The secrets of healthy aging

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Barbara Ruben

Dr. Luigi Ferrucci, scientific director of the National Institute on Aging, discusses the long-running Baltimore Longitudinal Study on Aging with colleague Dr. Toshiko Tanaka. In a new study, Ferrucci is now seeking very healthy people 80 or older to help uncover why they have aged so much better than their peers.
Photo by Doug Hansen, NIH

Luigi Ferrucci set out to study aging as a young man.

As an idealistic 20-year-old medical student and volunteer for the Red Cross in Italy, Ferrucci found himself intrigued by a professor who told him the coming wave of aging adults would transform not just medicine, but politics and society as well.

“He was absolutely right. If you think about it today, what everybody’s talking about in political discussion is passing healthcare [reform], how costly modern medicine is, how we’re going to afford Social Security, how we’re going to take care of people in a nursing home,” said Ferrucci, now 59.

He’s pursued his early interest ever since, and is currently the scientific director of the National Institute on Aging (NIA), part of the National Institutes of Health (NIH), where he oversees more than 600 employees.

From the NIA’s Baltimore offices, Ferrucci leads the largest and longest study of aging in the world — the Baltimore Longitudinal Study of Aging.

As part of that research, he is now studying the secrets of very old, very healthy people in a study aptly named IDEAL (short for “Insight into Determinations of Exceptional Aging and Longevity”).

But nearly 40 years after he first decided to focus on aging, it’s still a topic that gets far too little attention in everyday life, Ferrucci believes.

“Unless we’re really focused very, very intensively on aging, we’re not going to be able to address it. So our cities will be designed by young people but inhabited by old people. We will have a social and environmental structure designed for 30-year-olds, but will in fact be used by 60- or 70-year-old people. And that’s a problem,” he said.

Moving into research

When Ferrucci made the decision to become part of the solution, he began working in a geriatric hospital in Italy, but decided that wasn’t quite the right fit.

“It’s sort of difficult to be only a clinician when you work with aging because the rate of success is very low. You’re dealing with very old, frail people. I wanted to do research. I started being interested in the epidemiology of aging,” he said.

So rather than taking his vacation to relax in Rome or visit the canals of Venice, Ferrucci used his time off to go to NIA to learn about its work.

He soon began to commute between Baltimore and his native Florence, spending three months here each year before returning home to his family and his work with the Laboratory of Clinical Epidemiology at the (Italian) National Institute for Research and Care on Aging.

When the NIA sought a director for the Baltimore Longitudinal Study of Aging (BLSA), Ferrucci decided to apply, never dreaming he’d get the job.

“I thought it was unlikely an Italian would ever get such a good position. But I was wrong, because one of the beautiful things about this country is that it gives people a chance.

“They liked what I was saying, they liked the work I was doing, and they offered me a position. I was 48 or 49, and I thought if I don’t do it now, I’m never going to do it.”

So in 2002, Ferrucci took the reins of the longitudinal study, which had begun in 1958. A few of the earliest participants are still members of the study, which continues to accept new applicants. About 1,200 people are currently enrolled; in all, there have been more than 3,000 participants over the past 55 years.

Those entering the BLSA must be at least 20 years old and commit to spending two to three days at NIA every two to three years for intensive testing — on everything from cardiovascular health to personality.

“At the end of this visit, they do a survey and the most important complaint is that they do not have enough time to go to the bathroom because we test them constantly,” he joked.

“Up to about 10 years ago, almost everything we knew about aging was coming from the BLSA,” Ferrucci, said. “In the last 10 to 15 years, there has been a groundswell of interest, as many other people are starting to study aging.”

The BLSA has documented some sweeping discoveries about older adults, including the concept that there is no chronological timetable of aging; everyone ages differently.

Also, while people’s bodies change as they age, a number of disorders that typically occur in old age are a result of disease processes, not normal aging as had previously been thought.

Ferrucci said a few of the most important findings from the study are the following:

  • The development of the glucose tolerance test to diagnose diabetes was due to the BLSA.
  • The study discovered that artery stiffness is a strong predictor for cardiovascular disease.
    In autopsies of some of the study patients, their brains showed all the hallmarks of severe Alzheimer’s, yet they were able to function normally with no signs of dementia. (Those in the study are encouraged to agree to an autopsy, but it is not required.)
  • “If we could understand why some people escape the devastation of Alzheimer’s, that would be a very good way to develop new treatment strategies,” Ferrucci said.
  • The decline in strength during aging is much more severe than the decline in muscle mass indicates.
    “Not only do the muscles become smaller, their quality seems to decline. If we could understand the biological process, we could implement strategies that would allow us to prevent muscle decline and some of the disability that occurs with aging,” he said.
  • People maintain the same personality for their whole lives. “There are some stereotypes that people become more vicious and grumpy as they age, but BLSA data show this is actually not the case…When change in personality occurs, it usually indicates there is some pathologic problem, some disease is occurring,” Ferrucci said.

Aging ideally

Intrigued by the fact that some of the older study participants remain healthy while others don’t, Ferrucci began the IDEAL study two years ago.

“What we’ve realized is that being a centenarian is not what people really want. What people want is to be long-lived [and] to live those lives as fully and joyfully as possible. The real outcome everyone wants is to be old and healthy — to live many years, but not have disease or disability.”

The IDEAL study is now recruiting participants age 80 or older who can walk a quarter mile unassisted, have no severe memory problems, and have no major medical conditions.

These healthy agers will be compared with ones in the BLSA who have had more problems as they’ve grown older. Only about one-tenth of one percent of the population fits the criteria for the IDEAL study, Ferrucci said. There are currently about 70 patients in the study, primarily from the Baltimore and Washington areas.

Participants must spend two to three days at NIA each year for a battery of tests — including six hours of cognitive testing and an MRI of the brain, as well as testing of walking ability, vision, hearing, personality and more.

As he approaches 60, Ferrucci is applying his decades of research to his own life. His wife and two children in their 20s live in Italy, and he said he plans to be around for his grandchildren and beyond.

He follows a Mediterranean diet, including fruit and yogurt for breakfast; a lot of vegetables, nuts, fish and olive oil; a small amount of carbohydrates; and wine several times a week.

Ferrucci runs three to five miles several times a week and insists on getting at least six to six and one-half hours of sleep a night.

And he’s preparing for a time when he’s older. Worried he won’t be able to run for too many more years, Ferrucci is taking up tennis as an alternative, less intensive exercise.

He also believes it’s important to cultivate interests and social interaction. He’s honing his art skills, noting his mother painted while she was in her 90s.

He’s also trying to learn as much as he can from the patients in his studies.

“Friday is the best day of the week for me because I go to the clinic and talk with the patients. I’ve learned about mobility problems, about their everyday worries and concerns,” he said

“Unless you see them, unless you talk to them personally, your awareness of them as individuals and not just numbers is just not there.”

To find out more about the IDEAL study, call toll free 1-855-80-IDEAL (43325) or email