Old age demands to be taken very seriously–and it usually gets its way. It’s hard to be cavalier about a time of life defined by loss of vigor, increasing frailty, rising disease risk and falling cognitive faculties. Then there’s the unavoidable matter of the end of consciousness and the self–death, in other words–that’s drawing closer and closer. It’s the rare person who can confront the final decline with flippancy or ease. That, as it turns out, might be our first mistake.
Humans are not alone in facing the ultimate reckoning, but we’re the only species–as far as we know–who spends its whole life knowing death is coming. A clam dredged from the ocean off Iceland in 2006–and inadvertently killed by the scientists who discovered it–carried growth lines on its shell indicating it had been around since 1499. That was enough time for 185,055 generations of mayfly–which live as little as a day–to come and go. Neither clam nor fly gave a thought to that mortal math.
Humans fall somewhere between those two extremes. Globally, the average life span is 71.4 years; for a few lucky people, it may exceed 100 years. It has never, to science’s knowledge, exceeded the 122 years, 164 days lived by Frenchwoman Jeanne Calment, who was born when Ulysses S. Grant was in the White House and died when Bill Clinton lived there.
Most of us would like a little bit of that Calment magic, and we’ve made at least some progress. Life expectancy in the U.S. exceeds the global average, clocking in at just under 79 years. In 1900, it was just over 47 years. The extra decades came courtesy of just the things you’d expect: vaccines, antibiotics, sanitation and improved detection and treatment of a range of diseases. Advances in genetics and in our understanding of dementia are helping to extend our factory warranties still further.
None of that, however, changes the way we contemplate the end of life–often with anxiety and asceticism, practicing a sort of existential bartering. We can narrow our experiences and give up indulgences in exchange for a more guardedly lived life that might run a little longer.
But what if we could take off some of that bubble wrap? What about living longer and actually having some fun? A Yale University study just this month found that in a group of 4,765 people with an average age of 72, those who carried a gene variant linked to dementia–but also had positive attitudes about aging–were 50% less likely to develop the disorder than people who carried the gene but faced aging with more pessimism or fear.
There may be something to be said then for aging less timidly–as a sort of happy contrarian, arguing when you feel like arguing, playing when you feel like playing. Maybe you want to pass up the quiet of the country for the churn of a city. Maybe you want to drink a little, eat a rich meal, have some sex.
“The most important advice we offer people about longevity is, ‘Throw away your lists,'” says Howard Friedman, professor of psychology at the University of California, Riverside, and co-author of The Longevity Project. “We live in a self-help society full of lists: ‘lose weight, hit the gym.’ So why aren’t we all healthy? People who live a long time can work hard and play hard.” Under the right circumstances, it increasingly seems, so could all of us.
Marie Ashdown, 90, has lived in New York City for nearly 60 years, in an apartment on the east side of Manhattan. New York has beaten down younger people than her, but Ashdown, executive director of the Musicians Emergency Fund, loves city life. “I have a fire in my belly,” she says. “There’s not one minute of the day that I don’t learn.”
As a classical-music connoisseur, Ashdown organizes two concerts a year at Lincoln Center for the Performing Arts. When she’s not working, she takes weekend trips outside of the city, and spends her free time binding old books. Like many New Yorkers several decades her junior, she often orders takeout rather than bother with cooking. “We have the best and worst here,” says Ashdown. “We learn to cope, live on the defensive and conquer fear.”
She’s hardly the only senior who loves city living. In the U.S., 80% of people ages 65 and older are now living in metropolitan areas, and according to the World Health Organization, by 2030, an estimated 60% of all people will live in cities–many of them over age 60. You may lose a little sidewalk speed and have to work harder to get up and down subway stairs, but cities increasingly rank high on both doctors’ and seniors’ lists of the best places to age gracefully.
Every year, the Milken Institute Center for the Future of Aging (CFA) ranks the best metropolitan places for successful aging, and most years, major cities sweep the top 10 spots. No wonder: cities tend to have strong health systems, opportunities for continued learning, widespread public transportation and an abundance of arts and culture. That’s not to say that people can’t feel isolated or lonely in cities, but you can get lonely in a country cottage too. In cities, the cure can be just outside your door.
“We all long to bump into each other,” says Paul Irving, the chairman of the Milken Institute CFA. “The ranges of places where this can happen in cities tend to create more options and opportunities.”
It’s that aspect–the other-people aspect–that may be the particularly challenging for some, especially as we age and families disperse. But there are answers: a 2017 study in the journal Personal Relationships found that it can be friends, not family, who matter most. The study looked at 270,000 people in nearly 100 countries and found that while both family and friends are associated with happiness and better health, as people aged, the health link remained only for people with strong friendships.
“[While] in a lot of ways, relationships with friends had a similar effect as those with family,” says William Chopik, assistant professor of psychology at Michigan State University and the author of the study, “in others, they surpassed them.”
If the primacy of family has been oversold as a key to long life, so has the importance of avoiding conflict or emotional upset. Shouting back at cable news is no way to spend your golden years, but passion, it’s turning out, may be more life-sustaining than apathy, engagement more than indifference.
In a study published by the American Aging Association, researchers analyzed data from the Georgia Centenarian Study, a survey of 285 people who were at least (or nearly) 100 years old, as well as 273 family members and other proxies who provided information about them. The investigators were looking at how the subjects scored on various personality traits, including conscientiousness, extraversion, hostility and neuroticism.
As a group, the centenarians tested lower on neuroticism and higher on competence and extraversion. Their proxies ranked them a bit higher on neuroticism, as well as on hostility. It’s impossible to draw a straight line between those strong personality traits and long life, but the authors saw a potential one, citing other studies showing that centenarians rank high on “moral righteousness,” which leads to robust temperaments that “may help centenarians adapt well to later life.”
At the same time that crankiness, judiciously deployed, can be adaptive, its polar opposite–cheerfulness and optimism–may be less so. Worried people are likelier to be vigilant people, alert to a troubling physical symptom or a loss of some faculty that overly optimistic people might dismiss. Friedman and his collaborator Leslie R. Martin, a professor of psychology at La Sierra University in Riverside, Calif., base their book on work begun in 1921 by Stanford University psychologist Lewis Terman, who recruited 1,500 boys and girls born around 1910 and proposed to follow them throughout their lifetimes and, when he died–which happened in 1956–to have successors continue the work. Friedman and Martin have been two of those successors, and they’ve learned a lot.
“Our research found that the more cheerful, outgoing children did not, for the most part, live any longer than their more introverted or serious classmates,” says Friedman. “Excessively happy people may ignore real threats and fail to take precautions or follow medical advice. It is O.K. to fret–if in a responsible manner.”
One tip for long life that is not coming in for quite so much revisionist thinking is exercise–and some seniors are achieving remarkable things. Take Ginette Bedard, 84, of Howard Beach, N.Y.
It was a drizzly morning last Nov. 5, but that didn’t stop Bedard from crossing the New York City Marathon finish line first in her age group. Bedard picked up running decades ago as a way to keep fit, but she didn’t run her first marathon until she was 69 years old. “I was watching the marathon runners on TV and I was so envious,” she says. “I was thinking, I cannot do that, they are all superhumans.”
So she decided to become one of them. She began training daily until she could run the full 26.2 miles, and she’s run nearly every New York City Marathon since. “It takes discipline and brainpower and dedication,” she says. “The running is hard, but the finish line is euphoria.” She now runs three hours every day along the beach.
Few physicians would recommend that all octogenarians pick up a three-hour-a-day running habit, but adding even a small amount of movement to daily life has been repeatedly shown to be beneficial, for a whole range of reasons. “Exercise likely works through several mechanisms,” says Dr. Thomas Gill, director of the Yale Program on Aging. “Increasing physical activity will improve endurance; it benefits muscle strength and balance and [reduces] occurrence of serious fall injuries. It also provides a benefit to psychology, by lifting spirits.”
Exactly how much–or how little–exercise it takes to begin paying dividends has been one of the happy surprises of longevity research. A 2016 study found that elderly people who exercised for just 15 minutes a day, at an intensity level of a brisk walk, had a 22% lower risk of early death compared to people who did no exercise. A 2017 study found that exercising even just two days a week can lower risk for premature death. Researchers from McMaster University in Canada even found that breaking a sweat for just 60 seconds may be enough to improve health and fitness (as long as it’s a tough workout).
Healthy eating is something else that may have a lot more wiggle room than we’ve assumed, and if there’s such a thing as a longevity diet, there may be more on the menu than seniors have been told. “I have my wine and ice cream,” says Bedard without apology. Similarly, 90-year-old Ashdown phones her takeout orders into Tal Bagels on First Avenue, not some trendy vegan joint.
“It really is an issue of moderation,” says Peter Martin, a professor of human development and family studies at Iowa State University, who runs an ongoing study of centenarians. Martin notes that while most centenarians eat different but generally healthy diets, one consistent thing he has picked up from work with his 100-plus crowd is breakfast. “They rarely skip breakfast,” he says. “It’s often at a very specific time, and the routine is important.”
Alcohol has its place too. An August 2017 study published in the Journal of the American College of Cardiology found that light to moderate alcohol use (14 or fewer drinks per week for men and seven or fewer for women) is associated with a lower risk of death compared to people who don’t drink at all. If you’re a nondrinker, that’s no reason to start, and if you drink only infrequently, it’s no reason to drink more. Still, among the more than 333,000 people in the study, light and moderate drinkers were 20% less likely to die from any cause during the study period compared with their completely abstemious peers.
There’s also an argument for letting go of diet obsessiveness, especially if you’re at a reasonably healthy weight already. A 2016 study found that women over age 50 who were categorized as normal weight, but reported fluctuating (dropping more than 10 lb. and gaining it back at least three times) were 3½ times more likely to experience sudden cardiac death than those whose weight stayed the same. The takeaway: simply stay in a healthy range; striving for a smaller size isn’t necessarily doing you any longevity favors.
Finally, as long as seniors are enjoying themselves with some indulgent food and drink, they may as well round out the good-times trifecta with a little sex. It’s no secret that remaining sexually active has been linked to life satisfaction and, in some cases, longer life. One celebrated study, published in the British Medical Journal in 1997, followed 918 men in a Welsh town for 10 years and found that those with a higher frequency of orgasm had a 50% reduced risk of mortality. Friedman and his colleagues, working with the Terman group, found something similar–though not quite as dramatic–for women. A 2016 study from Michigan State University was less sanguine, finding that older men who had sex once a week or more were almost twice as likely to suffer a cardiovascular event than men who had less sex; that was especially so if the more active men were satisfied with the sex, which often means they achieved orgasm. For older women, sex seemed to be protective against cardiovascular event.
The problem for the men was likely overexertion, but there are ways around that. “Older adults have to realize that it’s intimacy that’s important,” says Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York. “If the focus is on pleasure rather than achieving orgasm each time, it can be fulfilling.”
In this and other dimensions of aging, Kennedy cites pianist Vladimir Horowitz, who died at age 86 and was still performing into his 80s. Conceding the limitations of age, he left the most demanding pieces out of his performances; of those that remained, he would play the slower ones first, making the faster ones seem faster still by comparison. “He would optimize, not maximize,” says Kennedy.
There is an admitted bumper-sticker quality to dictum like that, but compared with the familiar age-related wisdom–take it slow, watch your diet, stay cheerful–it’s bracing. There are, Kennedy says, no truly healthy centenarians; you can’t put 100 points on the board without getting worn out and banged up along the way. But there are independent centenarians and happy centenarians and centenarians who have had a rollicking good ride. The same is true for people who will never reach the 100-year mark but make the very most of the time they do get. The end of life is a nonnegotiable thing. The quality and exact length of that life, however, is something we very much have the power to shape.
–With reporting by AMANDA MACMILLAN
This appears in the February 26, 2018 issue of TIME.