Living Well: The Science of Postponing Aging

AUGUST 17, 2014
James F. Fries, MD

Compression of morbidity is achieved through the reduction of behavioral risks.

The compression of morbidity hypothesis was introduced in 1980 as a challenge to the then current theory of aging, which suggested that the human life span was indefinitely extensible but that human morbidity (disability) had a fixed age at onset.

This theory was termed “the failures of success” and held that science would achieve ever greater longevity while the onset of disability remained constant, thus increasing chronic ill-health at the end of life.

In this article, I introduce and elaborate on the compression of morbidity and how best to achieve it. I then suggest ways the pharmacist may contribute to the delay of aging and thus to compression of morbidity.

The negative and pessimistic view of human aging was, in turn, challenged by behavioral theories that aging processes were surprisingly modifiable and that disability could be delayed by interventions that improved skill sets and thus individual performance levels. The common secret for increasing skills was practice, practice, practice.

Importantly, the new positive health terms (compressed aging, active aging, wellness, successful aging, delayed aging) were strongly influenced by the World Health Organization definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” These positive health concepts focus on improving health, not disease.

Compression of morbidity, however, is not the only possible health future. Individuals do not benefit equally from scientific advances, and some are less healthy than their parents. Some nations and some historical periods show worsening health. There is war, pestilence, famine, and epidemic infections. There are new drugs to use and abuse, and environments to clean up or to contaminate. Compression of morbidity is a desirable but not inevitable health outcome.

The first online figure depicts 3 scenarios of lifetime disability. The upper scenario represents disability in a typical life span, with most of this disability toward the end of life. Disability often becomes detectable at 50 to 60 years of age, increases over time, and ends with death at 75 to 80 years of age.

The middle scenario also assumes that disability is first seen at 50 to 60 years of age, but that the age of death is postponed to perhaps 95 to 100 years. There is a longer morbid period and greater lifetime disability. This is “expansion of morbidity,” or “the failures of success.”

The third scenario postulates that the age of disability onset is delayed more than is the age at death. Disability then is squeezed between a delayed age at onset and a less postponed age at death. The morbid period is shorter, and lifetime morbidity is decreased even though life expectancy has increased. This is the compression of morbidity. It usually requires postponement of the onset of disability, represented as the first arrow in each scenario.

We and others sought proofs of the compression of morbidity. Study designs that guided our research include the longitudinal Framingham Study, the National Long-Term Care Study, and the National Health Interview Study. Since we needed longitudinal data over many years, we needed the study designs which required the greatest effort, discipline, and time. We needed to select controls with high educational attainment, access to high-quality medical care, and sufficient affluence to avoid many of the adverse outcomes resulting from poverty rather than aging.