Longevity with Dignity

L ongevity with D ignity B S J Rachel Lew Given the choice to live 10 years longer, would you take it? How about if you were offered 20 extra years? 50? How long of a life is too long? If you lived in, say, the 16th century, you might hold to the concept that one’s lifespan is always directly proportional to one’s happiness. It is an idea rooted in times before the birth of modern medicine, when people were more likely to die from “accidental” causes like untreated pneumonia than from “wear-and-tear” causes like cancer--and nowadays, it is beginning to be challenged. In August of 2013, a survey from the Pew Research Center’s Religion and Public Life Project showed that the majority of Americans do not want to live past the age of 90 (Pew Research Center, 2013), demonstrating that people have begun to consider whether or not there exists a natural limit to one’s age. Among the worries of these Americans was the possibility of lowered life quality in extreme old age. Some, like Ezekiel J. Emanuel, the author of the article “Why I Hope to Die at 75,” voice fears that a loss of cognitive function could lead to an undesirable quasi-vegetative lifestyle. Emanuel asserts that cognitive decline in extreme longevity “robs us group is a small one; the US is home to more centenarians than any other country in the world, yet in 2010, there were less than two centenarians for every 10,000 people in the US (Meyer, 2012). In 2011, the United Nations Population Fund estimated that the global count of centenarians was about 316,000 individuals, projected to increase to 3.2 million in 2050 (UNFPA, 2012). Gloomy depictions of life in extreme longevity are to some extent justified by the proven link between age-related cognitive impairment and lower odds of survival. A 1996 study, for instance, established that individuals with certain genotypes for apolipoprotein E, a protein that “mediates the clearance of several plasma lipoproteins and likely affects neuronal repair in the brain,” are both less likely to experience cognitive impairment and more likely to live longer (Corder, Lannfelt, & Viitanen, 1996). A 2004 analysis of the Heidelberg Centenarian Study drew similar results, discovering a logarithmic relationship between cognitive status and death in centenarians (Kliegel, Moor, & Rott, 2004). Moreover, the popular “compression of morbidity” hypothesis, developed by Stanford professor James Fries, proposes that the frequency “A 2004 analysis of the Heidelberg Centenarian Study. [discovered] a logarithmic relationship between cognitive status and death in centenarians. ” of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic” (Emanuel, 2014). So are the emotional benefits of extreme longevity truly outweighed by the costs of neurodegeneration? Fortunately, evidence that could be used to answer this question can be found by observing the growing number of centenarians, individuals who are at least 100 years old, in the world. This and severity of chronic diseases, including those of the brain, are compounded with age. Fries posits that since chronic diseases can therefore only be postponed and not cured, longevity past a certain age is simply the postponement of death. (Fries, 2002) Indeed, an analysis of data from the New England Centenarian Study found that centenarians “had compressed age-related diseases into the last 5.2% of their extremely long lives” (Sebastiani & Perls, 2012). Common among such afflictions are Alzheimer’s disease (AD) and argyrophilic grain disease (AGD), 1 • B erkeley S cientific J ournal • E xtremes • F all 2014 • V olume 19 • I ssue 1