About the Book Titled “The Big 100: The New World of Super Aging”

From a Wall Street Journal books column by Matthew Rees headlined “‘The Big 100’ Review: Young at Heart, If Not Otherwise”:

If Joe Biden wins re-election next year, he will be 86 at the end of his second term. His age, alongside his miscues and mishaps, has prompted a few Republicans to recommend mental-competency tests for presidential candidates. But it’s not a partisan issue. More than two-thirds of Democrats say President Biden may be too old to serve again.

A lot of us are getting old. Most notably, the vast baby-boomer cohort is moving into its sunset years. In 2034, the U.S. will have more people over 65 than under 17. Meanwhile, emerging medical technologies are showing ever more potential to extend life spans. A Stanford study says that half of today’s American 5-year-olds can expect to reach age 100.

So “The Big 100” comes not a moment too soon. William J. Kole, a veteran journalist, explores various aspects of the graying of America, including age-based discrimination, the challenges of dementia and loneliness, the shortage of elder care and the gerontocracy’s presence at the highest levels of government: Think not just of Mr. Biden but of Nancy Pelosi (83), Chuck Grassley (90), Bernie Sanders (82) and Mitch McConnell (81). Though Mr. Kole jokingly refers to his survey as a “geezer’s guide to the galaxy,” he promises to address “what we must do now to ensure our longer lives will truly be worth living.”

He begins with an overview of America’s life-expectancy trends, a topic that has had a pleasing trajectory until recently. He notes that the average age of death in 1900 was just 47; the leading causes of death, at the time, were pneumonia, tuberculosis and (yes) diarrhea. Thanks to chlorinated drinking water and medical breakthroughs—especially antibiotics—life expectancy steadily increased in the first half of the 20th century. Today it’s 76, though it has declined in the past few years, mostly because of the toxic trinity of Covid, opioids and obesity. There are about 60 nations where people live longer than in the U.S., including several countries with much lower per capita incomes, from Costa Rica to Thailand.

Why do some people live longer than others? Mr. Kole cites studies showing that only 25% of longevity is driven by genetics. Good dietary habits and plenty of exercise will help get you to 90, but genes take over after that. Men with a sibling who has reached 100 are 17 times more likely to become centenarians themselves. (For women, the figure is eight times.) Of the medical realms in which life-extending treatments seem most promising, Mr. Kole cites genetic sequencing, gene therapy and immunotherapy. He also mentions the potential of liquid biopsies, which involve analyzing blood for evidence of DNA fragments from cancer cells—a test that contributes to early detection. For developing countries, he thinks that a new vaccine for malaria holds out great promise. (Malaria killed 619,000 people in 2021.)

But much of “The Big 100” has to do with the social challenges of old age. Consider Alzheimer’s, which affects more than six million Americans today (and is projected to affect more than 12 million by 2060). So far there is no treatment for it, which means that family members must devote themselves to nearly full-time assistance or hire professional caregivers. For many, the emotional cost is high—and the financial one, too. The annual cost of assisted living or nursing-home care can be $100,000 or more. Government help is limited—there are strict criteria for what Medicare will cover. Mr. Kole thinks we need to liberalize our immigration laws to address the scarcity of caretakers. Japan, where life expectancy is about 85, has been trying to get around this problem by relying on robots in assisted-living facilities.

Other aspects of old age are less dire than Alzheimer’s but nonetheless troublesome. As friends and spouses die off, Mr. Kole reminds us, there is a danger of loneliness. He cites a study showing that prolonged isolation affects life span—the equivalent of smoking 15 cigarettes a day. The oldsters he talks to, including those who have reached the “big 100,” emphasize the value of staying active, maintaining friendships and helping others. The oldest living person today is 116. She has said her longevity is a product of “order, tranquility, good connection with family and friends” and “staying away from toxic people.” Mr. Kole writes about Jeanne Calment, a French woman who lived to be 122. Upon turning 120, she said: “I see badly, I hear badly, I can’t feel anything, but everything’s fine.” So a positive attitude seems to help.

Mr. Kole puts forward some familiar ideas for making long lives more prosperous and fulfilling. He believes that current Social Security payouts are too low, and he’d like to see a more robust federal law prohibiting age discrimination. He points to a World Health Organization analysis showing that artificial intelligence favors the young over the old when it is used to vet job candidates. He also cites statistics showing that most age-discrimination complaints are not pursued by the Equal Employment Opportunity Commission, and when cases do go to court, fewer than 10% are settled in favor of the plaintiffs.

More interesting is a study of seven nations in Europe showing that younger heads of state result in higher economic growth rates, since aging leaders tend to cling to the status quo and miss the opportunities presented by new technologies. That’s one more reason for apprehension about a presidential election that would—if (for the moment) we assume that Mr. Biden will run for re-election and that Donald Trump will be the Republican nominee—pit an 81-year-old against a 78-year-old. Maybe a competency test for candidates isn’t a bad idea after all.

Matthew Rees is the founder of Geonomica, a ghostwriting firm, and editor of the Food and Health Facts newsletter.

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