The silent often teach the most important lessons of all. While COVID-19 snatched life from many older residents, quiet communities of elders, known for their longevity, defied the odds, reminding us there is still much to learn.
At a time when COVID has been ruthlessly snatching life from the over age 65 population, some older populations have been quietly going about their business, as they’ve done for decades, many decades in fact. These older communities of nonagenarians (age 90-99) and centenarians (age 100+) are already noteworthy, because they have defied the odds and lived well past the typical life expectancy. What’s particularly intriguing is how resilient they are to seemingly everything, including the recent COVID-19 virus, in spite of being in a much higher risk group than the general population. How have these elders defied the odds?
Like an outlaw riding into town, COVID notoriously preyed on the old, the easiest targets of all, those 65 and older. They account for just 16% of the population but represent a devastating 80% of the deaths1. How have some elder communities managed to kick COVID’s butt and run it out of town? Most think age is what makes us weak and vulnerable, but there are hidden factors we tend to overlook.
The largest COVID mortality population study to date, led by Elizabeth Williamson, PhD, looked at 17,278,392 primary care records linked to 10,926 COVID-related deaths and assembled a comprehensive statistical analysis to arrive at Hazard Ratios for a cross-section of 49 risk factors2. What the study found confirmed that the oldest were most at risk, and not just by a small margin. They were at an exponentially higher risk, as seen in the Figure 1. Age 60+ account for almost half the combined risk ratios of the entire list. Over age 80 carried a staggering 38x risk ratio and accounted for 34% of all deaths.
Data can tell us a lot, but often we need to dig deeper to explain all that it’s telling us. Buried within the statistics is often where the richest insights are hiding.
Adult aging is predominately the accumulation of cellular dysfunction, due largely to cell-to-cell communication failures and the resulting chronic diseases that tend to pile on top of one another. The key to living longer is simply to defer onset of age-related diseases. This is also the conclusion of the New England Centenarian Study3, the largest centenarian prospective study ever conducted.
A handful of communities with uniquely older residents were featured by National Geographic in 2005 and known as blue zones4. These communities have been the focus of many longevity studies in recent years as we look to better understand the secrets to a long, healthy, happy life.
COVID presented a rare opportunity to compare neighboring communities. We’d expect older communities to have experienced higher death rates, based on their higher hazard ratios. One well known community of elders is Loma Linda California, just forty miles east of Los Angeles. To assess COVID’s impact on Loma Linda, we pulled in the death rates and population demographics for every community in San Bernardino County5 (see Figure 2). We also looked at the population size of the community to see if that told a story, which is indicated by the bubble size. It’s evident that there must be several younger residents living alongside its many elders, but Loma Linda still have many more over age 65 than most communities in the county. As we hoped for, Loma Linda also had a lower death rate than most other communities, about half that of the county average.
It’s notable that Los Angeles experienced a three times higher death rate than Loma Linda, even though they share the same geography and over age 65 demographic. It suggests there are less obvious factors at play.
Was Loma Linda’s low death rate an anomaly? We looked to the Nuoro province of Sardinia, Italy, for the answer. Nuoro was one of the first populations recognized for uncommonly long life. Despite the devastation Italy experienced early in 2020, Nuoro was also relatively unscathed, exhibiting a below average death rate for Sardinia and for all of Italy6-11. In fact many communities within the Nuoro province had no measurable increase in excess deaths. Despite having an even older population distribution than Loma Linda, Nuoro’s mortality was just half that of Loma Linda. Other well-known elder populations like Okinawa Japan, and Ikaria, Greece were also relatively unaffected, despite being in such a high-risk group.
COVID has exposed some harsh realities of our convenience-based lifestyles and further confirmed what we’ve learned from the Human Epigenome Project12, since its start 20 years ago. We don’t hold all the answers yet, but the floodgates have opened with research coming in from the world over, providing insights into how seemingly small lifestyle choices add up to big healthspan and longevity differences.
Longevity, at least to age 95, has very little to do with genetics and almost everything to do with epigenetics, the software that runs on our genes. It’s lifestyle interactions that switch some genes on and repress others, that slowly over time either accumulate into resilience or accelerate aging. This is a relatively new frontier for the general population and flies in the face of the marketing campaigns that have lulled us into believing that there’s a pill for every ailment.
Today’s centenarians have lived through multiple pandemics, countless flu seasons and millions of evolutionary genetic updates that each event provided. Their lifestyle habits, handed down over generations, has helped maintain their health in ways almost too simple to believe. And that’s the irony of longevity, it is astonishingly simple. It’s finding that balance, amid the distractions and misleading information with which we’ve been flooded for decades that takes all the effort. Our elders continue to find new ways to teach us and kicking COVID’s butt is just one of many. They are our beacon of hope and guide our research for the children of tomorrow.