Celebrating What's Right With Aging: Inside the Minds of Super Agers

Decoding the magic formula

But why are super agers resistant to age-related decline, to the point where their brains at 90 function better than the average 60-year-old brain? There seem to be three factors at play.

• Cognitive reserve. It’s not that their brains don’t age; it’s that super agers seem to be able to overcome the wear and tear that cognitively average people succumb to: age-related issues like inflammation or clogged blood vessels. In fact, postmortem studies of the brains of super agers reveal that some had the clinical pathology of Alzheimer’s but never experienced any of the symptoms.  

That is, some brains may have an added power that allows them to keep functioning well despite the presence of disease or the markers of cognitive decline. Since longer life and healthier cognition seem to run in families, it may be that this ability is genetic, but scientists don’t yet know. That said, genes are like programs on a computer: Having super ager genes is the first step, but genes can be “turned on” or “turned off” by environmental factors and lifestyle choices.

• Life achievement. People with higher education levels or greater career attainment tend to have greater cognitive reserve, says Yaakov Stern, professor of neuropsychology at the Columbia University Vagelos College of Physicians and Surgeons, who studies this aspect of brain health. But we don’t know yet whether educational and career success increases the chance of becoming a super ager or whether the natural cognitive advantages these folks have simply make them more likely to succeed. Interestingly, a recent study conducted at Massachusetts General Hospital at Harvard Medical School found that higher educational achievement and more years of schooling could act as a protective factor and slow down cognitive impairment and Alzheimer’s, even in individuals with strong genetic risks for dementia.

On the other hand, it may be that the natural mental abilities of super agers make them more likely to set off on advanced studies or successful career trajectories, or to grab those late-career brass rings. It’s one of the factors researchers are planning to study when looking at the impact of socioeconomics on super aging.

• Lifestyle. This may be the big one. Several clues are starting to emerge that point to parallels between the lifestyles of super agers. Healthy-aging researchers have identified four common habits.

A physically and intellectually active lifestyle.

The willingness or ability to constantly challenge oneself.

An active social life and a wide social network.

Moderation in all indulgences, allowing for the occasional glass of wine, for example.

In fact, while myriad studies now underway are probing the biological, genetic and scientific underpinnings of super agers, lifestyle and environment remain significant and consistent factors that most likely contribute to superior aging.

In addition to maintaining the four habits above, super agers make other lifestyle choices that seem to have a significant impact. Eating a Mediterranean diet (lots of produce, not too much red meat), exercising daily and actively managing stress levels and mental health issues are all shown to have a positive impact on cognition. Conversely, studies have documented the negative impacts of loneliness and social isolation, and even poor hearing and vision, on cognitive health. Passively sitting back watching television? Not on the list of things to do if you want to be a super ager.

Having a strong social network doesn’t mean that you’ll never get Alzheimer’s disease, says Rogalski of the SuperAging Research Initiative. But maintaining strong social networks could be on the list of healthy choices, like eating a certain diet and not smoking. [See “7 Secrets of the Super Agers.”]

Researchers concede there is much they still don’t know about exactly what makes a super ager. For example, the medical problems and health-related concerns of super agers are comparable to the health profiles of normal agers. According to Rogalski, studies have shown that the use and types of medications super agers take are pretty much the same as those used by people with average memory for their age. And there are super agers who have a range of diseases, from lymphoma to osteoarthritis; many use wheelchairs, despite their excellent cognitive health.

“Not all cognitive super agers are also physically exceptional,” says researcher Angela Roberts of the Canadian Centre for Activity and Aging.

Roberts and her team have been collecting data on lifestyle factors by using wearable sensors to study super agers. While findings are still preliminary, they have found that super agers in the study do 60 minutes of moderate to vigorous physical activity a day, and sometime as much as 90 minutes, which is well above the 150 minutes a week that’s generally recommended for older adults. The sensors also show that super agers tend to get higher-quality, uninterrupted regular sleep than non-super agers.

Researchers are now starting to look at other factors, including the vascular and cardiac health of super agers versus non-super agers, given that vascular health is critical to how the brain ages. They suspect that the cardio-vascular system of a super ager may be more “dynamic” than typical in people their age. They also hypothesize that super agers could have a protective pathway of sorts that may affect the development of dementia and other aspects of health.

“The idea is, as we age, our entire system becomes less dynamically responsive,” says Roberts. “We are exploring the genetic and lifestyle factors that help people age exceptionally from a cognitive perspective.”

Hitting the big 100

Some scientists believe that the best chance of understanding super agers may come from studying the oldest individuals in this cohort. That’s the premise behind the SuperAgers Family Study, which was started last year led by the American Federation for Aging Research and the Albert Einstein College of Medicine in collaboration with the Boston University College of Medicine. It has an ambitious goal: to enroll 10,000 individuals 95 and older — and their children. The mission is to identify inherited and behavioral and environmental factors that protect against human aging and related diseases as individuals near the century mark.

About one in 4,000 Americans are age 100 or older, according to Census Bureau statistics. And some of these individuals have the cognitive functioning of people who are 30 years younger, says Thomas T. Perls, a geriatrician at Boston University and the founder and director of the New England Centenarian Study.

“They’re the crème de la crème of our population,” says Perls. “What’s special in these people is that they have some protective genes that slow aging and decrease the risk for age-related diseases like Alzheimer’s.”

Indeed, findings from a recent study of centenarians in the Netherlands showed that if someone reaches 100 with their cognitive abilities intact, they are likely to remain cognitively superior, except for slight memory loss. This was true even if an examination of their brains after death showed the tau and amyloid plaque associated with Alzheimer’s.

Phil Horowitz, 102, recently completed his memoir, written from memory from the time he was 7 years old.

Courtesy Phil Horowitz

Turning 100 was a big deal for Boca Raton, Florida, super ager Phil Horowitz and his family, including his two children, six grandchildren, five great-grandchildren and far-flung network of nieces and nephews. (Disclosure: Horowitz, now 102, is this writer’s uncle.)

Longevity runs in Horowitz’s family. His mother lived until she was 104; his youngest siblings, a set of twins, are both still alive at 100, and his two other siblings lived well into their 90s. But none have the cognitive health or vitality that Horowitz does. The centenarian retired to Florida some years ago with his wife, Estelle, who died two years ago. Now he lives alone, but his children fly down often and a grandson who lives nearby visits all the time. Horowitz also plays poker and teaches Yiddish once a week to a group of residents in his assisted living facility.

Last year he completed his memoir, in longhand (he admits he started on a computer, but after mistakenly erasing everything, he went the old-fashioned route). “I have a good memory for dates,” he says, “so I decided to write my memoir chronologically, starting when I was 7 years old.”

The importance of passion

At 91, Frances Ito packs her schedule with gardening, online tai chi, weekly jam sessions with other musicians, art projects, Bible class via Zoom, volunteering at her church, exercising and moviemaking, which she took up in her late 70s. During the pandemic, Ito discovered the joy of reading, and she finished 20 books (“biographies, nonfiction and histories”). Despite cardiac issues and a few other health problems, Ito’s vitality and engagement earned her a spot in a University of Southern California super agers program. From learning the ukulele — as an homage to her home state of Hawaii — to growing fruits and vegetables on her drought-resistant front lawn, Ito refuses to surrender to aging. She’s having too much fun. Her latest film, The Purpose Driven Life, about her experiences as a super ager, was released in May.  

“I think the secret is attitude,” says Ito of her cognitive health.

Perhaps. What we do know is that becoming a super ager is the result of a complex combination of factors that account for superior memory and cognitive health.

“The hard part is proving it,” says Claudia Kawas, an investigator for UC Irvine’s 90+ Study. “Everyone wants it to be one thing, like blueberries or crossword puzzles. I don’t think it’s that simple. A good diet matters. Get as much education as you can. It doesn’t mean Nobel laureates don’t get Alzheimer’s, but at a lower rate. It confers lifelong prevention through some mechanism that we don’t understand yet.”

Frances Ito, 91, stays active in her community through volunteering. She also gardens and attends film classes.

Dario Griffin

Currently, there is no way to predict with any certainty if a younger person—in their 40s, 50s or even 60s — will be a super ager. “Those are open questions at this point — but future directions for sure,” says Huentelman of the SuperAging Research Initiative. More likely is that within the next decade, researchers will learn which genes may play a role in making someone a super ager, so we can better understand the optimal pathways for aging well and how we can slow or prevent other age-related diseases like dementia. “We will know how they stay on that course and what components might be identifiable based on lifestyle and other factors,” says Roberts of the Canadian Centre for Activity and Aging.

Indeed, look at Nobel winner Smith, who has spent his life working on economic theorems and academics and has three degrees, including a doctorate from Harvard in economics. His passion remains his profession. He wouldn’t consider retiring.

“Why would I do that?” says Smith. “I’d just do the same thing I’m doing now and wouldn’t get paid for it. I have an ancestor who lived to be 105. I want to live at least to 106.”