite foot counterclockwise. That’s a rough approximation of what it feels like.
Different functions peak at different times for different people, but physical fitness, in general, begins to decline in our 20s and 30s. Men who run middle-distance races, for instance, are fastest around the age of 25, no matter how hard they train after that. The best female marathoners can stay competitive well into their late 20s and early 30s, but their times begin to rise quickly after 40. Occasionally, exceptionally fit outliers—such as National Football League quarterback Tom Brady, National Women’s Soccer League defender Christie Pearce, Major League Baseball outfielder Ichiro Suzuki, and tennis legend Martina Navratilova—demonstrate that professional athletes can stay competitive into their 40s, but almost no one remains at the highest levels of these or most other professional sports much past their mid-40s. Even someone as resilient as Navratilova peaked when she was in her early 20s through her early 30s.
There are some simple tests to determine how biologically old you probably are. The number of push-ups you can do is a good indicator. If you are over 45 and can do more than twenty, you are doing well. The other test of age is the sitting-rising test (SRT). Sit on the floor, barefooted, with legs crossed. Lean forward quickly and see if you can get up in one move. A young person can. A middle-aged person typically needs to push off with one of their hands. An elderly person often needs to get onto one knee. A study of people 51 to 80 years found that 157 out of 159 people who passed away in 75 months had received less than perfect SRT scores.
Physical changes happen to everyone. Our skin wrinkles. Our hair grays. Our joints ache. We start groaning when we get up. We begin to lose resilience, not just to diseases but to all of life’s bumps and bruises.
Fortunately, a hip fracture for a teenager is a very rare event that nearly everyone is expected to bounce back from. At 50, such an injury could be a life-altering event but generally not a fatal one. It’s not long after that, though, that the risk factor for people who suffer a broken hip becomes terrifyingly high. Some reports show that up to half of those over the age of 65 who suffer a hip fracture will die within six months.12 And those who survive often live the rest of their lives in pain and with limited mobility. At 88, my grandmother Vera tripped on a rumpled carpet and broke her upper femur. During surgery to repair the damage, her heart stopped on the operating table. Though she survived, her brain had been starved for oxygen. She never walked again and died a few years later.
Wounds also heal much more slowly with age—a phenomenon first scientifically studied during World War I by the French biophysicist Pierre Lecomte du Noüy, who noted a difference in the rate of healing between younger and older wounded soldiers. We can see this in even starker relief when we look at the differences in the ways children and the elderly heal from wounds. When a child gets a cut on her foot, a noninfected wound will heal quite quickly. The only medicine most kids need when they get hurt like this is a kiss, a Band-Aid, and some assurance that everything will be okay. For an elderly person, a foot injury is not just painful but dangerous. For older diabetics, in particular, a small wound can be deadly: The five-year mortality rate for a foot ulcer in a diabetic is greater than 50 percent. That’s higher than the death rates for many kinds of cancer.13
Chronic foot wounds, by the way, are not rare; we just don’t hear much about them. They almost always begin with seemingly benign rubbing on increasingly numb and fragile soles—but not always. My friend David Armstrong, at the University of Southern California, a passionate advocate for increasing our focus on preventing diabetic foot injuries, often tells the story of one of his patients, who had a nail stuck in his foot for four days. The patient noticed it only because he wondered where the tapping sound on the floor was coming from.
Small and large diabetic foot wounds rarely heal. They can look as though someone has taken an apple corer to the balls of both feet. The body doesn’t have enough blood flow and cell regeneration capacity, and bacteria thrive in this meaty, moist environment. Right now, 40 million people, bedridden and waiting for death, are living this nightmare. There’s almost nothing that can be done for them except to cut back the dead and dying tissue, then cut some more, and then some more. From there, robbed of upright mobility, misery is your bedfellow and thankfully death is nigh. In the United States alone, each year, 82,000 elderly people have a limb amputated. That’s ten every hour. All this pain, all this cost, comes from relatively minor initial injuries: foot wounds.
The older we get, the less it takes for an injury or illness to drive us to our deaths. We are pushed closer and closer to the precipice until it takes nothing more than a gentle wind to send us over. This is the very definition of frailty.
If hepatitis, kidney disease, or melanoma did the sorts of things to us that aging does, we would put those diseases on a list of the deadliest illnesses in the world. Instead, scientists call what happens to us a “loss of resilience,” and we generally have accepted it as part of the human condition.
There is nothing more dangerous to us than age. Yet we have conceded its power over us. And we have turned our fight for better health in other directions.
WHACK-A-MOLE MEDICINE
There are three large hospitals within a few minutes walk of my office. Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Boston Children’s Hospital are focused on different patient populations and medical specialties, but they’re all set up the same way.
If we were to take a walk into the lobby of Brigham and Women’s and head over to the sign by the elevator, we’d get a lay of this nearly universal medical landscape. On the first floor is wound care. Second floor: orthopedics. Third floor: gynecology and obstetrics. Fourth floor: pulmonary care.
At Boston Children’s, the different medical specialties are similarly separated, though they are labeled in a way more befitting the young patients at this amazing hospital. Follow the signs with the boats for psychiatry. The flowers will take you to the cystic fibrosis center. The fish will get you to immunology.
And now over to Beth Israel. This way to the cancer center. That way to dermatology. Over here for infectious diseases.
The research centers that surround these three hospitals are set up in much the same way. In one lab you’ll find researchers working to cure cancer. In another they’re fighting diabetes.
