Will you live to 120?

Look to the Greeks for a robust view of old age

If one has acquired a lifetime’s cargo of books, one is liable to have to buy new copies of familiar texts, because one has no idea in which packing case one’s own copy is to be found. That is the drawback; the compensating advantage is that the books one did not even know one possessed float mysteriously to the surface, full of interest and promise.

To the true book lover, every day is Christmas and all the forgotten books are potential presents. Last week, in Somerset, I had a particularly satisfactory example of this serendipity, to borrow Horace Walpole’s word for those books which come to hand just when one wants them. I had, for some time, been thinking that I ought to read Cicero’s famous essay On Old Age. I do have it in Latin, but my grip on Latin is too feeble for me to wish to translate it for myself.

The reason I wanted to read this essay was that Cicero summarises the wisdom of the ancient world about the experience of ageing. He was not an original philosopher, but he had read widely in Greek philosophy; Cicero was something like a Roy Jenkins of the 1st-century BC, an experienced and scholarly statesman who used secondary sources to write excellent books.

I came across the essay on the dining room window ledge in Somerset — when every bookshelf is full, window sills take part of the overflow. It proved to be more than just a text of the work I wanted. On January 27, 1958, four days after her 66th birthday, my mother had bought the Everyman Library edition of Cicero, which included On Old Age. She had marked the passages that most interested her.

Sixty-six does not seem any great age to me nowadays; indeed I regard one’s 60s as a sort of amiable adolescence in which one prepares for the greater wisdom of one’s 70s. Yet I imagine that the date of the purchase means that her 66th birthday led my mother to think about her own old age — she was to live for another 20 years. As I read the passages that she had marked, it brought back memories of many similar conversations with her; the annotations, though brief, are characteristic.

Cicero takes a robust view of old age, which my mother shared in her own life. The first passage she marked was his account of the story of Sophocles, the great Greek dramatist: “Sophocles continued in extreme old age to write tragedies. As he seemed to neglect his family affairs while he was fully intent on his dramatic compositions, his sons instituted a suit against him, suggesting his understanding was impaired, and praying that he might be removed from the management of his estate . . . it is said that when the old bard appeared in court he desired that he might be permitted to read a play which he had lately finished; it was his Oedipus in Colonos . . . the result was that the court unanimously dismissed the complainants’ petition.”

Cicero was not himself an old man when he wrote his essay. He composed it in 44BC when he was only 62. In the following year he was killed by the triumvirate of Octavian, Mark Antony and Lepidus, in revenge for his speeches attacking Antony. His head was cut off and nailed to the Rostra in Rome, where he had so often spoken. Fulvia, Antony’s disagreeable wife, then drove a long needle through his tongue. Such were the hatreds of the revolutionary period in which he lived.

The next passage which my mother marked also expresses an optimism in which she shared. Cicero points out: “If long life may occasion our being the painful spectators of many calamities which an earlier death would have concealed from our view, it may equally afford us the satisfaction of seeing many happy events which could not have otherwise come within our notice.” For my mother the happy events of her later life included the birth of six of her grandchildren.

My mother also noted Cicero’s advice on health in old age. “We should be regularly attentive to the article of health, use moderate exercise, and neither eat nor drink more than is necessary for repairing our strength, without oppressing the organs of digestion.” That sentence gives me particular pleasure, since it is precisely the advice my doctor gives me.

Cicero was not the first to give such advice — I feel sure that it can be found in the works of early Greek physicians such as Galen and Hippocrates. The advance of medical science has not changed the best advice on diet and exercise in more than two millennia. That makes me think it is likely to be correct.

In old age, as Shakespeare observed, what may once have been a “big manly voice, turning again towards childish treble, pipes and whistles in his sound”. Cicero, who had earned his living and his reputation as an orator, was naturally conscious of the way the voice, as much as the face, alters with age. My mother, who before her marriage had earned her living as an actress in the United States — in 1916 she had played with Sarah Bernhardt on Broadway — was equally aware of it. She marked one rather reassuring observation; I feel sure that she applied it to herself, as Cicero applied it to himself.

“There is a certain sweetness of utterance which, I know not how, is not subject to be impaired by years, and this melody of voice (old as you see I am) I have not yet lost.”

Cicero was what one could call a broad church Stoic, which is a surprisingly English thing for an Ancient Roman to have been; it has endeared him to generations of Englishmen, particular those in public life, at least since the days of Sir Thomas More. Perhaps his stoic view of the countervailing benefits which offset the loss of “sensual gratifications” will seem less sympathetic to our modern Epicurean tastes.

He quotes the Greek philosopher Archytas of Tarentum, as saying: “Nature has not conferred on mankind a more dangerous present than those pleasures which attend the sensual indulgences; as the passions they excite are too apt to run away with reason, in a lawless and unbridled pursuit of their respective enjoyments. It is to gratify inclinations of this ensnaring kind that men attempted to hold clandestine correspondence with enemies of the state, to subvert governments, and turn traitors to their country.”

My mother marked that passage, with the comment: “Burgess, Maclean”. If Mark Antony had not had him killed, Cicero could have made a similar reference to the equally unstoic conduct of Antony with Cleopatra.

We shall not all find ourselves in agreement with Cicero’s attitude to old age. Stoicism is not the philosophy of our time, though it may still seem well adapted to human experience and human nature. It has certainly helped, through the grammar schools and the classical syllabus, to shape our English culture. What is “the stiff upper lip” but Stoicism in action?

Cicero emphasises that old age, given reasonable health, can be active, useful and enjoyable, and that it should be so. He understands the pleasure the old get from the company of the young, and the pleasure they also get from the company of their contemporaries; he would himself have made an admirable member of the Garrick Club, though he might have been blackballed if Mark Antony had been on the committee.

He recognises that the old have less physical strength, but considers that they usually retain those faculties they best develop when young. He cites the example of Roman judges: “Whose superior strength of understanding continued in all its force and vigour to the conclusion of their numerous years.” I have seen the same thing with retired law lords.

Old age is much more like the rest of life than the young can imagine. The old are happiest when they feel most alive, when they are active and useful, when they are social with their family and friends, when they are meeting new people or enjoying new ideas. Retirement itself, when it occurs, should, if possible, be filled with activity. In short, the old are human.

Getting old will be more fun than most of us think

THE common notion that Britain’s ageing population will create an intolerable burden on the NHS is a myth, an expert on health in old age said yesterday.

Visions of a future in which people routinely lived into their nineties, but spent their extra years in the grip of dementia or other debilitating chronic illnesses, were grossly exaggerated, according to Raymond Tallis, Professor of Geriatric Medicine at the University of Manchester.

Elderly people today were enjoying an unprecedented quality of life and health, and the cost of caring for them would not rise but fall as life expectancy increased over the next few decades, he told the festival in Salford.

The latest evidence indicated that people who lived to great ages did not spend significantly longer in hospital or long-term care homes than those who died younger, suggesting that their overall impact on health costs was negligible. Those who died at 90 had to spend only twice as many days in hospital during their lives as those who died at 45, and there was hardly any difference between those who died in their seventies and nineties. “The extra 20 years of life was not bought at the cost of an extra 20 years in hospital,” Professor Tallis said The proportion of men over 85 who could bathe, feed themselves and go to the lavatory without help had risen from 69 per cent in 1980 to 79 per cent in 1991, and the figures for women had increased from 64 per cent to 80 per cent.

In advanced old age, people were also more likely to succumb quickly to the illnesses that eventually killed them. This was a win-win situation in which the elderly could enjoy a long, healthy and active retirement, and then did not cause a prolonged care burden and block hospital beds when they developed their final illness. This contrasted with the gloomy future forecast by many experts.

“According to the nightmare scenario, serious illness begins at about the same time, but due to the unwise wonders of modern medicine, Mr and Mrs Average are ‘kept alive’ much longer,” Professor Tallis said. “A longer life is bought at the cost of a longer death: medicine adds to the sum total of human woe. In fact, we are spending more time living and less time dying than ever before. It is a cheerful prospect if we play our cards right. A progressive improvement in the quality of old age, in which the health span of a long life gradually approximates the life span, is feasible. We may all look forward to a better and better old age in which we do not place unsustainable burdens on the NHS, our supporters and the Treasury.”

The NHS was doing a good job in geriatric care, despite stories about elderly people on hospital trolleys that were the “tip of the wrong iceberg,” he said. The savings made from early health interventions, such as hip replacements, were huge over the long term, as they meant that there was less need to fund long-term specialist care, and could be improved further. “Everybody slags off the NHS but it is actually delivering quite well, though it could perform much better,” he said.

Breaking the age barrier

Wonder pills for the middle-aged and other medical advances are extending healthy life as never before. Even people in their nineties can benefit.

The secret of longevity

The professoressa is a bit tired,” an adviser to Rita Levi-Montalcini warned me as I prepared to interview Italy’s Nobel prize-winning Life Senator on the eve of her 100th birthday. “Don’t wear her out.”

I arrive to find the professoressa, as she is universally known, in the dress shop below her office in Rome, in an elegant black dress buttoned to the neck and a gold brooch of her own design, white hair immaculately coiffed, examining the rails of clothes with close and lively attention.

She is about to catch a plane for Sicily, she says, to address a conference, but can spare some time. In the office Levi-Montalcini, a diminutive, bird-like figure with an alert manner and engaging smile, speaks for more than an hour with an insight, stamina and sharp intellect that someone half her age would envy. Tired at 100? I don’t think so – but pessimistic, yes. This astonishing woman – who studied medicine, survived Fascism and prejudice, and went on to win the Nobel Prize in 1986, who still takes an active part in politics in the Senate, is planning another book and campaigning for the rights of women in Africa – thinks we are all doomed.

For Rita Levi-Montalcini is a global expert on the brain. She founded the European Brain Research Institute (EBRI) in Rome five years ago, and marked her 100th birthday last Wednesday not with a party but with an EBRI seminar at Rome’s city hall on Capitol Hill, entitled “The Brain in Health and Disease”, with speakers from all over the world. She herself delivered the opening remarks. “The brain has two hemispheres” she says, “one ancient or archaic, which governs our emotions and instincts, the other younger, which governs our capacity to reason. Today the archaic brain tends to dominate. It is the cause of all the tragedies that happen like the Shoah (the Holocaust) and it is putting an end to humanity today. It was the part of our brains which got us down from the trees, but it is the cause of all the disasters and the cause of the great danger to our planet today. It is taking the human race toward extinction. The end is already at hand.”

Crikey. Is there no hope? There are some good people in the world, after all. “ Unfortunately, human behaviour is not merely a result of genes. A child from the age of 2 or 3 absorbs what is in the environment around him or her, and what generates hatred for anyone perceived to be ‘different’ – we absorb everything that is in around us, whether it is anti-Semitism or the other forms that this hatred takes.

“All the things that camouflage themselves as ‘intelligence’ and reasoning are in reality instinct – and low-level instinct at that.” Hence terrorism, fundamentalism and weapons of mass destruction, and hence “totalitarian regimes such as those of Mussolini and Stalin that govern not by reason but by archaic instinct. The danger is that in moments of tragedy this is the side of the brain which prevails and controls our behaviour, and these are the kind of people who prevail.”

Does she see a danger today of a resurgence of xenophobia and racism? “Yes, I do, absolutely. Because in critical moments, in moments of great crises, as I said, we tend to use the instinctive part of our brains, not the reasoning, rational part.”

We are sitting not far from the Villa Torlonia, Mussolini’s Rome villa, now a museum and park. Did she feel frightened during the Fascist period? “No. I felt disdain and hatred for Mussolini, not fear.” At university in Turin, her home town, which she entered in the 1930s – when Fascism was at its height – she did not realise she faced persecution because she was Jewish.

“My university friends, who were Catholics, naturally, did not see any difference between myself and them. I didn’t feel any sense of danger when the persecutions started, it was all outside my experience.”

The initial obstacle to entering university was not Fascism, but her father. In her autobiography she writes that she and her twin sister Paola (an artist who died in 2000 and whose artworks decorate her office walls) were born to Adamo Levi, “an electrical engineer and gifted mathematician”, and Adele Montalcini, “a talented painter and an exquisite human being”. There were two older siblings, Gino and Anna, also both now dead.

“The four of us enjoyed a most wonderful family atmosphere,” she writes, “filled with love and reciprocal devotion. Both parents were highly cultured and instilled in us their high appreciation of intellectual pursuit. It was, however, a typical Victorian style of life, all decisions being taken by the head of the family, the husband and father.

“He loved us dearly and had a great respect for women, but he believed that a professional career would interfere with the duties of a wife and mother. He decided that the three of us – Anna, Paola and I – would not engage in studies which open the way to a professional career, and that we would not enroll in the University.” Asked about her father, she says, without bitterness, that he “was a person of great intellectual and moral value, but he was a Victorian. As a child, I saw him as a person who dominated everything I did.”

It was because she felt that her mother was also “dominated” that Levi-Montalcini never married. “I decided I would never marry and I kept my word. I did not want to be ‘in second place’ like my mother, whom I adored. I told my father I did not intend to be just a wife and mother. I didn’t know I wanted to be a scientist then, I didn’t know what science was, but I wanted to dedicate my life to helping others.

“I decided to study medicine. My father didn’t approve but he could not stop me.” She smiles. “I was 20 by then.” What she got from her family, she says, were “values: we were free from the religious point of view, that was not imposed, but behavioural standards had to be rigorously good. The sense of duty was strong in the family, we were never rewarded or punished. We had to behave properly and with decorum.”

The family was descended from Sephardic Jews from Spain who came to Italy in the 14th century, but she is resolutely “a lay person”. “I was very proud of Spinoza, for me he was a great Jewish thinker. But there was never a sense of pride, no sense that we were better than other people. This never entered our way of thinking. I felt Jewish, but also very Italian. I never had religious instruction. When people asked me what my religion was I told them I was a ‘free thinker’, though no one knew what I meant – not even me.”

At the University of Turin she sat at the feet of “the famous Italian histologist, Giuseppe Levi. We are indebted to him for a superb training in biological science”. She graduated in 1936 with a summa cum laude degree in medicine and surgery, and enrolled in the three-year specialisation in neurology and psychiatry. “I was still uncertain whether I should devote myself fully to the medical profession or pursue research in neurology.”

This time it was Mussolini who stood in the way, with the 1938 racial laws barring academic and professional careers to non-Aryan citizens, and then Italy’s entry into the Second World War in 1940. Instead of leaving Italy, the Levi-Montalcinis determined to stick it out. “I decided to build a research unit at home and installed it in my bedroom,” she writes in her autobiography. “My inspiration was a 1934 article by Viktor Hamburger reporting on the effects of limb extirpation in chick embryos.”

When the bombs began to fall in Turin she moved to “a country cottage, where I rebuilt my mini-laboratory and resumed my experiments.” When Mussolini was deposed in 1943 and the Germans occupied Italy the family fled to Florence, where it lived “underground”, secretly supporting the partisans until the Allies arrived in August 1944. She volunteered as a doctor for the Allied forces, helping war refugees and dealing with typhus and other diseases.

After the war she returned to Turin University, but was invited by Hamburger to join him in the US, at St Louis, to “repeat the experiments which we had performed many years earlier on the chick embryo”. She stayed until 1977, becoming a full professor, and founding a research unit in Rome and heading the Institute of Cell Biology at the Italian National Council of Research. In 1986 her crowning achievement was the Nobel prize for discovering the Nerve Growth Factor.

Her discovery, she says, was the highlight of her long life. “I immediately understood the importance of this discovery, which is more important today than it was then and which went completely against the dogmas of the time. The recognition in Stockholm gave me great pleasure, but it does not compare with the moment of the discovery itself, when I realised I was opening up a whole new scenario.”

Italy today has “immense human capital, a huge capacity for innovation, for tolerance and a capacity to live together in this beautiful country. And Italians are proud of their country and their past.”

What does she think of Silvio Berlusconi? “Let’s say that I am on the Left and Berlusconi isn’t.” She has in the past referred to the fact that Italy’s Catholic culture conditions attempts to introduce more liberal laws on bio-ethical issues, from artificial insemination embryo research and living wills. So what did she make of Pope Benedict XVI’s controversial remark that condoms “aggravate” the fight against Aids by encouraging promiscuity?

“It didn’t convince me as a scientist. But I was the first woman to be given the honour of being admitted to the Pontifical Academy of Sciences and I have enjoyed excellent relations with the Popes.” She is proud of her foundation to help African women, which raises money to help them study at university. “So far we have funded 7,000.”

Male and female brains, she insists, are genetically identical. “But men have always imposed their will on women, by their physical force.” She still goes regularly to her European Brain Research Institute, on the outskirts of Rome, where she encourages a team of women scientists “who are extremely talented. But I don’t differentiate between men or women.”

Do the workings of the brain still hold mysteries? “No, it is much less mysterious. We have the most amazing scientific and technological advances. We have been able to see how the brain does work. And now discoveries are being made by by anatomists and physiologists or experts in behavioural science, physicists and mathematicians, computer experts, biochemists, and molecular scientists. The barriers are breaking down between disciplines. At 100 years of age I am still making discoveries about the factor that I myself discovered more than half a century ago.”

As for herself, “my sight and my hearing aren’t as good, but the brain is fine. I believe I have a higher mental capacity today than I had when I was younger, with all the experience I have lived”. And her birthday? “I’m trying to forget about it. It just happened that I was born 100 years ago, merit had nothing to do with it. The secret of life is to keep thinking. And to stop thinking about ourselves. That’s the only message I have.”

Apart, that is, from the secret of death. “I am indifferent to my own death, that only affects my body. What will remain of me is what I have achieved, the work I have done during my lifetime. You don’t die at the time of your physical death. Your message lives on. I am not in the least frightened of dying, it will only affect this very small body that I have lived in. It is not important when I die. The important thing is to have lived with serenity using the rational left-hand side of one’s brain, and not the right side, the instinctive side, which leads to misery and tragedy.”

How to live to 100

If you want to live to a 100, you might consider following Rita Levi-Montalcini’s routine: get up at five in the morning, eat just once a day, at lunchtime, keep your brain active, and go to bed at 11pm.

“I might allow myself a bowl of soup or an orange in the evening, but that’s about it,” she says. “I’m not really interested in food, or sleep.”

The secret, she says, is work: she still goes to her laboratory every morning to supervise an all-female team developing her Nobel prize-winning research on brain cells, and in the afternoon she goes across town to her foundation in another part of Rome raising funds to help African women to study.

She remains a passionate advocate of the rights of women, and still remembers the thrill as a small girl of seeing women in uniforms driving trams in the First World War when the men were at the front.

“I have never been ill, and I don’t see the impairment of my hearing and sight as a handicap,” she says. She wears a hearing aid, and peers at you closely when you talk to her, but tells you – convincingly – “my brain functions better today than it did was I was 20”.

She loves the theatre, but is not a great opera fan: “I love colours, flowers, works of art, but I don’t know much about music, apart from a bit of Beethoven and Bach, and some Schubert, Mozart and Chopin.”

She tries, she says, to “encourage the young to have faith in themselves, and in the future”. She admired the late Pope John Paul II, but is not religious:”I envy those who believe in God, but I cannot. I cannot believe in a deity who rewards and punishes us and wants to hold us in his hands. But something of us lives on after death.”

Our soul? “No, our message survives us. Our actions, our thoughts, they way we are are remembered.”

Not all human beings should live to a 100 though, even if this were biologically possible. “No. There is no room. If we all lived to be a 100 or more, there would be no space for the newborn.”

Life, she says, “has not treated me badly. I am a woman with no regrets – and, I think, without any grave sins on my conscience”. Does she ever get tired of life? “Never.”

The women working into their nineties

Honor Blackman, Diana Athill and others may have passed the typical retirement age, but they still have plenty to offer

Men married to smart women live longer

There is a lingering suspicion among girls (as the unpopularity of science subjects demonstrates) that boys don’t value cleverness as an essential quality in a life partner. Given a choice between gorgeous or brainy, there is no guarantee they’ll do the right thing, because men think they’re clever enough for two. Well, it turns out they’re wrong. Swedish scientists have discovered that long life and good health have nothing to do with a man’s education and everything to do with his wife’s. Men married to smart women live longer — simple.

However, before you ring up your girlfriend to tell her that the man who left her for a bimbo will drop dead of brain atrophy, this is not a victory for women’s intelligence in general. It would be nice if our stimulating observations about FlashForward and the Tory agenda were keeping our men alert and full of life. Unfortunately, it’s simply our skill at processing advice about healthy lifestyles, and passing it on. All it boils down to is that “educated” married women have long since banned their men from eating pork pies at every other meal. They instinctively know about the importance of breakfast, the downside of dips (men think hummus is a diet aid) and the virtues of Green & Black’s 85% (the chocolate that doesn’t count). The Carla effect, in other words, is alive and well beyond the boundaries of the Elysée Palace.

Still, this seems like a narrow reading of how a woman’s intelligence affects her husband’s health. Cholesterol-watching is only the tip of the iceberg. On top of that, there’s the whole good exercise, bad exercise battle. (Men will only do exercise that results in a calf injury, and only in binges, so they are grey with exhaustion every day for a week, then laid up for the rest of the month; we are constantly lobbying for yoga.) There’s risk-avoidance training, too. For example, the struggle to prevent men walking to work in winter with sopping wet hair, wearing only a shirt; or, my personal favourite, reminding them not to shut the tea towel in the oven door, because that’s what causes all the black smoke and flames.

For some of us, the challenge of keeping our menfolk fit and well goes way beyond encouraging them to lay off the Player’s Navy Cut. Since being married to my husband, I have had to point out that swallowing chewing gum is not normal, let alone healthy. Ditto eating food that has been showered with glass. Lighting a fire in a tent. Cooking topless. Dialling while pedalling. Smoking over an open car bonnet (just kidding, but only just). The point is, without a female in the house, most men would come to a sticky end, with or without the daily sausage sandwich.

So what’s in it for us? Back in the days when the goal was to marry a rich man, at least you could look forward to a bit of his’n’hers indulgence. Now it’s all checking the salt content of the bran flakes and pushing selenium. You can’t help feeling a bit short-changed.

Brighter people live longer

Greater intelligence may in part partially explain why people from a high socio-economic background live longer than those of lower social status, researchers have suggested.

A study of former soldiers in the United States has indicated that differences in IQ may explain almost a quarter of the differences in mortality between people of higher and lower social classes.

It has long been accepted that social status affects mortality, with a particular influence on death from cardiovascular events such as strokes and heart attacks. Many of these differences have been ascribed to stress, to income, and to behavioural factors such as smoking and diet — but these cannot explain the whole gap in longevity between the highest socio-economic groups and the lowest ones.

The new study, from a team led by David Batty, of the MRC Social and Public Health Sciences Unit at the University of Glasgow, compared outcomes from a group of 4,289 former American soldiers drawn from diverse social backgrounds.

It found that variations in IQ explain about 23 per cent of the survival differences between different social groups. Details of the study are published in European Heart Journal.

Professor Sir Michael Marmot, of University College, London, who leads the Whitehall II study of civil servants, which has uncovered many of the effects of social class on mortality, and his colleague Mika Kivimaki, offered three possible explanations for the effect in a commentary for the journal.

“Intelligence might lead to greater knowledge about how to pursue healthy behaviours,” he wrote. Intelligence may “cause” socio-economic position; that is, more intelligence leads to more education, and greater income and occupational prestige. “Intelligence may be a marker for something else, and it is that something else, early life exposures, for example, that leads to mortality,” Dr Batty said.

“We already know that socio-economically disadvantaged people have worse health and tend to die earlier from conditions such as heart disease, cancer and accidents. Environmental exposures and health-related behaviours, such as smoking, diet and physical activity, can explain some of this difference, but not all of it. This raises the possibility that as-yet-unmeasured psychological factors need to be considered. One of these is intelligence or cognitive function, commonly referred to as IQ. This measures a person’s ability to reason and problem-solve. IQ is strongly related to socio-economic status.

“IQ wasn’t a magic bullet in this study, but this psychological variable had additional explanatory power on top of the classic variables such as smoking, high blood pressure, high blood glucose and obesity. It has partially explained the differences in death from heart disease and all causes.”