“You can age well – with grace and wisdom, wit and experience, energy and vitality. This is realism, not fantasy,” says Dr. James F. Fries, MD, and he makes sure his readers know that he practices what he preaches.
Longevity Is Not the Main Goal
But a High Quality of Life to the Very End
Dr. Fries is convinced that each of us – at least to a considerable extent – decides “whether or not to age.” We all age, of course, but we can choose to age poorly or to age well. In other words, the lifestyle choices we make over the years ultimately determine how we grow old. “You will probably live longer than you think, and you need to plan for it. You need to cultivate a healthy mind in a healthy body, and you will need to find ways to compensate for a slowing biology to achieve your personal potential,” he writes in his landmark book, “Aging Well.”†
Avoiding major illnesses by adherence to healthy eating habits and regular exercise are a given, but other elements are equally as important and must not be neglected, especially at an advanced age. Maintaining our mental health through constant intellectual stimulation matters greatly and so does our social health. Boredom and social isolation are major components of a failed aging process. The goal, according to Dr. Fries, is not simply to extend longevity but rather to improve the quality of our senior years.
As a professor of medicine at Stanford University School of Medicine, Dr. Fries foresaw a society in which “the active and vital years of life would increase in length, the onset of morbidity would be postponed and the total amount of lifetime disability would decrease.” At the heart of his vision is an “emphasis on preventive medicine and the untapped potential of health promotion and prevention.”
Based on his hypothesis of “compression of morbidity,” he argues that the illnesses we (inevitably or not) suffer throughout our lives should be “compressed” into a shorter period of time near to the age of death. In other words, we should live our lives in ways that allow us to be as healthy as possible for as long as possible and then die of natural causes after a brief period of illness. The trick, if you will, is to delay the onset of infirmity. The increase in longevity may be comparatively modest, but the period of decline, both physical and mental, would ideally be much shorter.
“Think about two points on a typical human lifespan, with the first point representing the time at which a person becomes chronically ill or disabled and the second point representing the time at which that person dies. Today, the time between those two points is about 20 years or so. During the early portion of those years, chronic disease or disability is minor but increases nearer to the end of life. The idea behind “compression of morbidity” is to squeeze or compress the time horizon between the onset of chronic illness or disability and the time in which a person dies.”
Since Dr. Fries published his “compression of morbidity” hypothesis, his work has become widely recognized as a roadmap for healthy aging at both individual and policy levels and is thought of as a foundation for pro-active health promotion.
Dr. Fries was not always interested in medicine. His first love was philosophy, which he studied as an undergraduate at Stanford University. He describes himself as “a young man who was very interested in the “great thoughts” on which classical philosophy is based: Why are we here? How do we define the human condition?” Only later, he says, he surprised himself when he began to find answers to these questions in the study of medicine.
“In the course of my studies, I began to believe that the possibility of understanding life through forces of reason and without data had been exhausted. Instead, I began to believe that a greater understanding of life and death would come from the data of biological sciences and, in particular, medicine.”
At Johns Hopkins School of Medicine, where he graduated with a degree in internal medicine and completed a fellowship in rheumatology, Dr. Fries was particularly interested in studying chronic rheumatologic disease. He describes his work then as a progressive involvement in “the art of dealing with the person and the science of projecting long-term outcomes.” He recalls: “It was here that I really developed an interest in moving medicine and healthcare in general from short-term outcomes to long-term outcomes.”
When Dr. Fries joined the medical faculty at Stanford University in 1970, he formulated the “compression of morbidity” hypothesis for the first time and put it to paper during his first sabbatical in 1978 to 1979 at the Center for Advanced Studies and Behavior Sciences, an independent research institute in Stanford. The study of “aging” was the center’s theme during that academic year, and issues of improving the capabilities of seniors were the main focus of the discussions.
“We entered the twentieth century in an era of acute infectious diseases, with tuberculosis the number one killer of our population and smallpox, diphtheria, tetanus, and other infectious illnesses comprising 80% of all deaths in 1900. With these diseases nearly eradicated by the 1970s, mortality from these diseases have been reduced by nearly 99%, ushering in an era where the major burdens of illness in the United States are chronic diseases – heart disease, stroke, cancer, and diabetes. As life expectancy steadily rose and patterns of disease experienced a profound shift, the prevailing mythology at the time suggested an unfortunate scenario for future health. As medical progress increasingly prolonged life, those extra months and years would be spent in ill health. This theory, termed “the failure of success,” assumed that although advances in medicine and public health could prolong life, they could not delay the onset of chronic, degenerative diseases. At the time, aging and the field of gerontology in particular, had been described as the science of drawing downwardly sloping lines.”
Dr. Fries and his fellow-researchers clearly felt that much more could and should be done. What they were looking for was nothing short of a “paradigm shift” in terms of how the medical profession was to deal with the aging process of ever-growing parts of the population.
“The compression of morbidity hypothesis presented a new lens through which to examine aging – a lens that viewed prevention, lifestyle changes, and health improvements as the keys to delaying the onset of morbidity.”
In contrast to what many demographers and health policy workers of the time believed, the “compression of morbidity” hypothesis represented a new concept, with the ideal of a long life with a relatively short period of terminal decline. The idea of reducing morbidity and disability, as pioneered by Dr. Fries and his colleagues at a time when most gerontologists and epidemiologists considered aging as a pandemic of disabilities, subsequently sparked a lot of new research that had never been done before.
Naysayers faulted it for being naively optimistic, others feared it to be a threat to the preparation required to care for growing elderly populations. But there were early supporters of the “compression of morbidity” hypothesis, including Robert Butler, president and CEO of the International Longevity Center, who described Jim Fries as a “positive force” in aging, and Everett C. Koop, a former U.S. Surgeon General, who characterized the hypothesis as “groundbreaking” and called Dr. Fries’ work “visionary.” Dr. Koop went on to say: “Jim (Fries) has made a greater contribution than anyone else in the understanding that there is a way to be free of health problems until the very end of life and how important this is in both health care costs and quality of life each of us can enjoy.”
Over the past 20 years, the “compression of morbidity” hypothesis has generated a tremendous amount of research, including rigorous, longitudinal studies through
the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS), a databank established by Dr. Fries and funded by the National Institutes of Health as the National Arthritis Data Resource.
Despite of the enormity of data collected through his work that confirmed many of his assumptions, Dr. Fries realized that “compression of morbidity” cannot be achieved by lifestyle factors alone.
“For example, although there has been a reduction in smoking in the general population of the United States, there has been a simultaneous increase in obesity, and rates of physical activity have remained flat for the past 25 years. Healthy living and reduction of health risks have played a huge role in the “compression of morbidity,” but to truly understand the phenomenon we also need to look at other factors, such as joint replacement, statins, better control of diabetes, and other medical innovations introduced in the past few decades that could have contributed to the delay in morbidity. This also suggests that the true promise of health promotion of risk reduction in further “compressing morbidity” remains unknown.”
Still, he expects the “compression of morbidity” hypothesis to hold true as long as society continues to value health-promoting lifestyles, further improvements in preventive medicine and better living conditions for the elderly.
“We cannot compress morbidity indefinitely, but the paradigm of a long, healthy life with a relatively rapid terminal decline is most certainly an attainable ideal at both a population level and individual level.”
Although Dr. Fries maintains that there is not one way to compress morbidity, he stresses regular (even strenuous) physical activity as a key to delaying the onset of morbidity. He heeds his own advice, having run at least 500 miles each year since 1970. He has also completed the Boston Marathon and is a high-altitude climber who has reached some of the tallest summits on six continents. Together with his wife, Sarah, he continues to lead an active life that includes skiing and adventure travel around the world, from the North Pole to Southeast Asia. In February, they celebrated the 50th anniversary of their marriage.
“Do I have any words of wisdom? Remember that there is no one magic pathway to living a happy life of longevity and vitality. But there are endless possibilities and we can all have a substantial effect upon our future health,” he once said. Words to live and grow old by.
This article is based on a previously published portrait of Dr. James F. Fries, MD by Aimee Swartz, a science and medical writer living in Northampton, MA. Permission for use and editing was given by Dr. Fries.
† James F. Fries, MD, Aging Well – The Life Plan for Health and Vitality in Your Later Years, Addison-Wesley 1989
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