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72 is the new 65

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Meghan Lodwick:

Welcome to a La Trobe University podcast. I'm Meghan Lodwick and today I'm interviewing John McCormack, Director of the Australian Centenarian Study at La Trobe. Dr McCormack has been the Australian representative on the International Database on Longevity since 2001 and validated the ages of half of the recorded Super Centenarians in Australia. John, thanks for your time.

John McCormack:

Thanks Meghan.

Meghan Lodwick:

Now, how did you get into studying centenarians and super centenarians?

John McCormack:

Well, it started a while ago, in about 1995 I went to a Gerontological Society of America conference. I noticed that people were presenting papers on people aged 100 years or more, and thought, Oh gee, when I go back to Australia I'll have a look at how many we have. To my surprise, when I came back and investigated it, I found that nothing had been written on centenarians in Australia. Even the census I think had just had a box that you ticked for 99 years or more, so we didn't know how many were actually aged 100, let alone 101 or 102. That definitely stimulated my interest and I then went about trying to find out how many we have, and I've been trying to do that ever since.

Meghan Lodwick:

What kind of process do you go through in finding these people?

John McCormack:

Word of mouth is probably one of the most common ways I find out about people, and because I've been doing it for a fair while now, people know me. So it's sort of a bit of a scatter gun method but I keep a list of the oldest people. I've had to say, for women, I really only need women 106 or more, and for men, 105 years or more, because I was having so many that I couldn't keep the list up to date.

Meghan Lodwick:

Is there a sort of a validation process or something that you go through?

John McCormack:

Yes, there's quite an extensive and rigorous validation process and it's actually written in a book called Species of Evidence. We have about ten different stages of proof that are required to actually say, yes, we're pretty sure this person is the age they're saying, and our proof is actually higher than the Guinness Book of Records, so if we validate someone's age, they usually accept that straight from us. It is important to find out that people actually are the age they say they are.

Meghan Lodwick:

How many are there, in Australia?

John McCormack:

Probably about 4,000 people aged 100 years or more at the moment. About 95% of those would be in the age group 100 to 104 and about 4% aged 105 to 109, and then we have super centenarians aged 110 years or more. There's probably around about four of those in Australia alive at the moment.

Meghan Lodwick:

And is that number growing?

John McCormack:

Yes. It sort of doubles about every eight years.

Meghan Lodwick:

Why do you think that's increasing so fast?

John McCormack:

Yeah, there's sort of many reasons. I mean, historical in a way. We have to look back at who was born a hundred years ago and how many, and what wars occurred and things like that because they affect the number of people around, and also migration is a big issue. People born overseas are over-represented amongst centenarians in Australia and that's probably because to migrate to Australia they had to pass a health test, so they were probably fairly healthy people. That's sort of where we're at at the moment.

Meghan Lodwick:

What are some of the biological and psychological issues that people face when living that long?

John McCormack:

The two main questions people ask is, one, how do you live to be a hundred? Then, secondly, what is life like if you do reach that age. And is life worth living? And I suppose one of the most significant findings of my study, I've interviewed probably about 130 centenarians now, is that basically the majority of people, more than 80%, say it is worth living to age 100. It's interesting – if you asked people in the general population, who wants to live to age 100, you often get about a third will say, yes. But if you then say, what if you were fit and able and independent, then it goes up to about two thirds. But there's always about a third who say, oh well, I don't really want to live that long. We weren't supposed to live that long, and so on. So there's a bit of variation in why people live that long, but basically how you get there tends to be a bio-medical understanding, and it shows up in my study quite clearly, where you get more than half of these people had what we call familial clustering. They had relatives, siblings, parents, who lived to old ages as well. So that's why a lot of the biological scientists are saying, you know, that genes, at very old age, have quite a strong impact. But of course there is an environmental influence as well and what I found is that most of the people have lived fairly sort of healthy lives. Most of them are from a different era, so all of the jobs they had then were physically hard. We didn't have as much food as we have now. I do a body mass index and I haven't found any centenarian in Australia overweight, on that body mass index. I find very few smokers, or some of the ones who did smoke gave up a long time ago, although there's a bit of a cultural factor there because in the Hungarian centenarian study, there were about 22% who were current smokers, so that's probably a cultural influence, and these were people with pretty hardy genetic make up, but we've had over the past hundred years, we've now got good sewerage, good clean water, those things have made a big impact, but obviously the health advancements we've made in pharmaceuticals and treating fatal diseases like heart disease and cancer, we're improving all the time. So they're the sort of, I think, socio environmental factors that have influenced the increasing number of centenarians and this will probably keep increasing. It's a bit of a debate as to how long we can live and is there a limit?

Meghan Lodwick:

Is there a limit?

John McCormack:

Madame Jeanne Calment the famous French lady who lived to 122 years and five months, she pushed the extent of the human life span beyond where anyone had thought possible. The old bible story of three score and ten were way past that. It seemed to be in the literature that people thought there was a maximum organ capacity of about 120 years. Well, she lived past that. Very, very extensive validation of her age. She smoked until she was about 117, about three a day. She said that the only wrinkle she had was the one she was sitting on. So she had quite a sense of humour as well. She had a hip replacement at age 114 years. So she was quite remarkable.

Meghan Lodwick:

It would seem that it would be hard to get those kinds of surgeries at that age.

John McCormack:

Yes. I think in the past people at age 100, I think we had this stereotype view that everyone was frail and decrepit and in a nursing home and not able to do anything for themselves. Whereas my own study, and backed up by the census data shows that more than half the people aged 100 live in the community, not in a skilled nursing facility, and that's increasing as well.

Meghan Lodwick:

Is there a different life cycle? It's commonly known that women at 50 go through menopause – are there stuff that goes on in the 90s and 100, even 110, that we're learning about now?

John McCormack:

Certainly women still predominate amongst the centenarians. About 80% are female, although the gap is closing a little bit. And it's interesting that men who reach age 100 tend to live longer than women. So if you can get to 100, and a lot of those aren't married, so who knows what the understanding behind that is, but it still certainly is women – women tend to look after themselves better than men, health-wise. There's all sorts of other theories. More than a third of my sample of 130 had no children, which is a bit over the standard representation in the census. Or if they did have children, they often had them in their forties. It seems like maybe they'd delayed, or pushed menopause back a little bit, which may be an indication that somehow or other they were aging a bit more slowly. But there wasn't much contraception and so on. The double X theory about women's genetic make-up – some of the scientists seem to think that that extra X has a protective factor.

Meghan Lodwick:

So, you've mentioned unmarried men and women that have had children later in life. What other characteristics have you seen throughout your studies?

John McCormack:

Certainly, people in their early childhood, they remember their mother giving them good food and growing their own vegetables, and keeping them warm and so on. So, it doesn't just start at 80. Living to 100 obviously starts from in the womb and it's a life course perspective. So working hard is a very common statement that people make. On the other hand, while some people say they never drank, other say, I've always had a nip of whisky every night. Or, I never smoked, and some did smoke. So there's similarities and differences. But the familial clustering, that presence of long-lived relatives seems to be fairly strong.

Meghan Lodwick:

People are living longer, there's no doubt about that. What kind of pressure does that put on Australian society as a whole?

John McCormack:

Some people I guess are concerned about over-population. Thomas Malthus thought that increasing population and old age would make us poor, but it doesn't seem to have happened that way. And my focus is really about healthy aging. So how can we live longer, but we're not just adding years to life. We've got to add life to years. What we call that is a longevity dividend. What that means is that if you want to, and you're able, you might be able to work longer, which means you might have better income, you'll be able to save more, that has benefits for the individual and for the communities. So longevity dividend I think is an important thing. A lot of the actuaries in health insurance and so on these days talk about longevity risk. It's always got this sort of paradoxical two sides to it. That to benefit in some ways, but people see it as a burden as well. Hopefully we can learn – what is it about these people that actually enables them to live that way so that other people can benefit from that knowledge.

Meghan Lodwick:

Does that mean that our 65 and plus bar will be raised?

John McCormack:

Yeah, I think it does. I actually think that 72 is the new 65, because when you look at the life tables, we've actually added seven years to life expectancy at age 65. And certainly, some of the experts say that particularly the females born today, maybe half of them will live to age 100. I think that's fantastic, as long as we're healthy. I mean, these people are really re-defining our old age. We used to think of old age as aged 65, but they are pushing the bar right up and it really is changing, so that 65 is almost like a prime age again.

Meghan Lodwick:

Does that put any pressure on the government as far as policy goes?

John McCormack:

Government does worry a bit, particularly about health costs, because we had this association that the older you are, the sicker you are. But in fact, one of the best studies, the New England Centenarian Study from the States, their motto really is, the older you are, the healthier you've been. And I've found that with a lot of my centenarians. Up to age 105 and 106, a lot of them are quite independent, living at home, and then suddenly they'll fall and there's quite a considerable drop. And even when you look at Medicare statistics and pharmaceuticals, the curve does increase with age, in terms of expenditure, but then when it gets to about 90, it sort of plateaus out and even starts to turn down. Now I don't know whether that's because doctors won't give older people drugs, or sometimes the people don't want the drugs. We need to do a lot more research on that, particularly focussed on healthy aging.

Meghan Lodwick:

You mentioned that people were living seven years above what they were decades ago. What does that mean for social workers, in the field? Is there more people being employed?

John McCormack:

There are, but it still tends to be in that sort of residual area where it's about placing people in residential care. We don't really fund people to look at those who are healthy and run health promotion programs. It's important for students at La Trobe too. I run a gerontological social work elective and students can pick their electives, and I used to always to unfortunately be the least popular. I don't think it was me, people often see old age as something – oh, we don't want to know about that until we get there and so on. But what I find now, I always ask my students, how many have four grandparents? Anyone have any great grandparents? And over the years, I've noticed this increase in the number who have four grandparents. I mean, I have some now who have six grandparents. It's because we've got blended families. It's actually much more multi-generational. And I think for me the benefit of these students, is because they have more interactive with grandfathers and grandmothers, they're more interested in old age. So I have moved up in the ranks of popularity and now I get probably just as many students wanting to do gerontology as any of the other electives.

Meghan Lodwick:

It sounds like we're becoming more culturally acceptive of it as a society.

John McCormack:

Yeah, I definitely think we are. There's an awareness. Part of it is negative but the government is concerned about costs, but as I say, if you look at this longevity dividend, if the focus was on that, the cost issue is not such a big deal.

Meghan Lodwick:

Especially if we kind of extend the retirement age.

John McCormack:

Yes, people who can and want to work. And we know from life satisfaction studies, that people who do continue working tend to have better health. It maintains their health and they're interacting with other people and so on.

Meghan Lodwick:

So John, as far as centenarians and super centenarians go, what does the next fifty years hold?

John McCormack:

Well, it's probably a bit of an unknown, but we do have more people interested in this area now and doing research. I think just last week a story came out from UNSW about some drug they were developing that they believed might help people live to age 150. We have this chap Aubrey De Grey from Cambridge University – he's a biologist for reducing senescence. He believes we'll live to age 1000. There's a lot of mights, and coulds, and mays in this. Then we have the immortalists and the cryonics movement who want to freeze their head and so on and the fellow Ray Kurzweil who believes in the singularity that's emerging. The singularity is man and machine interact and artificial intelligence and we'll have much more power. Young people's lives should be better and that's what aging is, it's a lifelong process.

Meghan Lodwick:

That's all the time we've got for our La Trobe University podcast for today. If you'd like to leave some feedback about this, or any other podcast in the series, you can get in touch with us at podcast@latrobe.edu.au. John McCormack, thank you very much for your time.

John McCormack:

Thank you.

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